Stopping the allergic march

Shobha Shukla, CNS (Citizen News Service)
It begins within the first few months of life with skin allergy or dermatitis (eczema) and food allergy in infancy, and as the children grow up, the allergic march may progress to the development of allergic rhinitis (nasal allergy) and/or allergic asthma. So this Allergic March, refers to the natural history or typical progression of allergic diseases that often begin early in life. These allergic conditions could primarily be genetically inherited; however, the conditions or environment in which a child grows up also affects their development.

So how do we arrest this march? The obvious answer would be to identify and effectively treat any allergic condition early on. But it is easier said than done.

Speaking with CNS (Citizen News Service), on the sidelines of the 51st annual conference of National College of Allergy, Asthma and Applied Immunology (51st ICAAICON) that was being held in King George's Medical University (KGMU) and Era University, Lucknow, some eminent experts shared their insights on the challenges in dealing with the various types of allergies plaguing the Indian populace.

Every third patient of allergic rhinitis is potential future candidate of bronchial asthma: Prof Surya Kant

Professor (Dr) Surya Kant, Organizing Secretary of 51st ICCAICON, and Head of Department of Respiratory Medicine, KGMU, listed some common allergies that affect 25-30% of the country’s population. These are: allergic rhinitis; bronchial asthma; allergic conjunctivitis; skin allergy or urticaria; and food allergy. Another allergic reaction that could be life-threatening is Anaphylaxis, that can be triggered by an allergy to a particular food (peanuts or shellfish), stinging insects (bees), medication (like penicillin), latex, etc. It can affect multiple organs and requires urgent medical attention.

Allergic rhinitis can very often lead to bronchial asthma, warned Prof Surya Kant, who also is the national President of National College of Chest Physicians (NCCP) and past President of Indian Chest Society. The anatomy and physiology of the nasal epithelium is such that the same lining which is in the nose continues in the bronchi and lungs.

He called the nose and lungs to be the roof and floor of the human body. So if the roof is leaking (rhinitis) it will spoil the floor (result in lung allergy or asthma). Thus every third patient of allergic rhinitis is a potential future candidate of bronchial asthma, said Prof Surya Kant, current President of Indian Medical Association (IMA) in Lucknow.
Dr Surya Kant blamed the changes in our dietary habits for resulting in increasing episodes of food allergy as well as of bronchial asthma. Consumption of junk/fast food has been found to worsen symptoms and precipitation of asthma, he said. Another equally important risk factor is living in a house replete with sofas, carpets, curtains, soft toys, pets, etc that create an allergic indoor environment by allowing dust mites to settle on them. Air conditioners and coolers encourage fungal growth and cigarette smoke adds to indoor pollution. All these are triggers for allergic reactions. Smell of paints, incense sticks, mosquito coils can also precipitate allergic reactions, including asthma, said Dr Surya Kant.

Afforestation policy should take allergens into account: Dr AB Singh

While Dr Surya Kant rightly called for having more greenery by planting more trees to combat air pollution and reduce the risk of allergies, Dr AB Singh, Scientist Emeritus at Institute of Genomics and Integrative Biology, and an authority on pollen allergy, gave a word of caution. He called for a national policy on identifying the top ten pollen allergen grasses, plants and trees, which should not be included in mass afforestation programmes. In his opinion, trees like Gular (Cluster Fig) and Peepal that are much less allergenic as compared to others, should be given preference.

 Dr James Hindley, Executive Director, Indoor Bio-technologies, UK, said that the more time one spends indoors, the more is the exposure to risk factors associated with allergies. He lamented that in Europe (as well as other countries too) about 90% of a person’s time is spent indoors, in a closed environment which is full of soft furnishings, carpets, sofas and air conditioners, all of which harbour allergens. He advised having properly ventilated houses that allow in a lot of sunshine and fresh air and also increasing the diversity of food in our diet to increase the body’s immunity.

Professor (Dr) Rajendra Prasad, Director (Medical Education) and Head, Department of Tuberculosis and Chest Diseases, Era's Lucknow Medical College and Hospital; and Organizing Chairman of 51st ICCAICON shared the current treatment modalities for some commonly occurring allergies. Best treatment of any allergy is avoidance of allergens (triggers) responsible for it. If it is not possible to completely avoid allergens (like pollens, dust mites), we can at least take steps to reduce exposure to them - not keep pets in the house, have less amount of furnishings, carpets, avoid junk food. Next come the drugs, which could be oral pills, injectables, and/or in the form of anti allergic inhalers. There is another form of therapy too called immunotherapy.

Prof Rajendra Prasad who is the former Director, Vallabhbhai Patel Chest Institute, Delhi, and also the former Director of UP Rural Institute of Medical Sciences and Research in Saifai, said that allergen immunotherapy, also known as hypo-sensitization, involves exposing people to allergens responsible for that allergy, slowly increasing the dose to change the immune system's response so that the patient no longer remains allergic to those allergens. Initially there was only subcutaneous (injectable) immunotherapy. But now sublingual immunotherapy, in which oral pills are used is coming up very fast. While immunotherapy is useful for environmental allergies (due to dust mites, pollen, pet dander, etc) allergies to insect bites, and asthma, it is not useful in food allergy.

Dr MK Agrawal, Head of Respiratory Allergy and Immunology at Metro Hospital, urged for identifying the causative allergens in the local contexts, because very often a particular allergy could be due to some allergen present in that particular area/city where the patient lives. He called for opening of more diagnostic and treatment centres for allergies, because as of now only 6% of those who are suffering from some respiratory allergic disorder are able to access proper diagnosis and treatment in India. He also cautioned against the unethical practice of diagnosing allergies through blood tests, as they are very unreliable.

Stem cell therapy to treat asthma

Dr BS Rajput, Founder Vice President of Stem Cell Society of India, explained the use of stem cell transplantation in treating asthma. Stem Cell therapy in India is relatively new, and is currently being used in orthopaedics, neurology, pulmonology and cardiology. Since the past 4-5 years it has been giving a new lease of life to patients of lung fibrosis and interstitial lung disease (ILD), by using patients’ own bone marrow mesenchymal cells to increase blood circulation and decrease fibrosis. Dr Rajput said that doctors should start using this technique for treatment of asthma too. This can be done by procuring either mesenchymal stem cells from the umbilical cord of a new born baby, or the patient’s own T regulatory stem cells. Even in case of severe bronchial asthma, stem cell therapy contributes to the regeneration of lung tissue, thus leading to a significant reduction in the incidence of asthma attacks and their duration. It also increases patients’ immunity and reduces the allergic response to allergens. He said that it is not a costly procedure as the bio material is obtained from the patient only. However there is lack of knowledge about this therapy which needs to be overcome.

So as we grapple with the ever increasing army of allergies, let us at least try to make people aware of the causative risk factors, and make sincere efforts to reduce the avoidable ones like cigarette smoke, dust mites, molds, and junk food.

Shobha Shukla, CNS (Citizen News Service)
17 March 2018

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