Allergies: Nothing to sneeze at

If it was all just a few sniffles, allergies could be discounted as a minor irritant. That’s what they are for the majority of people who endure them. About 40 to 50 million North Americans have allergies. Every year, five to six hundred die because of them. 

On top of that, we spend billions of dollars annually for medications and other treatments. In addition, there are the costs, financial and other, associated with lost hours from school, work and leisure activities. Allergies are serious business.

Allergies are also a curious business, in that science has yet to explicitly define why some people are laid low by ordinary agents – be it pollen, cat dander, ragweed or dust – that affect other people not a whit.

As June Engel, Ph.D., explains in The Complete Allergy Book, allergies are “non contagious reactions in which people begin to itch, sneeze, wheeze, swell up, break out in hives (red, raised welts), have difficulty breathing or occasionally collapse, in response to normally harmless substances or conditions.”

Common disorders
“Allergic diseases are due to a sensitivity, a hypersensitivity, that certain people develop toormally harmless substances,” says Dr. Norman Epstein, an allergist and director of the Allergy Clinic at St. Joseph’s Health Centre in Toronto.

“A susceptible person who’s exposed to these substances will have a symptom of disorder in the eyes, the respiratory organs – nose, ears, chest, sinuses – the digestive organs, such as the bowel, due to a food allergy, and the skin.”

The most common of these disorders are:
· Hay fever
· Asthma
· Intestinal disturbances
· Rashes due to contact (poison ivy or some cosmetics)
· Eczema
· Hives 
· Recurrent colds
· Polyps [benign growths] of the nose
· Sinus trouble.

Allergies can return
While allergies can affect people at any age, they’re commonest in children, adolescents and young adults, Many people with childhood sensitivities “outgrow” them – though it’s not always a permanent deliverance.

Like bad pennies, allergies can return, usually on the back of another condition. With people over 50 who have allergies, there’s usually a history. If you take a careful history, you find that most of them had a lot of colds when they were younger,” Epstein says.

In fact, noted contributing editor Susan V. Seligson in Health magazine, “it’s common to become allergic to something in midlife – usually after moving to a new locale. ‘Adult-onset’ patients sometimes aren’t aware that allergies are behind their chronic sinus infections, colds, headaches or fatigue.”

Treatment crucial
“But treatment is crucial for all serious allergy sufferers. Experts now recognize that unchecked allergies can lead to asthma in someone who’s predisposed. There’s a strong genetic component to allergies. If one or both of your parents react or reacted to cat dander or house dust, you’re more likely to as well.”

Since Seligson’s article in September 1995, the incidence of both allergies and asthma has continued to rise, although no one is certain why. With asthma, it may be at least partially attributable to better awareness and diagnostic techniques.

But some of the increased incidence may also be due to our changing environments – especially indoors. We live in better insulated houses and work in sealed office buildings with continually re-circulated air, ideal conditions for exposure to the most common allergens, the agents that provoke an allergic response.

Common allergens
What are these nasty agents?
· Outdoors, the most common is pollen from trees, grasses and weeds; insect venom and plant moulds.
· Indoors, it can be dust mites, cat dander, cosmetics, foods, medicines and moulds. 
· Triggering agents lurk in innocent objects.

For example, latex allergy is on the rise amongst hospital workers. It’s hardly surprising. The list of products containing latex used in the operating room is six pages long.

Too much exposure
We become sensitized to things we’re exposed – or over-exposed – to, whether in our surrounding environment or in our food.

The prevalence of food allergy to rice, for instance, is highest in China, where it’s a staple of the people’s diet. In North America, wheat, which is common in our diet, causes more allergies.There’s a greater reaction to corn in the American south, where it’s used in everything from grits to corn-mash whiskey.

We can also react to things with which we’re simply in physical contact – poison ivy being the most obvious, but there are lots of little known examples. Recently Finnish researchers announced they’d detected previously unsuspected levels of nickel, a component of stainless steel and other alloys, in a host of common products.

Nickel is now the commonest cause of contact allergy in a number of countries in the European Union, which is why the EU has established guidelines on nickel content in manufactured items.

Earrings, by weight, for example, are supposed to contain less than .05 per cent nickel; there’s even a formula governing how much of the metal they’re allowed to release into the air, through oxidation, every week.

What the Finnish researchers discovered was that the standard tests used to measure nickel content were hopelessly inadequate. By applying more sophisticated test measures, they found that 25 of 66 earring samples exceeded EU limits for nickel content.

Snowball effect
And, as one of the researchers noted, developing an allergy to your earrings can snowball. “If you’re allergic to one thing, you’re more prone to get another allergy. The threshold is lower.”

That may help to explain an allergy phenomenon from the ’80s, when a sudden rash of people developed allergies not just to a few odd items, but to practically everything. They were apparently hypersensitive to a wide range of environmental triggers, from cigarette smoke and automobile exhaust to ingredients in cosmetics, detergents, adhesives and paints – even the electromagnetic fields pulsing out of TVs and computers.

Their condition was variously dubbed “total allergy syndrome,” “20th-Century Disease” and, most recently, “multiple chemical sensitivity,” or MCS.

As June Engel notes, however, people with MCS “lack the hallmarks of real allergic (immunological) reactions. ‘The majority of people with [MCS],’ says one allergist, ‘has no evidence of environmental allergy… Their symptoms are vague and nonspecific’.”

“An allergy implies a specific mechanism,” says Dr. Susan M. Tarlo, a respirologist with an interest in allergy. Tarlo is director of the Occupational Disease Clinic at The Toronto Hospital, Western Division.

“Most allergies are due to a type of antibody called IgE [Immunoglobulin E].”
Antibodies are cellular watchdogs in the blood. The most common of their ilk – immunoglobulin G, or IgG – search out, lock onto and help destroy uninvited invaders, such as bacteria and viruses.

Allergic havoc
A strong immune response to a harmful invader is a good and wonderful thing. An allergic reaction, however, is a case of too much of a good thing, or rather, perhaps, an inappropriate use of the body’s natural protection. In essence, IgE production gets out of hand. To initiate the inflammatory cascade, the IgE antibodies lock onto other immune cells, which are chock full of antihistamine and other inflammatory chemicals.

And there you have it: allergic havoc. “Just what kind of havoc depends on where these chemicals are released,” wrote Susan Seligman in Health. “In the nose and eyes, they bring sniffles and tears. In the chest, they cause narrowing of the air passages, hence coughs and wheezing; in the skin, itching and hives; in the intestine, diarrhea and cramps. In the brain, they may even be responsible for migraines.”

Can anything be done about all this havoc? Indeed, yes. There are counter-measures and treatments you can employ for nearly every form of allergy-no matter how ghastly.