ALLERGY MANAGEMENT

Allergies are increasing at an alarming rate worldwide. It is estimated that one person in five is suffering or is likely to suffer from allergic problems during his or her lifetime.

Allergies begin before the child is born as a result of genetics and environmental factors. If unchecked, the target organs affected change throughout life and according to the age of the patient.

If the progression of allergy was checked at an early age, the patient will not have to suffer through this “march” ending in irreversible remodelling and permanent scarring of various tissues within the body.
Following a detailed history, including family and environmental history, accurate and appropriate allergy testing will determine the responsible allergens in almost 90% of our patients. A specialized management plan is then implemented to help you treat your allergic problems.

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AERO-ALLERGENS

There are many allergens that are found in the air that we breathe. These vary according to the location, season, proximity with pets and of course environmental pollution such as forest fires etc. Pollutants are not considered allergens as such but they help to worsen many allergy problems.

In Malaysia, our most common aeroallergens can be broken up into the outdoor variety and indoor variety.

Outdoors we have many different types of pollen, grasses, weeds, moulds and pollutants.

Indoors we are exposed to the house dust mites, cockroach and various animal dander (e.g. cat/dog dander). Even indoors we are not safe from various pollutants e.g. cigarette smoke.

Though puff of smoke may look innocuous, it contains around two thousand different substances, many hazardous to health.

Avoidance measures are always paramount in the treatment of allergic diseases. However a lot of this exposure sometimes cannot be avoided and this is where the treatment of the allergic disease becomes necessary.

FOOD ALLERGIES

Diagnosing food allergy is one of the most difficult areas in Allergology. Although there are many diagnostic tests available, only selected few are reliable and reproducible. The end result of these tests would be to conduct an elimination diet, with a food diary and to conduct a challenge test under controlled medical conditions.

Because of the wide variety of foods in any Malaysians diet, it may be difficult to pin-point or limit the number of potentially offending foods. Always remember that our food contains various coloring and preservative agents, and that one food class may cross-react with another.

Foods can cause many symptoms which range from severe acute allergic reactions with hives, rashes and generalized swelling, through eczema, diarrhoea, vomiting, tummy aches, asthma, blocked/ runny nose and sinusitis. Migraines are and can be largely due to food allergies.

In small children, it can also cause an accumulation of fluid in the middle ears (like other allergies) leading to reduced hearing and therefore learning disabilities. Many of these problems can cause considerable discomfort and therefore children often become quiet irritable and difficult. Like other allergies, symptoms occurring at night can disturb sleep patterns leading to a lethargic individual the next day – of course other organic causes must also be out ruled before blaming these symptoms purely to food or other allergies.

If crucial elements need to be eliminated e.g. milk, wheat etc, one must always ensure that these are adequately supplemented. Your allergist or physician will advice you accordingly.

ANAPHYLAXIS

Anaphylaxis is a severe allergic reaction – the extreme end of the allergic spectrum. Being a systemic disease, the whole body gets affected, usually within seconds or minutes of exposure to the allergen but sometimes only after a few hours.

Every type of allergen is capable of causing Anaphylaxis but foods, insect stings and drugs are the common culprits.

WHAT ARE THE SYMPTOMS?

Any or all of the following may be present:

  • Swelling of the throat and mouth
  • Difficulty in swallowing or speaking
  • Difficulty in breathing – due to asthma or throat swelling
  • Hives anywhere on the body, especially large hives
  • Generalized flushing of the skin
  • Abdominal cramps, nausea and vomiting
  • Sudden feeling of weakness ( drop in blood pressure)
  • Sense of impending doom, followed by collapse and unconsciousness.

If any of the above symptoms were to happen to you – rush to your nearest major hospital where full resuscitational facilities are available. Once better, contact your physician or allergist to prevent this from happening again – or you may not have a second chance.

DIAGNOSIS OF ALLERGIES

There are a few methods of which to diagnose allergies.

  • A proper allergy history is essential
  • A food diary must be kept
  • See your Physician / Paediatrician / ENT specialist/ Dermatologist/ Allergy Specialist for guidance

There are a few methods of diagnosis, according to what your allergy may be:

  • Skin Prick Tests
  • Contact Patch Testing
  • In- vitrio RAST blood test
  • MAST CLA blood tests
  • IgG delayed food sensitivity tests

TREATMENT OF ALLERGIES

The treatment of Allergies will depend on the type of allergy in question

  • Always, prevention is better than cure – so avoid the allergens.
  • Ensure that living areas are dust and house dust mite free (there are special dust mite covers and dust mite killers/neutralizers available)
  • Anti histamine medications
  • Nasal Corticosteriod / anti-allergy sprays
  • Immunotherapy

CONTACT PATCH TESTING

A reliable tool for non IgE mediated or delayed type hypersensitivity. Particularly useful in contact dermatitis and other industrial or occupational contact exposure.

We use the most sensitive tests from Sweden and combine the tests required with the patients history for higher reliability. Each test is unique to the patients requirements and will be interpreted by highly qualified medical allergy specialists.

IMMUNOTHERAPY

Apart from the various “rescue” medications available for the containment of allergies – there is only one treatment and cure.

Immunotherapy is the only known cure for allergies by immune modulation of the immune system to accept the previously offending allergen.

This treatment is proving to be a huge success for selected allergies and we hope that many more patients in Malaysia will finally be able to benefit from our advances.

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