March Madness: Allergic Diseases on the Offense
March Madness takes a different form from brackets and basketball as many in our community suffer from debilitating Allergies. A common disease, affecting more than 50 million Americans annually, Allergies is the fifth leading chronic disease in the U.S. in all age groups, and are even more pronounced in children where it is the third leading chronic disease. Spring has sprung in southern Nevada with many experiencing symptoms as Utah starts to warm up slowly.
How does an allergic response happen? Our immune system detects an incoming intruder and responds forcefully. The physiological process is much like a boxing match, when Ige, an antibody, is generated in higher levels in an allergic person, and the Ige binds to mast cells and basophils, which are normal white blood cells, thereby activating the mast cells, basophils and eosinophils causing a release of histamines, which are leukotrienes and cytokines. This “release” causes bronchoconstriction, vasodilation and a strong inflammatory response. In the worst cases, anaphylaxis can cause death.
This “overreaction” tends to run in families, with 80 percent of sufferers having a family history of Allergies. It may seem like Allergies (including food allergies) are considerably worse than a generation ago, and that is accurate, mostly due to increases in environmental allergens like dusts, industrial byproducts and auto-emissions. Allergies start early in the year, typically in February in warmer climates and continue into summer with elevated pollen levels. In Nevada, Cedar and Elm pollen starts in February, joined by Ash and Mulberry pollen later, followed by Olive, and grass pollen. In the fall, Sagebrush and Elm, grass and ragweed pollens thrive during cold night and warm days, with all pollen levels peaking in the morning. With wind, pollen counts surge. Certain drugs can also cause Allergies, like antibiotics, sulfonamides, anticonvulsants, and chemotherapy drugs.
Allergies cannot be cured, but there are three measures that can help reduce their symptoms.
First, taking control of one’s environment, like avoiding allergens, increasing household cleaning and filtration to remove mites and dust, allowing sunlight into the home and using dehumidification to control molds.
Second, drug therapies have also proven to help control symptoms, yet some drugs are more effective
on different people. According to Dr. Manas Mandal, Ph.D., “Allergy sufferers need to try different over the counter medications to see which works best for them.” Antihistamines block histamine receptors, and are in the form of Benadryl, Claritin, Zyrtec and Allegra. Corticosteroids are anti-inflammatory, and reduce inflammation. Prednisone is by prescription only, and Flonase, a nasal spray is now available over the counter. Adrenergic agents like Epinephrine are for extreme allegoric responses, and work to relax the smooth muscles of the bronchioles, and is the agent in an Epipen. Xolair is an injection used to treat moderate to severe asthma or chronic hives, and it works by binding to Ige and blocking binding of these cells to mast cells.
Lastly, Allergen immunotherapy works to desensitize patients to allergens thereby decreasing or eliminating the reaction and symptoms of it. Allergists typically conduct a family history, a medical history of allergic signs and symptoms, and detection of Ige via In Vivo skin tests and In Vitro tests. Immunotherapy is done by a series of injections with increasing amounts of the allergen detected in earlier tests. This kind of treatment has been effective against a variety of allergens, including Food Allergies like peanuts. A new approach in oral immunotherapy targeting gut mucosa is addressing grass pollen and peanut Allergies.
Food Allergies seem more common than ever before, and present an important public health problem for both children and adults. While there is no treatment or cure, research has shown that inclusion of foods containing Vitamin D in maternal diets may have positive effects on childhood allergic rhinitis. Introducing peanut-containing foods in a child’s diet during infancy (4-6 months) can help prevent the development of peanut allergies.
While Allergies are at their peak and debilitate millions of Americans, there are options to help reduce the symptoms that can provide short term and longer term relief. Knowing the trigger is the best possible way to find the best treatment and trial and error helps reveal which treatment options are most effective for sufferers.
To monitor daily levels of local allergens in your community, visit:
Excerpted from the Neighborhood Health Series presentation, “March Madness: Allergic Diseases on the Offense,” by Manas Mandal, Ph.D., Associate Professor, College of Pharmacy, Roseman University of Health Sciences. March 16th, 2017.