Living with allergies: When even hot water harms

Dr Kuljit... Those with allergic emergencies require immediate hospital treatment or an injection.

It's never fun when you always have to scrutinise the ingredients of your meals, or avoid places and substances that cause your body system to react sensitively or negatively.

Yet these are some of the precautionary measures for people with allergies - the problematic reactions that can manifest in such symptoms as skin inflammation, or even breathing difficulties in more severe case scenarios.

For Melanie (not her real name), her allergy problem only surfaced when she was about 28 years of age. It was back in 2006, where she led a hectic work life in a shopping mall that demanded much of her attention.

During that period, she was also doing her part-time professional diploma course with Universiti Malaya.

"All of a sudden, I discovered an outbreak of rashes (hives) all over my body," recalls Melanie, who says she is today adverse to soy-based foods, beans (red bean, green bean and mungbeans used in Chinese bak chang or dumplings, which she considers the worst) and oats.

"I used to be allergic to nuts and eggs in 2006, but eventually outgrew it."

Her allergy would usually manifest as itch and hives, but if not properly controlled, the affected area would turn into eczema, which she says takes a longer time to heal.

"The worst part of this allergy is the breathing difficulties I encountered."

She has paid a few visits to general practitioners and specialists and consumed countless amounts of medications in an effort to tackle her allergies.

"The doctor's advice to me is to control my food intake, reduce my stress level, and lead a better lifestyle. It can become really bad if I don't handle those areas well.

"There were several times when I had to go to the clinic immediately for jabs to control the allergy, even in the middle of the night. There have also been nights that I could not even sleep, or were at times awoken by the itch.

"Emotionally, it does affect me."

Besides needing to screen her food intake now - which she says can be an arduous task as she always has to inform the waiters who take her food orders - Melanie also has to ensure she lives in a primarily clean and dust-free environment.

"There are times that I tend to forget I'm allergic to this and that and I would suffer at the end of the day. Over time, my family and friends who learnt of my allergies would help remind me or do my (food) ordering.

"Out of desperation, and at doctors' recommendation, I've resorted to taking IV vitamin C in high dosage as a supplement, which has helped me quite a fair bit."

Soy and beans aside, Melanie also cites tuna and most seafood as her allergens. If she is in a function with no chance of avoiding this kind of food, she will take an antihistamine tablet half-an-hour before the dish is served.

And hot water is a no-no for her too as it will aggravate the siutation. Playing outdoor sports on grass will also trigger her allergy, so maintaining a certain standard of hygiene is of outmost importance to her.

In the case of Wendy, her 15-month-old goddaughter started developing allergies a few weeks ago after consuming sweet potatoes. About two to three hours after the intake, the toddler developed rashes, swollen eyes and redness on her forehead and neck areas.

"She was given regular food like fish congee and milk powder all this while and only recently fed with sweet potatoes. After seeing her allergic reaction to it, her parents dare not even let her have any potatoes at all since," says Wendy.

Ramachandran, whose sister is allergic to alcohol, says the family first realised her sensitivity when they threw an 18th birthday party for her. At that time, she began burning up with rashes all over, starting from her arm area.

"She burns up very quickly whenever her allergy comes," he says. "We have taken her to a doctor, and she's under medication, but the best is for her not to consume any alcohol.

"She also always carries her antihistamines as a precaution these days, and is very particular with her food."

Datuk Dr Kuljit Singh, a consultant ENT specialist who has a deep interest in allergies, says based on his own experience in treating patients and conducting research studies for the past 10 years, allergies occur due to multiple factors.

"An allergy isn't something that you can contract overnight, like getting into contact with something and you suddenly become allergic.

"Allergies are built as part of your biological system from birth and people usually develop certain kinds from young, which can be as early as two years old or earlier.

"It persists through adulthood and only when you reach the age of 50 or 60, that the symptoms show signs of reduction, marking the tail-end of your allergy.

"This natural progression is called the allergic march," he says.

He cautions, however, that allergies can in fact start at any age, even manifesting only during one's adulthood.

He adds that there are different groups of patients he has seen so far. "There's a small group who previously had no allergies at all, but one day, an allergy blows up when they consume something.

"There are people who are always allergic to particles like dust mites that can trigger persistent runny nose, for example. Some allergic reactions are so bad that it can go on to trigger asthma, or worse.

"Those with allergic emergencies require immediate hospital treatment or an injection. For young kids, a paediatrician is able to detect the allergy, and parents too need to look out for items like maybe soft toys or even milk that can be the cause of the allergy," he says, adding that detection and prevention measures are all trial and error-based.

Adults, he adds, could have skin or allergy tests done.

He cautions however, that once sensitisation to the allergens becomes bad (sensitisation is production of an antibody to counter the allergen), one can run the risk of becoming hypersensitised.

In layman terms, hypersensitivity is when the body has been primed to an allergen, thus its readiness to react on contact. It is also known as hypersensitivity reaction, which are undesirable reactions produced by the normal immune system.

"These reactions may be uncomfortable, damaging or occasionally fatal. Hypersensitivity reactions would require a pre-sensitised (immune) state of the host," he says. "It's tough to avoid hypersensitivity but desensitisation can be done with immunotherapy."

Meanwhile, the Malaysian Society of Allergy and Immunology (MSAI) president Dr Amir HA Latiff states that the common foods causing allergies are cow's milk, egg white, peanut, wheat, peanuts and tree nuts, fish and shellfish, and soya.

He says the prevalence of food allergies differ from country to country, and while allergy-inducing foods other than the aforementioned are generally less common, there has been an increasing trend of food allergies worldwide in the last few years.

"The exact cause with regard to this surge isn't well established at the moment, but the risk factors postulated (to increase the risk of food allergy) include genetic risks, association with atopy (for example, atopic eczema), and the hygiene hypothesis," says Dr Amir, who is also a consultant paediatrician and consultant clinical immunologist/allergist.

When asked about the kind of allergies that people develop other than food allergies, he explains that allergies have many clinical presentations.

They can manifest as eczema/dermatitis, allergic rhinitis and allergic asthma (the latter two are often referred to as respiratory allergies).

Other known allergies, adds Dr Amir, are drug allergies (especially antibiotics and anaesthetic agents), insect sting allergies (from wasp or bee), and latex allergy.

"Then, there's anaphylaxis, a severe life-threatening allergic reaction that may result in fatality."

Dr Amir says the actual statistics for Malaysians diagnosed with allergies are rather sparse and were mainly reported in the late 1990s or early 2000 - mostly for respiratory allergies and eczema.

"The data is available in the World Allergy Organisation White Book on allergy, in the survey report of society members (MSAI is one of the 93 members of the organisation).

"What's urgently needed are new statistics, particularly where food allergy and atopic eczema are concerned," he says.

As part of MSAI's efforts to generate greater awareness about allergies and other immune-mediated diseases, public forums have been organised almost yearly for the past 13 years.

The forum is held during MSAI's annual congress, which involves international and local speakers, apart from ongoing activities like round-table discussions and symposia throughout the year. These are organised in different states to keep doctors updated on allergy.

A support group by MSAI is not available yet, but it will likely be in future works.