Allergy Spot

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Our "Allergy Spot" has been written by Dr John Rees BSc(Hons) FIBMS. Dr Rees has a PhD in Allergy from St Bartholomew's Hospital, London for his work on dust mite allergy, is a member of the British Society for Allergy and Clinical Immunology and Fellow of the Institute of Biomedical Science. Dr Rees has spoken on national and local radio, presented at international scientific meetings and contributed to many newspaper and magazine articles on the subject of allergies and food intolerances.

The UK has one of the highest rates of allergy in the entire world. Allergies can range in severity from mild hayfever symptoms occuring for just a few days in summer to life threatening allergic reactions. There have been many reasons proposed for why we have such a high rate of allergies... and why they still seem to be increasing but the only thing we know for sure is that around 1 in 3 people in the UK have allergy related symptoms.

Allergy symptoms can include hayfever, asthma, eczema, food allergy as well as life threatening anaphylactic reactions. Whether we get allergies depends mostly on our genes. If both your parents have allergies then the risk of you suffering too can be as high as 80%. These genetic risk factors together with environmental concerns such as pollution from fossil fuels combine to determine whether we get symptoms.

There are broadly three types of allergies;

1. True allergies

These allergies are responsible for symptoms such as hayfever, asthma, eczema, food allergies and anaphylactic reactions and are often triggered by everyday things such as dust mites, pets, pollens and foods. These types of allergies can be diagnosed from a good clinical history and tests that measure the levels of antibodies in the blood known as Immunoglobulin E (IgE).

2. Food intolerances

Food intolerances are difficult to diagnose as the symptoms can be highly variable triggering anything from tiredness to IBS type symptoms. One of the most serious forms of food intolerance is coeliac disease (also spelt celiac) which is an intolerance to gluten found in wheat, barley and rye. Only 1 in 5 people with coeliac disease has been diagnosed putting others at risk of severe complications later on in life such as osteoporosis, infertility and bowel cancer. Thankfully, there are now excellent tests for coeliac disease and even a simple and reliable home test which will give you a result in just 5 minutes. Another major food intolerance is lactose intolerance which is caused by your body producing insufficient digestive enzyme called lactase which is responsible for the digestion of lactose the sugar found in milk. Many people with undiagnosed coeliac disease may also suffer from lactose intolerance. Other food intolerances are difficult to diagnose by conventional methods that your doctor would be familiar with.

3. Contact allergies

These reactions often cause skin rashes and dermatitis. The triggers can range from occupational allergens through to foods and inhalant allergens. A frequent cause of contact dermatitis is sensitivity to nickel. Contact allergies are diagnosed by a consultant dermatologist.

Common causes of allergies

Dust mites

Dust mites are one of the most common triggers of allergy symptoms -much more so than food allergies and intolerances. House dust is a complex mixture of fibres, minerals, dried food, moulds and microscopic spider like creatures called house dust mites. Dust mites live in nearly all homes and feed on flakes of human skin. They normally live unnoticed in warm and moist places such as bedding, sofas, curtains, carpets and children's furry toys - but if you have an allergy to them you may well notice the symptoms!

Many people with asthma, eczema and rhinitis (hayfever) symptoms all year round are sensitive to the waste products of the house dust mites.

Dust mites can trigger symptoms all year round causing misery to anyone who is sensitive to them. Symptoms of asthma, eczema and rhinitis (hayfever) are commonly associated with dust mite sensitivity and may include itchy, runny or blocked nose and sneezing, itchy red, sore eyes, itchy sore throat and tongue rashes and eczema.

It is almost impossible to completely eliminate dust mites in your home. As a general guide if the amount of moisture (humidity) in the air in your home is high then so will be the level of house dust mites;

reduce indoor humidity with a dehumidifier
use a high filtration vacuum cleaner
vacuum you mattress, carpets and soft furnishings at least once a week to remove mites
wash sheets, blankets, duvet covers and pillowcase regularly (A minimum 60C was is required to ensure dust mites and eggs are killed)
damp dust all surface to stop the allergens becoming airborne
keep your bedrooms well ventilated to prevent the build up of humidity
air your mattress once per month if possible
protective bedding can be purchased

Pet allergy

Up to 10% of the population may be allergic to pet animals to some degree - for those with asthma this rises to almost 30%! Up to 40% of children with asthma are allergic to cats.

cats are the most common cause of pet allergy
dogs are the second most common cause

The cat allergens are present in the skin scales, saliva, sweat glands and tears of the cat but it is distributed over the fur during grooming. The saliva dries on the cat hair and becomes airborne. In dogs the allergen is found mainly in the skin scales and the saliva. Small animals such as mice, rats and guinea pigs also have allergens in their urine and is also found in dust from their litter.

Pets can trigger asthma leading to cough, wheezing, tightness in the chest and shortness of breath. Pets can also be the cause of rashes and eczema. Other allergy symptoms may include

itchy, runny or blocked nose and sneezing
itchy red, sore eyes
itchy sore throat and tongue

Treatment and avoidance measures;

don't keep furry pets - however, if you can't bare parting with your pet then try to limit them to one room in the house
keep your pet out of the bedroom and off any furniture in a room where you spend most of your time, as exposure can be very high
don't let your pet near your face or clothing as this can exacerbate your symptoms
wash your pet regularly - allergens can be easily washed away with a wet sponge (wear gloves when washing your pets or better still get someone else to do it or you)
ask someone else to brush your pet to remove allergens from the fur or hair- preferably outside the house!
vacuum carpets and soft furnishings regularly to remove animal hairs
replace bedding that pets have been in contact with regularly - it can take months or even years to remove allergens from fabrics
consider installing an air cleaner

If you are visiting the home of a pet owner then request that they do not vacuum clean immediately before your visit as the pet allergens can remain airborne for up to a day making the allergens more likely to be breathed in. There is also evidence that allergen levels can be 200% higher in homes with poor ventilation.

Pollen Allergy and Hayfever

Hayfever (grass pollen) is one of the most common allergic reactions and complaints in the UK. In general it starts between the ages of 8 and 20 years old, with the symptoms becoming less severe as the person gets older, but unfortunately there is no age limit on who can suffer.

There is evidence that suggests hayfever is increasing in prevalence along with other allergies. It is thought that pollution may be an important contributor.

Acting early in the season can mean you suffer fewer symptoms and suffer less misery. Avoid areas of long grass during the summer months, keep windows closed midmorning, late afternoon and early evening when the pollen counts are highest, keep car windows closed when driving - check whether your car has a pollen filter and whether it needs replacing, wear glasses to reduce contact of pollen with the eyes, check pollen counts broadcast on the TV, radio or listed in newspapers before going out for the day and take avoidance action. Your pharmacist can advise on suitable medications which are available without prescription such as antihistamines, decongestants and anti-inflammatory nasal sprays and eye drops.

Pollen is released from different plants at different times of the year. Knowing when your symptoms occur can help you identify the likely trigger. Hayfever (grass pollen) is the most common seasonal sensitivity.

Tree pollens - Spring
Grass pollens (Hayfever) - Summer
Weed pollens - Autumn

Hayfever symptoms can be experienced all year round, and may be confused with a cold. They can also trigger more severe conditions such as asthma, cough, wheezing and shortness of breath. Other allergy symptoms may include;

frequent bouts of sneezing
runny, itchy or blocked nose
watery, itchy red or sore eyes
itchy sore throat and tongue
headache and loss of concentration

Pollen may be from trees, grasses and weeds with increase in symptoms coinciding with the flowering of these plants. Trees can cause symptoms during Spring, grasses in the Summer, with weeds and mould spores prevalent during autumn and winter. Dust mites can also trigger hayfever type symptoms and if you have a problem all year round these could be the culprits.

Pollen and mould spores are airborne allergens that are blown into contact with the eyes, nose and lungs where they cause symptoms in sensitive people. Plants that cause hayfever are usually those producing vast quantities of pollen and use the wind for pollination. Generally, insect pollinated plants do not contribute to hayfever.

Food allergy

Food allergies are suffered by a million people in the UK. However, most affected are children under two years old. Food allergy symptoms may include; itching, swelling lips and face, coughing, shortness of breath and wheezing, asthma, dry, itchy throat and tongue, itchy skin, rashes and eczema, diarrhoea, vomiting, headache or anaphylaxis. The most common foods that cause allergic reactions are; milk, eggs, wheat / gluten, citrus fruits, peanuts, walnuts, fish, shell fish and sesame seeds.

It is important that once you confirm you have a food allergy that you seek medical advice. You should not attempt to check your sensitivity by eating a food you suspect may be causing the problem. Similarly, avoidance of common foods such as milk, eggs or wheat should only take place after consultation with a dietician or your doctor as unnecessary avoidance of these foods can lead to nutritional deficiencies.

Food intolerance

Allergic reactions have two phases an early phase reaction which appears within minutes after inhalation or ingestion of an allergen and a late phase which can occur many hours or even a day later. These late phase symptoms may be more severe than the initial early phase reaction and can be confused with a food intolerance. Food intolerance can be caused by a wide range of triggers including true food allergies mediated by IgE antibodies. There are other types of food intolerance, some of which are psychological such as a dislike of a particular foods texture or flavour. People with a wheat intolerance may in fact have coeliac disease - this is usually diagnosed by a blood test followed by a biopsy of the intestine for study in the laboratory. An excellent home test kit is now available for the initial diagnosis of coeliac disease. Some people with intolerance's to dairy products may have a lactose intolerance. Lactose is a sugar found in milk. People with a specific deficiency of the enzyme lactase may have symptoms associated with lactose intolerance after they drink milk.

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Allergy spot

Allergies and food intolerances affect a third of the UK population. Find out more about your allergies, allergy tests and how you can control your symptoms in our allergy spot written by allergy and intolerance expert Dr John Rees.

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"Thank you very much for your quick response... my dietician suggested me having a test so I though I'd do the home one first. Thank you again for your very quick service" Susan, Edinburgh

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