Prone to allergies? What you must know

From food to skin, allergies in India are rapidly on the rise, says Nikita Puri.
Illustration: Dominic Xavier/Rediff.com

It's usually towards the end of a consultation, when a doctor pulls out her prescription pad, that I brace myself for a discussion that has become routine.

"In my 50 years of practice, I have never come across anyone with a paracetamol allergy. It's very rare. We give paracetamol even to children!" exclaims my new doctor.

Unless there is a family history involving a specific allergen (substance that causes an allergy), most people discover they have an allergy the hard way.

The 'safe for children' acetaminophen, commonly known as paracetamol, first caused muscle stiffness when I was about eight.

By the third dose, muscle cramps set in.

"You couldn't walk," my mother tells me. "You had to be carried everywhere for days after that."

Besides paracetamol, painkillers such as ibuprofen and pethidine have since joined my personal list of banned medications.

At the hint of a cold, home remedies involving ginger and turmeric become my lifelines.

An inordinate amount of sleep and several cups of hot soup are my fever-alleviation remedies.

It's a long, uncomfortable, battle.

Remarkably enough, I am not alone.

As a chronic sufferer from an uncommon allergy, it's natural for this case from halfway across the world to resonate with me: when Minnesota, USA, resident Brittany Angerman's daughter, Ivy Lynn, turned one, the toddler began to break out in rashes and blisters every time she was given a bath.

The family went from testing the child's shampoos and soaps to bathing the child at different locations, from her grandparents' home to hotel bath tubs.

But the rashes kept returning.

Ivy Lynn, now two, was finally diagnosed with aquagenic urticaria. 'Urticaria' is more commonly known as hives.

The child is allergic to water -- even her own sweat and tears can bring about an onslaught of red swollen welts.

Her case sounds like straight out of a science fiction novel, but medical literature has about 100 cases of aquagenic urticaria on record.

The rare allergy to water might seem like plain bad luck, but doctors across the board agree that allergies are on the rise.

"It's definitely grown over the last few years. We seem to have developed lower immunity as we continue to live between air-conditioned environments and a polluted outdoors,' says Dr Deepali Bhardwaj, dermatologist and allergist at Delhi-based Skin Care India.

"Besides, our food often has additives or pesticides, which in turn has led to strange mutations and allergies."

All the doctors I spoke to agreed that too many people take their allergies too lightly.

Dr Bhardwaj adds that the consequence of ignoring them can be serious, even fatal.

In 1980, the prime allergen for patients at Nagendra Prasad KV's Bengaluru Allergy Centre was pollen.

"By 1998, after television became popular, we began to see an increase in cases involving exposure to indoor allergens like house dust mites and cockroaches," says Dr Prasad, an allergist and immunologist.

As Dr Srinivas Jakka, a Hyderabad-based paediatric pulmonologist and allergy specialist, notes on his blog, milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, soy and sesame are the culprits in an estimated 85 per cent of cases.

"The proteins in these foods, like casein in milk, are resistant to heat and acid and remain intact even after cooking and digestion," says Dr Jakka.

A study by Mahesh PA, director at the Allergy Asthma & Chest Centre in Mysuru, found evidence of brinjal, cucumber, okra and papaya causing allergies in a population sample from Mysuru and Bengaluru.

Elsewhere, doctors and unsuspecting victims share tales of how capsicum (and coloured peppers) and tomatoes caused rashes, body ache, itchy tongues and even fever.

Dr Bhardwaj adds the invasive weed parthenium, commonly called congress grass, to the list of common allergens.

Having one allergy often becomes the gateway to developing other allergies, she adds.

In 2011, the World Allergy Organisation -- yes, there is such a thing -- estimated that 20 to 30 per cent of India's population had one or two allergies and that this figure was rising dramatically.

They estimated that by 2050, approximately 50 per cent of all children will have developed some sort of allergy.

The prime reasons behind the surge: Declining biodiversity, growing pollution, concretisation, rising temperatures and sedentary lifestyles.

Allergies change how they manifest themselves.

The first time a friend was asked to have Vitamin B Complex, she developed rashes and discontinued it.

A few years later, another doctor suggested she give it a second shot.

This time around, she was on her knees emptying out her stomach contents.

On the other hand, another friend is rediscovering his love for oranges, sweet lime and all things with Vitamin C.

For over 15 years, every time he'd have lime or even raw onions, white spots would appear on his lips. 'Avoid all things with citrus,' a doctor had told him.

But the white spots don’t show up anymore.

Diagnosing food allergies can be particularly tricky.

"A blood test can give you lots of false positives. It can say you are allergic to 25 things when you aren't," cautions Dr Prasad.

He says 30 to 35 per cent of his current cases apparently owe to food allergies.

But on closer inspection backed by tests, he found that true food allergies present themselves only in six to eight per cent of the children that he sees; his adult patients comprise only one to two per cent.

"In most cases, food is only an aggravating factor and not an inducing factor," says Dr Prasad.

"Your allergy may be subtle, but as soon as you eat something, you may notice eruptions on the skin that lead you to believe you are allergic to a particular food."

One way to fight allergens is to be a permanent player in a game of hide and seek, where you keep your distance from, say, pollen or seafood.

Another way is to rely on antihistamine tablets and nasal sprays, but doctors advise not to depend on them overly lest you build up resistance.

Yet another method is to build tolerance through immunotherapy, which can be a long and expensive process.

Checking history and ruling out common allergens don't rack up the bills, but other steps -- like double-blind, placebo-controlled tests, and medicine that is customised to counter your allergy -- can run into several thousands of rupees.

Also, Dr Prasad points out, one has to observe the body's reaction to allergies through changing seasons, rendering it impossible to wrap up the whole business in a few weeks.

In any case, as Dr Jakka says, "Immunotherapy has only proven itself when it comes to pollen and house dust mites."

In the case of medication allergy, one method is to de-sensitise the body to the allergy the medicine causes. This can be done by giving small amounts of the medicine to build immunity, much like how vaccines work.

"But this has to be done in carefully controlled conditions because of the potential for severe reactions," Dr Jakka cautions.

A home remedy that Dr Bhardwaj recommends is yogurt, a spoonful of flaxseed and olive oil taken daily (not necessarily together).

"They soothe the mast cells in our body." (Mast cells get agitated when exposed to allergens and release powerful chemical mediators like histamine.)

Though not a 'cure' for allergies, it may be a helpful precaution to avoid environmental and food allergens.

India-specific research on allergies still has a long way to go in building up an allergy profile for the country.

"There's very little data. We just have trends," says Dr Jakka.

He points to one of the newest health fads: The love of all things wheat.

"We didn't really have gluten allergies in the South. It was mostly seen in North India," he says. But with the intermingling of cultures and diet fads, there is a marked uptick in gluten (wheat protein) allergy.

The allergy problem is not simple. And neither are solutions.

Those of us diagnosed with allergies usually find our own methods of negotiating our way around the villains we've identified.

And, of course, we can always live in hope: Like in the case of my lucky friend and citrus fruits, maybe, just maybe, the allergy will simply sort itself out.