Until Matthew was 17 he was never really ill. He would get the occasional cold every now and again, a sprained ankle or bruise from exercising too enthusiastically but these were short lived problems which he completely forgot as soon as he would get rid of them. Then one year, it was the month of May, he woke up one morning with a blocked nose and a thumping headache; he remembered that over the past few days he’s been sneezing once, twice, three …. ten times and that his nose and eyes were watery.   ‘Mhhh I’m getting a cold’ he thought. ‘Oh well, it will be gone soon!’ But after a week he wasn’t better, nor after two weeks, nor after three or even four. In fact it took him almost three months to get rid of the cold and he didn’t like it. His blocked nose made breathing very difficult. And not only breathing, everything he did was harder: talking, eating, school work, biking, running, and even sleeping became a sort of a struggle.  Besides, the headache was there almost constantly, his eyes were itchy and swollen and streaming down continuously, his nose was dripping and itchy as well. Going out made things even worse and although he didn’t want to lag behind his friends, he found sometimes difficult to keep the step with them. He never thought to go to the doctor… it was after all just a cold! In the end he got rid of it, but it was almost at the end of the summer, just in time for going back to school! Then the autumn came and he forgot all about it, until … next May when one morning he again woke up breathing hard through his mouth because his nose was blocked; he again had dozens of bouts of sneezes all day and his eyes and nose were itchy and watery. ‘Oh, not that cold once more!’ he thought! It was in the middle of his summer exams and the blocked nose made him sleep badly and wake up tired, making concentration difficult. He felt sleepy and irritable. And reading the papers through streaming, itchy eyes didn’t make things easier either! That year again the cold lasted him weeks and once more he might have put up with it without going to doctor if he wouldn’t have gone out biking with his brother that afternoon.  Half way up the hill, which was not really very step and he used to climb it in a nick of a time he had to stop. He was terribly breathless and felt like there was a heavy weight on his chest which he had to shift up every time he took a breath. He made wheezing sounds when breathing and felt strangely panicked. He laid down in the grass by the road trying to catch up his breath but it seemed to get worse rather then better. In the end, they had to go back home walking slowly besides their bikes. He was still not well when he got home so his parents, alarmed took him to the doctor. And this is how Matt found out that the cold that troubled so much of his last two summers was in fact hay fever and the breathlessness that scared him and his parents that afternoon was an asthma attack which often accompanies hay fever.

Although Matt is a fictional character which I created this morning, his story is neither imaginary nor uncommon. It brings together real stories of patients I saw in my clinic.

If you recognize yourself in this story, then you might find useful to follow the series on hay fever which I’m starting today. You will learn why hay fever is not a cold and also that if you left it untreated not only it will get worse itself but it can open the door for other diseases like asthma, sinusitis or otitis; it can also make you moody and unable to enjoy life as before and it can also affect your intellectual performance and getting the wrong treatment may make this worse. There will also be a few simple tips that might allow you to take control of your disease rather than the opposite.

The continuation will be here in a few days. Come back for it! And remember that you can leave a comment on what you did and did not like; or about what you would like me to write; or ask me questions about your disease.

This is a little booklet which can teach you about allergy through colourful images and matching text explanations.  The book is not available for sale but we will post it on our web hoping that it might help if you suffer from an allergic disease. You can also get a free CD copy of the book when you come for an allergy consultation or an educational evening in The Artemisia Clinic.

Today we will post for you the beginning of the story. If you like it and want to read the continuation, remember to come back regularly to our web-site.

“ AAAAH THIS IS A VERY GOOD QUESTION. IT’S AN INAPPROPRIATE RESPONSE OF YOUR IMMUNE SYSTEM.”

INAPPROPRIATE RESPONSE OF MY IMMUNE SYSTEM?!!! DOCTOR, WHAT DO YOU MEAN?

Let me explain. You see, from the first day of our life we are constantly exposed to aggressive attacks form the outside world: microorganisms, like bacteria, viruses or parasites, continually try to invade our body because it provides ideal means for their survival. But what would be good for them would mean disease for us! So to prevent this, our body is equipped with a complex defence army called immune system which is very smart and has different defending mechanisms for each type of aggressor, depending on their size, entrance gate and the weapons they use when they try to take advantage of our body. For small aggressors like viruses and bacteria which can gain easy access inside our body, it is the white cells in the blood that trigger the defence: as soon they encounter such an invader, they engulf it and in the same time signal other immune cells about the danger. It is not the same for parasites. These aggressors are much larger so they cannot get access into our body if they don’t break an opening into it. For this they release substances called digestive enzymes (a little bit like those we use to digest the food we eat) which destroy the bonds between the cells of our skin or the lining of our gut, nose or lungs. It is the recognition of the digestive enzymes that warns the immune system of a parasite invasion. However, parasites are usually much bigger than the immune cells and so they cannot be engulfed. Therefore the immune system has developed a different elimination strategy: it surrounds them by cells that release aggressive substances which irritate and damage the parasite’s skin. This results either in parasite killing or it makes it feel very unwelcome, determining it to leave our body.

An allergic reaction matches the responses to parasites, but it’s inappropriate because it is mounted against allergens which are agents that are not harmful. Consequently, the immune system from the protector of our body turns itself into an aggressor.  

Come back on our website to follow up the story; next time you will learn about allergens - substances which can trigger allergic reactions.

END

• Anaphylaxis
• Angioedema (swellings)
• Asthma
• Drug Allergy
• Eczema, Atopic (atopic dermatitis)
• Eczema, Allergic Contact
• Food Allergy
• Food Intolerance
• Hay Fever
• Immunotherapy
• Insect Allergy
• Urticaria (hives)
• Glossary of allergy terms

Does someone in your family suffer from allergy?

You are not alone! Today one in three UK adults and children suffer from hay fever and one in four has asthma, allergic eczema or peanut allergy.

What are the causes of the increase in allergy and why is UK one of the most affected countries?

Come along to find out how our modern lifestyle is making us more allergic.

Also, is there anything we can do about it?

If any any of these questions are relevant for you or someone close to you, join our discussion at the Fenwick hospital.

The entrance is FREE but there is a limited number of places. To book your placein advance e-mail info@fenwick2.co.uk

END

1. Allergens for skin prick testing are watery solutions stored in small bottles.  The doctor will chose which allergens to test based on the information received from the patient while taking the clinical history.

2. One small drop of the allergenic solution is placed on the skin of the forearm. Besides the allergens, a positive control (histamine), and a negative control must always be used with every patient.

3. The skin is then pricked through the drop with a sterile lancet with a very fine tip, which ensures that only the superficial layers of the skin are penetrated. So there is almost no pain and not a single drop of blood.

4. The name of the tested allergens can be written on the skin, to ensure that there will be no confusion when reading the results. Here the first allergen is house dust mite (HD) the second one is grass pollen (Grass), third is the negative solution      (-ve) and the fourth is the positive solution test (+ve). The excess of allergen solution is wiped off the skin with a paper tissue.

5. Results are red after 15 minutes. Reactions induced by the allergens must always be compared with the positive and negative tests. The positive control should induce a red itchy swollen area (a weal) of at least 5 mm in everyone while the negative test should not show any reaction at all. A positive reaction to a tested allergen is indicated by the presence of a red weal more than 2mm greater in diameter than the negative test and more than ½ of the size of the reaction induced by positive control. This patient has a strong positive reaction to house dust mite and no allergic reaction to grass pollen.

Usually the itch accompanying the positive reaction subsides in 30 minutes to 1 hour while the redness and swelling may persist for a few hours before wearing off completely. Skin prick tests do not  leave any permanent marks on the skin.

I remember one particular thing that my friend said: ‘It is amazing that in the 21st century we still suffer from hay fever! We can replace people’s arms and legs, transplant hearts, and even take out parts of the brain, but we are incapable of curing as easy a disease as hay fever!’ If she tried her best, she couldn’t have illustrated better the paradox of allergy. With a few exceptions, allergies largely express through trivial symptoms – sneezes, sniffles, watery nose and eye, itch, hives that come and go out of the blue – creating the image of a simple and not really serious problems.

Not surprisingly then if, just like my friend, we think that allergy treatment should be within easy reach: just avoid that cat or flower or food or drug and everything will be back to normal. Leonardo da Vinci used to say that ‘Simplicity is the ultimate of sophistication’.

A perfect description for allergy, which, similar to an iceberg, shows only one third of the problem – the symptoms – while the main part is hidden. Although seeming to affect isolated organs, allergy is in fact a whole body illness. It is a disease of the immune system which consists of an army of cells dispersed throughout our body, intercommunicating permanently and ready to commute from one organ to another, fighting whatever threats arise. Sometimes, however, the immune system gets things wrong. In allergy it mistakes harmless substances like pollens, house dust mite or even food, with parasites. So masses of immune cells rush to our nose, skin, lungs or gut, releasing toxic substances aimed to kill the parasite. But as there is no parasite, only allergens, it’s our own organs that get harmed. Our immune system is programmed at birth to react like this; its abnormal behaviour is encoded in our genes. This is why allergy does not go away like a simple cold, but strikes again and again, every time we come across the allergen.

However, in some patients, immunotherapy (allergy shots) brings a hope for curing allergy. Immunotherapy consists of repeated administration of small amounts of allergen which make the immune system tolerant to it. In the past this was done by injections, which carried a risk for severe unwanted effects, were unpleasant and time consuming. Nowadays, though, there are allergen solutions or tablets that can be taken by mouth which are much safer and easier to use.

They must be taken daily but you can do it at home and don’t need to see your doctor more than three-four times a year. Thanks to these newly developed products, immunotherapy is on the rise and is promising to help a great many allergy sufferers to obtain long term relief from their disease.

Dr Diana S Church is allergy specialist and from September 2009 will run an allergy clinic at Fenwick Hospital, Lyndhurst – Diana S. Church – MD

END