Unable to bear it any longer, he rushed to a private hospital the next morning. The dermatologist declared it was a minor rash and prescribed ointments, which did nothing to help. A desperate Ashwin then consulted senior dermatologist Dr Putta Srinivas, Director of Medical Education, government of Telangana.
The doctor questioned the patient about his diet and came to know that he had eaten prawns a couple of days ago.
He was diagnosed with seafood allergy and prescribed medicines, which failed to check the itching. Within a week, Ashwin had broken out in hives. He again consulted Srinivas, who after taking a look at the rash, diagnosed him with scabies, a condition of very itchy skin caused by tiny mites that burrow into the skin. The itching is caused by an allergic reaction to the mites.
He was prescribed Permethrin and a couple of other tablets and recovered soon after.
In another case, 30-year-old government school teacher Sumita from north Karnataka suffered for more than a year from puffy teary red eyes, and constant itching. Despite undergoing treatment at various local clinics, she found no relief. She even contemplated quitting her job. Finally, on the advice of a local physician, she landed up in Bengaluru and underwent a thorough examination at Narayana Nethralaya.
After five or six consultations with various doctors, Sumita was found allergic to chalk. “She never had these symptoms during holidays or Sundays. She was using chalk daily to write on the blackboard and was exposed to chalk dust from morning till evening. We advised her to switch to a plastic board and use a marker,” says Dr Rohit Shetty, Vice Chairman, Narayana Nethralaya.
So what exactly is an allergy? Doctors describe it as a hypersensitivity disorder of the immune system of the human body. Allergic reactions occur when a person’s immune system reacts abnormally to normally harmless substances, present in the environment. A substance that causes a reaction is called an allergen. Allergy is formally called type I (or immediate) hypersensitivity and is one of the four or more forms of hypersensitivity.
“Allergy is a hypersensitive reaction of the immune system to any foreign particle,” says Dr Sanjay Kumar Rai, Additional Professor at AIIMS, Delhi. “The human body has a natural tendency to fight foreign particles. So even if the particle is not harmful, the body in its effort to kill foreign particles causes reactions that manifest in the form of allergies,” he adds.
According to the World Allergy Organisation (WAO), industrialisation and changing biodiversity coupled with sedentary lifestyles are causing a surge in allergic diseases, especially among children in India. At present, about 20 to 30 per cent of India’s population suffers from one or more allergic diseases and the numbers are increasing.
The ailments include asthma, rhinitis, anaphylaxis, food and drug allergy, insect allergy, eczema and urticaria (hives) and angioedema.
The prevalence of asthma and rhinitis was 1 and 10 per cent respectively in 1964. New data, however, shows that about 14 per cent of people now have asthma, while over 20 per cent have allergic rhinitis—the result of an IgE-mediated inflammation of the nasal mucosa.
A report quoted Dr Ruby Pawankar, President of WAO, as saying that the increase has been particularly hard for children. “The way these are occurring, we believe by 2050, about 50 per cent of all children will have some sort of allergies,” Pawankar says.
Allergies vary according to age. Atopic dermatitis is the most common allergy that one comes across in children below five years of age. The main reason for this is genetic and they are born with “itchy skin”. In adults, food allergy, drug allergy, nasal allergy, metal allergy and leather allergy are among those which usually occur.
Reports show that one of every six Indians has allergic rhinitis. Often dismissed as a trivial problem, allergic rhinitis can cause fatigue, headache, cognitive impairment and other symptoms in children. Allergic rhinitis can appear with comorbid conditions like conjunctivitis, pharyngitis, sinusitis, asthma, eczema, otitis media, lymphoid hyperplasia, obstructive sleep apnea, speech impairment, failure to thrive, reduced quality of life, family disruption and impaired sexual quality of life in adults.
Difficult to diagnose as symptoms can vary radically from person to person, allergies are the bane of modern life. “Providing accurate diagnosis is challenging as it is difficult to pinpoint a single allergen. This is why acquiring the complete history of the patient is crucial,” says Dr Sathavahana Chowdary, ENT and allergy specialist at Apollo Hospital, Hyderabad. When quizzed about allergies which are specific to India, Dr Chowdary says, “Indians are more prone to drug allergies, because we use combination drugs—putting multiple drugs in a single tablet. These must be controlled and it is always better to give one drug at a time instead of combining two to three drugs in a single tablet.”
Pointing out various India-specific allergies, Dr P L Chandravathi, consultant dermatologist at Care Hospital, Hyderabad, says, “There are several allergies which are found only in India. For example, bindi dermatitis, allergies to artificial jewellery, ear studs and nose rings are all common in India. Some people are also allergic to sindoor, which many Indian women apply. Mehendi, which is part of Indian weddings, often serve as a trigger for allergic reactions. Indians are also allergic to seafood.”
According to Dr P Sukumaran, a pulmonologist who has been specialising in allergy cases for the last three-and-a-half decades, “anything under the sun, including the sun, can trigger an allergy”. He narrates the case of one of his patients in her twenties, who displayed allergic symptoms after her affluent family moved house. Finally it was found that a new carpet was the culprit. “Allergy caused by pets is another increasing trend. Earlier, pets were not so common. It is almost impossible to conduct all the possible tests to diagnose the allergy. So my advice to junior doctors is to first sift through the history of the patient, which will be of great help,” says Sukumaran.
Dr Rai says allergies may prove fatal if not administered timely treatment. In case of insect bite, he explains, the spread of allergy depends on the amount of venom released by the insect. “There are times we get an eruption or a rash from an insect bite, which spreads to other body parts. When the allergen enters the blood stream for the first time, the body’s immune system reacts by producing anti-bodies. The second time, the memory cells which had earlier registered the allergen trigger fast reaction causing severe rashes,” he adds.
Pollen grains trigger severe asthma. “Pollen grains are often ample in the atmosphere during the change of seasons, usually in the months of February or March, in cities like Bengaluru,” says Dr Rai. While Parthenium is the most common pollen, asthma is also caused by different grasses, fungus like Asphodelus and dust.
“Dust allergy is an ambiguous term. The body parts of dead insects like cockroaches and mosquitoes usually dry up and integrate into the dust and become allergens. These insects contain proteinous substance which causes allergies,” says Prof. Raj Kumar, head, Respiratory Allergy and Applied Immunology and National Centre for Allergy and Immunology, Vallabhbhai Patel Chest Institute, Delhi.
While protein is the chief compound in an allergen that triggers allergy, it is the same that causes food allergy in people. “That is why many people are allergic to milk and milk products as well as eggs due their high protein content,” says Dr Rai.
Dr Kumar, however, says contrary to statistics which records that 60-65 per cent of people complain of being allergic to certain foods, massive studies in this field have found only 2 per cent actually suffer from food allergy while for the rest it is more imagined than real.
According to WAO experts, one of the biggest reasons for a surge in allergies is declining biodiversity caused by growing pollution due to urbanisation, rising temperatures and lifestyle changes. Over-hygienic lifestyles lower resistance as well. Stressing the need to keep interiors well-ventilated, doctors say insulated spaces are a veritable breeding ground for allergies and could lead to deterioration of the indoor air quality.
Though most common symptoms of allergies are itching and rashes, Dr Chandravathi advises people against scratching. When people constantly scratch an itch, the top layer of the skin comes off and attracts germs and bacteria. This could lead to boils, cellulitis, skin turning blackish and other ailments, apart from respiratory allergies such as nose-blocking and sneezing fits. In some cases, allergic reactions can also cause Anaphylaxis, which is the most severe and life-threatening reaction.
On the uncommon types of allergies, Dr Kumar says many people are allergic to dander of dogs and horses, mango, coconut and even certain plants. “There was an acquaintance, a doctor who used to get bouts of asthma whenever he visited a particular farmland. We decided to probe into the matter and on a visit found cannabis being cultivated there. We tested him for the allergen and he was diagnosed allergic to the plant,” he explains.
Fancy footwear may cause allergy in some people. IT professional Anand, 25, came to the Vydehi Institute of Medical Sciences and Research Centre in Bengaluru in June last year with some unusual markings on his toes. He was diagnosed with foot dermatitis and advised steroid creams and tablets along with a strong recommendation to stop wearing leather shoes. He ignored it.
“After a month, he returned, complaining that the marks were causing extreme pain. The doctors did a ‘patch test’ by taking a bit of skin from the toes. It revealed that the dermatitis condition had, in fact, flared. He was asked to change his footwear immediately as the patch test clearly revealed that his problem was related to leather dermatitis,” says Dr Hanmanthaya, dermatologist.
Says Dr K Sharmatha, dermatologist at SINS Hospital, Chennai: “Toxic epidermal necrolysis is a serious allergy which can prove fatal at times. It is caused due to the reaction to drugs. The skin gets blisters which graduate to peeling of skin. The patient may lose his or her entire skin and die if not treated immediately.”
Emphasising that immediate diagnosis is necessary in such cases, she cites the case of a 17-year-old girl whose condition deteriorated due to wrong diagnosis. “The girl started getting eruptions on her skin after she took tablets for fever. Her family quarantined her thinking it was chicken pox, but her skin started peeling. By the time she was admitted, she had lost 30 to 50 per cent of skin. We admitted her in ICU and had to put her on steroids for a week. It would have been fatal if her family had delayed admitting her,” she says.
Though allergies can never be completely cured, they can be kept under control after proper diagnosis. Says Dr Pramod V Sathya, Consultant Physician at Vikram Hospital in Bengaluru, “Allergies are highly individualised. Hence the patient has to look for triggers to his allergies. However, allergic skin testing and RAST (Radio Allergo Sorbent Test) may help. Anti-allergic tablets, steroids, nasal sprays and inhalers help in treating allergies.”
Immunotherapy is the most effective treatment for allergies for people who have identified the allergen but cannot avoid it. “There are different types of immunotherapies which a person can take for two to three years. There is the rush immunotherapy where therapy is done over a few hours (instead of days and weeks) to increase a patient’s tolerance to an allergen,” he says.
It is important for a doctor to know the medical and genetic history of a patient before doing an allergy test. Dr Sharmatha, however, says patch testing is a sure shot way to diagnose a skin allergen. “We stick patches containing allergens like paint, fish protein, metal jewellery on a medicated sheet to the patient’s back. The allergen is identified if the area turns red,” she says.
Dr Sharmatha says the skin allergies respond to medication (ointments and steroids) in 90 per cent cases, reducing the chances of immunotherapy.
Alex Gazzola, author of Living with Food Allergies, says India, with its diverse and unique culinary culture, has acquired its own portfolio of allergens. Research shows that brinjal, cucumber, lady’s finger and papaya among the most common foods causing clinical symptoms in population samples taken from Mysore city and Bengaluru.
Gazzola adds that food allergy could become an enormous problem in India. They cause roughly 30,000 emergency treatments and 100 to 200 deaths per year. However, most reactions in India tend not to be life-threatening yet. The most common symptoms, according to doctors, appear to be headache, itching, joint pain and vomiting.
The worry is this situation will worsen, with anaphylaxis increasing. With a lack of national allergy programmes and poor medical care in rural areas, India would find it difficult to cope with.
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