What are allergies?
An allergy is an exaggerated reaction by the immune system in response to exposure to certain foreign substances. These foreign substances are normally seen as harmless by the immune system in nonallergic individuals, but in allergic individuals, part of the immune system generates a response.
When an allergic individual comes in contact with an allergen, the immune system mounts a response through an antibody called immunoglobulin E (IgE). People prone to allergies are said to be allergic or "atopic."
Allergy-producing substances are called "allergens." Examples of allergens include:
- Pollens
- Dust mites
- Molds
- Animal proteins
- Foods
- Medications
Where are allergens?
Allergens may be inhaled, ingested (eaten or swallowed), applied to the skin, or injected into the body either as medication or inadvertently by an insect sting. The symptoms and conditions that result depend largely on the route of entry and the type of allergen.
- The chemical structure of allergens affects the route of exposure.
- Airborne pollens, for example, tend to have little effect on the skin.
- They are easily inhaled and will thus cause more nasal and respiratory symptoms with limited skin symptoms.
- When allergens are swallowed or injected, they may travel to other parts of the body and provoke symptoms that are remote from their point of entry.
- For example, allergens in foods may prompt the release of mediators in the skin and cause hives.
The specific protein structure is what determines the allergen's characteristics.
- For example, cat protein, Fel d 1, from the Felis domesticus (the domesticated cat), is the predominant cat allergen.
- Each allergen has a unique protein structure leading to its allergic characteristics.
In the Air
Aside from oxygen, the air contains a wide variety of particles, including allergens. The usual conditions that result from airborne allergens are hay fever, asthma, and conjunctivitis. The following allergens can trigger allergic reactions when inhaled by sensitized individuals:
- Pollens from trees, grasses, and/or weeds
- Dust mites
- Animal proteins, including dander, skin, and/or urine
- Mold spores
- Insect parts, especially cockroaches
Foods and Medications
Foods and medications are the two most common allergens that are ingested, and they can cause allergic reactions, some of which can be severe. These reactions often start with localized tingling or itching and then may lead to a rash or additional symptoms, such as swelling, nausea, vomiting, diarrhea, or difficulty breathing.
- Foods: The most common food allergens are cow's milk, eggs, peanuts, tree nuts, wheat, soy, shellfish, finned fish, and sesame. Cow's milk, egg, wheat, and soy allergies are most common in children and are often outgrown over time. The most common allergens in adults are peanuts, tree nuts, and shellfish.
- Gluten is not a common food allergy, and true gluten hypersensitivity, or celiac disease, is mediated by another type of antibody (not IgE but IgA) and also leads to different symptoms (including chronic abdominal discomfort, nausea, vomiting, change in stool, and anemia).
Injections
The most severe reactions often occur when allergens are injected into the body and gain direct access to the bloodstream. This intravenous access carries the increased risk of a systemic reaction, such as anaphylaxis. Commonly injected allergens that can cause severe allergic reactions include:
- Insect venom
- Medications
- Allergy shots
What are the most common types of allergies?
The most common allergic diseases include the following:
- Allergic rhinitis (hay fever/nasal allergies)
- Allergic conjunctivitis (eye allergies)
- Allergic asthma
- Eczema (atopic dermatitis)
- Hives (urticaria)
- Food allergies
- Anaphylaxis (severe allergic reaction which can be fatal if not treated promptly)
What is an allergy prevalence?
Allergy prevalence includes the following:
- According to the Asthma and Allergy Foundation, more than 100 million people in the United States experience various types of allergies each year.
- Allergies are the sixth leading cause of chronic illness in the U.S.
- Allergic rhinitis (nasal allergies) affects roughly 26% (67 million) of adults and 19% (14 million) of children in America.
- Between prescription costs, physician visits, and missed days of work/school, the economic burden of allergic disease is approximately $3 to $4 billion annually.
- Asthma affects more than 27 million Americans or about 1 in 12 people.
- The estimated health costs for asthma are nearly $82 billion annually, including medical costs along with lost work days.
- Food allergies affect about 33 million Americans, including about 5.6 million children.
- The prevalence of allergic conditions has increased significantly over the last two decades and continues to rise.
What causes allergies?
The immune system is the body's organized defense mechanism against foreign invaders, particularly infections. Its job is to recognize and react to these foreign substances, called antigens.
- Antigens often lead to an immune response through the production of antibodies, which are protective proteins that are specifically targeted against particular antigens.
- These antibodies, or immunoglobulins (IgG, IgM, and IgA), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it.
- The allergic person, however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances, such as cat dander, pollen, or foods.
- Other antigens, such as bacteria, do not lead to the production of IgE and therefore do not cause allergic reactions.
- Once IgE is formed, it can recognize the antigen and can then trigger an allergic response.
What causes pet and skin allergies?
Pet Allergies
Although it might occasionally appear as if an allergic reaction has occurred on the first exposure to an allergen, there needs to be prior exposure for the immune system to react. Typically, there is a period of sensitization ranging from days to years before an allergic response. It is impossible to be allergic to something that an individual has truly never been exposed to before, though the first exposure may be subtle or unknown. The first exposure can even occur in a baby in the womb, through breast milk, or the skin.
Skin Allergies
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Another part of the immune system, the T-cell, may be involved in allergic responses in the skin, as occurs from the oils of plants, such as poison ivy, poison oak, poison sumac, reactions to metal, such as nickel, or certain chemicals. The T-cell may recognize a certain allergen in a substance contacting the skin and cause an inflammatory response. This inflammatory response can cause an itchy rash.
Who is at risk for allergies?
Allergies can develop at any age, but most food allergies begin at a young age, and many are outgrown.
- Environmental allergies can develop at any time.
- The initial exposure or sensitization period may even begin before birth.
- Individuals can also outgrow allergies over time.
- It is not fully understood why one person develops allergies and another does not, but there are several risk factors for allergic conditions.
- Family history, or genetics, plays a large role, with a higher risk for allergies if parents or siblings have allergies.
- Children born via Cesarean section have a higher risk of allergy as compared to children delivered vaginally.
- Exposure to tobacco smoke and air pollution increases the risk of allergy.
- Boys are more likely to be allergic than girls.
- Allergies are more common in westernized countries, and less common in those with a farming lifestyle.
- Timing of exposures to antigens, use of antibiotics, and numerous other factors, some of which are not yet known, also contribute to the development of allergies. This complicated process continues to be an area of medical research.
What are the common symptoms of allergies?
The parts of the body that are prone to allergic symptoms include:
The common symptoms of most allergies include:
- Sneezing
- Itching
- Watery eyes
- Runny nose
- Hives, blisters, or rashes on the skin
- Skin redness or dryness
- Noisy breathing or wheezing
- Shortness of breath
- Chest tightness
- Nausea with or without vomiting
- Pain in the abdomen
- Diarrhea
- Malaise or a feeling of being unwell
- Swelling over the lips, tongue, around the eyes, or on the entire face
Although the various allergic diseases may appear different, they all result from an exaggerated immune response to foreign substances in sensitive individuals. The following are brief descriptions of common allergic disorders.
- Allergic rhinitis (hay fever)
- Asthma
- Allergic eyes (conjunctivitis)
- Eczema (atopic dermatitis)
- Hives (urticaria)
- Anaphylaxis
When to seek help for your allergy symptoms
Contact your doctor for allergy symptoms if you experience the following:
- Your symptoms do not improve or get worse despite home management.
- You feel dizzy or lightheaded.
- You get a fever.
The following are symptoms of anaphylaxis, a potentially life-threatening severe allergic reaction that comes on quickly or suddenly. Common triggers for anaphylaxis include foods, medications, and insect stings.
Anaphylaxis is a medical emergency. Use your epinephrine autoinjector and then call 911 (or have someone call for you) to get medical treatment immediately for suspected anaphylaxis.
- You experience breathlessness, hoarseness, or chest tightness.
- There is swelling over your face, throat, or lips.
- You experience palpitations.
- You develop severe itching or rash over your body.
What specialists diagnose and treat people with allergies?
How do healthcare professionals diagnose allergies?
What are treatment options for allergies?
The treatment for allergies depends on the particular condition. Some general guidelines are as follows:
Environmental control measures may have limited efficacy.
- Oral antihistamines
- Nasal antihistamines
- Antihistamine eyedrops
- Nasal corticosteroids
- Allergen immunotherapy (see below)
Asthma
- Rescue inhalers
- Inhaled corticosteroids, inhaled corticosteroids/long-acting bronchodilator combinations, long-acting anti-muscarinic medications
- Oral maintenance medications (anti-leukotriene medications, theophylline)
- Injectable medications, called "biologics" must be administered at a medical facility or sometimes at home
- Allergen immunotherapy (see below)
- Oral steroids
Eczema (atopic dermatitis)
- Routine moisturization
- Topical corticosteroids
- Oral antihistamines to help control itching
- Immunosuppressive medications in severe cases
- An injectable biologic medication, dupilumab (Dupixent)
Hives (urticaria)
- Oral antihistamines
- Oral steroids
- Injectable medications (biologic) administered in a medical facility
- Immunosuppressive medications in severe cases
Anaphylaxis
- Epinephrine is the only treatment for anaphylaxis, a severe allergic reaction that can involve multiple body systems and is life-threatening.
Allergen immunotherapy (allergy shots)
- Allergy shots have been shown to decrease symptoms of environmental allergies and asthma and may also be beneficial in eczema.
Are there home remedies for allergies?
Although there is significant research examining the role of vitamins, herbal medications, and other therapies in the treatment of allergies, there are currently no proven home remedies that successfully treat allergies.
What is the prognosis of allergies?
People with allergies have an excellent prognosis. Many children outgrow allergies over time, particularly food and medication allergies, such as penicillin. On the other hand, allergies can develop at any age.
Allergies should not affect life expectancy, and with proper management, the majority of individuals with allergies should maintain an acceptable quality of life.
What are the complications of allergies? (Anaphylaxis)
Anaphylactic shock is a potentially life-threatening allergic reaction that can affect several organs at the same time. Allergens that typically lead to anaphylaxis are foods, medications, and venom (bee stings). Environmental allergens rarely lead to anaphylaxis, except anaphylaxis can result from allergy shots (subcutaneous immunotherapy).
Some or all of the following symptoms may occur:
- Hives itching or flushing present in 80%-90% of cases
- Nasal congestion, runny nose, itchy eyes
- Swelling of the tongue and/or throat
- Abdominal discomfort, nausea, vomiting, diarrhea
- Shortness of breath, wheezing, coughing
- Low blood pressure, leading to lightheadedness, passing out, or shock.
Is it possible to prevent allergies?
- Having family members with allergic conditions increases the risk of allergy.
- Numerous environmental influences may also affect the development of allergies, such as:
- Breastfeeding
- Cesarean sections
- Diet during pregnancy
- Vitamin D levels
- Use of antibiotics
- Use of probiotics
- Animal exposures
- Bacterial exposures
- Pollutant exposure.
How can I prevent allergies from flaring up?
To help prevent your allergies from flaring up, follow these tips:
- Identify your allergens. Top environmental allergens include:
- Animal dander
- Dust mites
- Pollen
- Household hold
- Avoid touching or rubbing your nose.
- Wash your hands often with soap and water.
- Wear sunglasses and a wide-brimmed hat to prevent pollen from getting into your eyes.
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