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Iqra Mazhar

Global warming is a serious threat to public health. Increased pollen allergy is one of the effects of global warming, leading to a rise in seasonal allergies.

Is Global Warming causing a Rise in Seasonal Allergies?

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Is Global Warming Causing A Rise In Seasonal Allergies?

Ismail Munir

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Crop Burning And Allergies - Is There A Link?

Introduction

Allergic disorders are not a threat to life in most cases, but they do impair a person&rsquo;s functionality. It eventually has an adverse effect on an individual&rsquo;s physiological well-being and quality of life. However, these implications can be minimised if the <a href="https://www.merisehat.pk/disease/allergies">allergies </a>are detected early and treated appropriately. 
&nbsp;

Understanding Link Between Crop Burning And Allergies

Both indoor and outdoor activities can cause swelling and sinus pain, in addition to watery eyes, nasal congestion, and sneezing. Airborne allergens can cause hay fever or rose fever/ rose cold, which are seasonal or constant persistent allergies.

People with allergies usually have more than one type of allergy, and the most common are indoor/outdoor allergies. The triggers are grass pollen, tree pollen, weed pollen, mould spores, cockroaches, dust mites, cat or dog dander, and rodent urine.

&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Allergies In The United States</h5>
	</li>
</ul>

In the United States, more than 50 million people experience different types of allergies every year and it is the sixth leading cause of chronic illnesses. It is the most common health issue that affects children in the US, and every year 90,000 people visit the emergency room due to anaphylaxis.&nbsp;Medicines, food, insect bites, or stings are the most common anaphylactic triggers.

Furthermore, medicines cause the most common allergy-related deaths. Older adults and African Americans have the highest death rates because of allergies.

Seasonal allergies in the US equal 8% of adults and 7% of children. They usually occur during fall when pollen, trees, and grasses are in the air. Moreover, according to research from 2018, caucasian children are more likely to get hay fever compared to African American children. Allergies of the eyes are usually triggered by the same indoor/outdoor triggers<a href="#accordion">[1]</a>.

&nbsp;

<ul>
	<li>
	<h5>Allergies In The United Kingdom</h5>
	</li>
</ul>

Allergies are rising by 5% each year in the United Kingdom. The first wave of the allergic season started 50 years ago with enormous surges in asthma and hay fever. Currently, we are facing the second wave of allergic diseases, especially fatal food allergies. The figures from the year 2012 indicate that one in forty children suffer from serious allergies in the UK.

During the last decade, the emergency departments in the UK have seen an increase in anaphylactic shocks. More children and adults are being diagnosed with food allergies at present compared to the past.

One in three people is affected by allergic disorders in the UK, which is estimated to be around 20 million people. Although allergies are most common in children, 6-8% of infants have also been diagnosed with food allergies and have experienced anaphylaxis at some point. These numbers are reflected in the admission rates which have doubled. More people were admitted to hospitals with severe allergies seven times more between 2002 to 2012 compared to the 1990s.

One in four people in the UK have hay fever, and it equates to approximately sixteen million people. Also, the prevalence of allergies such as asthma, food allergies, and eczema in the UK is almost four times higher. Furthermore, allergic rhinitis is poorly managed and does not have enough recognition. The number of people being diagnosed with eczema, food allergies, and allergic rhinitis has increased over the last thirty years. The growing numbers are a cause of concern as allergies often severely restrict the sufferer&#39;s everyday activities<a href="#accordion">[2]</a>.

&nbsp;

<ul>
	<li>
	<h5>Allergies In Pakistan</h5>
	</li>
</ul>

Allergies and diseases related to allergies are very common in all parts of the world and involve all ethnicities. These diseases include allergic rhinitis, bronchial asthma, conjunctivitis, and eczema. However, the data on the prevalence of allergic diseases in Pakistan is limited, indicating a need for further exploration.&nbsp;

In recent times, allergic diseases, especially bronchial asthma is increasing worldwide. But there is no data available about the prevalence of allergic diseases among school-going kids in Pakistan. However, data is available for certain age groups i.e. adults.&nbsp;&nbsp;

To bridge this gap, researchers in Pakistan have conducted surveys to know the prevalence of allergic diseases among kids aged 3 to 16 years of age. They used the same questionnaires for data collection that had been used in Saudi and UAE in 2007. The survey was done in Karachi and distributed among various schools covering 2000 to 3000 individuals. According to the results, the frequency of asthma is 15.8%, while the frequency of allergic rhinitis is 28.5% in school kids. The parameters of the analysis included dry cough, eczema, wheezing, and breathlessness. The survey also highlighted that the presence of a smoker in the family increased the risk of asthma, dry cough, wheezing, allergic rhinitis, and breathlessness.&nbsp;

The study signified that school-going kids in Karachi displayed symptomatic allergies. It had also been postulated that indoor environmental exposure and family circumstances also play a role in increasing the chances of asthma and other allergies in kids<a href="#accordion">[3]</a>. 
&nbsp;

A survey was also conducted among healthcare workers to see the frequency of allergic rhinitis among them. These included doctors, dentists, nurses, technicians, and pharmacists. After the survey, it was noted that 13 individuals missed their work because of allergic rhinitis indicating work absence due to allergies<a href="#accordion">[4]</a>.

&nbsp;

Exposure to pesticides and crop burning in communities can cause allergies according to research. Studies have been conducted to review the effects of agricultural exposure on the respiratory health of kids. These studies were conducted predominantly in industrial agricultural areas.

These studies assessed exposure and its effect on various respiratory health outcomes, for example, asthma, measurements of lung function, and acute respiratory symptoms. It was found that pesticides influenced the respiratory health of children. Furthermore, exposure to agricultural burning influenced the respiratory health of kids and the effect was severely adverse. To summarise, a positive association between exposure to agricultural burning and adverse effects on the respiratory system was seen<a href="#accordion">[5]</a>.

&nbsp;

The burning of crops and their residue is becoming a serious problem in Pakistan, and is a cause of concern for both health reasons as well as climate change. This unfortunate situation is not only limited to Pakistan and applies everywhere else in the world, due to its mitigating effects. It has led to an impairment in the quality of air, heat waves, strong haze, and several health problems.&nbsp;

&nbsp;

The primary database of Punjab was used to assess the extent of the problem in Punjab, Pakistan. The health and environmental effects of crop burning residue were assessed. It was found that crop burning had a drastic impact on households with chronic and non-chronic diseases. Also, the severity of the diseases was seen to increase during the period of crop burning.

This situation can be avoided by adopting sustainable crop management practices. The first step towards this could be raising awareness among farmers and engaging them in this dialogue.&nbsp;&nbsp;

&nbsp;

Key Points

<ul>
	<li>Allergic rhinitis is very common in most parts of the world, which includes Pakistan as well.</li>
	<li>Asthma, a very common allergy is associated with seasonal changes, pet dander, and other environmental factors.</li>
	<li>Respiratory problems due to crop burning are also of great prevalence.</li>
	<li>New policies and meaningful implications should be adopted to promote using the residues of crops in Pakistan to improve the situation.</li>
</ul>

&nbsp;

[1] Warren, C.M., Jiang, J. and Gupta, R.S., 2020. Epidemiology and burden of food allergy. Current allergy and asthma reports, 20(2), pp.1-9.

[2] Gupta, R., Sheikh, A., Strachan, D.P. and Anderson, H.R., 2007. Time trends in allergic disorders in the UK. Thorax, 62(1), pp.91-96.

[3] Hasnain, S.M., Khan, M., Saleem, A. and Waqar, M.A., 2009. Prevalence of asthma and allergic rhinitis among school children of Karachi, Pakistan, 2007. Journal of Asthma, 46(1), pp.86-90.

[4] Siddiqui, M.I., Dhanani, R. and Moiz, H., 2020. Prevalence of allergic rhinitis among healthcare workers and its impact on their work: A cross-sectional survey at a tertiary healthcare centre in Pakistan. JPMA. The Journal of the Pakistan Medical Association, 70(8), p.1432.

[5] Van Horne, Y.O., Farzan, S.F., Razafy, M. and Johnston, J.E., 2022. Respiratory and allergic health effects in children living near agriculture: A review. Science of The Total Environment, p.155009.

[6] Raza, M.H., Abid, M., Faisal, M., Yan, T., Akhtar, S. and Adnan, K.M., 2022. Environmental and Health Impacts of Crop Residue Burning: Scope of Sustainable Crop Residue Management Practices. International Journal of Environmental Research and Public Health, 19(8), p.4753.

Staff Writer

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

I Can’t Sleep. Is It Because Of My Allergies?

If you have allergies, the symptoms can worsen at night due to various reasons, other than exposure to the triggers at home. Furthermore, your body&rsquo;s normal <a href="https://www.merisehat.pk/article/how-an-over-prescription-of-antibiotics-affects-your-immune-system">immune </a>cycles and hormones can change during the evening, triggering the symptoms.

&nbsp;

Understanding Relationship Between Sleep And Allergies

Exposure to allergens makes allergies worse, and in some cases may induce a severe allergic reaction.&nbsp;Common allergens include:

<ul>
	<li>Fabrics</li>
	<li>Dust mites</li>
	<li>Detergents</li>
	<li>Lotions</li>
	<li>Pet dander</li>
	<li>Medications</li>
</ul>

If your allergies worsen in the evening, or when you are in bed, take an appointment with your doctor to try and identify the reasons.

&nbsp;

Your body experiences multiple changes in a day, and the normal patterns of your hormones or immune cycles can affect your response to inflammation. These triggers can drastically worsen the symptoms of allergy.&nbsp;

Adrenaline and cortisol (anti-inflammatory hormones) are the lowest during sleep<a href="#accordion">[1]</a>. In addition, the anti-inflammatory proteins, for example, cytokine, interleukin, and histamine worsen the symptoms of allergy when you are lethargic or tired.

People with allergies often have a disrupted sleep pattern, without realizing that their allergies are the causative factor. Altered sleep patterns and breathing is also seen in children suffering from allergies. They also have a bedwetting tendency, which can be attributed to disturbed sleep due to allergies.&nbsp;

&nbsp;

Sleep problems linked with asthma can cause daytime sadness and fatigue. It has been suggested by experts that people who cannot find an explanation for their sleep disturbance, get screened for respiratory problems such as asthma<a href="#accordion">[2]</a>.&nbsp;

Sleep problems related to asthma include the following:

<ul>
	<li>Inability to fall asleep</li>
	<li>Insomnia</li>
	<li>Disrupted sleep</li>
	<li>Feeling unrefreshed in the morning</li>
</ul>

Unfortunately, the situation worsens in cases of uncontrolled asthma, and sufferers usually have a very poor quality of sleep.&nbsp;Several factors worsen asthma symptoms at night, such as the body&rsquo;s immune changes and exposure to allergens, e.g., fabrics.&nbsp;

&nbsp;

Since the most common symptoms of allergic rhinitis are sneezing, nasal congestion, runny nose, itchy nose, and eyes, it can interfere with sleep.&nbsp;Nasal congestion, though, can be treated with intranasal corticosteroid sprays. It can reduce the symptoms and help you sleep well at night.

&nbsp;

Skin itching is associated with atopic dermatitis, which can make sleeping at night worse. The reverse is also true, wherein sleep disturbances can worsen symptoms of atopic dermatitis, and affect the immune system at large.

&nbsp;

Do you wake up with a stuffy nose or sneeze in your sleep? Whether the allergies are seasonal or chronic, they can disrupt your peace.

Around 40% of Americans suffer from allergies<a href="#accordion">[3]</a>. The common symptoms are sneezing, an itchy nose, and watery eyes. Moreover, as mentioned earlier, sleep patterns are also disrupted. People with allergies are more prone to insomnia.&nbsp;

&nbsp;

When allergens irritate your nasal passages, they trigger nasal congestion and sneezing, in addition to watery eyes. Your ability to breathe is easily worsened and you experience disturbed sleep. These are the two main reasons associated with poor sleep quality.If you are missing out on sleep because of allergies, you will end up becoming groggy and irritated the next morning. When you are tired, your performance at work or school is consequently impaired, and it also has a negative effect on your overall health. Furthermore, poor sleep can also increase your anxiety and response to stress, which further makes it hard to fall asleep at night.&nbsp;Allergies don’t just affect your ability to sleep. It also hinders staying asleep all night without any disruptions. People with allergies keep waking up in the middle of the night because of their symptoms leading to sleep deprivation. Hence, creating a vicious cycle. Reliance on sedatives to help sleep better increases, which isn’t a very good idea and can lead to addiction.

All aspects of sleep are affected because of allergies. Not only do sufferers experience poor quality of sleep but also daytime fatigue, morning headaches, or sinus pain.

A correlation has also been seen between the severity of the allergies and sleep problems, i.e., the intensity of the allergies worsens sleep patterns.&nbsp;People with allergies are at risk of developing obstructive sleep apnea.

&nbsp;

Sleep apnea is a sleep disorder that should be taken seriously. Your breathing repeatedly stops and starts. The symptoms are loud snoring and feeling tired after a full night&rsquo;s sleep.

The main types of sleep apnea are:

&nbsp;

<h5 dir="ltr">1. Obstructive Sleep Apnea&nbsp;</h5>

It is a common form and happens during the relaxation of the throat muscles.

&nbsp;

<h5 dir="ltr">2. Central Sleep Apnea</h5>

It occurs when proper signals are not sent to the brain by the muscle that controls breathing.

&nbsp;

<h5 dir="ltr">3. Complex Sleep Apnea Syndrome</h5>

This occurs when someone has both obstructive and central sleep apnea. It is also called treatment-emergent central sleep apnea.

&nbsp;

If you think you might have sleep apnea, see your doctor. Treatment can ease your symptoms and prevent other complications, e.g., heart problems.

&nbsp;

Although sleeping with allergies is tough, it is possible. You can follow the following tips to cope and sleep better:

&nbsp;

<ul>
	<li>Air Purifier</li>
</ul>

An air purifier clears your bedroom of common allergens and helps you sleep better. It is helpful for people without allergies, too.

&nbsp;

<ul>
	<li>
	<h5>Doors And Windows</h5>
	</li>
</ul>

Make sure the doors and windows of your house are always closed to prevent allergens from entering.

&nbsp;

<ul>
	<li>
	<h5>Dust-Free Environment</h5>
	</li>
</ul>

Pakistan is a very dusty country, and the house tends to accumulate dust. You should make sure that you clean and dust your house regularly to avoid the accumulation of debris. Avoid carpets because they trap dust very fast, and avoid keeping a lot of storage in your room. Dust traps very easily in old books, shoes, and clothes.

&nbsp;

<ul>
	<li>
	<h5>No Pets</h5>
	</li>
</ul>

If you have allergies, it is best to avoid keeping pets, but if you do have them, restrict them from entering your room. Moreover, make sure you wash your hands after touching them.

&nbsp;

<ul>
	<li>
	<h5>Change Your Clothes</h5>
	</li>
</ul>

During pollen season, change your clothes after coming home to avoid the trapped allergens from affecting you. Don&rsquo;t dry your clothes outside either. Try to dry them inside on hangers.

&nbsp;

<ul>
	<li>
	<h5>Allergy Medications&nbsp;</h5>
	</li>
</ul>

Speak to your doctor about taking allergy medications regularly to prevent allergies. Moreover, some allergy medicines also have sedatives, which help you sleep better and don&rsquo;t cause an addiction either.

&nbsp;

<ul>
</ul>

<ul>
	<li>Allergies worsen at night and can affect your sleep, which results in problems, e.g., fatigue during the day and trouble concentrating doing your daily tasks.</li>
	<li>Symptoms of allergic diseases such as allergic rhinitis, atopic dermatitis, and asthma can have a negative effect on the quality of sleep.</li>
	<li>When you have severe allergies, it can prevent you from sleeping well at night and affect your mood. It can also cause severe sleep disturbance, for example, sleep apnea.</li>
	<li>Hence, if you suffer from an allergic condition, or if your allergy is affecting your sleep, it is best if you talk to your physician. Therapy and lifestyle adjustments, along with medical care, can help you rest better.</li>
</ul>

&nbsp;

[1] Hirotsu, C., Tufik, S. and Andersen, M.L., 2015. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science, 8(3), pp.143-152

[2] Colten, H.R. and Altevogt, B.M., 2006. Extent and health consequences of chronic sleep loss and sleep disorders. Sleep disorders and sleep deprivation: an unmet public health problem, pp.55-135.

[3] Isolauri, E., Rautava, S. and Kalliomäki, M., 2004. Food allergy in irritable bowel syndrome: new facts and old fallacies. Gut, 53(10), pp.1391-1393.

[4] Koinis-Mitchell, D., Craig, T., Esteban, C.A. and Klein, R.B., 2012. Sleep and allergic disease: a summary of the literature and future directions for research. Journal of Allergy and Clinical Immunology, 130(6), pp.1275-1281.

[5] Slowik, J.M. and Collen, J.F., 2021. Obstructive sleep apnea. In StatPearls [Internet]. StatPearls Publishing.

Humza Khizer

Say Goodbye To Allergies: A Comprehensive Guide To Allergy Shots

Allergy shots, sometimes called allergen immunotherapy, allergy desensitization, or hypo-sensitization, increase a person&#39;s tolerance to the allergen over time. 
&nbsp;

Understanding Allergy Shots: A Complete Guide

Allergy shots introduce the allergen into the body&rsquo;s circulation over time. Doses are increased gradually to develop tolerance in the body. Consequently, it results in a less severe reaction. 
&nbsp;

The allergy shots are injected into the upper arm. They must be administered in two phases to produce an effective response<a href="#accordion">[4]</a>: 
&nbsp;

<ul>
	<li>
	<h5>Phase 1</h5>
	</li>
</ul>

The buildup phase usually lasts 3-6 months with shots being administered 1-3 times a week.

The amount of allergen in the shots gradually increases until the patient achieves the maintenance dose, which is the maximum amount that may be administered without significantly affecting the patient&#39;s condition. 
&nbsp;

The building phase can sometimes be completed more quickly. This is known as rush immunotherapy. However, this method calls for multiple injections with increasing doses during each doctor&#39;s appointment.

While this shortens the time it takes to enter the maintenance phase and experience relief from allergy symptoms, it also increases the likelihood that the person experiences a severe reaction. 
&nbsp;

<ul>
	<li>
	<h5>Phase 2</h5>
	</li>
</ul>

The maintenance dose is administered regularly, often once monthly for 3-5 years.

Note: Stay in your doctor&#39;s office for 30 minutes after each shot to assess if your body has an adverse reaction and deal with it. 
&nbsp;

Allergies are thought to cause around 50% of adult asthma cases and 80% of pediatric asthma cases<a href="#accordion">[5]</a>. 
&nbsp;

Generally, people who are susceptible to inhalation allergens and insect venoms typically respond best to allergy injections. However, those with the following conditions may take allergy shots:

<ul>
	<li>Allergic rhinitis</li>
	<li>Allergic asthma</li>
	<li>Eye allergies or allergic conjunctivitis</li>
	<li>Allergies to some insect bites, especially bees or some stinging insects</li>
	<li>Atopic Dermatitis<a href="#accordion">[6]</a> 
	&nbsp;</li>
</ul>

Also, people can opt for allergy shots if:

<ul>
	<li>They want to reduce their long-term medication use</li>
	<li>They feel their medications are not controlling their symptoms effectively</li>
	<li>They feel their medications have bothersome side-effects 
	&nbsp;</li>
</ul>

Kids above the age of 5 are given allergy injections. Younger children may be unable to express any potential adverse effects or pain that would call for discontinuing the therapy. 
&nbsp;

Additionally, allergy injections are not advised for:

<ul>
	<li>Pregnant women</li>
	<li>Severe asthmatic patients</li>
	<li>Heart disease patients 
	&nbsp;</li>
</ul>

<ol>
	<li>
	Reduces Allergic Symptoms
	</li>
</ol>

Allergy shots alleviate allergic symptoms, like sneezing, itching, and runny nose. 
&nbsp;

<ol start="2">
	<li>
	Long-Lasting Results
	</li>
</ol>

Allergy shots can be effective long after the therapy ends. In some situations, they can even be permanent. 
&nbsp;

<ol start="3">
	<li>
	Safe And Effective
	</li>
</ol>

Allergy injections are thought to be both safe and efficient for the majority of allergy sufferers. 
&nbsp;

<ol start="4">
	<li>
	Cost-Effective
	</li>
</ol>

Allergy shots are a more affordable option when compared to other types of allergy treatment, such as over-the-counter drugs. 
&nbsp;

<ol start="5">
	<li>
	Prevents Future Allergic Reactions
	</li>
</ol>

Allergy shots can reduce the necessity for other allergy treatments by developing a tolerance to the allergen and preventing future allergic reactions. 
&nbsp;

While allergy shots are pretty harmless for most, they can trigger an adverse reaction in a few people. 
&nbsp;

<h5>Local Reaction</h5>

<ul>
	<li>Local reactions at the injection site include redness, swelling, or irritation. These often appear a few hours after injections. They usually last for a brief period and go away on their own. 
	&nbsp;</li>
</ul>

<h5>Systemic Response</h5>

<ul>
	<li>Systemic responses occur less frequently, but they&rsquo;re more serious. They include hives, nasal congestion, and sneezing. More severe reactions include tightness in the chest, wheezing, and swollen throat. 
	&nbsp;</li>
</ul>

<h5>Anaphylaxis</h5>

<ul>
	<li>Anaphylaxis is a rare but potentially fatal reaction to allergy injections. It usually starts within 30 minutes of the injection and causes low blood pressure and breathing problems. 
	&nbsp;</li>
</ul>

Women are often advised against beginning allergy injections while pregnant.

However, in case a woman already taking her allergy shots becomes pregnant, doctors usually suggest continuing the allergy shots, with some changes to the dosage to avoid the risk of side effects. 
&nbsp;

Note: It&#39;s crucial to speak with a doctor about the best method to handle allergy symptoms if they appear during pregnancy. 
&nbsp;

<ol>
	<li>
	<h5>Age Requirements</h5>
	</li>
</ol>

Allergy shots can be administered to five-years-old, as long as their general health allows it. 
&nbsp;

<ol start="2">
	<li>
	<h5>Dosage</h5>
	</li>
</ol>

The dose is set according to their age as well as weight. Doctors usually request regular visits to track the child&rsquo;s development and modify the dosage as necessary. 
&nbsp;

<ol start="3">
	<li>
	<h5>Compliance</h5>
	</li>
</ol>

It is challenging for a child to adhere to the allergy shot schedule or to take the appropriate precautions, like limiting exposure to the allergens, after the dose. Children get the due care and treatment given the caregiver and doctors monitor them closely. 
&nbsp;

<ol>
	<li>
	<h5>Dosage</h5>
	</li>
</ol>

Adults often receive a higher dosage of allergens in regular allergy shots than children due to their weight and greater tolerance for the medication. 
&nbsp;

<ol start="2">
	<li>
	<h5>Compliance</h5>
	</li>
</ol>

In contrast to children, adults can stick to the allergy injection schedule and take the appropriate measures. However, some individuals can find it challenging to follow the prescribed course of action, especially if they have a hectic schedule or cannot see the allergist frequently. 
&nbsp;

<ol start="3">
	<li>
	<h5>Workplace Considerations</h5>
	</li>
</ol>

Adults receiving allergy shots need to consider how the treatment may affect their workflow, including the time needed for doctor visits and any potential shot adverse effects. 
&nbsp;

Conclusion

Allergy shots can offer long-lasting relief from symptoms. Even though they are considered an effective and safe technique to manage allergies in children and adults, allergy shots can be risky. Discuss the pros and cons with a medical professional before beginning therapy. 
&nbsp;

Key Takeaways

<ul>
	<li>Immunotherapy, sometimes called allergy shots, is a long-lasting form of treatment for allergies.</li>
	<li>Allergy shots gradually increase the body&#39;s tolerance to allergens, such as pollen, dust mites, and animal dander.</li>
	<li>Allergy shots don&#39;t work instantly and take years of commitment for results.</li>
</ul>

[1] Worm M, Lee H-H, Kostev K. Prevalence and treatment profile of patients with grass pollen and house dust mite allergy. JDDG J der Dtsch Dermatologischen Gesellschaft. 2013;11(7):653–61.

[2] Fornadley J. Allergy immunotherapy. Otolaryngol Clin North Am. 1998;31(1):111–27.

[3] Dinsmoor R. Allergy shots: Taking the sting out of allergic asthma. Asthma Mag. 2001;6(3):14–6.

[4] Allergy shots. Mayo Clinic

[5] Akar-Ghibril N, Casale T, Custovic A, Phipatanakul W. Allergic Endotypes and Phenotypes of Asthma [published correction appears in J Allergy Clin Immunol Pract. 2020 May;8(5):1779]. J Allergy Clin Immunol Pract. 2020;8(2):429-440. doi:10.1016/j.jaip.2019.11.008

[6] Persaud Y, Memon RJ, Savliwala MN. Allergy Immunotherapy.

Neelam Asad

Medilink Consultant clinic

Saad Ullah Siddiqui

Latex Allergy FAQs

Natural latex rubber is a substance acquired from the sap of the rubber tree Hevea Brasiliensis. Although used interchangeably, natural latex rubber should not be confused with the variety of synthetic rubbers that are commonly referred to as &ldquo;latex.&rdquo; 
&nbsp;

Latex allergy is the overreaction of your body to a protein found in natural latex rubber. Synthetic rubbers don&rsquo;t release the proteins that trigger <a href="https://merisehat.pk/disease/allergies">allergic</a> responses. 
&nbsp;

Understanding Latex Allergy

Latex allergies are very uncommon for e.g. less than 1% of Americans suffer from latex allergy<a href="#accordion">[3]</a>.

While the incidence rate had always been pretty low, it spiked in the 1980s when a majority of healthcare professionals began using powdered latex gloves to prevent infections.

However, the frequency of new cases dropped again in the 1990s when they were introduced to gloves that were either made out of synthetic latex and/or were powder-free<a href="#accordion">[1]</a>. 
&nbsp;

A reaction can be set off if you come into physical contact with latex. Similarly, latex particles that are released into the air when latex gloves are removed can trigger a response when they&rsquo;re inhaled. 
&nbsp;

What is this allergic response? Let&rsquo;s see:

<ul>
	<li>As soon as your skin comes into contact with latex, it sets the alarm bells ringing.</li>
	<li>Your immune system starts a chain reaction to protect itself from the allergen.</li>
	<li>The immune system marks the allergen as harmful.</li>
	<li>This results in the release of antibodies called immunoglobulin E (IgE), which react with the proteins found in natural rubber latex.</li>
	<li>The defensive attack produces symptoms varying from mild to life threatening. 
	&nbsp;</li>
</ul>

There are 3 types of allergic reactions to latex<a href="#accordion">[2]</a>.

<ol>
	<li>
	<h5>IgE-Mediated Allergy (Type I)</h5>
	</li>
</ol>

Also known as latex hypersensitivity<a href="#accordion">[7]</a>, this is an immediate and most serious reaction to latex. It is caused by direct contact of the latex products with your skin and the mucosal surface (e.g., mouth, nose, eyes) as well as inhalation of latex particles. The IgE antibodies, which are produced as a result of latex exposure, attach to the antigen and start a chain of reactions, including the release of histamine and other inflammatory chemicals.

Latex allergies caused by IgE are rare but fatal. Symptoms include nasal allergy, rapid heartbeat, trouble breathing, and chest pain. 
&nbsp;

<ol start="2">
	<li>
	<h5>Cell-Mediated Contact Dermatitis (Type IV)</h5>
	</li>
</ol>

Also known as allergic contact dermatitis, this type of allergy is a delayed immunological response to your exposure to latex. It often causes skin inflammation and irritation. &nbsp;While cell-mediated contact dermatitis does not pose a life-threatening risk, it can be extremely uncomfortable and, in rare instances, proceed to IgE-mediated latex allergy<a href="#accordion">[3]</a>. 
&nbsp;

Symptoms, including a rash along with oozing blisters or papules, present themselves 24-48 hours after exposure. If there is repeated exposure to the allergen, the condition becomes chronic &ndash; it is no longer just confined to the point of contact and it also lasts longer. 
&nbsp;

<ol start="3">
	<li>
	<h5>Irritant Contact Dermatitis</h5>
	</li>
</ol>

If you frequently come in contact with rubber items as part of your routine, you are vulnerable to this type of reaction. In fact, it&rsquo;s not even a reaction; it&rsquo;s mainly dryness, scaling, itching, and other skin issues that make it the least threatening type.

This is because it is brought on by repeated skin washing, perspiration, and/or irritation from lubricants rather than the immune system sensitisation witnessed in the allergic response. As a result, the rash is itchy and often dry and red. There can be skin cracks, but an outbreak of oozing papules or blisters is rare. Also, the rash never goes past the point of contact. 
&nbsp;

A latex allergy can cause mild or severe symptoms<a href="#accordion">[3][5]</a>.&nbsp;From swollen lips due to latex balloons to vaginal irritation due to latex condoms, if you are allergic to latex, your skin can easily become inflamed after it touches latex.

This rash may or may not spread to other parts of your body. Similarly, there&rsquo;s no fixed time for symptoms to manifest; they can emerge immediately after you&rsquo;re exposed to latex or they can take a while.

Then there are some people who don&rsquo;t experience any symptoms the first time they come into contact with latex so it&rsquo;s possible that you present with one or more of the following signs after repeated exposure:&nbsp;

<ul>
	<li>Wet or itchy eyes</li>
	<li>Difficulty breathing, may be accompanied with wheezing or whistling sound</li>
	<li>Hives or skin lumps that are swollen and itchy 
	&nbsp;</li>
</ul>

In case you develop a severe latex allergy, you can develop anaphylactic shock. It causes difficulty breathing, chest constriction, and swelling of the tongue or throat. It occurs suddenly and progresses quickly. This is a medical emergency and anyone experiencing these signs needs to be rushed to a hospital.

Note: Serious reactions require immediate emergency care. 
&nbsp;

Anybody can acquire a latex allergy, so that means you are at risk irrespective of your circumstances. However, some people are more prone to it than others. 
&nbsp;

<ul>
	<li>
	<h5>Latex Exposure On A Regular Basis</h5>
	</li>
</ul>

Regular exposure to latex triggers an allergic response. If you use latex gloves regularly, like those who work in the healthcare and beauty industries do, then you are more likely to develop a latex allergy. 
&nbsp;

<ul>
	<li>
	<h5>Frequent Surgical Procedures </h5>
	</li>
</ul>

Medical supplies that are used for various operations, such as rubber gloves and catheters, have latex. Additionally, if you have undergone a lot of operations as a child or even as an adult, you are more likely to acquire a latex allergy. For example, spina bifida requires several surgeries and medical treatments at a young age; therefore, children with the condition are susceptible to latex allergy. 
&nbsp;

<ul>
	<li>
	<h5>History Of Allergies</h5>
	</li>
</ul>

A latex allergy frequently coexists with other allergies, such as allergic rhinitis or hay fever. Bananas, kiwis, and chestnuts are some of the foods that you can be allergic to if you have latex allergy. You should also avoid vegetables, including potatoes and carrots, since they can trigger a reaction as well. This is known as &quot;latex-food syndrome.&quot; 
&nbsp;

There are so many products &ndash; everyday items &ndash; that are made out of latex and that you should avoid at all costs<a href="#accordion">[4][5]</a>:

<ul>
	<li>At Hospital &ndash; Surgical and examination gloves, bandages, catheter, blood pressure cuffs, stethoscope, IV tubing injection sites, wheelchair tires, electrode pads, and adhesive tape</li>
	<li>At Home &ndash; Dishwashing gloves, rubber bands, condoms, undergarments, diapers, water hoses, mattress, bath matt, baby pacifiers, rain boots, raincoats, and socks</li>
	<li>At School &ndash; Lab goggles, spandex swimsuit, erasers, adhesive tape, and paint</li>
	<li>At Restaurants &ndash; Latex gloves used during food preparation and cleaning tables 
	&nbsp;</li>
</ul>

There are always alternatives that you can use instead of risking an allergic reaction. For instance, you can use items made out of plastic, silicone, or vinyl. 
&nbsp;

Around 30-50% of persons who are allergic to latex also experience reactions when they consume, touch, or even smell particular foods<a href="#accordion">[7]</a>.&nbsp;It&rsquo;s called a cross-reaction and it occurs because some of the proteins in fruits and vegetables are structurally similar to the proteins that are responsible for latex reactions. 
&nbsp;

If you are allergic to any of the following foods, you may be allergic to latex without knowing it. The list includes: avocado, banana, celery, cherry, chestnut, fig, grape, hazelnut, kiwi, melon, nectarine, papaya, peach, pineapple, plum, potato, rye, strawberry, tomato, wheat, almonds, peppermint, and mustard.

Inform your dentist and doctor so they do not expose you to latex during your treatments for other ailments. It&rsquo;s also important to inform the chef at any restaurant you chose to dine at to wear latex-free gloves. 
&nbsp;

Your doctor will check you and inquire about your symptoms and latex exposure. They&rsquo;ll also ask you about any other allergies, particularly food sensitivities, that you have. Inform your health care provider if you are aware of any cases of allergies in your family<a href="#accordion">[3]</a>.

Your doctor will request a blood test to determine whether you are allergic to latex. They can also order a skin prick test, which is another method to identify latex allergies. 
&nbsp;

<h5>What Is A Skin Prick/Scratch Test?</h5>

Your healthcare professional will apply a little quantity of latex to your skin, often on your forearm or back. They will then prick or scratch it so that a small amount of latex penetrates the skin&#39;s surface. If you have a latex allergy, your skin will respond in 15-30 minutes. The region will get red, irritated, or develop wheals which shows that your immune system is reacting.&nbsp; 
&nbsp;

Unfortunately, there is no cure for latex allergy. Avoiding contact with latex is all you can do to prevent a reaction from occurring. If you have a mild reaction to latex, your doctor may recommend a course of antihistamines, corticosteroids, or hydrocortisone cream. For a more severe reaction, they may advise epinephrine, IV fluids, and constant vigilance by a medical professional<a href="#accordion">[7]</a>.

Note: Always consult a board-certified allergist for treating a latex allergy. 
&nbsp;

If you are already allergic to latex, you should<a href="#accordion">[6]</a>:

<ul>
	<li>Always keep your medical alert bracelet on</li>
	<li>Carry your own gloves, preferably nitrile or vinyl, and avoid latex ones</li>
	<li>Have a twin-pack of epinephrine auto-injectors on hand always, especially if you have ever suffered anaphylaxis</li>
	<li>Inform all medical personnel of your allergy</li>
	<li>Keep a card with you that details your history of latex allergy and lists your doctor&#39;s phone number in case of an emergency 
	&nbsp;</li>
</ul>

<ul>
	<li>Natural latex rubber is a substance acquired from the sap of the rubber tree Hevea Brasiliensis. Latex allergy is the overreaction of your body to a protein found in natural latex rubber.</li>
	<li>The development of latex allergy typically occurs after prolonged contact to medical and consumer goods that include natural rubber latex.</li>
	<li>Types of latex allergies are: IgE-mediated allergy (type1), cell mediated contact dermatitis (IV), and irritant contact dermatitis.</li>
	<li>Signs and symptoms of latex allergy vary from mild to severe and life threatening.</li>
	<li>It can either be caused by direct contact or through inhalation of the irritant.</li>
	<li>Diagnosing latex allergy requires taking history, performing a physical exam, and laboratory and clinical testing.</li>
	<li>There is no treatment, but symptoms can be reduced by corticosteroids, antihistamines, and epinephrine.</li>
	<li>People with food allergies can have latex allergies too and be unaware of it.</li>
	<li>Prevention is possible only by avoiding the use of latex products. 
	&nbsp;</li>
</ul>

[1] Latex allergy. American Academy of Allergy Asthma & Immunology.

[2] Complete Guide to Latex Allergy. Allergy & Asthma Network.

[3] Latex allergy: What it is, symptoms, prevention. Cleveland Clinic.

[4] Where in the world is latex? Allergy & Asthma Network.

[5] Latex allergy. Latex Allergy | Johns Hopkins Medicine.

[6] Latex allergy and covid-19: What you need to know. Allergy & Asthma Network.

[7] Latex allergy: Symptoms, diagnosis, types, treatment, prevention. WebMD.

Mariam Chughtai

Climate change threatens public health tremendously. Although every individual&rsquo;s health is at risk, some groups of people are at a greater risk than others. For example, people who suffer from chronic diseases, like <a href="https://www.merisehat.pk/disease/asthma">asthma</a>, and allergies. Furthermore, people living in slums or lower-socioeconomic communities, senior citizens, pregnant women, and children are at a higher risk compared to healthy young individuals.

The Asthma and Allergy Foundation of America (AAFA) has highlighted some ways climate change affects seasonal allergies in their 2022 Allergy Capitals report, which are as follows:&nbsp;

<ul>
	<li>A cycle is created because of climate change. The global temperature rises, which makes extreme events even worse. The airflow becomes stagnant because of weather changes. This means that the air doesn&rsquo;t move, increasing the ground-level ozone, which is a major reason behind urban smog.</li>
	<li>The air pollution and smog increase the carbon dioxide and that causes the temperature to rise further, re-starting the cycle.</li>
</ul>

&nbsp;

Understanding Link Between Global Warming And Allergies

When the temperature is warmer and there is an increase in atmospheric carbon dioxide, the plants have longer growing seasons. Their flowering time changes because of this, giving them a chance to create pollen for a longer period. Moreover, the impact of climate change is stronger in urban areas with warmer temperatures and extreme heatwaves. This effect is called the urban heat island (UHI).&nbsp;

UHIs have higher temperatures compared to their surroundings because of more buildings, roads, populations, and less greenery. Hence, at risk people are more susceptible to higher rates of allergies and asthma.&nbsp;

Millions of people already suffer from allergic rhinitis, which is seasonal and the major cause behind it is pollen allergies. If there is a worsening change in the climate count and pollen count, air pollution will get worse. The cycle of climate change is very dangerous and needs to be stopped.

<h5 dir="ltr">&nbsp;</h5>

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Rise In Seasonal Allergies</h5>
	</li>
</ul>

People who suffer from allergies dread the first few warm days of spring because the air fills with pollen from blooming flowers and trees. Furthermore, the climate becomes hotter, and the dreadful season becomes longer.

Higher temperatures worsen allergies<a href="#accordion">[1]</a>. According to research, the spring bloom comes at least forty days sooner if the greenhouse gas emissions remain high. Furthermore, during fall, the grass can release pollen for nineteen days more than usual.&nbsp;

The rise in temperature can also cause some plants, for example, oak and cedar to release pollen, which means the allergy attacks and asthma attacks in people increase. 10% to 30% of the people around the world have pollen-related allergies<a href="#accordion">[2]</a>. Moreover, worldwide sensitisation to IgE antibodies is around 40% of people.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Springtime Blooming Of Flowers Is Earlier</h5>
	</li>
</ul>

Temperature is one of the main blooming signals for most plants, which is usually the warmer spring season. During fall, many of the weeds produce pollen till the winter chill starts and these tiny grains are everywhere in the air or carried around by insects. And, for humans, this means allergies, asthma attacks, and visits to the ER due to the severity of their allergic symptoms.

Some of the plants also get boosted because of higher carbon dioxide in the atmosphere, as it acts as a fertilizer. It makes the plants grow bigger and the plants also release more pollen. Although the effects are uncertain, a limited number of plants are affected by high levels of carbon dioxide.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Worsening Allergy Season</h5>
	</li>
</ul>

People with allergies are already suffering and experiencing the multiple drastic effects of climate change. Some studies have proven that pollen season has become twenty days longer between the years 1990 to 2018<a href="#accordion">[3]</a>.

Another study has shown that there is also an increase in medical costs per year due to seasonal allergies because pollen has many health consequences for several people. In addition, there are many non-intuitive effects too, for example, losing productivity at work, daily performance, and going about everyday chores.&nbsp;

Climate change can also cause unexpected allergies in some people because when the temperature becomes hotter earlier, plants grow in new locations. Moreover, ragweed will migrate more towards the north because the environment is more suitable. Hence, the timing of allergy season and the location will shift.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Increase In Pollen Allergies</h5>
	</li>
</ul>

The dust-like grains that grass and plants produce are pollen. They contain male genetic material that reproduces the plants. The amount of pollen produced is dependent on the growth of the plant. Rising temperature will cause the growth of plants to boost in many areas and this has a great effect on pollen production. However, the temperature is not the only thing of relevance. A rise in carbon dioxide emission is a bigger driver for the increase in pollen in the future.

As the temperature is becoming higher, the growing season will extend and give plants more time for pollen reproduction and emission. Photosynthesis is fuelled by carbon dioxide, which makes the plants grow bigger and more pollen is produced. It has been found that pollen will have a greater impact on the increase in pollen in contrast to high temperatures in the future.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Regional Variation In Pollen Changes</h5>
	</li>
</ul>

After looking at fifteen different pollen types, it was concluded that pollination starts from leafy deciduous trees during the later winters and spring. The three top trees that cause allergies are the following:

<ol>
	<li>Alder</li>
	<li>Birch</li>
	<li>Oak</li>
</ol>

<div>
<div class="container" style="max-width:1320px; padding:0px; width:966.007px">
<div class="content">
<div>
Other trees that can cause allergies include mulberry and many others. The grasses come out during the summers, and it is followed by ragweed in the late summers.&nbsp;

It has also been found that pollen season for a lot of the trees in the Northeast will overlap because there will be a rise in temperature and carbon dioxide emission. This means that unlike before when oak would pollinate first followed by birch pollination, the pollen season will overlap and there is no fixed order for it.

Moreover, in general, the pollen season will move more towards the north instead of the south, because there is a larger increase in temperature in the northern areas.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr" style="margin-left:0px !important; margin-right:0px !important">Improved Pollen Forecast</h5>
	</li>
</ul>

The forecast for pollen has a very broad estimate currently and part of the problem is that there aren&rsquo;t many stations for observing pollen counts, especially in third world countries like Pakistan. However, it is important to mention that the&nbsp;Pakistan Meteorological Department&nbsp;does update a daily pollen count for Islamabad, but the information on other cities is limited. Moreover, there aren&rsquo;t any allergy clinics in Pakistan, but this problem is present even in the US, where some states do not have any allergy clinics.

Measuring different types of pollen is a very labor-sensitive job, as a result, the forecast is usually very uncertain. Furthermore, they are mostly based on the part of the station the observation is being done and the weather forecast too.

&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr" style="margin-left:0px !important; margin-right:0px !important">Integrated Pollen Forecast</h5>
	</li>
</ul>

If a proper model is integrated into forecasting, the pollen forecast will improve. Satellite data will be able to provide an estimate of the ground surveys.&nbsp;

In addition, the influence of temperature when pollen comes out is called the phenology of pollen. This information can be used in combination with meteorological factors, for example, wind, precipitation, and humidity, to figure out the mechanism of how pollen gets into the air. The atmospheric models show how it blows and moves around for creating real-time forecasts.&nbsp;

<h5 dir="auto">&nbsp;</h5>

All the information can be used to see where pollen may be in space or in time. This will help people dealing with allergies know what is going to be happening in their area.

&nbsp;

&nbsp;
</div>
</div>
</div>
</div>

There will be a few limitations. For example, scientists are still not aware of the long-term projections of pollen<a href="#accordion">[4]</a>. They don&rsquo;t even know why some plants produce more pollen during some years compared to other years. There is no way to include this in models either. Furthermore, it is not fully clear how plants respond to very high carbon dioxide levels.

&nbsp;

A study conducted in 2021 found that the overall pollen season is twenty days longer in the United States compared to the year 1990. Moreover, the pollen concentrations were increased by up to 21%<a href="#accordion">[5]</a>. The impact of pollen will be much higher in the future, and it will not just be limited to headaches and sniffles. Seasonal allergies influence 30% of the population, while also placing a huge burden on the healthcare system and society at large.&nbsp;&nbsp;

&nbsp;

Climate change is an environmental problem and a threat to public health. Although the governments of most countries have plans to reduce this problem, allergy season can get worse because of rising temperatures. It can also become longer, which can cause more allergies and asthma attacks. So, people need to take the necessary preventions to avoid getting affected.

The following steps can be taken if you have severe allergies:

<ul>
	<li>Contact your doctor and ask them for advice on antihistamines, and other over-the-counter allergy medications. If you have asthma and severe allergic reactions, get treatment accordingly.</li>
	<li>Check the air quality index before leaving your house to see the pollution in the air. This will ensure you are protected before you go outside.</li>
</ul>

&nbsp;

[1] Zhang, Y. and Steiner, A.L., 2022. Projected climate-driven changes in pollen emission season length and magnitude over the continental United States. Nature communications, 13(1), pp.1-10.

[2] Schmidt, C.W., 2016. Pollen overload: seasonal allergies in a changing climate.

[3] D’Amato, G., Chong‐Neto, H.J., Monge Ortega, O.P., Vitale, C., Ansotegui, I., Rosario, N., Haahtela, T., Galan, C., Pawankar, R., Murrieta‐Aguttes, M. and Cecchi, L., 2020. The effects of climate change on respiratory allergy and asthma induced by pollen and mold allergens. Allergy, 75(9), pp.2219-2228.

[4] Kurganskiy, A., Creer, S., De Vere, N., Griffith, G.W., Osborne, N.J., Wheeler, B.W., McInnes, R.N., Clewlow, Y., Barber, A., Brennan, G.L. and Hanlon, H.M., 2021. Predicting the severity of the grass pollen season and the effect of climate change in Northwest Europe. Science Advances, 7(13), p.eabd7658.

[5] Anderegg, W.R., Abatzoglou, J.T., Anderegg, L.D., Bielory, L., Kinney, P.L. and Ziska, L., 2021. Anthropogenic climate change is worsening North American pollen seasons. Proceedings of the National Academy of Sciences, 118(7).