The big sneeze

The big sneeze

While other schoolchildren spent their fortnightly tuck money on biscuits and chocolates, Gayathri Sreedharan used her allowance for extra packs of Kleenex from the Rishi Valley on-campus provisions store. “I spent my entire school years with a tissue in hand," Sreedharan, now 24, says. Yet she was not immediately diagnosed as suffering from allergic rhinitis (also called hay fever). “Those days in India, and I am talking about 1985 here, people didn’t understand the concept of hay fever," says Anjana Sreedharan, Gayathri’s mother, who suffers from bronchial asthma.

“When she was young, the doctors would tell me she had gotten an ‘allergic cold’," Anjana Sreedharan says, adding that going away to the relatively pollution-free environs of Rishi Valley actually helped improve her daughter’s condition.

The allergy up your nose

“Allergic rhinitis, as the name suggests, is a kind of allergy of the nose, an oversensitivity," says Vikram Jaggi, medical director of the Asthma, Chest and Allergy Centre in New Delhi and Gurgaon. But to what? To “irritants" that people unaffected by the condition wouldn’t respond to in the same way.

Dr Jaggi adds, “Hay fever is an old term and a rather unfortunate one because it is often not caused by hay alone and there is no fever." That last is, in fact, one of the ways to distinguish it from a viral infection (such as the common cold), he notes.

Immune confusion

Your body’s immune system starts picking up on signs of what might be dangerous to it early on in life. The immune system is like a clean slate and maturation occurs quickly, explains Dr Jaggi. Like a growing child, it is preprogrammed to learn—in this case, to identify potential health threats and attack them.

However, because of widespread vaccination drives in industrialized and even developing nations, the immune system (which, in the absence of such initiatives, would be busy warding off threats posed by other, more dangerous pathogens) is left relatively free to focus on otherwise minor environmental irritants.

Fighting back

Once the body reads a molecule or biological cell, such as dust or pollen, as being dangerous to it, it produces what is known as immunoglobulin E, or IgE—an antibody whose structure is adapted specifically to the object perceived as a threat. These IgEs then attach themselves to mast cells (also part of the immune system) in the body. The process is known as sensitization.

When an irritant (such as pollen or dust) to which the immune system of an individual is “sensitized" enters the nasal passage, it fits into the already present IgE antibodies on the mast cells, much as a key fits into a lock. Mast cells contain within them a cocktail of chemicals, including histamines—one of the most important mediators of allergies in the body. When the allergen fits into the IgE structure, it completes a circuit of sorts. This triggers a reaction that causes the membrane or wall of the mast cells to rupture, releasing the histamines contained within. This results in symptoms that include a runny nose, watery eyes and difficulty in smelling things. It’s basically a system-wide emergency signal spreading through your body, alerting it to a potential threat while simultaneously trying to wipe out the threat.

Call cancel

It is this emergency signal that is your “allergy". “I take zinc supplements and antihistamines when the symptoms get worse," Gayathri Sreedharan says, explaining how she copes when her allergies worsen. It’s the most common “treatment" sufferers adopt, perhaps because it is the easiest one. “But antihistamines only combat the symptoms without going into the reason," says Dr Jaggi.

There are other, more thorough options to recover your quality of life—which is badly affected, as sufferers well know. While most may think a runny nose and sneezing a nuisance at worst, Dr Jaggi says studies indicate the impact of allergic rhinitis on the quality of life is comparable with that of moderately severe heart disease or diabetes. Sreedharan recalls she was often irritable, and did not participate much in outdoor sports while growing up.

Studies have also shown a link between allergic rhinitis and poor performance in examinations. The disease affects the overall quality of life, including the capacity to learn. One way to root out the problem, he adds, is to opt for hyposensitization or specific immuno therapy.

Marching to a stressful tune

“Every medical condition is coloured by stress," says Dr Jaggi. The same is true of allergic rhinitis, the symptoms of which can worsen under stressful situations such as preparing for examinations.

Allergic rhinitis can also potentially develop into asthma and other allergies in what he describes as the “allergy march", where someone suffering from food allergies is likely to develop skin allergies, nasal allergies and then asthma, in that order.

Allergic rhinitis is slightly more prevalent than asthma the world over. Also, 60-80% asthmatics suffer from allergic rhinitis as well; conversely, 20-30% people who have allergic rhinitis are also likely to be asthmatic.

A Stitch in time

Failure to detect and address the root causes (including masking them by using antihistamines to suppress symptoms in the short term) is not very likely to have any drastic consequences, Dr Jaggi admits. However, in most cases, what is lost is the chance to prevent recurrence of the allergy.

If and when the condition develops into ailments such as asthma, patients will seek medical advice, Dr Jaggi says. “Sneezing is not taken seriously in this country, wheezing is," he says, adding that asthma is a more dramatic disease and perhaps that is why it gains more of our sympathy. Actually, though, he adds, “allergic rhinitis is fairly common in India… Not less than in the West. It’s just that the diagnostic labeling there is more precise".

So why do so many of us wait to wheeze if we can stopper the sneeze?

Myth 1: You can’t pass on an allergy

Study your history, suggests Dr Jaggi. Anjana Sreedharan says that when her daughter first exhibited symptoms such as a blocked nose and difficulty breathing, she feared that her daughter had inherited her respiratory problems.

Heredity is a significant factor in developing allergies, says Dr Jaggi. People with a family history of allergies are more likely to develop them as well. For instance, while one is 25% more prone to developing allergic rhinitis if one parent is affected, the predisposition jumps to 60% if both parents suffer from the disease.

Myth 2: Allergy candidates need “sensitive" treatment

Persons with a family history of allergies need not always put unfounded caution before pleasure, abstaining from activities such as gardening and keeping pets.

Dr Jaggi says for someone with a family history of allergies, proximity to a pet might actually build tolerance instead of sensitizing them. This is still a somewhat gray area though, he says, emphasizing that if the person exhibits signs of being allergic to pets “then the answer is a clear no".

In the case of gardening, he says that most people are allergic to grass pollens, and since the concept of mowing one’s own lawn is not prevalent in India, most people with a family history of allergic rhinitis can still indulge their green fingers without too much discomfort.

Myth 3: You will outgrow your sneezes soon

Anjana Sreedharan believes her daughter’s allergies have gotten much better since she was a baby. However, a severe allergy attack as late as 2007 caused Gayathri Sreedharan to take a week off from work and return home to New Delhi from Mumbai, where she was working with a television news channel at the time. “We are overly optimistic in this respect (about outgrowing our allergies)," says Dr Jaggi. “Because we want to believe it so much, we think it may be so."

He says while it has been known to happen, in most cases such an allergy is more likely to worsen and develop into other allergies. “The more severe the disease and given factors such as family history, the less likely one is to outgrow one’s allergies."

Breaking the seasonal cycle

Now if you’re ready to deal with it and not just live with it, the first step to managing allergic rhinitis is avoidance. “The commonest pattern for allergic rhinitis is perennial, with seasonal manifestations," says Dr Jaggi. He explains that while seasonal allergies peak during March-April and September-October when pollen count in the air soars, perennial symptoms stay year-round.

For people suffering from allergic rhinitis, avoidance may be the best course. “Be vigilant as to what provokes these attacks and minimize exposure to the allergen… Avoid things such as sudden changes in environment that could provoke an attack. For example, when you step out of a hot shower into cold air, the temperature change can set off sneezing and trigger a cascading effect. This is best avoided," Dr Jaggi advises.

Finally, a cure!

There are at least two effective ways to correct allergic rhinitis as well: One is to hyposensitize the body to the specific allergen; the second, to take a course of corticosteroids.

In the first, the specific allergen that affects a patient is identified using a skin test. In a skin test, samples of substances known to cause allergies are placed on the inside of the forearm and small pricks are made to help the allergen make contact with the bloodstream. A person sensitized to, say, dust will exhibit signs, including redness and swelling, in response to the sample containing dust.

A vaccine is then developed to hyposensitize the patient to that particular allergen: This customized vaccine is administered to the sufferer over a period of time till the body stops producing antibodies against the irritant and builds up tolerance to it.

The second option involves steroids. “People don’t have to be mortally afraid of the word corticosteroids," says Dr Jaggi. He makes a distinction between oral and inhaled corticosteroids, cautioning that while oral steroids taken in an unguided way can have side effects over a period of time, inhaled or local corticosteroids used in the form of a nasal spray are “quite safe". He adds, “People have to weigh the pros and cons of the treatment."

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