The Allergy Epidemic: A Look into the Future

U. Wahn


Over the past decades, the increasing rates of allergic conditions among affluent societies have posed a heavy burden on healthcare systems. Cross-sectional studies such as the International Study of Asthma and Allergies in Childhood (ISAAC) have confirmed that atopic diseases such as atopic dermatitis, asthma, and seasonal allergic rhinoconjunctivitis represent major health problems in many countries, particularly in childhood.

During the past 2 decades, two general hypotheses have been proposed in the literature in connection with the observed increases of atopy and asthma in childhood:
- New risk factors that were not known several decades ago might have become relevant in connection with nutrition, environmental exposure, and lifestyle. Protective factors related to a more traditional lifestyles common in the past might have been lost, which could have led to increased susceptibility to atopic diseases.

Allergic diseases are increasing in prevalence worldwide

Allergic diseases are increasing in prevalence worldwide, in industrialized as well as industrializing countries, affecting from 10%–50% of the global population with a marked impact on the quality of life of patients and with substantial costs. Thus, allergy can be rightfully considered an epidemic of the twenty-first century, a global public health problem, and a socioeconomic burden. With the projected increase in the world’s population, especially in the rapidly growing economies, it is predicted to worsen as this century moves forward.

Allergies are also becoming more complex. Patients frequently have multiple allergic disorders that involve multiple allergens and a combination of organs through which allergic diseases manifest. Thus exposure to aeroallergens or ingested allergens frequently gives rise to a combination of upper and lower airways disease, whereas direct contact or ingestion leads to atopic dermatitis with or without food allergy.

Food allergy, allergic drug responses and anaphylaxis are often severe and can be life-threatening. However, even the less severe allergic diseases can have a major adverse effect on the health of hundreds of millions of patients and diminish quality of life and work productivity. The need of the hour to combat these issues is to promote a better understanding of the science of allergy and clinical immunology through research, training and dissemination of information and evidence-based better practice parameters.

Facts About Allegra & Fruit Juice

When you take a medication orally, it ends up in your digestive tract, where it starts to do its work. All medicines must somehow make their way into your bloodstream, which carries them where they need to go to have an effect.

Allegra was designed to target tiny receptors on cells in your small intestines. These receptors absorb the Allegra and help it work where it needs to. Unfortunately, certain fruit juices, especially orange and grapefruit juice, interfere with this absorption.

Studies have shown that absorption can be reduced by as much as 40%. And that means, you're not really getting your full dose of Allegra! So, obviously, it's not going to work as well as you'd expect either.

Antacids have a similar "blocking" effect on the receptors.

Allegra

Allegra, or fenofexadine in generic form, is a second-generation antihistamine that just became available over-the-counter early in 2011. It happens to be my antihistamine of choice, and for many other allergy sufferers as well. It doesn't make you drowsy, and when taken as directed, it can provide extraordinarily effective control over bothersome allergy symptoms.

I've taken Allegra off an on for years (couldn't always get it when it was still a prescription medication). But I have to admit, I just recently learned of the problem with its effectiveness when taken with fruit juice.

Contact allergies can protect against a small number of cancers

Contact allergies can protect against a small number of cancers, Danish researchers write.

Men and women was found inverse association between contact allergy and non-melanoma skin cancer, and breast cancer. Women with a contact allergy was found to reverse the trend of brain cancer.

However, the authors have also identified positive associations between contact allergy and bladder cancer.

Inverse associations support the theory of immunological surveillance, in which allergic symptoms - a negative impact hyperimmune, according to a report published in the online edition of «BMJ Open» on July 11.

The reason for these associations remains unclear, and they are not necessarily the result of a causal relationship. "Our study - the research, and it is difficult to make recommendations directly to clinicians based on a single study," - said Dr. Kaare Engkild (National Allergy Research Center, Copenhagen, Denmark).

"I would not recommend the reduction of screening for breast cancer, non-melanoma skin cancer, or cancer of the brain, although the emergence of such associations should lead to further research", - said Dr. Engkild.

Using the registration data, Dr. Engkild and colleagues identified 16 922 patients with dermatitis who underwent tests for contact allergy from November 1984 to December 2008. Of this group, 6065 (35.8%) tested positive for at least 1 allergen, at least in one case. The authors note that the prevalence of contact allergy was higher in women than in men (41.4% vs. 26.1%).

The data were linked with the Danish Cancer Registry, and 3200 patients (18.9%) with dermatitis has been identified as having a benign tumor and / or malignant cancer diagnosis, 1207 (37.7%) of them also had positive test results for contact allergy .

Approximate analysis of the data showed "a confident and significant association" between contact allergy and the presence in the Register of Cancer (odds ratio 1.1). Odds ratios for different groups of cancer were calculated using logistic regression analysis, after adjusting for age and sex.

Breast cancer (odds ratio 0.80) and non-melanoma skin cancer (odds ratio 0.83) in both sexes, were found to inversely and significantly associated with contact allergy. Bladder cancer is positively and significantly associated with contact allergy (odds ratio 1.44).

The authors also studied the interaction between the different subtypes of cancer and sex, and only found a link to brain cancer / central nervous system. Following a standardized regression in women with dermatitis between brain cancer / central nervous system and contact allergy to reverse the trend of association (odds ratio 0.36).

Further studies, standardized by environmental factors such as smoking and socio-economic background needed to understand the role of contact allergy in the development of cancer, the scientists conclude.

Intestinal bacterium Helicobacter pylori protects the body from allergic asthma

At the conclusion of Immunology of the University of Zurich, an intestinal bacterium Helicobacter pylori protects the body from allergic asthma.

In a joint study with the University of Mainz allergists of Johann Gutenberg (University Medical Center of the Johannes Gutenberg University Mainz) found a strong case to support the hypothesis that the incidence of allergic diseases in developed countries is associated with the rapid disappearance of certain microorganisms, which in most cases asymptomatic organisms live in each of the second person on the planet.

Almost an epidemic prevalence of allergic asthma in recent decades due to traditionally pollution, smoking, hygiene hypothesis, and the widespread use of antibiotics. According to the hygiene hypothesis, reduced exposure to bacterial antigens in early childhood and lack of immune stress leads to increased risk of developing allergies and autoimmune diseases.

Researchers have shown that the increase in asthma cases may be due to the disappearance of gastric bacteria Helicobacter pylori in developed societies of the West. These bacteria can survive in the acidic environment of the stomach. Most Helicobacter pylori strains not pathogenic to humans and their small concentration does not lead to diseases of the gastrointestinal tract.

However, in certain circumstances, in particular, the weakening of the immune system, infection can cause gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Therefore, doctors often prescribe prophylactic antibiotics, which destroy Helicobacter pylori, even those patients who have no complaints.

During the experiment it was shown that Helicobacter pylori infection early in life protects against asthma. In the experimental mice infected with the bacteria in a few days after birth, there was a immunulogic tolerance to Helicobacter pylori and the almost total lack of response to allergens that cause asthma. Animals that are at an early age have not been infected with Helicobacter pylori, were exposed to an allergy to a much greater extent.

Avian Flu in Egypt

November 2, 2011 Ministry of Health of Egypt has informed World Health Organization of the case of human infection with avian influenza A (H5N1).

September 17 at the year-old boy developed symptoms. September 21 he was hospitalized. The child was treated, recovered and 25 September he was discharged from the hospital.

Investigations into the source of infection showed that the boy had contact with poultry is contained near his home.

The case was confirmed by the Central Public Health Laboratories and the Egyptian National Influenza Center under the WHO Global Influenza Surveillance.

Of the 152 cases confirmed to date in Egypt, 52 have been fatal.

Paracetamol and antibiotics increase the risk of atopic dermatitis

As shown by a study by Spanish scientists, when taking infants paracetamol and antibiotics increases the risk of atopic dermatitis in older age.

Dr. Luis Garcia-Marcos of the University of Murcia, say that at present the accuracy is unknown whether the increased risk of drugs called themselves of infection, in which they are used, or something else .

The link between paracetamol and asthma is shown for both children and adults, but previous attempts to figure out how to influence the development of atopic dermatitis receiving paracetamol and antibiotics, have produced conflicting results. "It also is complicated by the fact that children who are given paracetamol from the heat, often simultaneously receive and antibiotics," - says Dr. Garcia-Marcos.

We used data from 13 900 children aged 6-7 years who participated in the International study of allergic reactions and asthma in children (International Study of Asthma and Allergies in Childhood) in Spain. Of these, 7% had atopic dermatitis place.

It was found that children who received the first year of life acetaminophen, the risk of atopic dermatitis increased by 56%, and those receiving antibiotics - up to 66%, and the results did not depend on whether one child at the same time, and other drugs.

It is curious that in children with asthma or seasonal allergic rhinoconjunctivitis results were somewhat different. If in infancy they were given paracetamol, but not antibiotics, the risk of atopic dermatitis did not increase, but the reception and paracetamol, and antibiotics increased the risk even more than children not suffering from these diseases.

"Nevertheless, we can not exclude the possibility that this reaction does not provoke the antibiotics and the infection," - said Dr. Garcia-Marcos.

"Paracetamol - a very safe drug, it is used for many years, not watching with serious side effects, but the parents, fearful of atopic dermatitis, can replace it with ibuprofen," - he said.

"In order to estimate the risk more precisely controlled, randomized trials would be required - adds the scientist. - In the meantime, the main conclusion we can draw from the study is this: the events occurring in early childhood may have consequences later."

Good news for families who would like to have a dog or a cat, but are afraid of allergies in children.

Good news for families who would like to have a dog or a cat, but are afraid of allergies in children. Pets has positive effect on children's health, say Australian researchers.

The researchers found that children who had contact with animals at an early age, had lower rates of nasal allergies, as well as adolescents.

"Family pets, especially dogs, should not be removed to prevent allergies, and, in fact, may protect against it" - said Dr. Melanie Matheson ( (University of Melbourne).

After examining almost 8500 adults from Europe and Australia, researchers have focused on subjects who grew up with pets, and patients suffering from nasal allergies.

Communicating with pets already associated with a lower risk of other types of allergies. A study from the University of Cincinnati in 2010 showed that the presence of dogs may reduce the risk of eczema and skin diseases in childhood. Similarly, a study from Henry Ford Hospital in Detroit in 2011 found that the presence of pets in children life reduces the risk of developing an allergy to animal hair in half.

In a new study published in the online edition of «Journal of Allergy and Clinical Immunology» from 13th July, more than one in four respondents complained of nasal allergy, in most cases began in adolescence.

Many factors have been associated with increased risk of nasal allergies in the study. Some, such as family history of allergy and maternal smoking during pregnancy are well documented risk factors.

But the scientists also found that young children who had younger brothers or sisters, or attending nursery and kindergarten, had a lower risk of nasal allergies. And the more relatives of siblings had a child, the lower were the chances that a child will develop nasal allergies later in life.

The researchers also observed a similar association among subjects who grew up on a farm or have had pets before their fifth birthday. Compared with the norms of the people who had no contact with the animals closely in early childhood, the chances of nasal allergy in adolescence were 30% lower in subjects who grew up on a farm, and the presence of a dog or cat was associated with a 15% reduced risk of th nasal allergies.

Asthma Facts

Asthma is characterized by inflammation of the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. Asthma symptoms can be caused by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged and constricted airways. Symptoms include difficulty breathing, wheezing, coughing tightness in the chest. In severe cases, asthma can be deadly.

• There is no cure for asthma, but asthma can be managed with proper prevention and treatment.
• Asthma has a genetic component. If only one parent has asthma, chances are 1 in 3 that each child will have asthma. If both parents have asthma, it is much more likely (7 in 10) that their children will have asthma.
• More Americans than ever before say they are suffering from asthma. It is one of this country's most common and costly diseases.

Fast Facts

Every day in America:

• 40,000 people miss school or work due to asthma.
• 30,000 people have an asthma attack.
• 5,000 people visit the emergency room due to asthma.
• 1,000 people are admitted to the hospital due to asthma.
• 11 people die from asthma.

Prevalence

• An estimated 20 million Americans suffer from asthma (1 in 15 Americans), and 50% of asthma cases are “allergic-asthma.” The prevalence of asthma has been increasing since the early 1980s across all age, sex and racial groups.
• Asthma is the most common chronic condition among children.
• Asthma is more common among adult women than adult men.
• Asthma is more common among male children than female children.
• Asthma is more common among children (7 to 10%) than adults (3 to 5%).
• Nearly 5 million asthma sufferers are under age 18. It is the most common chronic childhood disease, affecting more than one child in 20.
• Asthma is slightly more prevalent among African Americans than Caucasians.
• Ethnic differences in asthma prevalence, morbidity and mortality are highly correlated with poverty, urban air quality, indoor allergens, and lack of patient education and inadequate medical care.

Morbidity

• Asthma accounts for one-quarter of all emergency room visits in the U.S. each year, with 2 million emergency room visits.
• Each year, asthma accounts for more than 10 million outpatient visits and 500,000 hospitalizations.
• The average length of stay (LOS) for asthma hospitalizations is 3 days.
• Nearly half (44%) of all asthma hospitalizations are for children.
• Asthma is the third-ranking cause of hospitalization children.
• Asthma is the #1 cause of school absenteeism among children accounting for more than 14 million total missed days of school.
• African Americans are three times more likely to be hospitalized from asthma.

Mortality

• Each day 11 Americans die from asthma. There are more than 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. In addition, asthma is indicated as “contributing factor” for nearly 7,000 other deaths each year.
• Since 1980 asthma death rates overall have increased more than 50% among all genders, age groups and ethnic groups. The death rate for children under 19 years old has increased by nearly 80% percent since 1980.
• More females die of asthma than males, and women account for nearly 65% of asthma deaths overall.
• African Americans are three times more likely to die from asthma. African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women.

Social and Economic Costs

• The annual cost of asthma is estimated to be nearly $18 billion.
• Direct costs accounted for nearly $10 billion (hospitalizations the single largest portion of direct cost) and indirect costs of $8 billion (lost earnings due to illness or death).
• For adults, asthma is the fourth leading cause of work absenteeism and “presenteeism,” resulting in nearly 15 million missed or lost ("less productive") workdays each year (this accounts for nearly $3 billion of the "indirect costs" shown above).
• Among children ages 5 to 17, asthma is the leading cause of school absences from a chronic illness. It accounts for an annual loss of more than 14 million school days per year (approximately 8 days for each student with asthma) and more hospitalizations than any other childhood disease. It is estimated that children with asthma spend an nearly 8 million days per year restricted to bed