Historically, Total IgE measurement on a blood sample was used as an entry level test to identify allergy prone patients. However over the years it have become apparent that Total IgE levels can vary in both allergic and non allergic individuals. Some patients with significant nasal allergies may in fact have relatively low Total IgE, whilst those with extensive eczema of the skin will have very high Total IgE even if they have no allergy at all. Total IgE can also be raised with an underlying parasite infection. Some individuals may have a Total IgE of several hundred units but have no allergy at all. Total IgE measurement can therefore confuse the diagnostic process and should not be used as an entry level allergy screening test. It is far more useful to do Specific IgE blood testing for suspected allergens after taking a thorough allergy history from the allergy sufferer.
The sudden hot weather due to hit Southern England and London this Easter weekend will act as a massive stimulus to grass and trees to pollinate and erupt with a very high pollen release called a “Pollen Bomb”. This will be most unpleasant for Allergic Rhinitis and Hay Fever sufferers, and they should start taking antihistamine medication immediately to try and control this event and their allergic condition. Symptoms will include profuse sneezing, eye and nose itching, together with nasal congestion, blurred vision and a very runny nose. Some people may experience asthma-like symptoms with wheezing and a tight chest. Be prepared and stock up with antihistamines such as cetirizine, loratadine or chlorphenamine all available without prescription form a pharmacy.
Local Pharmacies are marketing small devices that shin red light into the nose as a treatment for hay fever and rhinitis. There has been a lot of interest in the role of Rhinophototherapy using narrow band red light phototherapy and its ability to stabilise the nasal mucous membranes. Some patients report positive results with this non-invasive therapy which requires a few sessions of treatment. At this point we don’t have enough clinical studies to confirm or refute the efficacy of this treatment. But one would assume it would need to be administered by a health professional who is experienced in the treatment and not by an OTC red light torch available in a Pharmacy.
Narrow band red light phototherapy in perennial rhinitis and nasal polyps. Neuman, Finkelstein in Annals of Allergy 1997 Apr; 78(4) 399-406
Rhinophototherapy: Gimmick or an emerging treatment option for allergic rhinitis . Leong in Rhinology 2011 Dec; 45(5) 499-506.
Irritable Bowel Syndrome (IBS) can be very debilitating with abdominal discomfort, bloating, excess wind and frequent loose stools. IBS can severely affect quality of life (QOL). Various hypotheses have been put forward as causes for this chronic condition including stress, disordered bowel flora and sensitivity to gas forming carbohydrates in the diet such as fermentable FODMAPs including lactose, wheat, certain fruits and vegetables. Interventions include a low FODMAP diet, introduction bifidobacteria probiotic supplementation and even a non-absorbable antibiotic to clear any offending bowel flora thought to trigger IBS. This antibiotic Rifaximin is taken 3 times a day for 2 weeks to clear the bowel flora and doesn’t have any systemic effects. Preliminary studies have been encouraging, but further studies are planned.
Ever since naturopath Dr Peter D’Adamo published his book “Eat Right 4 Your Type” in 1996, there has been intense media interest in the concept that certain blood group individuals respond better to high plant versus high protein and paleo diets. The book makes interesting reading and although the diets are healthy and all avoid junk foods, there seems very little evidence that manipulating your diet in this way has any impact on allergies
Allergic rhinitis and hay fever affect 1 in 5 adults in the UK. Peak pollen counts (May to July) coincide with GCSE examinations and hay fever sufferers are likely to drop a grade in their exams due to detrimental symptoms of hay fever. 70% of hay fever sufferers are on antihistamines and of these at least 28% are on sedating antihistamines such as chlorphenamine. This further compounds the problem of concentration and fatigue at exam time. The way forward is to recognise the impact of hay fever on quality of life and concentration, and to prepare for the exams using a non sedating antihistamine (desloratadine, fexofenadine or levocetirizine) or preferentially a low-dose steroid nasal spray (fluticasone, mometasone or beclomethasone) that won’t impact cognitive function.
Coconut is a tree nut and can cause allergic reactions such as occurs with Brazil nuts, Cashew nuts and Hazelnuts. We used to think it was quite a rare food allergy and was not often reported as problematic. But prevalences seem to on the increase and more people report oral allergic reactions and rashes when consuming Coconut in Asian foods and exotic drinks. Coconut milk is now readily available in health stores and supermarkets and more people drink Coconut milk than ever before. Sensitisation may occur in babies and young children when coconut oil is applied to the skin as a moisturiser. Coconut allergy testing can be done on the skin (Skin Prick Test) and on a blood sample (RAST test). See Wikipedia for more information on Coconuts.
Vitamin D is known as the Sunshine Vitamin and studies show that 50% of the population have insufficient vitamin D levels. This can effect bone development and cause deformities also in children. Australian allergy studies show that infants and young children who are deficient in Vitamin D are more likely to develop egg and peanut allergies and supplementing the vitamin has a protective effect in childhood. Unfortunately once the allergy is established, supplementing Vitamin D won’t reverse the allergy. The American Academy for Asthma, Allergies and Immunology (AAAAI) have more information.
It’s hard to believe that the next summer isn’t far off. For those hay fever sufferers, now is the time to start considering desensitisation immunotherapy for grass pollen. This treatment needs to be started at least 2 months before the grass pollen season gets under way for best results. All too often hay fever sufferers leave it until the last minute. For the Timothy Grass Pollen Hay Fever desensitisation oral immunotherapy (SLIT), treatment should commence by 1st March. For grass pollen desensitisation, Grazax is a recommended treatment and needs to be taken daily as an effective oral treatment.
Caesarian section delivery of infants is associated with increased risks of developing allergies to common foods and inhalant allergens according to the Journal of Allergy and Clinical Immunology (Sept 2018). Studies in the USA show a greater risk of developing allergies in babies born by Caesarian Section and lower rate in those born by Vaginal birth. It seems healthy full term babies with a family history of allergies are most at risk. Premature babies paradoxically are at lower risk of developing allergies because their immune system is stressed very early. It is postulated that the Vaginal Delivery method of birth introduces the infant to its mothers natural gut and vaginal flora in the birth canal which then stimulate the baby’s immune system to develop normally. Caesarian birth is a sterile procedure and the baby is thus not naturally introduced to the mother’s normal bacteria in early life.