Voices Pushpesh Pant Ravi Shankar Preeti Shenoy Ajai Sahni Dinesh Singh mata amritanandamayi THE new sunday express MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment june 2 2024 SUNDAY PAGES 12 Allergy Nation India is in the grip of an unacknowledged allergies epidemic, endangering the next generation. Lacking well-funded research, a definitive policy and medical awareness, combating it is tough going Types of Common Allergens Airborne Airborne allergens can trigger hay fever (allergic rhinitis) symptoms, and can also be responsible for eczema and asthma. These allergies can’t be cured, but one can help reduce the severity. Eg: Pollen, dust mites, pet dander, mold & mildew Food Food allergy affects an estimated 8% of children under age 5 and up to 4% of adults. Even a tiny amount of the allergy-causing food can trigger symptoms such as digestive problems, hives or swollen airways. Eg: Tree nuts and peanuts, milk, eggs, soybeans, fish, shellfish and wheat SKIN This is the most common form of allergies. Skin allergies can have causes that aren’t due to underlying disease. They are largely an inflammation of the skin triggered when the immune system releases histamine. Eg: nickel, latex, fragrances, cleaners, cosmetics and plants Medication It's when your body's immune system overreacts to medications. Your body develops sensitivity to one of the substances in the medication and may produce an antibody against that drug. Eg: chemotherapy medicines, sulfa drugs, penicillin, NSAIDs and anti-convulsants By smitha verma Sneezing fit? God bless you, pop a pill. Got a bad rash? Slather on some cream. Horrible itch? Look for that ointment that worked last time. Going to the bogs all night? Take a costive. It’s just an allergy, right? There is nothing called just an allergy At best, you get . away with a runny nose, watery eyes and restless sleep. Or you get eczema or hives. Things can get serious like allergic asthma, which inflames the lungs so much that you can’t breathe; the inflammation causes the swelling and restricts airflow. At worst, you could die from anaphylaxis: your blood pressure drops, your pulse becomes weak and you could become unconscious—if not treated immediately . Anaphylaxis, the Darth Vader of allergies occurs when a specific antibody that identifies any threat to the body’s immune system, triggers the production of histamine, leading to dilation of blood vessels, inflammation of tissues, itching of the skin and respiratory symptoms like wheezing, coughing or sneezing. Whether diagnosed or not, allergies—mild or severe— must be taken seriously since one allergic reaction cannot indicate the severity of another; some mild reactions can become severe later. A paper published in March 2019 in the Journal of Evolution of Medical and Dental Sciences, mentions that 36 per cent of Indians suffer from one form of allergy or the other. According to the Global Asthma Report 2018, an Respiratory allergies such as hay fever or allergic rhinitis occur when the immune system reacts to airborne substances like pollen, dust mites or pet dander estimated 300 million people worldwide have asthma, with 37.9 million of them living in India. In another study published in the same year in the journal Clinic Resp J, the prevalence of allergic rhinitis was at 11.3 per cent in Indian children aged six to seven years and 24.4 per cent in children aged 13 to 14 years. The person who knows the poorly treated, and often ignored, danger too well is Dr Neeraj Gupta. Five years ago, he would see around three or four odd allergy patients in a day. Today, the number has gone up to 10. “Allergies are on the rise and often they are misdiagnosed,” says Dr Gupta. Simply put, an allergy is the immune system’s response to the invasion of a foreign substance, which could be pollen, bee venom, pet dander or a specific food like shellfish. The phenomenon is a vast medicopedia of irony since something that doesn't cause an allergy in one person could affect someone else and vice versa. More than 170 food items create allergic reactions of which the biggest culprits are milk, egg, peanut, tree nuts, wheat, soy, fish, crustacean shellfish and sesame. In India, 20-30 per cent of the population reportedly has at least one allergic disease. The most common of these include dal, prawns, aubergine, milk and egg. By the way, North Indians could think twice about their Sunday rajma chawal; kidney bean allergy affects over 20 per cent of the food-allergic population in Delhi. Dr Gupta, a paediatric allergy specialist, who conducts the ‘Paediatric Allergy & Asthma’ diploma course in Sir Ganga Ram Hospital (SGRH), Delhi, is irked when his peers suggest an allergy drug panel test to patients without bothering to narrow down the problems to key four to six allergens for the test. The national medical curriculum, till date, has not incorporated allergology as a field of study. “There should be specialists to treat allergies in patients, just like with other medical specialities,” he stresses. Gurugram resident Saisha Verma is one such individual. The 17-year-old student’s mornings start with a bout of sneezing. By the time she is ready to leave for school, she has an itchy nose, watery eyes and a scratchy throat. Chances of her tiffin being left at home are higher than not finding an Allegra in her bag. “Popping Allegra has become a way of life,” says Verma. An otolaryngologist diagnosed her condition as swollen sinuses and gave her a nasal spray and prescribed medicines for a fortnight. “But it was of little help. Every morning, I still wake up sneezing,” she says. She is lucky Earlier last month, . Nikhitha N, a 20-year-old girl from Thodupuzha in Kerala, died after accidentally eating prawn curry served in her hostel. In 2021, a government panel studying Covid-19 vaccine side-effects had confirmed that the death of a 68-year-old man was from an allergic reaction to the vaccination. According to the Dyson Global Dust Study 2022, 69 per cent of homes surveyed reported one person allergic to dust. Allergies are everywhere. And they are on the rise. Under the sun, anybody could be allergic to anything, including the sun. A to Z of Allergy In India, weather and allergies are like bread and butter. People with allergies may get their worst symptoms during the summer months, when it’s hotter and plants and grasses pollinate. Last year, an allergy study by Mumbai-headquartered Metropolis Healthcare Ltd tested 65,000 individuals; 30 per cent tested positive for one or more allergens. “In the allergic population, the highest allergy was towards dust mites, closely followed by food allergies,” says Dr Alap Christy, Associate Vice President, Lab Operations & Scientific Business Head, Clinical Chemistry, Metropolis Healthcare Ltd. Food allergies are on the upward trend. Some of them, such as milk and egg allergy, are more likely to be outgrown in late childhood compared to others such as peanuts and tree nuts. According to research conducted by the National Institute of Nutrition in Hyderabad, published in The Journal of Allergy and Clinical Immunology in May, 91.6 per cent of eczema patients believed that at least one common food item was linked to their condition; 77 food items perceived to trigger and/or exacerbate it were identified. The most notable allergens were cumin, chickpeas, walnut, cabbage and betel leaf. “Understanding the different types of allergies is crucial for proper diagnosis,” explains Dr Gupta. He believes that awareness must begin in hospitals where instead of a one-size-fits-all approach, allergy cases are treated after detailed investigation. “Awareness is crucial for patients, too,” he adds. Samira Ferns, a 44-year-old event planner from Chennai is a case in point. Over the last two decades, she has been dealing with multiple allergies. She has self-diagnosed the trigger points and taken precautions accordingly because “it doesn’t matter as much anymore”. Initially, she used to pop an antihistamine but realised it was leaving her in a daze. She has switched to paracetamol though “it doesn’t really help”, but provides her “psychological” satisfaction. “I have a pollen allergy, dust allergy and detergent allergy. Even perfumes trigger a sneeze fest. I have noticed extreme stress also flares up my allergy,” she reveals. An allergy apocalypse is slowly brewing in India. And it is not going anywhere, anytime soon. An Allergy Avalanche Allergies, like any severe physical response can indeed stress you out because you are dependent on medication: you never know when and where it will strike. Until recently, Akash Mohla was allergic to onions. The only way he dealt with it was to strictly avoid them. When he was four years old, he had a severe outbreak of painful rashes all over his the growth of insects and dust mites. Cockroaches are blamed for many things, but news is that they may trigger atopic asthma. India’s tropical and humid climate allows allergycausing moulds and fungi to flourish. Then, there is climate change: as heat waves push the thermometer to even cross 50 oC in some places; this has altered the pollination cycle of weeds, which had led to a higher discharge of pollen in the air. Dr Neha Rastogi Panda, consultant-infectious diseases at Fortis Memorial Research Institute, Gurugram, is concerned that seasonal allergies are no longer seasonal. For many individuals, symptoms are beginning earlier, and extending beyond, the traditional pollen period. She is seeing more patients with allergic symptoms post-Covid. “There is a 15 to 25 per cent increase in their numbers. Pollen allergy or dust, contact dermatitis or food-related, almost all allergies According to the American Academy of Allergy, Asthma & Immunology, 30 to 40 per cent of the world population have some form of allergy body and scalp. Someone recommended he take a dip in a hot sulphur spring as a cure, but ended up landing in Emergency care. Today, Mohla is a veteran at dealing with irritated immune systems. After he became an adult, his allergies have become sporadic. “Still, I can’t afford to leave home without an antihistamine,” says the 32-year-old stock trader from Noida. Everything comes with a price, including economic growth. The construction and infrastructure boom that marked the first two decades have also caused an allergy boom. So has uncontrolled urban migration and industrial expansion. One of the highest concentration rates in the world in air pollution from fossil fuels, and vehicles is in India. Mosquito coils, incense and dhoop sticks are responsible for indoor pollution, according to a reputed health lab in Bengaluru. Crowded urban living conditions lead to poor sanitation, which encourages are on the rise,” says Dr Panda. A new report from the Association of American Medical Colleges, released last year, places blame on climate change since warmer temperatures result in longer allergy seasons and more intense conditions. “We have seen many changes in the immune systems of people who had Covid. They have become hypersensitive to eternal stimuli. Sedentary lifestyles have changed the allergy paradigm. What we used to consider as only food allergies previously, could be from pollen,” explains Dr Panda. Oral Allergy Syndrome, also known as Pollen Food Allergy Syndrome, often affects adults with a history of seasonal allergies and can develop during adolescence or adulthood due to cross-reactivity between proteins in certain fruits, vegetables and pollen. It appears, of late, our immune systems are throwing a wild rave. Turn to page 2