Q. What does allergy means?

A. Allergy is an acquired altered body response of a person to normally harmless substance which usually does not affect most people in their daily life.

Q. What name is given to a substance which produces allergy?

A. Any foreign substance that provokes reaction in the body is called an allergen.

Q. Please tell me about different types of allergens?

A. The different types of substances producing allergy are pollen grains of flowers, dust particles, house dust mite, outdoor & indoor molds or fungus, insect venom of bee / wasp, animal dander like sloughed off skin, saliva and excreta of dog cat etc, secretions and excretions of birds, body parts and excreta of insects i.e cockroach, foods like milk, egg, fish, prawns, beef, mutton ,chicken, peanuts, & some drugs like penicillin, sulfa drugs, insulin, etc.

Q. What other drugs can cause breathing problem ?

A. Drugs used to treat blood pressure (beta blockers) like Tenormin and Aspirin, NSAID’s (pain relieving drugs) produce cough, wheeze and asthma like symptoms in sensitive individuals.

Q. What are common indoor allergens?

A. The common ones are:

• House dust mite present in the dust of carpets, old books, furniture, boxes, blankets, mattress and stuffed toys.

• Presence of the body parts and excreta of cockroaches where cleanliness is lacking and ample garbage is left uncovered which also serve as a food factor for these insects.

• Indoor mold or fungal growth in dark damp places, basements, toilets, leaking pipe area & wall papers which collect humidity thus helping in the proliferation of molds as well as dust mite.

• Dander of cat dog etc.

Q. Are allergies hereditary?

A. Yes, if both parents are allergic then there is a tendency that the child has 55- 60% chance of developing allergies. If one parent is affected than the chance is 40%. The chance decreases further if grand parents or siblings have allergies.

Q. Beside allergens, what other factors can increase allergies?

A. Beside allergens, other factors that increase allergy in susceptible persons are preservatives, pollutants or irritants i.e. food preservatives, coloring agents and preservatives in cosmetics etc. cigarette or automobile smoke, cold air, perfumes, air fresheners, chemical sprays, fumes of gases like nitrogen dioxide, sulphur dioxide, carbon monoxide released from vehicles, industries, gas stoves or from burning of fuel like wood, dung etc used in homes for cooking /heating purpose, vapors of varnish, paints, polish etc can also cause allergy.

Q. How can I understand that my sneezing and running nose is due to cold or due to allergy?

A. If you get a cold symptom which is a viral infection, then you will suffer from mild fever, sore throat, some sneezing, thick mucous in nose, nasal obstruction aches and pains etc. But if the symptoms are due to allergy than you will get itching in eyes, nose, intense sneezing, watery discharge from the nose, dry irritating cough and no fever.

Q. What is allergic rhinitis?

A. when some allergy producing particles enters the nose and comes in contact with the internal linning of the nose than as a reaction their is swelling and inflammation in the nose and the patient suffers from symptoms like sneezing, nasal itching , watery nasal dripping, watering of eyes and mild sore throat etc.

Q. What is hay fever?

A. Hay fever is also called seasonal allergic rhinitis because it often occurs in a specific season. It is mostly seen in spring season when pollen count is high in the air or in early summers when harvesting is done and there is a lot of thresher dust in the air.

Q. If I have a nasal problem all the year round what is it called ?

A. This is called perennial allergic rhinitis and it is mostly due to house dust mite, indoor molds or animal dander?

Q. Please give me some tips regarding my allergy?

A.

• Use filter face mask when you go out in dusty area or are doing any sweeping.
• Avoid to go in gardens during pollen season and also avoid smelling flowers. use gloves when you do gardening and wash hands after work.
• To reduce pollen exposure, wash your hair before going to bed. This removes pollen entangled in the hair strands.
• Avoid cat, dog and birds. Their fur, shed off skin cells, salivary secretions or excreta/ bird droppings can cause allergy or increase your already existing allergy problem.
• Prefer air conditioner as compared to room cooler which increase humidity and help in increasing mite growth. However, wash the filter of your air conditioner once or twice during the season because it can collect outdoor mold spores.
• If you are an allergic patient avoid unnecessary furniture ,carpets/rugs in the bed room, keep your living place clean and wet dusting /wet mop and vacuuming should be done once a week preferably by some one else.
• If you have eye allergy use good quality sun spectacles containing glazed glass. It can protect your eyes from dust, sun rays and rays coming out from the computer’s monitor screen. Don’t use contact lenses because lens use can increase the eye problem in sensitive individuals and even you can get an eye infection and some time pollen grains can even get trap beneath the lens.
• It is better for you to carry some common allergy medications if you are traveling out of the city.
• Cover your mattresses and pillows with mite proof casings made of plastic or vinyl coverings and wash your linens once a week in hot water at 130F or approximately 54C to kill the dust mites living on your shed off skin.
• Do nasal lavage with saline solution one hour before going to bed so that all the water is removed and as a precautionary measure sleep with your head slightly elevated.
• To control cockroaches use insecticide sprays when you are not in your home otherwise traps are the preferable option. Maintain cleanliness in your home especially kitchen. Cover garbage container and don’t throw food in your kitchen sink which could be a good source of food supply for the insect’s living and proliferation.
• Remove stuffed animal ,and stuffed toys.

Q. How allergens or other factors enter my body?

A. Allergens or other factors can enter your body through many routes i.e through your nose while you breathe or through mouth when you eat or even do mouth breathing, other ways of entry could be direct absorption through your skin or through your muscles when you receive injections.

Q. Please tell me which body parts are affected by allergy?

A. The body parts affected by allergy are nose(nasal allergy), bronchial tube and lungs (bronchial/ lung allergy), intestine (intestinal allergy causing allergic diarrhea /abdominal cramps), skin (skin allergy causing rashes, eczema etc).

Q. What are other signs of allergy?

A. The sign and symptoms of allergic rhinitis are sneezing accompanied by running nose, coughing and postnasal drip, itching in the eyes, nose and throat and watery eyes. The sign and symptoms of asthma are feeling of tightness in the chest, cough, breathlessness and wheezing. The sign and symptoms of eczema include red, itchy and dry skin.

Q. One of my friends say that if your teeth are alright and still you develop toothache especially if you are suffering from cold it is because of a sinus problem, is it true?

A. Yes, if your teeth are alright but toothache lingers on for some time than it is necessary that you should consult an ENT specialist who will examine you and where necessary he will exclude the sinus problem through conducting x-ray’s of the paranasal cavities of your face.

Q. How can I reduce dust in my house?

A. You can reduce dust in your house by taking following preventive measures:

• Remove carpets especially wall to wall carpets which collect dust ,animal dander, dust mite etc
• Remove unnecessary furniture from your bedroom, these collect dust.
• Use wet mop to clean furniture .
• Do vacuum cleaning of your carpets.
• Hang your clothes in almirah in a plastic cover or keep them in plastic bags.
• Keep your shoes in cupboard or boxes.
• Keep windows close especially if they open to wards roadside.
• Use filter face mask while cleaning.

Q. Why house dust is harmful to some people?

A. House dust is a mixture of many substances and may contain fabric fiber, microscopic creatures like dust mite, mold spores, body parts of cockroaches and many other debris. These things can sensitize a susceptible individual.

Q. How can I get rid of house dust mite?

A. There is no definite way of getting rid of house dust mite but you can be benefited if you wash your bed linen and pillow covers, blankets in hot water up to 50-55 degree centigrade once a week. Also encase your pillows and mattresses in air tight covers. Use wet mop to remove dust and vacuum your carpets & curtains. Remove stuffed toys and wall papers from asthmatic person room because they collect dust and moisture which are factors for the presence and growth of dust mite.

Q. What are the symptoms of food allergy?

A. You may experience itching in throat & mouth, hives on body, swelling of lips, eye lids and in severe cases, vomiting, difficulty in breathing etc.

Q. What common food provoke food allergy and please tell me about the cross reacting foods.

A. Food Allergy Cross Reacting Food
Cows Milk Goat Milk
Shrimps Other similar sea food
Peanut Soy bean, green peas, green beans.
Wheat Grains like rye etc

Q. What are different type of occupation related allergic diseases?

A. The different types of occupational related allergic diseases are occupational asthma and occupational rhinitis in bakers, flour mill workers, farmers and cotton workers from flour dust, mold and plant dust. Skin allergies like contact urticaria and contact dermatitis seen in cooks, barbers, dentist, surgeons and other medical professionals from various food items, detergents, shampoos, hair dyes, soaps, talc powder, plaster of Paris and latex gloves etc.

Q. Should I stop eating rice, curd, milk or cereals in my diet.

A. There is no scientific reason to stop these food items in your diet unless there is some clue about any food allergy. A balanced diet containing all necessary food items is good for your health.

Q. I have heard that patients allergic to pollen have cross reaction to other food items, please tell me the name of some of these foods?

A. Some time cross reaction to certain foods can occur if pollen allergic patients eat green apples, peaches, almonds, tomatoes, potatoes. This is mostly true for patients sensitive to birch pollen and grass.

Q. What is a pollen ?

A. They are Minute microscopic grains or the reproductive cell, produced and shed by flowers ,weeds, herbs, shrubs and trees etc. They are oval and round in shape and in urdu language they are called zardana.

Q. Which type of plants produce allergy producing pollens?

A. Pollen shed / produced by some of the trees, weeds, grasses which are plain looking plants can produce allergic reaction in sensitive people. The plants which produce colorful beautiful flowers are less allergenic.

Q. Please tell me the names of some common allergy producing plants?

A. The allergy producing plants as identified by NIH are Paper Mulberry or Jungli Shahtoot,Eucalyptus or Safaida, Canabis or Bhang, Acacia or Phalai & Keeker, Sun flower or Suraj Mukhi, Bottles Brush, Zea Maize or Makai, Pinus or Cheer, mix grasses like Kubble, Dubb, Timothy grass, Meadow grass, hedge like Sanatha,other plants are Sorgum orJjawar, Sumbul, Hibiscus or Gul-e-Kaira.

Q. Please tell me the peak pollen time when I should be more careful while going out?

A. The peak time at which the pollen count is high in the atmosphere is 5:00 am to 10:00 a,m. in the morning and 5:00 p.m. to midnight. At this time the pollen is heavy and is at the ground level. It is better to avoid these hours but if it is unavoidable then you can use a filter mask to cover your nose while going out.

Q. Please tell me why pollen count is high during morning and evening times?

A. The pollen count is high during these hours because the atmosphere is cool and the pollen is heavy so most of the pollen is present at the ground level but after 10:00 am the pollen loose moisture becomes lighter and rises as high as 2000 meters in air. In the evening as the day cools the pollen gather moisture becomes heavy and comes to the ground level again.

Q. Please tell me why pollen allergy problem is high in Islamabad during pollen season?

A. There are many cases of pollen allergy during spring season in Islamabad mostly because of the growth of male paper mulberry plant. This plant produces catkin or toot. Each catkin produces more than 200 flowers and each flower shed more than 3-6 million pollen during the spring season. Thus there is a lot of pollen in the atmosphere. During spring season the count reaches up to more than 40,000 pollen per cubic meter affecting mostly sensitive indivisuals. How ever the possibility of frequent/high exposures in less sensitive individuals making them prone to become sensetised cannot be excluded.

Q. My child is getting frequent respiratory infections but I avoid antibiotics and use home made remedies to control it, is there any chance for him to develop asthma?

A. No doubt your child’s exposure to respiratory infection is a problem but these children have less chance to develop asthma as their immune /defence system has become well developed due to frequent exposure to common pathogens in their childhood. In case of attack by the micro-organisms the immune system recognizes them and combact the infection by release of various defensive factors thus the chances of asthma is decreased in them.

Q. I have heart burn at night, should I consult my care provider?

A. You should consult your treating physician because regurgitation at night can lead to acid aspiration into your airway irritating and inflaming the inner linning of the windpipe and thus you can get irritant induced asthma.

Q. I am an asthmatic and now a days due to my work load I am under stress please tell me whether this psychological stress would affect my disease ?

A. Try to get out of this stress because asthmatics are sensitive to stressful conditions. Psychological stress play part either by modifying your behavior for example smoking a lot of cigarettes per day exposes the person to cigarette smoke which in turn can act as an irritant and affects the lungs or some other stressful condition can make the nervous system to release certain factors or hormones in the body affecting the immune system which in turn helps in increasing the level of bad immunoglobulin IgE in the body which could affect the asthma condition.

Q. Dear doctor when ever I do sternous work or do any exercise I become breathless what should I do?

A. Sternous or heavy work and exercise are known triggers for getting an asthmatic attack because quick breathing ( increase ventilation) and inhalation of large amount of cold dry air can bring an asthmatic attack. It is better to reduce or avoid such activities.

Q. I am breast feeding my baby who is seven months old, is it beneficial for him because I am suffering from allergic asthma ?

A. Yes, breast feeding is beneficial and protective for your child. There is evidence that breast feeding reduces the risk of atopic disease in offspring’s of asthmatic mothers.

Q. I am obese and asthmatic and I want to know if obesity has any effect on my disease?

A. Yes, it is recommended that obese patients should reduce their weight this would help them to have good asthma control.

Q. What diet is beneficial for my child who is suffering from asthma?

A. A balanced diet containing fruits and vegetable is effective because food and vegetable contain certain substances which protect the lungs from damage caused by air pollution.

Q. My brother is ten years old and since one year he frequently develops recurrent wheeze, recurrent difficult breathing, cough which is worse at night, his cold goes to the chest and take more than ten days to clear up. The symptom increases in winter season and worsen after exertion, please tell me what to do?

A. From the type of symptoms which you have mentioned it appears that your brother is suffering from asthma, you should consult the chest physician who will investigate the child by doing lung function test to confirm the diagnosis of asthma and he will then advise treatment according to the condition of the lungs.

Q. My child has moderate to severe asthma attack during winter season, is it advisable to vaccinate him with influenza vaccine every year?.

A. Yes, it is safe to vaccinate him with inactivated influenza vaccine as advised by your physician.

Q. I have a cat in my house and since few months I am feeling difficulty in my breathing. What should I do?

A. Remove the cat from your house or at least sleeping area, it is the animal dander which is causing you to breathe with difficulty.

Q. I have asthma and I want to know that in which season /weather I should take more care?

A. In spring season when pollen is high you should be careful. You should also be careful in rainy season (July-August) and winter season (Oct-Jan) when mold and viral infections can aggravate your problem. Wheat crop harvesting season (May-June) is troublesome for asthma and allergic rhinitis patients when huge amount of thresher dust is present in the environment. Avoid going in fields and when you are traveling you should use face mask. Patients living in cotton growing areas of Punjab and Sindh should take care during winter season when the cotton harvesting is done.

Q. I am suffering from asthma and planning to have a baby. What should I do?

A. If you are asthmatic and are planning to become pregnant, you should consult your doctor regarding your asthma and medications.

Q. I have constant but mild allergy symptoms, what should I do?

A. Constant low grade allergy symptoms are more annoying than occasional severe symptoms because it disturbs your good night sleep, concentration at work and you don’t feel fresh, so do not ignore the symptoms and allow it to linger on, do consult an allergy specialist to get in time treatment.

Q. At what age allergies are more encountered?

A. No age is exempted, allergy or allergic reaction can occur at any time in your life from birth to adulthood but teenagers are more susceptible.

Q. Can asthma be cured permanently?

A. No, it can not, but like hypertension, diabetes and some other diseases with proper care and medication it could be controlled and one can lead a normal life.

Q. I am allergic to bee venom and my son is allergic to penicillin group of antibiotics, what should I do?

A. It is necessary that you and your son should wear a bracelet or carry a card indicating allergy to bee venom and penicillin group of drugs and always carry a kit containing adrenaline and solucortef injection, so that any life threatening allergic reactions could be controlled by the emergency doctor in case you or your son get a reaction.

Q. Is it true that people allergic to wasp venom are also allergic to bee venom?

A. It is not true because bee and wasp venom contain different allergens. People allergic to wasp venom are rarely allergic to bee venom.

Q. I am a bee keeper and exposed to bee sting, am I at risk to develop bee sting allergy?

A. Yes, If you are stung frequently by bees than there is a possibility that you can become allergic to bee venom.

Q. Should I get allergy shots?

A. If you feel that you have tried all types of medication for your allergy and still it is not improving and allergen preventing/controlling measures are also difficult, it is advisable to get an advice from your treating physician before considering to get allergy shots.

Q. What is the method to get allergy shots?

A. On the basis of your clinical history and positive skin prick test the doctor has diagnosed that you are suffering from allergy. He has also identified the problem causing allergen by performing the diagnostic test, and now in gradual incremental doses you will receive subcutaneous allergy shots for an optimal period.

Q. How long I have to continue my vaccine treatment?

A. If you are doing well you will have to continue your treatment for a period of three to five years. How ever in some cases the period is individualized by the allergist depending upon the response of the person.

Q. What necessary precautionary measures should be taken before and after the allergy vaccine is prescribed?

A. Before receiving allergy shots your clinical diagnosis regarding allergy should be clear. Stop taking antihistamines, steroids and tranquillizers for 2-3 weeks. After receiving an allergy shot wait for 15- 20 minutes in the hospital before you move. Keep your vaccine in refrigerator at 4-8 degree centigrade, don’t freeze it and use insulin syringe for receiving subcutaneous injections.

Q. How does allergy vaccine help?

A. Allergy shots either down regulate your immune response or produce an immune deviation/shift so that the production of bad immunoglobulins called IgE is prevented.

Q. Please tell me some home remedies for my running nose problem?

A. You could take preventive measures by wearing filter face mask and using saline solution for nasal wash. You can prepare it at home by taking distil or boiled water in a cup and adding a pinch of table salt to it. Put this solution in a sinus rinse bottle/ordinary nasal drops bottle and do nasal lavage/nasal wash once/twice a day.This method will help in reducing/washing off allergens trapped in the cilia of your nose. Also apply petroleum jelly to both the nostrils so that the allergens are trapped at the exit point of your nares and thus gain no entry inside.

Q. What should I do for my itching skin?

A.

1 Apply emollients before and after taking bath.

2 You can clean yourself using a none perfumed colorless soap.

3 In case of intense itching apply an ice cube to the area where you want to scratch, so that the itch-scratch cycle is stopped.

4 Take bath by putting one cup of vinegar in your bathing tub, it will produce a soothing effect on your body and will help in relieving your itch.

Q. What should I do to prevent chest congestion?
A. Drink hot liquids, soups and cinnamon green tea. Take steam inhalation once or twice a day. If you have difficulty in breathing or a wheeze than nebulize your self.

Q. I am using a steroid inhaler, some time I get soreness in my mouth, what should I do?

A. The soreness in your mouth is due to deposition of the dry powder in your mouth helping in the growth of oral candidal infection which is a fungal infection. To prevent this, use a spacer device with your metered dose inhaler and do mouth washing after using a dry powdered inhaler.

Q. Please guide me about my asthma and allergy drugs?

A. The drugs are in the form of tablets, inhalers & injections. You should use them as advised by your doctor, who has prescribed them according to the severity and type of your asthma or allergy problem.

Q. I am afraid of using steroids, my friend says it will affect my health, what should I do?

A. Steroids in inhaler form are safe as compared to oral or injection form. Use inhaler according to the advice of your doctor, shake it well before use and learn the proper technique of using inhaler from your care provider.

Q. What are hives?

A. Hives are called urticaria in English language, draper in Urdu or Punjabi, Larama or Matakay in Pushto.It is the sudden onset of red itchy and swollen lesions appearing any where on the body with round or irregular borders. They occur as a result of allergic reaction in the skin due to exposure to allergens and in most cases disappear within six hours.

Q Why there is itching and swelling in hives?

A. The cells present in the skin are damaged by the allergens resulting in the release of histamine and other factors from these cells. These allergy producing factors causes itching, swelling and redness in the skin.

Q. If the hives don’t subside within six hours and last longer than twentyfour hours than in that case what should be done?

A. If this situation occurs than consult a skin specialist because now it is not an ordinary hives problem but a problem of blood vessels underlying the skin and needs to be investigated.

Q. Some times my brother develops swelling of his lips and become ugly and feel quite embarrass, Please tell me what to do?

A. When the soft tissues of the lips or the area around the eyes become swollen it is called angioedema and needs to be investigated by your treating physcian so that the cause is identified and that your brother gets the right treatment.

Q. What is asthma?

A. Asthma is a condition in which there is a breathing problem. The main wind pipe called bronchus divides into smaller tubes called bronchi which open’s into both sides of the lungs. In sensitive individuals these bronchi are hypersensitive or hyper responsive and when ever some allergen or pollutant comes in contact with the inner lining of the bronchi, then the bronchi respond intensely resulting in sudden narrowing of the tubes with excessive mucous secretion adding more to the narrowing effect and the person becomes restless using extra efforts to breath, takes a sitting postures, uses his chest muscles to take out breath, develop cough and produce whistling sounds called wheeze.

Q. My friend is asthmatic, last year he was well controlled with no emergency department visit but this year he is having frequent visits what should he do ?

A. Your friend should see his treating physician because there could be two main possibilities for his uncontrolled asthma:

1 Either the prescribed medication could be inadequate and he need treatment on a higher side that is the addition of some other drug or increasing the present dose.

2 The prescribed medication is correct but the patient is taking it incorrectly i.e taking his drugs irregularly or taking wrong /low dose or not taking any drug at all.