PATIENT: I’m allergic to oxygen.
ANESTHESIOLOGIST: You allergic to oxygen?! Where you from? Mars or something?!
This confused patient, an anaesthesiologist once told me about, was evidently allergic to something else. It definitely could not have been to the life-sustaining gas that makes up 21% of the atmosphere. The word ‘allergies’ is often used rather loosely. Let us therefore explore its various manifestations and treatments.
The Hippocratic Oath declares, ‘first, do no harm.’ In other words, if you can’t make them better, by all means, don’t make them any worse. There are few faster ways to make a patient more deadly ill than by giving them medication they are allergic to. So please don’t get too irritated when one healthcare professional after another seems obsessed with double-checking this particular piece of information.
Most patients’ medical charts will be recorded as having NKDA: no known DRUG ALLERGIES. Penicillin, Sulphur and Iodine are the most common culprits. Patients with multiple allergies have more limited options for drug treatment, but in the majority of cases there are effective alternatives. An allergy is a reaction within minutes or hours of taking the drug. It generally takes the form of a rash: puffy, patchy, scratchy welts spreading quickly over the body. It is a miserable feeling that can progress to swelling of the throat and difficulty breathing. Emergency treatment with steroids can be life-saving. Of course, absolutely stop the medication immediately. Then make sure that anyone treating you in the future knows the exact name of the offending medication.
ENVIRONMENTAL ALLERGIES provide more of a diagnostic challenge. In many cases patients come with that characteristic rash without the slightest idea of the aggravating agent. Of course, there is the obvious case of bee sting allergy, for example. As you may know, a bee sting is no fun. It suddenly burns like hell. However, for those having an allergic reaction on top of that, it is a lot more serious matter. Ever heard of someone at picnic resting down their open can of soda? – and a passing bee decides to go in there to have a sip of that? … So simple, yet so tragic. The lip is close to the throat where the air can be cut off. Not to mention that picnic areas tend to be somewhat further away from hospitals, from whence cometh our help.
Environmental allergies include dust mites and pet dander. Housewives allergic to dust may not get a lot of love in certain countries. Nevertheless, there may be a scientific basis to why some people don’t like to clean house. (Just don’t come to me for a medical excuse!) Then there are those who do not believe in separation of the species. They sleep with their pets and have lovingly exchange warm, wet kisses, regardless where else these creatures may be licking before. Not surprisingly, one of the most difficult tasks of a paediatrician is to convince parents that their furry friend may be complicating their child’s asthma.
In temperate countries, trees undress en masse in the fall and bear neither flowers nor fruits all winter. (Strange way to run agriculture, but they somehow still maximize production). With spring, however, comes a huge surge in the pollen count so much so that it is monitored by meteorologists as closely as wind speed and rainfall. It is a season of reddish, congested noses and a large portion of miserable people clinging to wads of Kleenex – perhaps about to shake your hand. If there is ever a time for sanitizer alert, spring is it!
Places in paradise, on the other hand, are bombarded with waves upon waves of fruit all year round. Just when you get tired of mangoes, it’s time for sugar apple, or soursop or paw paw or whatever else one’s palate delights in. Lush greenery and flowers keep popping up all around. Doctors therefore have to be a lot more clever to discern whether some particular pollen, virus or other allergen is causing the patient’s congestion.
Finally, the third major category is CONTACT ALLERGIES. Zuti is an example of a plant that will inflict itching on contact. It’s like poison ivy or poison oak in other countries. Some people are surprisingly resistant and others are exquisitely sensitive. Just clearing bush (involving the offending plant) releases airborne particles which can cause some poor soul to break out dozens of houses downwind. Cosmetics, lotions, air fresheners and laundry detergents have all been implicated as contact allergens in sensitive persons.
Kids tend to wear cheap jewelry actually made of tin, zinc or nickel. The fickle ‘gold plate’ chips within days causing a skin rash in some cases. Often times, they even use tabs from soft drink or beer cans and whatever else. Children, who cannot wait to get that ring on their finger, may be the same ones as adults who cannot wait to get it off. Benadryl, Hydrocortisone cream, Calamine lotion, Sudafed are some of the wide variety of over-the-counter medications available at your pharmacy which can offer some good measure of relief. FOOD ALLERGIES is a whole separate topic by itself. I published research in my nutrition book which offers fascinating new insights into why certain people have difficulty losing weight or chronically lack energy, for instance.
In medical training, I once had an Irish classmate who was allergic to potatoes! And I almost dated a woman who was allergic to chocolate, flowers and perfume – seriously! (Or was she just trying to tell me something?! Hmmmm…whatever!) Anyway, as we’ve seen, “I have allergies” can mean several different things. At least, after having this conversation, I better not hear that you told somebody something like you’re allergic to water or oxygen!
Dr. Sam Christian is surgeon who runs the Urgent Care on 137 Bath Road. It offers general medical care, office surgery, acupuncture and microdermabrasion. He is Medical Adviser to the Dominica Cancer Society and author of the faith and fitness nutrition book, ‘Mannafast Miracle.’ Dr. Christian can be reached at 440-9133 or by writing to [email protected].
i never knew that Hydrocortisone had a cream and it was over the counter
….is it over the counter in Dominica? i have food allergies and i was prescribed the pills but because its a steriod i couldn’t get it just so when i broke out i needed a presciption can u confirm that for me plz…..and nice article by the way… very informative!
Allergy: is a state of abnormal, and individual hypersensitivity acquired through exposure to a particular allergen, reexposure revealing a heightened capacity to react. Allergies can be divided into three major types:
(1). delayed-reaction allergies caused by sensitized lymphocytes; (2) antigen-antibody allergies caused by a reaction between immunoglobulin G ((IgG) antibodies( immunoglobulins), and antigens; and (3) atopic or inherited allergies, which are characterized by the presence of large amounts of sensitizing antibodies called IgE antibodies.
Examples of delayed-reaction allergies also called cell-mediated hypersensitivity include contact dermatitis, or skin eruptions resulting from exposure to certain drugs, to chemicals, such as those in cosmetics, and household cleaners, or to the toxins of Poison Ivy, Oak, and Sumac. On first contact with the allergen there may be no response, however, with repeated exposure some lymphocytes become sensitized. Once these lymphocytes are activated they remain in the body until a subsequent contact with the allergen to which they are sensitized.
Then they diffuse into the skin, and bring about a cell mediated immune response. During this reaction toxins are released from the sensitized lymphocytes, and macrophages invade the tissues. In the event this process continues unchecked, there can be extensive destruction of the affected tissues. Antigen-antibody allergies occur when an individual has built up a high titer of antibodies, usually of the IgG type, following exposure to a specific antigen. Subsequent exposure to a high level of that antigen results in the formation of an antigen-antibody complex that precipitates, and deposits as small granules on the walls of blood vessels.
Eventually, through the actions of proteolytic enzymes released during the reaction, small blood vessels become inflamed, and are severely damaged, or destroyed; this kind of reaction is sometimes called cytotoxic (cyto-toxic) hypersensitivity. Examples of antigen-antibody reactions include: Transfusion reactions, hemolytic disease of the newborn secondary to incompatibility of Rh factor in the maternal and fetal blood, rejection of transplanted tissues and organs, autoimmune disease, and drug reactions. I need to brief so I will conclude.
Atopic a., is hereditary allergy
Bacterial a., is a specific hypersensitivity to a particular bacterial antigen, i. e., Mycobacterium tuberculosis.
Bronchial a., asthma.
Cold a., is any condition in which signs, and symptoms of allergy are produced by exposure to cold, such as cold urticaria. Delayed a., is an allergic response which appears hours, or days after application, or absorption of an allergen, it includes contact dermatitis, and bacterial allergy. Food a., gastrointestinal a., allergy produced by ingested antigens, such as food or drugs; strawberries, milk, and eggs are the most common offenders; the organ affected usually is the skin.
I will not comment on “hereditary, induced, and physical a.”
Francisco Etienne-Dods Telemaque
SO DOCTOR CHRISTIAN WHAT IS AQUAGENIC URTICARIA ?
HENCE THE REASON WHY I DO NOT AGREE WITH EVERY THING THAT YOU SAID…
I WOULD ADVISE PARENT THAT IF A CHILD APPEARS SCARED OR STRANGE WHEN THE SEE OR EAT SOME THING THAT THEY DO NOT LIKE DO NOT OBLIGE THE CHILD TO EAT IT…SOME CHILDREN CANNOT REALLY EXPLAIN HOW BAD THEY FEEL…ONLY THE SMELL OF SEA FOOD EXCEPT FISH HE BECOMES RED AND START VOMITING …
I do not like to get into people’s business, especially when I discover that there are some who pretends to know, they talk plenty of crap such as I am responding to.
If you do not know the meaning of “urticaria” how on earth can you tell Sam who is a medical doctor, one who can save your life that you do not agree with him. Well, since Sam may not respond to you, I the kid will explain to you what is urticaria. some people will never understand Sam unless they are into medicine, or have a medical background.
Note: Urticaria is a vascular reaction of the skin marked by transient appearance of slightly elevated patches or “wheals” that are redder, or paler than the surrounding skin, and often attended by severe itching; called also hives. The existing cause may be certain foods, infection, or emotional stress.
Now adj., Urtica’rial. Cold u., urticaria precipitated by cold air, water, or objects, occurring in two forms: In the autosomal dominant form, which is associated with fever, arthralgias, and leukocytosis, the lesions present as erythematous, burning papules, and macules.
The more common acquired form is usually idopathic, and self-limited. Although I a aware you may not understand what I conveyed to you and perhaps the will not make sense, I will introduce you to the following hopefully it will benefit some one:
Giant u., is angioneurotic endema.
u. hemorrhag’ica is purpura with urticaria.
u. medicamento’sa, that is due to the use of a drug.
Papular u., u. papulo’sa, is an allergic reaction to the bite of various insets, with appearance of lesions that evolve into inflammatory, increasingly hard, red or brownish, persistent papules:
u. pigmento’sa is the most common form of mastocytosis, occurring primarily in children, manifested as persistent pink to brown macules, or soft plaques of various size; pruritus, and urtication occur on stroking the lesions:
u. pigmento’sa, juvenile, urticaria pigmentosa present at birth or in the first few weeks of life, usually disappearing before puberty, taking the form of a single nodule or tumor, or of a disseminated eruption of yellowish brown to yellowish red macules, plaques, or bullae:
solar u., is a rare form produced by exposure to sunlight.
I suggest that people who do not know should ask questions, before they make themselves look stupid writing in all block letters, talking about they disagree. How can you disagree when you have no concept of what the man conveyed?
Francisco Etienne-Dods Telemaque
As a point of order, Doc:
Our help cometh from the Lord – not PMH.
You, of all persons, should know better.
Nice article though…