7 minute read
Allergies
Allergies and What We Need to Know About Them by Sharrada Subramaniam
How often do you su"er from an annoying runny nose, sneezing, watery eyes, or hives on your skin? #e common cold shares many similar symptoms; however, what goes unnoticed very often is the underlying allergy. An allergy is a disorder of the immune system whereby the body overreacts to the allergen (substance causing the allergy).
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An allergen could be an airborne particle (e.g., house dust mites or pollen), a food allergen (commonly peanuts, milk or seafood), and other proteins such as natural rubber latex, animal dander, toxins from insect stings or drugs (e.g., penicillin or aspirin).
An allergic response can range anywhere from being mild and hardly noticeable, to dangerous and life threatening. Common allergic symptoms include sneezing, watery eyes and itching, while severe allergic responses can lead to breathing di$culties (asthma) due to narrowing of the airways or excess mucus production. #e most severe, often life threatening, form of an allergy is anaphylaxis, which leads to a systemic response a"ecting major body systems.
Worldwide statistics from the American Academy of Allergy, Asthma, and Immunology (AAAAI) show that up to 40% of the world population is sensitised to foreign antigens, while 10-30% &ŝŐƵƌĞϭ͗ůůĞƌŐĞŶĞdžƉŽƐƵƌĞĐĂƵƐĞƐƐĞĐƌĞƟŽŶŽĨ/Ő ͘dŚŝƐůĞĂĚƐƚŽ of the population amounting to hundreds of ƚŚĞƌĞůĞĂƐĞŽĨĂůůĞƌŐŝĐŵĞĚŝĂƚŽƌƐ;Ğ͘Ő͕͘ŚŝƐƚĂŵŝŶĞͿ͕ĐĂƵƐŝŶŐĂůůĞƌŐŝĐ millions of people are a"ected by allergic rhinitis ƐLJŵƉƚŽŵƐƚŚĂƚĐĂŶŽĐĐƵƌǁŝƚŚŝŶƐĞĐŽŶĚƐƚŽŵŝŶƵƚĞƐŽƌŚŽƵƌƐ͘ŽŶ[1,2]. #ree hundred million others su"er from ƐƚĂŶƚĞdžƉŽƐƵƌĞƚŽƚŚĞĂůůĞƌŐĞŶĐŽƵůĚůĞĂĚƚŽĐŚƌŽŶŝĐĂůůĞƌŐŝĐƌĞĂĐƟŽŶ͘ asthma [1]. For the last 50 years, the prevalence /ůůƵƐƚƌĂƟŽŶďLJ^ŚĂƌƌĂĚĂ^ƵďƌĂŵĂŶŝĂŵ͘ of allergies has shown an increasing trend [1]. Atopy is a condition whereby individuals are more Risk factors and causes likely to develop an allergic response to allergens. In Malaysia, we are frequently exposed to dust mites, Atopic individuals have a higher level of serum pollen, and spores. While many of us are immune immunoglobulin E (IgE) antibody compared to to these harmless allergens, they trigger an allergic healthy people. Genetic studies have identified reaction in others. It is not fully understood why candidate genes and gene cluster patterns that might some people respond to the allergens, but not others, explain these di"erences. although genetics and environmental factors may play a role. Some allergies are present from a young age while others can develop over time. Overexposure to an #e genetic predisposition to have an allergic disease allergen for a prolonged period of time can lead to a is 70% if an identical twin has it, and 40% for nonprocess of sensitisation to the allergen. Children who identical twins [3]. Early contact with airborne grow up being near to cats and dogs whose dander allergens could cause atopic disease later in life [4]. is a common cause of allergies are at a higher risk of
developing an atopic allergy [5]. Hence, environmental or to con!rm suspected allergens. A tiny amount of factors play a pivotal role in allergic diseases. the antigen is placed on the skin or below it, and any signs of in%ammation are observed. IgE levels can also More than two decades ago, an epidemiological study be measured from blood samples. proposed the “Hygiene Hypothesis” which suggested that the occurrence of hay fever in a family with #e best way forward in allergy prevention is avoiding children was inversely proportional to the household the antigen. Firstly, one needs to identify the allergen, size [6]. Children who were exposed to dirtier living which may prove more challenging if it is not a conditions when they were young were less likely to common allergy. Change of lifestyle can help avoid develop certain allergies when they were older. Instead, common allergic attacks. #is may include using children who contracted fewer childhood infections “allergen impermeable” covers on bedding, keeping may have an ine$cient maturation of the immune humidity low and avoiding close proximity with cats system and may be more susceptible to allergies [7]. or dogs in the early years [10]. Di"erent versions of this hypothesis were formulated years later, pointing to the link between the lack of It is also very important to be prepared for the symptoms early exposure to parasites and other microorganisms that may appear and have the necessary precautions and the likelihood of allergic diseases. taken. For those with a risk of an anaphylactic shock, having handy a dose of adrenaline may save a life. It is !e main player in the allergic response - IgE equally important for asthmatic patients to have their First described in the 1960s by Kimishige Ishizika inhalers with them at all times too. and colleagues [8], IgE belongs to a class of antibodies (proteins that are made when the body encounters While a number of treatment options are available, a foreign antigen) together with other isotypes such nearly all of them target the symptoms rather as IgG, IgA, IgM and IgD. than the prevention of the IgE, which is coincidentally the least abundant isotype in “up to 40% of the world allergy. Anti-histamines, anti-inflammatory drugs, healthy humans, is the main player in the manifestation of population is sensitised bronchodilators as well as decongestants are among more an allergic response. to foreign antigens, while commonly used prescriptions to relieve common allergic Why then do humans produce IgE antibody? There have 10-30% of the population symptoms such as rhinitis, hives, and asthma attacks due been some suggestions that IgE have been evolutionarily amounting to hundreds to bronchial constriction. produced for immunity against worm or parasitic of millions of people are While scientists understand a lot about the production of infections in mammals, which used to be a severe problem affected by allergic rhinitis” IgE, as well as the cellular and molecular pathways involved, in developing countries. a complete understanding Nonetheless, we still retain the of this complicated “allergic ability to deal with a parasitic infection, and mount response” is still lacking. New generation drugs are a defense reaction to eliminate the parasite. #is targeted to inhibit the production of IgE, rather than bene!cial role of IgE comes with a disadvantage: when just alleviating the symptoms. Research in the !eld is IgE is released under non-threatening circumstances, faced with many limitations due to the scarcity of IgE, the immune system recognises it as foreign, and thus, the rarest immunoglobulin isotype. Nonetheless, this triggering allergic symptoms (Figure 1). is a hot topic in immunology today, as drugs which are able to inhibit IgE production could bring relief An acute allergic response is an immediate response to millions of people worldwide. to the allergen which can bring about a localised (e.g., rhinorrhea, or eczema) or systemic reaction (e.g., REFERENCES anaphylaxis). #is early stage response stems from [1] Pawankar et al. (2012) World Health Organization activated mast cells that release their contents leading [2] http://goo.gl/4wtFA to the various symptoms. The late phase allergic [3] Galli (2000) Curr Biol. 10:R93-R95 response, which happens hours later is due to the [4] Soothill et al. (1976) Clin Allergy. 6:305-319 recruitment of specialist cells to the site of encounter [5] Warner et al. (1990) Pediatr Allergy Immunol. 1:79-86 with the antigen. [6] Strachan (1989) BMJ, 299:1259-1260 [7] Holt et al. (1999) Nature. 402:B12–B17 Diagnosis, treatment and prevention [8] Ishizaka et al. (1966) J Immunol, 97:75-85 Nowadays, a simple skin or blood test can often reveal [9] Janeway et al. (2001) Immunobiology, Garland Science. the allergenic status of a person to common allergens [10] http://goo.gl/5DMSwD
ABOUT THE AUTHOR
SHARRADA SUBRAMANIAM is a !nal year A*STAR scholar at Singapore Immunology Network/NTU pursuing a PhD on the regulation of allergic diseases. Her work focuses on identifying and characterising the key players in an allergic response using murine models. She obtained her BSc (Hons) Biomedical Sciences at the University of Manchester, United Kingdom in 2010. Prior to that, she studied at Wesley Methodist School and Tunku Abdul Rahman college in Kuala Lumpur. Find out more about Sharrada at http://www. scienti!cmalaysian.com/members/sharrada/
ABOUT ALLERGY, DID YOU KNOW THAT...
1 in 5 Malaysian children could develop allergies.
If both parents have an allergic con- dition, their child may have a 50-80% risk of having an allergic condition.
Allergic rhinitis is the most common of all childhood allergies, causing runny nose, nasal blockage and sneezing.
Anaphylaxis or anaphylatic shock is the most severe form of allergy affect- ing 0.05-2% of world’s population, with rapid onset and may cause death.
There are no known cures for many types of allergies.
Malaysian Allergy Day 2014 was held in Kuala Lumpur on 14 th June 2014.
Source: MedlinePlus (NIH); Malaysian Society of Allergy and Immunology (MSAI)
AR: allergic rhinitis; Adapted from “Allergy Self-Test”, MSAI, www.allergymsai.org
