ALLERGY

Submitted by:

Shari Mitra Class XI B

INDEX

1. INTRODUCTION 2. CERTIFICATE

..........................pg 3 ..........................pg 4

3. ACKNOWLEDGEMENT ..........................pg 5 4. WHAT IS ALLERGY? 5. CAUSES 6. ALLERGENS ...........................pg 6 ............................pg 7 .............................pg 8

7. SIGNS AND SYMPTOMS .......................pg 10 8. IMMUNE SYSTEM 9. LAB INVESTIGATION 10. TREATMENT ........................pg 12 ........................pg 15 .............................pg 18

11. STATISTICAL DATA .............................pg 20 12. SUMMARY 13. CONCLUSION ............................pg 23 ..............................pg 24 ............................pg 25

14. REFERENCE

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Introduction
Allergies are quite a common affliction most of us suffer in our day-to-day life. Thus, as a subject it is relevant as well as interesting to know the symptoms, causes and cure. While studying some reference books on Biology, I came across this subject and felt interested to study this subject in detail. This study is the outcome of my efforts in gathering relevant excerpts, exhibits and diagrams from various sources and putting it together with my understanding on the subject. I have tried to present the subject in a simple manner. I have enjoyed doing this project. It has also added to my knowledge and interest in Biology.

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CERTIFICATE
This is to certify that Shari Mitra of Class XI B has carried out this study as a part of her Biology practical for the 2010-11 session.

Date:

Signature:

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ACKNOWLEDGEMENTS

I would like to thank our biology teacher, Dr Ms Shylaja Pillai, for teaching and guiding me. I would also like to thank our school principal for providing me this opportunity. I am deeply indebted to Dr Ms Kavita Merchant for providing valuable tips and information for this project. Lastly I would like to thank my parents and friends for their love and support.

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WHAT IS ALLERGY?
Allergy is a hypersensitive disorder of the immune system. It refers to an exaggerated reaction by our immune system in response to bodily contact with certain foreign substances. It is exaggerated because these foreign substances are usually seen by the body as harmless and no response occurs in non- allergic people. Allergic people's bodies recognize the foreign substance and one part of the immune system is turned on. Allergy-producing substances are called "allergens." When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it .These reactions are acquired, predictable, and rapid. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic." Strictly, allergy is one of four forms of hypersensitivity and is called type I (or immediate) hypersensitivity. It is characterized by excessive activation of certain white blood cells called mast cells and basophils by a type of antibody known as IgE, resulting in an extreme inflammatory response.

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CAUSES
Risk factors for allergy can be placed in two general categories, namely host and environmental factors. Host factors include heredity, gender, race, and age, with heredity being by far the most significant. Our own risk of developing allergies is related to our parents' allergy history. If neither parent is allergic, the chance that we will have allergies is about 15%. If one parent is allergic, our risk increases to 30% and if both are allergic, our risk is greater than 60% . However, there have been recent increases in the incidence of allergic disorders that cannot be explained by genetic factors alone. Four major environmental candidates are alterations in exposure to infectious diseases during early childhood, environmental pollution, allergen levels, and dietary changes. It is clear that we must have a genetic tendency and be exposed to an allergen in order to develop an allergy. Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.

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ALLERGENS
Allergens are substances that are foreign to the body and can cause an allergic reaction in certain people. These can also be categorised as indoor, seasonal, food and miscellaneous allergens, shown as below,

Indoor Allergens

   

DUST MITES MOLDS PET DANDER COCKROACH

Seasonal Allergens

   

POLLENS GRASS WEEDS POISON IVY

Food Allergens

 PEANUT  MILK  CHOCOLATES

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SPICES SEEDS SHELL FISH NUTS WHEAT

Miscellaneous

         

NICKEL COINS LATEX CANDELS COSMETICS WALL PAINT ANTIBIOTICS ASPIRIN INSECT STINGS PERFUME DETERGENT

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ALLERGIES, AFFECTED ORGANS & SYMPTOMS

Affected organ Symptom swelling of the nasal mucosa (allergic rhinitis), running nose, sneezing, stuffy nose, nasal itching allergic sinusitis redness and itching of the conjunctiva (allergic conjunctivitis) sneezing, coughing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as laryngeal oedema feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage, itchy ears rashes, such as eczema and hives (urticaria), itchiness

Nose

Sinuses

Eyes

Airways

Ears

Skin

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Gastrointestinal abdominal pain, bloating, vomiting, diarrohea tract

MULTIPLE ORGAN AFFLICTIONS Insect stings, antibiotics, and certain medicines produce a systemic allergic response that is also called anaphylaxis; multiple organ systems can be affected, including the digestive system, the respiratory system, and the circulatory system. Depending on the rate of severity, it can cause cutaneous reactions, bronchoconstriction, oedema, hypotension, coma, and even death. Skin involvement may include generalized hives, itchiness, flushing, and swelling of the lips, tongue or throat. Respiratory symptoms may include shortness of breath, wheezes and low oxygen. Gastrointestinal symptoms may include crampy abdominal pain, diarrhea, and vomiting. Cardiovascular symptoms are due to the presence of histamine releasing cells in the heart coronary artery, thus spasm may occur with subsequent myocardial infarction or dysrhythmia. Nervous system symptoms are due to drop in blood pressure, which may result in a feeling of lightheadedness and loss of consciousness. There may be a loss of bladder control and muscle tone, and a feeling of anxiety and "impending doom".

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RESPONSE OF IMMUNE SYSTEM TO ALLERGENS

The immune system is the body's organized defence mechanism against foreign invaders, particularly infections. Its job is to recognize and react to these foreign substances, which are called antigens. Antigens are substances that are capable of causing the production of antibodies. Antigens may or may not lead to an allergic reaction. Allergens are certain antigens that cause an allergic reaction and the production of IgE. The aim of the immune system is to mobilize its forces at the site of invasion and destroy the enemy. One of the ways it does this is to create protective proteins called antibodies that are specifically targeted against particular foreign substances. These antibodies, or immunoglobulins (IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it.(IL-4). The allergic person however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances. Immunoglobulins are a group of protein molecules that act as antibodies. There are five different types; IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody. In the early stages of allergy, a type I hypersensitivity reaction against an allergen, encountered for the first time, causes a response in a type of immune cell called a TH2 lymphocyte, which belongs to a subset of T cells that produce a cytokine called interleukin-4 (IL-4).

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These TH2 cells interact with other lymphocytes called B cells, whose role is production of antibodies. Coupled with signals provided by IL-4, this interaction stimulates the B cell to begin production of a large amount of a particular type of antibody known as IgE. Secreted IgE circulates in the blood and binds to an IgE-specific receptor (a kind of Fc receptor) on the surface of other kinds of immune cells called mast cells and basophils, which are both involved in the acute inflammatory response. The IgE-coated cells, at this stage are sensitized to the allergen. If later exposure to the same allergen occurs, the allergen can bind to the IgE molecules held on the surface of the mast cells or basophils. Cross-linking of the IgE and Fc receptors occurs when more than one IgE-receptor complex interacts with the same allergenic molecule, and activates the sensitized cell. Activated mast cells and basophils undergo a process called degranulation, during which they release histamine and other inflammatory chemical mediators from their granules into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction. This results in rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, allergen, and mode of introduction, the symptoms can be systemwide (classical anaphylaxis), or localized to particular body systems; asthma is localized to the respiratory system and eczema is localized to the dermis.

After the chemical mediators of the acute response subside, late phase responses can often occur.

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This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site. The reaction is usually seen 2 24 hours after the original reaction. Cytokines from mast cells may also play a role in the persistence of long-term effects. Late phase responses seen in asthma are slightly different from those seen in other allergic responses, although they are still caused by release of mediators from eosinophils, and are still dependent on activity of TH2 cells.

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LAB INVESTIGATION / DIAGONOSIS

Skin testing
Prick test It is also known as "puncture testing" and "prick testing" due to the series of tiny puncture or pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye. A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside forearm and the back. If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to a full-blown hive (called "wheal and flare") in more sensitive patients. Interpretation of the results of the skin prick test is normally done by allergists on a scale of severity, with +/meaning borderline reactivity, and 4+ being a large reaction. To ensure that the skin is reacting in the way it is supposed to, all skin allergy tests are also performed with proven allergens like histamine or glycerine . The majority of people do react to histamine or glycerin. If the skin does not react to these allergens then it most likely will not react to the other allergens. These results are interpreted as falsely negative.

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Patch test The patch test simply uses a large patch which has different allergens on it. The patch is applied onto the skin, usually on the back. The allergens on the patch include latex, medications, preservatives, hair dyes, fragrances, resins and various metals. When a patch is applied the subject should avoid bathing or exercise for at least 48 hours. Skin end point titration Skin end point titration (SET) uses intradermal injection of allergens at increasing concentrations to measure allergic response. To prevent a severe allergic reaction, the test is started with a very dilute solution. After 10 minutes, the injection site is measured to look for growth of wheal, a small swelling of the skin. Two millimeters of growth in 10 minutes is considered positive. If 2 mm of growth is noted, then a second injection at a higher concentration is given to confirm the response. The end point is the concentration of antigen that causes an increase in the size of the wheal followed by confirmatory whealing. If the wheal grows larger than 13 mm, then no further injection are given since this is considered a major reaction.

Blood Testing
This kind of testing measures a "total IgE level" - an estimate of IgE contained within the patient's serum. This can be determined through the use of radiometric and colormetric immunoassays. Radiometric assays include the RAST test method, which uses IgE-binding (anti-IgE) antibodies labeled with radioactive isotopes for quantifying the levels of IgE antibody in the blood. Other newer methods use colorimetric or fluorometric technology in the place of radioactive isotopes.
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An absolute eosinophil count is a blood test that measures the number of white blood cells called eosinophils. Eosinophils become active when you have certain allergic diseases.

Elimination/Challenge tests
This testing method is utilized most often with foods or medicines. A patient with a particular suspected allergen is instructed to modify his/her diet to totally avoid that allergen for determined period of time. If the patient experiences significant improvement, he/she may then be challenged by reintroducing the allergen to see if symptoms can be reproduced. Challenge testing is when small amounts of a suspected allergen are introduced to the body orally, through inhalation, or other routes.

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TREATMENT
Treatments for allergies include allergen avoidance, use of antihistamines, steroids or other oral medications, immunotherapy to desensitize the response to allergen, and targeted therapy. A few common methods of treating allergies:

 For air borne allergens - medications like nasal sprays, decongestants and antihistamines have known to be effective. Also, eye drops can be used in case of itchiness of the eye.

 For ingested Allergens - in case of a resultant skin reaction use easily available skin ointments which can be procured over the counter. In case of wheezing, choking etc. antihistamines might come in hand. If ingested material is some sort of food then avoiding it altogether might help.  Allergy to insect bites or certain types of drug - Injections of Epinephrine (adrenaline) are known to be helpful
Traditional treatment and management of allergies consist simply of avoiding the allergen in question or otherwise reducing exposure. For instance, people with cat allergies are encouraged to avoid them. Avoidance is always the best treatment for allergies regardless of which allergens are the triggers. However, while avoidance of allergens may reduce symptoms and avoid life-threatening anaphylaxis, it is difficult to achieve for those with pollen or similar air-borne allergies.
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Nonetheless, strict avoidance of allergens is still considered a useful treatment method, and is often used in managing food allergies.

PHARMACOTHERAPY
Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, glucocorticoids,epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved for treatment of allergic diseases.[citation needed] Anti-cholinergics, decongestants, mast cell stabilizers, and other compounds thought to impair eosinophil chemotaxis, are also commonly used. These drugs help to alleviate the symptoms of allergy, and are imperative in the recovery of acute anaphylaxis, but play little role in chronic treatment of allergic disorders.

Immunotherapy
Desensitization or hyposensitization is a treatment in which the patient is gradually vaccinated with progressively larger doses of the allergen in question. This can either reduce the severity or eliminate hypersensitivity altogether. It relies on the progressive skewing of IgG antibody production, to block excessive IgE production seen in atopys. In a sense, the person builds up immunity to increasing amounts of the allergen in question. Studies have demonstrated the long-term efficacy and the preventive effect of immunotherapy in reducing the development of new allergy. A second form of immunotherapy involves the intravenous injection of monoclonal anti-IgE antibodies. These bind to free
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and B-cell associated IgE; signalling their destruction. They do not bind to IgE already bound to the Fc receptor on basophils and mast cells, as this would stimulate the allergic inflammatory response. A third type, Sublingual immunotherapy, is an orallyadministered therapy which takes advantage of oral immune tolerance to non-pathogenic antigens such as foods and resident bacteria.

ALERNATIVE TREATMENT
A number of allergy treatments are described by its practitioners, particularly naturopathic, herbal medicine, homeopathy, traditional Chinese medicine, and applied kinesiology.

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STATISTICAL DATA
One in every 10 Indian children suffers from allergies and asthma, yet the condition is often not acknowledged because medical schools do not recognise the treatment of allergies as a legitimate specialisation. As a result, there are only a few trained experts who can diagnose the condition. There is also evidence of an important link between allergic diseases and air pollution outdoors and indoors. In cities and especially in city centres, where air is polluted the most the number of children with asthma is increasing the most. The consequences for children are particularly harmful. A study on the prevalence of allergic rhinitis in Southeast Asia found that allergies impacted the quality of life of up to 80 per cent of children in the age group of 6 to 11 years. Conditions like allergic rhinitis affected their sleep pattern, their learning performance, and their ability to play games and participate in leisure activities. The condition get aggravated when pollution levels rise in the city atmospheric pollutants like sulphur dioxide, or nitrogen oxides or suspended particulate matter (SPM) which are not allergens but they enhance and amplify the severity of the disease in people who are already sensitive to a variety of allergens such as dust mites, animal dander, pollen, fungi, moulds and even cockroaches. Insects, particularly mosquitoes, cockroaches and dust mites, are to blame for nearly 50% of the allergies in India. And food especially peanuts, chocolates and legumes is the other big culprit. Study also shows that allergies can be gender-sensitive. Teenage boys are less likely to be sniffling through college as they outgrow their allergies by adolescence while girls may continue to suffer in these years.

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In the US and Europe, pollen from flowering plants is a common trigger for allergies, accounting for 20% of all cases. Not so in India where a mere 8.61% of patients studied showed wheezing or blocked noses because of pollen. Asthma and rhinitis predictably formed the major chunk of all allergies in India.

Interestingly, food allergies are more common here than among westerners. Take, for instance, the allergy to rice which was only reported from Japan till now but which has showed up among Indians. Or take chocolates, the second most common food allergen in the study. While the western palate is most sensitive to milk, egg, meat and wheat, Indians are likely to react to peanuts, chocolates, and legumes (dal).

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SUMMARY
An allergen or substances that causes allergy, like pollen, makes the body defend itself by producing antibodies. When an allergen and an antibody combine, the body releases histamine and other chemical substances into the bloodstream, causing an allergic response. Pollen, dust, mould or other substances that can be inhaled, are common allergens. Insect stings, antibiotics, and certain medicines produce a systemic allergic response called anaphylaxis where multiple organ systems are affected, including the digestive system, the respiratory system, and the circulatory system. This might even become fatal if not treated properly on time. Laboratory diagnosis may help in identifying allergens afflicting the person through specific tests. Treatments for allergies include allergen avoidance, use of antihistamines, steroids or other oral medications, immunotherapy to desensitize the response to allergen, and targeted therapy.

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CONCLUSION
Allergies are a serious public health problem in many countries. In the past three decades the number of allergic diseases (including asthma) has increased sharply and it seems that the upward trend will continue in the future. The number of sick people has increased both among children and adults and in all social classes. According to the World Health Organization, 25% to 40% of people in industrialized countries have allergic rhinitis and 20% have allergic asthma, which poses a serious threat to public health.

Lack of information about the condition leads most people to deal with the problem symptomatically. People need to first recognise what triggers off their allergies.

Even parents treat children for such allergies only up to the point where they get some relief without understanding that it is a condition that ought to be taken seriously and treated.

Avoidance is always the best treatment for allergies regardless of which allergens are the triggers.

Many doctors admit that there is no cure for many allergies, however the new generation of drugs allow people to manage allergic reactions and lead a normal life.

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REFERENCE
 Wikipedia  MedicineNet.com  E-medicine.com  Paediatric Help & Future Science Group  Merchant Homeopathic Clinic, Anand  pharmabiz.com  Hindustan Times article dated 22 July, 2008  The Hindu article dated 5 Dec, 2004

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