Dr. Vivek Baliga B. is a consultant physician and cardiologist, and director of Baliga Diagnostics in Bangalore. He is a keen advocate of patient education and loves to blog about all things health related. Learn more about him at drvivekbaliga.com.
Allergic rhinitis. What a nuisance.
Are you someone who suffers from allergies all the time? Is early morning sneezing becoming an annoying routine? Nose getting constantly blocked?
Well, off late I have been encountering many patients who complain of this problem. Frankly, they find it a nuisance as it gets in the way of their daily lives. Allergies are common. Many people have them. But they can be troublesome.
Why exactly do allergies occur? What can you do to control them or get rid of them?
There are numerous kinds of allergies that we suffer from. However, I will only talk about allergic rhinitis, or the ‘sniffles’. Allergic rhinitis consists of 4 main symptoms – a runny nose, sneezing, itching in the nose and a blocked nose.
So why do humans get allergies? Are we the only species to suffer from allergies?
The weather has been funny recently. We have had warm days, rains in the evening and cold, chilly nights. This weather makes it easy for viruses and pollen to ‑oat around. These are called ‘allergens’ and are responsible for causing allergies.
Allergic rhinitis (runny nose and sneezing) affects a large population in India, and I personally see around 10 to 15 patients with this problem every day. Before I go into the nitty gritty details of allergic rhinitis and allergies, it is important to recognise that different allergic rhinitis conditions take place at different times of the year.
Seasonal allergies only occur in the spring when pollen is floating around aimlessly in the air. Perennial allergies take place throughout the year and can be triggered by just one exposure to an allergen. I have listed some of the common allergens that cause runny nose in the box below.
Allergens that cause allergies
1. Dust mites
2. Pollution – Smoke, Smog
4. Dog dander
5. Cat saliva
6. Pet birds
Moving on to why we get allergies… So, the human body likes to keep itself in a healthy condition. However, when these allergens that are floating around in the air move into the nostrils, they lead to what is called an ‘allergic reaction’.
In an allergic reaction, the immune system (body’s defense mechanism) kicks in, with the allergens being recognised by cells called macrophages and dendritic cells (these are also called antigen presenting cells). Cells called T-lymphocytes, specically T-helper cells TH1 and TH2, are stimulated to release mediators that fight these allergens. This keeps allergies at bay.
In people who are prone to developing allergies, these antigen presenting cells that come in contact with the allergen recognize it as an invader. The antigen presenting cells carry this allergen to the T lymphocytes, which in turn stimulates cells called B cells to release antibodies. Antibodies are the enemies of allergens. They are the soldiers within the immune system.
The antibodies produced are called Immunoglobulin E, or IgE. When the first ever exposure to an allergen occurs, the IgE stays bound to cells called mast cells. However, when a second exposure takes place, the IgE is stimulated. This in turn prompts the mast cells to release a mediator called histamine. It is histamine (along with some other mediators) that leads to the allergic response. It is histamine that is responsible for the sneezing, mucus production and a blocked nose.
This phenomenon where the initial exposure to the allergen does not cause problems, but subsequent exposure does, is called ‘allergen sensitization’. I hope this is clear (confused me for more than a year of medical school!).
Classification of allergic rhinitis
Allergic rhinitis has been classified into 2 different categories by the Allergic Rhinitis And Its Impact On Asthma (ARIA). One category is based on intensity of the condition, while the other is based on how frequent the symptoms are.
1. Intermittent Allergic Rhinitis
Here symptoms take place < 4 days a week, or < 4 consecutive weeks.
2. Persistent Allergic Rhinitis
Here, the symptoms take place > 4 days a week, and > 4 consecutive weeks.
3. Mild Allergic Rhinitis
Here, the patient has –
Normal sleep patterns
No effect on daily activities
No effect on work or schooling
Presence of symptoms but they are not troublesome
4. Moderate to Severe Allergic Rhinitis
Here, the patient has –
Difficulty in regular activities
Trouble attending work or school
Any 2 combinations of the above may take place.
Treatment of allergic rhinitis – role of probiotics
Over the years, numerous treatments for allergic rhinitis have evolved. Primarily, the treatments include steam inhalation, the use of antihistamine medication and avoiding allergens that can result in symptoms. In addition to this, immunotherapy also has a role. These are allergy shots. They are useful to an extent, and need to be given over a period of 6 months. However, allergy shots are not freely available in India.
There are many individuals who continue to suffer from such symptoms despite taking every measure possible to prevent allergies. It can become quite a nuisance and can significantly impact the quality of life.
Over the last few years, probiotics are being used more frequently in the treatment of allergic rhinitis. Probiotics are basically ‘good bacteria’ that can boost the host immune system and modify how allergies develop within the body. However, the exact mechanism of action has not been clear. The good news however is that taking probiotics is not associated with long-term side-effects. It is perfectly safe and extremely beneficial in preventing allergies.
Types of probiotics that are useful
Okay, there are literally hundreds of good bacteria currently useful in treating various medical problems. However, if you look at the clinical studies, only a few of them have helped in the treatment of allergic rhinitis. These include –
Lactobacillus paracaseiLactobacillus casei
Lactobacillus rhamnosus • Bidobacterium longum
Lactobacillus johnsonii EM1
Escherichia coli Nissle
How probiotics work
There are many ways that probiotics work. However, the primary mechanism appears to be reducing the levels of harmful mediators being released from the allergic cells in the body.
These mediators are called cytokines. But are probiotics really safe? Generally, they are. However, some clinical trials have pointed out problems, seen mostly in people with low immunity. In those people who are on cancer therapy or those who are immunocompromised (very low immunity due to some cause), giving probiotics could cause infection.
Advanced or more serious cases could lead to sepsis. A small number of patients may develop resistance to antibiotics. In practice, we have used probiotics in patients with constant allergies with some good results. Many have come off their allopathic medicines.
Preventing allergic rhinitis
It is generally hard to prevent allergic rhinitis in our country, given our pollution levels. Installing air filters may be helpful. Whenever possible, try to avoid dust exposure. If you notice that you are allergic to certain elements, do your best to avoid or get rid of them. Some people have even gone to the extent of leaving their new pets back in the animal shelter.
As a general advice, I have personally found that performing steam inhalation regularly at times of allergies can keep bad symptoms at bay. Warm water gargling helps as well.
Allergies are a nuisance and allergic rhinitis can be extremely troublesome. Simple steps and probiotics may help get rid of the problem completely.
This article originally appeared in the TeacherTribe Magazine February 2021 edition.