Reprinted with permission of Life Extension®.
Allergies are abnormal immune reactions to specific agents known as antigens or allergens. Examples of common allergens are foods, drugs, pollens, dust mites, mold spores, animal dander, feathers, and insect venoms, as well as other substances which non-allergic people find relatively non-dangerous with usual exposure. Allergies may develop when an otherwise innocent substance has significant contact with an already inflamed surface (sensitization), such as from a viral infection or exposure to irritants, and becomes involved in the immune response.
Thereafter, repeated exposure to such a substance may evoke an allergic response with the release of histamine and a variety of other pro-inflammatory substances, including enzymes, leukotrienes, and interleukins, and the creation of damaging free radicals. The multiplicity of these pro-inflammatory substances explains why single medications such as antihistamines often fail to completely control symptoms.
TYPES OF REACTIONS
Allergic reactions may involve any part of the body, but they typically involve the body surfaces that serve as exposure points and gateways. Reactions include hay fever, allergic rhinitis, allergic sinusitis, allergic conjunctivitis, itchy throat, itchy ears, plugged-up ears, asthma, hives, giant hives (angioedema), allergic GI symptoms, and various types of allergic dermatitis and rashes. Headaches, dizziness, fatigue, joint and muscle pains, and many other symptoms can also be allergic in nature.
The most severe life-threatening reaction is anaphylaxis or anaphylactic shock. This may include anyof the above symptoms to an extreme degree plus vascular collapse or swelling sufficient to occlude airways, including the mouth and throat. Such a severe reaction is an absolute medical emergency and requires prompt emergency care. Anyone who has ever experienced such a reaction should go to all extremes to prevent a recurrence and should carry medications for prompt self-administration. Should there be a recurrence, the patient should go straight to the nearest medical facility, even if the self-administered medication seems to give temporary relief. Anyone who has had a significant reaction to a medication should know the name of the medication and have this information as well as the names of close relatives on his or her person at all times. A medallion or bracelet is an easy type of identification for medical personnel to find.
Immunological reactions are divided into four categories:
AVOIDANCE OF ALLERGENS
- Type I reactions include anaphylactic shock as noted above, as well as allergic rhinitis, allergic asthma, and many acute skin reactions, such as acute drug reactions. In a Type I reaction, an antigen (allergen) binds to IgE antibodies on the surface of mast cells or basophils that release histamine and other mediators that produce tissue damage and symptoms.
- Type II reactions include autoimmune processes, such as immune hemolytic anemia and Rh hemolytic disease in the newborn, as well as other multiple examples of antibody (IgG or IgM or both) directed against antigens (including normal receptor sites) on one's own tissue. Autoimmune antibodies are far more common than generally appreciated, and they tend to increase with age. Their activity is a factor in many age-related problems. Many bacteria, including some normally found in our GI tract, share antigens similar to those located on some human cells. Significant exposure to an immune response such as these bacterial antigens can evoke autoimmune disease. An example of this is the role of the intestinal organism Klebsiella in precipitating ankylosing spondylitis in genetically susceptible people. This becomes a significant concern in the leaky gut syndrome.
- Type III reactions are immune complex reactions. When an antigen and antibody combine in large enough amounts, complexes may be formed which can be deposited in tissues and blood vessels, resulting in tissue injury. This may be seen in some types of nephritis, arthritis, drug reactions, and some infections, as well as in the leaky gut syndrome.
- Type IV reactions are termed delayed hypersensitivity reactions and, unlike the first three types, are not related to humoral antibodies (water-soluble proteins generated by the body termed immunoglobulins), but to T-lymphocytes which, as the name implies, require longer to respond in a sensitized person. Examples include contact dermatitis (as in poison ivy), graph rejection, elimination of tumor cells, and the immune response to fungal, viral, and intracellular bacterial infections. The well-known TB skin test is an example of a Type IV delayed hypersensitivity reaction. Other responses in a previously sensitized individual can take from minutes to hours for manifestation, but Type IV reactions can be thought of as taking from hours to days.
Whenever possible, the best therapy for an allergic problem is to avoid the offending substance or substances. The environment of an allergic person should be kept as free of known allergens or potential allergens as possible. Allergy-proof and mite-proof covers should be used on all pillows, mattresses, and box springs in the sleeping area, and all bedding should be washed weekly in very hot (135°F) water. Mold exposure is to be avoided by eliminating moisture-laden growth areas and any new growth must be eliminated promptly. Mold-inhibiting substances are available and should be used freely on mold-prone surfaces. Pets should be kept out of the sleeping area. Cats and dogs should be bathed frequently to reduce the amount of surface allergens on their bodies. Air-conditioning is helpful for pollen allergies, but filters must be changed regularly.
Food allergies are commonly recognized by allergic individuals when tracking their exposure to an offending food. Food allergies may also be identified through the use of elimination diets with cautious reintroduction of suspected foods. The foods most commonly implicated are peanuts, tree nuts, fish, shellfish, cow's milk, eggs, wheat, corn, and soy. Citrus, tomatoes, strawberries, and other fresh berries and fruits are also possible offenders. Supplemental digestive enzymes may be taken at meal time to assist the prompt breakdown of food into simpler hypoallergenic components. It has been suggested that liquid intake at meal time be minimized to avoid dilution and possible reduction in effectiveness of enzymes. (However, it is absolutely essential that allergic individuals remain well hydrated and this need must be balanced against the above suggestion. It is also suggested that patients experiencing difficulty with food allergies or with digestion maximize their fluid intake between meals and not at meal time.) Supplemental digestive enzymes may also be helpful.
For patients with respiratory allergies which are not being adequately controlled, consideration should be given to possible rebound or irritant effects such as occurs with nasal sprays. Potent vasoconstrictors such as oxymetazoline (present in many nasal sprays) are well-known for causing a rebound-type effect. Less frequently recognized is an effect caused by some of the preservatives commonly used in nasal sprays, both prescription and over-the-counter preparations. Benzalkonium chloride is still used as a preservative in most prescription and over-the-counter sprays for the treatment of allergy, and some such products still contain phenylmercuric acetate, an organic mercury product. If symptoms are not being properly controlled, allergy and/or irritation relative to one or more components in the medications should be suspected.
Bernstein (2000) stated in the Journal of Allergy and Clinical Immunology that "a worthy technological goal for the new millennium would be a universally adaptable nasal delivery system that would eschew the need for anti-bacterial additives, thereby eliminating potential adverse effects on the nasal mucosa."
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