Wiping out allergies

 5 September 2012

In 400BC, the Greek physician Hippocrates observed that drinking milk caused hives in certain people and eating nuts sent some into shock.

Today, allergies continue to affect millions of people.

Consultant paediatrician and clinical immunologist and allergist Dr Amir HA Latiff who is the president of the Malaysian Society of Allergy and Immunology discusses ways of controlling or eradicating allergies.

Allergies are on the rise worldwide. How serious is the situation in Malaysia, particularly among young children?

Allergies are indeed a serious issue worldwide as well as in Malaysia. There is also a changing pattern in allergic diseases, with eczema and food allergies rising faster than allergic rhinitis and asthma.

Thus, it becomes an issue amongst young children because an allergy tends to appear early during childhood in the forms of eczema and a food allergy.

Is there an urgency to address allergy now?

Young children are our future generation. Hence, the socio-economic status of countries will be affected if these children, who have or are at risk of an allergy, are not managed and treated adequately.

What are the common types of allergies seen in children of one to five years old?

Eczema, food allergy, asthma and allergic rhinitis, with the latter two conditions usually appearing later. Since allergies have no cure, it is important for parents to protect their children from allergies right from the start. 

How do you prevent allergies in children?

Allergy prevention strategies are divided into three categories: Primary, secondary and tertiary. Tertiary prevention is simply treatment of the allergic diseases. When we have symptoms or a flare-up of an allergic disease, we take medication to prevent the condition from worsening. We also avoid the allergens that caused it.

Secondary prevention aims at stopping one form of allergic disease from progressing to another, eg from eczema to asthma, and/or preventing someone who is known to be sensitised to an allergen (eg house dust mites) from developing symptoms.

Sensitisation to an allergen (as confirmed by a blood or skin prick test) does not mean having an allergy at that stage, but could mean a higher risk of developing an allergic disease in the future.

Allergen-specific immunotherapy (ASIT) appears promising in secondary prevention and also offers a potential “cure” for certain allergic diseases.

Primary prevention tries to avoid the development of a sensitisation state to allergens. To do this, various methods have been studied including the use of a partially-hydrolysed protein-base formula, probiotics, prebiotics and polyunsaturated fatty acids, with varying success. Immunotherapy seems promising in preventing or reducing the risk of an allergy. 

What is immunotherapy?

In immunotherapy, an allergic person is given increasing quantities of a product to which he is allergic to (called allergen), gradually, to ease the allergic symptoms caused by future exposure to that allergen. This produces tolerance towards that allergen and long-term efficacy. It may also prevent the progression of the allergic disease, resulting in a better quality of life.

What types of allergic diseases can immunotherapy be applied to?

Allergic rhinitis (with or without allergic conjunctivitis) and allergic asthma due to breathed-in allergens (eg pollens, dust mites, cat and dog dander) and an insect sting allergy (eg bee, wasp).

In addition, there is increasing evidence that patients with atopic eczema related to dust mite allergy may benefit from immunotherapy. 

How is it done for a patient?

Standard methods of allergen-specific immunotherapy (ASIT) include injections, drops (under the tongue) and oral tablets (but not for all allergens, as yet), with an initial updosing phase of around three to four months, followed by a maintenance phase of three to five years.

Does it “cure” the allergy?

It may potentially “cure” an allergy if ASIT patients are monitored beyond the treatment period of three to five years. Nevertheless, with a long-term efficacy of more than seven years, ASIT certainly helps to improve a patient’s quality of life.

Is immunotherapy proven effective scientifically?

Thousands of scientific research publications have shown its effectiveness and safety since its conception in 1911.

ASIT is now considered a standard treatment for patients who do not respond to conventional anti-allergic medication. ASIT has also been researched for patients with food allergy and preliminary results look encouraging.

Article courtesy of the Malaysian Society of Allergy & Immunology. For details or further information on allergies, visit www.allergymsai.org orwww.xyzofallergy.org.

Taken from ParenThot, thestar online, www.thestar.com.my.