Rooting out Allergies

CHENNAI: It was only after years of trouble and a good course of trial and error that Karan* found out that he was allergic to an assortment of medications. It had all started with a bout of allergic reaction on his hands, feet and penis from time to time. He figured it was some kind of an infection, given that it was always accompanied by a spell of cold. A few months down the line, the common cold was suspected to be the causal agent — perhaps, it manifested in such severe terms for just him.

So, he made sure to take medicines. It was another few months before any suspicions turned towards the medication itself. “Cetirizine is used to treat allergies but I am allergic to the medicine itself. I’m also allergic to a bunch of antibiotics; even one of the medications for COVID is a problem (he found out when he tested positive for the virus last year),” he lists.

It took a round of experimentation with his doctor to figure the drugs he was allergic to. Now, every doctor’s visit — be it for a simple case of fever or a major consultation is not complete without this information. The people around him family members, close friends and roommates are always informed of this restriction, in case of an emergency. While Karan’s case was handled in a rather systematic way, very few cases of allergies get such a level of attention in an average Indian household.

Karan’s mother herself is prone to skin allergies; yet, they have not figured out the allergen so far. His cousin, after having eaten some sweet, had a massive allergic reaction, with his face and neck swelling massively within minutes. He was rushed to the hospital to be administered a shot of epinephrine. With the cause having not been diagnosed, he should be carrying an epipen with him at all times; but, he doesn’t.

Out of body, out of mind
The treatment of allergies often stops with addressing a single manifestation or particular bout of symptoms. When a generic combination of medicines is able to attend to the problem at hand, it’s quickly forgotten about. Rahul discovered when he was kid that he was allergic to mangoes, courtesy the painful mouth sores that showed soon after he tasted the fruit.

Since then, the 30-year-old has had to choose between forgoing the delicacy altogether or giving in from time to time and paying the price for it. Even when the allergen is easy enough to determine (say pollen or peanuts), people often resign themselves to having to suffer the consequences all through life. Seema* has always pegged her sneezing spells to “allergies”.

What she is allergic to she doesn’t know yet. But, she is forever prepared with a couple of antihistamine tablets. While all this may seem enough, there’s much that can be done to effectively handle allergies, says Dr Suresh Natarajan, senior consultant - General Paediatrics, Paediatric Pulmonology and Allergy Specialist, Rainbow Children’s Hospital. And that begins with understanding allergy manifestations better, he adds.

Down to the basics
“When you say ‘allergy’, the layman’s belief is that it is just skin rashes. But, allergies can involve a variety of things. It involves three systems: one is skin. Here, rashes can be of two types rashes that come and go (urticaria) or eczema. Some people will have sneezing bouts in the morning, soon after they wake up. Later in the day, they will become better. This is known as allergic rhinitis; it involves the nasal passage. Others have wheezing and breathing difficulty in the October-November period; this is asthma, involving the lung pipes.

The third system that gets affected is the gastrointestinal system caused by food allergies, there can be vomiting, diarrhoea and such. This is the spectrum of allergy manifestation that we see. But, many times, patients don’t know that respiratory problems are because of allergies,” he details. While a blood sugar test can indicate the presence of diabetes, there is no single test to determine allergies, says Suresh. The ‘gold standard test’ he suggests is the allergy skin test or the skin prick test.

“The allergy specialist will put the allergen on the forearm area and do a small prick and observe for ten minutes. If the patient were allergic to the substance, there will be some redness and/or swelling. Based on this, we tell the patients what they are allergic to and ask them to avoid it. They will be symptom-free as long as they are not introduced to the allergen,” he explains. This is only the first step.

While the reaction would have been addressed, the underlying cause would remain. Just the way an ointment would address the skin condition resulting from diabetes but wouldn’t actually rid you of the disease itself. For that, one has to be desensitised to the allergen, he advises. “For example, if a patient is allergic to dogs, I have to desensitise them with some medicines. We have a lot of facilities to do that. I would start the immunotherapy with a combination of tablets and injections. Over a period of treatment, it is curable,” he elaborates.

Things to remember
As much as an allergy screening can be life saving, Suresh says there is no need for you to take the test if you do not have any of the classic symptoms. While you don’t have to jump the gun with every sneezing bout or breakout of rashes, he reminds you that allergies tend to run in the family.

If one parent has an allergy, the child’s chances of having it too is 30-40 per cent; if both parents had it, the chances increase 70-80 per cent. Besides, when just one person in the family (especially the child) develops a symptom when no one else has it there might be reason to worry.

In case of a flu or cold, if it were to happen episodically and the person’s health is in good shape otherwise, there is no concern of allergies. He also advises against self-medication, pointing out that it would only be treatment for the symptoms and not the cause itself. When in doubt, it is always wise to consult your doctor, he concludes.

* Names changed