An allergen is any substance that can cause an allergy. In technical terms, an allergen is a non-parasitic antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals.[1]
Most humans mount significant Immunoglobulin E (IgE) responses only as a defense against parasitic infections. However, some individuals mount an IgE response against common environmental antigens. This hereditary predisposition is called atopy. In atopic individuals, non-parasitic antigens stimulate inappropriate IgE production, leading to type I hypersensitivity. Sensitivities vary widely from one person (or other animal) to another. A very broad range of substances can be allergens to sensitive individuals.
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Dust mite excretion, pollen and pet dander are all common allergens, but it is possible to be allergic to anything from chlorine to perfume to royal jelly.[2] Food allergies are not as common as food sensitivity, but some foods such as peanuts (a legume), nuts, seafood and shellfish are the cause of serious allergies in many people.
Officially, the United States Food and Drug Administration does recognize eight foods as being common for allergic reactions in a large segment of the sensitive population. These include peanuts, tree nuts, eggs, milk, shellfish, fish, wheat and their derivatives, and soy and their derivatives, as well as sulfites (chemical based, often found in flavors and colors in foods) at 10ppm and over. See the FDA website for complete details. It should be noted that other countries, in view of the differences in the genetic profiles of their citizens and different levels of exposure to specific foods due to different dietery habits, the "official" allergen list will change. Canada recognizes all eight of the allergens recognized by the US, and also recognizes sesame seeds,[3] and mustard.[4] The European Union additionally recognizes celery.
A few people have been recorded to be allergic to certain chemicals found in almost all water, and even water itself (see Aquagenic pruritus).
Another type of allergen is urushiol, a resin produced by poison ivy and poison oak. It causes the skin rash condition known as urushiol-induced contact dermatitis by changing a skin cell's configuration so that it is no longer recognized by the immune system as part of the body. A little over half of North Americans are known to be allergic to urushiol and repeated exposure can increase one's sensitivity to the allergen.
An allergic reaction can be caused by any form of direct contact with the allergen—consuming food or drink one is sensitive to (ingestion), breathing in pollen, perfume or pet dander (inhalation), or brushing a body part against an allergy-causing plant (direct contact, generally resulting in hives). Other common causes of serious allergy are wasp, fire ant and bee stings, penicillin, and latex. An extremely serious form of an allergic reaction is called anaphylaxis. One form of treatment is the administration of sterile epinephrine to the person experiencing anaphylaxis, which suppresses the body's overreaction to the allergen, and allows for the patient to be transported to a medical facility.
In 1952 basidiospores were described as being possible airborne allergens[5] and were linked to asthma in 1969.[6] Basidiospore are the dominant airborne fungal allergens. Fungal allergy is associated with seasonal asthma.[7][8] They are considered to be a major source of airborne allergens.[9] The basidospore family include mushrooms, rusts, smuts, brackets, and puffballs. The airborne spores from mushrooms reach levels comparable to those of mold and pollens. The levels of mushroom respiratory allergy are as high as 30 percent of those with allergic disorder, but it is believed to be less than 1 percent of food allergies.[10][11] Heavy rainfall (which increases fungal spore release) is associated with increased hospital admissions of children with asthma.[12] A study in New Zealand found that 22 percent of patients with respiratory allergic disorders tested positive for basidiospores allergies.[13] Mushroom spore allergies can cause either immediate allergic symptomatology or delayed allergic reactions. Those with asthma are more likely to have immediate allergic reactions and those with allergic rhinitis are more likely to have delayed allergic responses.[14] A study found that 27 percent of patients were allergic to basidiomycete mycelia extracts and 32 percent were allergic to basidiospore extracts, thus demonstrating the high incidence of fungal sensitisation in individuals with suspected allergies.[15] It has been found that of basidiomycete cap, mycelia, and spore extracts that spore extracts are the most reliable extract for diagnosing basidiomycete allergy.[16][17]
In Canada, 8% of children attending allergy clinics were found to be allergic to Ganoderma, a basidiospore.[18] Pleurotus ostreatus,[19] cladosporium,[20] and calvatia cyathiformis are significant airborne spores.[9] Other significant fungal allergens include aspergillus and alternaria-penicillin families.[21] In India fomes pectinatis is a predominant air-borne allergen affecting up to 22 percent of patients with respiratory allergies.[22] Some fungal air-bourne allergens such as coprinus comatus are associated with worsening of eczematous skin lesions.[23] Children who are born during autumn months (during fungal spore season) are more likely to develop asthmatic symptoms later in life.[24]
In addition to foreign proteins found in foreign serum (from blood transfusions) and vaccines, common allergens include:
Seasonal allergy symptoms are commonly experienced part of the year, usually during spring, summer or fall when certain trees or grasses pollinate. This depends on the kind of tree or grass. For instance, some trees such as oak, elm, and maple pollinate in the spring, while grasses such as Bermuda, timothy and orchard pollinate in the summer.
Grass allergy is generally linked to hay fever because their symptoms and causes are somehow similar to each other. Symptoms include rhinitis, which causes sneezing and a runny nose, as well as allergic conjunctivitis, which includes watering and itchy eyes.[26] Also an initial tickle on the roof of the mouth or in the back of the throat may be experienced.
Also, depending on the season, the symptoms may be more severe and people may experience coughing, wheezing, and irritability. A few people even become depressed, lose their appetite, or have problems sleeping. Moreover, since the sinuses may also become congested, some people experience headaches.[27]
If both parents suffered from allergies in the past, there is a 66% chance for the individual to suffer from seasonal allergies, and the risk lowers to 60% if just one parent had suffered from allergies. The immune system also has strong influence on seasonal allergies, since it reacts differently to diverse allergens like pollen. When an allergen enters the body of an individual that is predisposed to allergies, it triggers an immune reaction and the production of antibodies. These allergen antibodies migrate to mast cells lining the nose, eyes and lungs. When an allergen drifts into the nose more than once, mast cells release a slew of chemicals or histamines that irritate and inflame the moist membranes lining the nose and produce the symptoms of an allergic reaction: scratchy throat, itching, sneezing and watery eyes. Some symptoms that differentiate allergies from a cold include[28]:
Among seasonal allergies, there are some allergens that fuse together and produce a new type of allergy. For instance, grass pollen allergens cross-react with food allergy proteins in vegetables such as onion, lettuce, carrots, celery and corn. Besides, the cousins of birch pollen allergens, like apples, grapes, peaches, celery and apricots, produce severe itching in the ears and throat. The cypress pollen allergy brings a cross reactivity between diverse species like olive, privet, ash and Russian olive tree pollen allergens. In some rural areas there is another form of seasonal grass allergy, combining airborne particles of pollen mixed with mold.[29] Recent research has suggested that humans might develop allergies as a defense to fight off parasites. According to Yale University Immunologist Dr Ruslan Medzhitov, protease allergens cleave the same sensor proteins that evolved to detect proteases produced by the parasitic worms.[30] Additionally, a new report on seasonal allergies called “Extreme allergies and Global Warming”, have found that many allergy triggers are worsening due to climate change. 16 states in the United States were named as “Allergen Hotspots” for large increases in allergenic tree pollen if global warming pollution keeps increasing. Therefore, researchers on this report claimed that global warming is bad news for millions of asthmatics in the United States whose asthma attacks are triggered by seasonal allergies.[31] Indeed, seasonal allergies are one of the main triggers for asthma, along with colds or flu, cigarette smoke and exercise. In Canada, for example, up to 75% of asthmatics also have seasonal allergies.[32]
Based on the symptoms seen on the patient, the answers given in terms of symptom evaluation and a physical exam, doctors can make a diagnosis to identify if the patient has a seasonal allergy. After performing the diagnosis, the doctor is able to tell the main cause of the allergic reaction and recommend the treatment to follow. 2 tests have to be done in order to determine the cause: a blood test and a skin test. Allergists do skin tests in one of two ways: either dropping some purified liquid of the allergen onto the skin and pricking the area with a small needle; or injecting a small amount of allergen under the skin.[33] Alternative tools are available to identify seasonal allergies, such as laboratory tests, imaging tests and nasal endoscopy. In the laboratory tests, the doctor will take a nasal smear and it will be examined microscopically for factors that may indicate a cause: increased numbers of eosinophils (white blood cells), which indicates an allergic condition. If there is a high count of eosinophils, an allergic condition might be present. Another laboratory test is the blood test for IgE (immunoglobulin production), such as the radioallergosorbent Test (RAST), implemented to detect high levels of allergen-specific IgE in response to particular allergens. Although blood tests are less accurate than the skin tests, they can be performed on patients unable to undergo skin testing. Imaging tests can be useful to detect sinusitis in people suffering from chronic rhinitis, and they can work when other test results are ambiguous. There is also nasal endoscopy, wherein a tube is inserted through the nose with a small camera to view the passageways and examine any irregularities in the nose structure. Endoscopy can be used for some cases of chronic or unresponsive seasonal rhinitis.[34]
Treatment includes over-the-counter medications, antihistamines, nasal decongestants, allergy shots, and alternative medicine.
In the case of nasal symptoms, antihistamines are normally the first option. They may be taken together with pseudoephedrine to help relieve a stuffy nose and they can stop the itching and sneezing. Some over-the-counter options are Benadryl and Tavist. However, these antihistamines may cause extreme drowsiness, therefore, people are advised to not operate heavy machinery or drive while taking this kind of medication. Other side effects include dry mouth, blurred vision, constipation, difficulty with urination, confusion, and light-headedness.[35]
There is also a newer second generation of antihistamines that are generally classified as the "non-sedating antihistamines" or anti-drowsy, which include cetirizine, loratadine, and fexofenadine.[36]
An example of nasal decongestants is pseudoephedrine and its side-effects include insomnia, restlessness, and difficulty urinating. Some other nasal sprays are available by prescription, including Azelastine and Ipratropium. Some of their side-effects include drowsiness. For eye symptoms, it is important to first bath the eyes with plain eyewashes to reduce the irritation. People should not wear contact lenses during episodes of conjunctivitis.
Allergy shots, also called immunotherapy, are also available and are especially recommended for people who cannot tolerate allergy medications or who severe symptoms, and also for those who develop asthma during pollen season.
Immunotherapy contains a small amount of the substance that triggers the allergic reactions [37] and it should start after the pollen season to get prepared for the next season.
Natural remedies are another option that patients look to for relief. One of the most popular recently is the European herb butterbur (Petasites hybridus). The British Medical Journal published a study in which Swiss researchers proved how one tablet of butterbur four times daily was as effective as an antihistamine in controlling symptoms of hay fever. On a second study, a group of British researchers gave their approval to butterbur's effectiveness in battling symptoms of grass allergy. Other herbal supplements that function as remedies include freeze-dried nettles (Urtica) and a tonic made from the goldenseal herb (Hydrastis candiensis), which doctors recommend in addition to saline nasal spray (another natural remedy).[38]
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