STERLING

PAPERBACKS
An imprint of
Sterling Publishers (P) Ltd.
A-59, Okhla Industrial Area, Phase-II,
New Delhi-110020.
Tel: 26387070, 26386209; Fax: 91-11-26383788
E-mail: sterlingpublishers@airtelmail.in
ghai@nde.vsnl.net.in
www.sterlingpublishers.com

5 Steps to Combat
Asthma and Allergies
2010, Dr. Anjali Arora
arora_doc@hotmail.com
ISBN 978-81-207-4920-7
E-ISBN 978-81-207-9042-1

The author wishes to thank all academicians, scientists and writers who have been a source of
inspiration.

The author and publisher specifically disclaim any liability, loss or risk, whatsoever, personal or
otherwise, which is incurred as a consequence, directly or indirectly of the use and application of any
of the contents of this book.

All rights are reserved.
No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any
form or by any means, mechanical, photocopying, recording or otherwise, without prior written
permission of the author.

Printed and Published by Sterling Publishers Pvt. Ltd.,
New Delhi-110020.

Contents
1. Allergy: Type and Treatment
2. Histamine and Histamine Releasing Foods
3. Insect Allergy and Anaphylaxis
4. Drug Allergy: An Overview
5. Asthma: Its Management and Treatment
Myths and Fact File

Find out the level of your awareness about allergy and asthma.
1. If a rash appears and disappears over a period of time
a. It may be chicken pox
b. Rash
c. It may be prickly heat
2. You are allergic to hair dye
a. There is no itching after application
b. There is itching behind ears and nape of neck after 24 hours of application
c. There is itching after two months of application
3. Continuous coughing in an asthmatic throughout the day and night can lead to
a. Whooping cough
b. Status asthmaticus
c. Allergy
4. Air pollution can be due the presence of one of the following gases
a. Oxygen
b. Nitrous oxide
c. Manganese oxide
Answer the above questionnaire and the more you answer (b), the more knowledgeable you are about
this problem.

1 Allergy: Type and Treatment

Anything which enters the body is foreign to it. The list is endless starting from your food, drinks to
cosmetics and even medication.
The immune system deals with these foreign substances continuously. It is only when an allergic
substance comes in contact with the body that it reacts to suppress or eliminate it. This allergic
reaction may be in the form of mucous secretion, itching, or eruption. The foreign substances activate
the immune system in order to fight and protect the body.
An immune system which is deficient provides a lower defense mechanism than required. On the
other hand, a hypersensitive reaction occurs when the body overreacts to certain substances.
Allergy is a disorder of the immune system. It is also called atopy. Allergic reactions can occur due
to the presence of certain substances known as allergens. Common allergic reactions include eczema,
hives, hay fever, asthma and food allergies. Reactions to the venom of stinging insects such as wasps
and bees are also allergic in nature.
All over the world mild allergies like hay fever, conjunctivitis, itching and a running nose are
highly prevalent among human beings. Similarly, conditions such as asthma are common. In an
asthmatic attack, the body reacts by releasing mucous. It also causes constriction which can be
between a gentle wheeze and a tight feeling which can make breathing very difficult. Asthma can often
be accompanied with other problems like eczema. In some people, severe allergies to dietary
allergens, environment or medication may result in lifethreatening anaphylactic reactions.

Antibodies, Antigens and Immunoglobins

Antibodies
are found in the blood serum and are produced against foreign bodies (virus, bacteria).

Antigen
is a substance that causes the production of antibodies which act against the allergen.

Immunoglobins
is a scientific term for antibodies.

Immunoglobins are divided into five groups

IgE or Immunoglobulin E is the antibody responsible for allergic reactions.

Ig is the first to appear during an immune response but remains for a short period.
IgA is concerned with protection in the gut or mucosal surfaces. It is only present in a small quantity.
It is also available in sweat, saliva and tears.
IgG is the largest amount of antibody found in the body. It is present in response to the presence of
bacteria or virus. It also helps in blocking IgE from triggering an allergic response.
IgD responds against food antigens.

Allergic Reaction
Type I immediate or anaphylactic. This involves the presence of IgE immunoglobulin and the
release of powerful chemicals from the cells of the body. It is present in diseases like asthma and hay
fever.

Allergies Which Commonly Occur

Urticaria
It is also known as hives or nettle rash. The rash becomes worse on scratching. In urticaria the rash
can appear anywhere on the body. The rash appears as welts. The welts come in groups big or
small. The welts which spread over a large area of the body are referred to as giant urticaria.
Angioedema is the twin condition of urticaria. It does not itch but has more complications and
disfiguring. Both these conditions may occur in individuals who appear to have no other allergies.

Causes of urticaria:

 Certain foods e.g. fish, shellfish, peanuts and eggs

Food additives like azo dyes, benzoates (preservation used in manufacture of foods).
Salicylates : Aspirin can also be a cause of an allergic reaction resulting in urticaria.
The skin lesions caused in urticaria are due to the inflammatory reaction in the skin. The leakage of
capillaries in the dermis, a layer of the skin results in oedema (swelling of the area).

Common types of urticaria:

Acute Urticaria:
Normally comes up after a few minutes of contact with the allergen. Food allergic reactions are
usually a cause of this condition.

Chronic Urticaria:
Persists for 6 weeks or more. It is due to the hives which are already present.

Physical Urticaria:
Can occur due to cold, as a reaction to body heat or direct sunlight.

Exercise Urticaria:
Strenuous exercise, particularly jogging can result in this type of urticaria.

Management of urticaria
Urticaria is not an easy disease to manage. The primary part of the management involves the
awareness of ones trigger. Medical treatment given is of :
Antihistamines like cetrizine or other H1 receptor antagonists.
Stress management (helps relieve discomfort and itchiness during an attack).
Drinking 6-8 glasses of water each day helps to keep the skin well hydrated.

Contact Dermatitis

Contact Dermatitis is a term used for defining a skin reaction. This reaction results from exposure of
the skin to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). It can be
either acute or chronic. Contact dermatitis is normally associated with irritants like toxins in
detergents or surfactants. These irritants have the effect of directly affecting the barrier properties
of the skin epidermis (upper layer of skin). The fat emulsion gets removed inflicting cellular damage
on the epithelium. This increases the transepidermal water loss, damaging the horny layer of cells in
the skin. In turn water-binding mechanisms get affected damaging the DNA (deoxyribonucleic acid)
of the skin. The result is thinning of the skin layer.

Contact dermatitis can be caused by certain metals

Nickel is a highly allergenic metal. It is used commonly in plating and alloys. The gold plated
nickel sleeper used in ear piercing can cause rash on the ear lobe. Clip-on earrings and cheaper
ones can also cause an allergic reaction.
Hair pins, spectacles, zips, rings, watch straps, and bracelets can cause contact dermatitis.
A person can also be allergic to arms of metal chairs, taps, scissors and surgical instruments.
Artificial rubber is another common cause of contact dermatitis. Sponges, shoes and gloves can
produce symptoms with contact.

Bubble gum allergy (reaction on the lips) can be due to the presence of artificial rubber in the gum.
Hair dyes can also be a source of allergy.
An individual can react to formalin or any other preservative found in a shampoo.

 Nail varnish, furniture lacquers and dyes are known to cause contact dermatitis. Certain plants can
also cause itching and dermatitis.
Avoid the allergens. For allergy topical steroids should be used as advised by your doctor.

Allergy can worsen in an individual due to:-?

Infection
Weather conditions
Emotional disturbances

Photo Contact Dermatitis (PCD)

PCD is an eczematous condition which is triggered by an interaction between a less harmful substance
on the skin and ultraviolet light (320-400nm UV). It manifests itself only in regions where the sufferer
has been exposed to these rays. Areas of skin which are left uncovered by clothing develop this form
of contact dermatitis.

Symptoms
Red rashes
Blisters
Itchy, burning skin

Treatment
Immediately after an exposure to a known allergen or irritant, wash the affected area with soap and
cold water. This will help remove or inactivate most of the offending substances.

 To avoid irritation, oral antihistamines can be taken.

Application of calamine lotion and cool colloidal oatmeal baths may help relieve itching.
If blistering develops, cold moist compresses applied for 30 minutes three times a day can offer
relief.
Avoid scratching, as this can cause secondary infections.
In case of severe reaction, contact your doctor.

Eczema
Eczema results in the inflammation of the upper layers of the skin. It is a form of dermatitis. The term
eczema is broadly applied to a range of persistent skin conditions. These include dryness and
recurring skin rashes. The rashes are characterised by redness, skin oedema, itching, dryness and
cracking. Crusting, flaking, blistering, oozing, or bleeding can also occur. Areas of temporary skin
discolouration may develop. These are often due to healed lesions.

Common Types of Eczema

Atopic eczema
It is a skin condition which is often inherited. Here the eczematous reaction is due to food (eggs or
milk) or inhaled allergens (pollen or dust).
Xerotic eczema
It is a dry skin condition that becomes so acute that it turns into eczema. It worsens in dry winter

weather.
Seborrhoeic dermatitis
Dry or greasy scaling of the scalp and eyebrows result in this condition. In newborns it causes a
thick, yellow crusty scalp rash called cradle cap.
Irritant eczema
It can be caused due to contact with everyday irritants, e.g. washing powder and detergent.

Diagnosis
Diagnosis of eczema is generally based on the appearance of an inflamed, and itchy skin in the
eczema sensitive areas such as face, chest and other skin crease areas. If the eczema flares up, your
doctor is likely to ascertain a number of other things before making a diagnosis
An insight into family history
Dietary habits

Lifestyle habits
Allergic tendencies
Any chemical or material exposure at home or workplace

 Any prescribed drug intake

In the diagnosis of eczema, the blood may show a raised IgE or an eosinophilia. The blood can also
be sent for a specific test called Radioallergosorbent Test (RAST) or a Paper Radioimmunosorbent
Test (PRIST). High levels of antibodies in the blood signify an allergy to that substance. Another test
for eczema is skin patch testing. The diagnosis may also be made on the basis of a skin biopsy.

Care and Treatment

Mild eczema in a baby or individual should not be overlooked. Factors afflicting the skin condition of
any individual should be looked for. Some of these factors can be:
Diet Foods that are commonly allergenic (fish, milk, eggs, prawns) can be detected with the help
of skin tests. A restricted diet, avoiding the allergenic foods often helps the skin condition.

Personal clothing Wool, polyester fabrics can be skin irritants. Pure cotton is ideal for an
allergic or eczematous individual.

Furnishings Heavy furnishings, e.g. rugs, heavy fabrics in an allergic childs bedroom should be
avoided. The room should be kept clean. Linen and curtains should be washed regularly. Pillows

filled with down or feathers should not be used.

Pets If the presence of a pet is exacerbating allergy, parting with the family pet may be painful but
necessary.

Scratching A child or individual affected by eczema should avoid scratching. In a baby, nails
should be kept short and filed gently. Medicated bandages can be used for soothing the inflamed
eczematous skin.
Soap If a soap has to be used by a person suffering from eczema, then the following should be
kept in mind:

a) Avoid harsh detergents or drying soaps

b) Choose a soap that has an oil or fat base. A superfatted goat milk soap is best
c) Use an unscented soap
d) Patch test your choice of soap by using it only on a small area until you are sure of its results.
e) Use plain yoghurt instead of soap.
f) Never rub your skin dry or else your skins oil/ moisture will get depleted. Pat dry instead.

Moisturising
Eczema can be exacerbated by dryness of the skin.
Moisturising is one of the important self-care treatments for sufferers of eczema.
Another option is trying to bathe with a colloidal oatmeal bath.
Moistening agents or emollients e.g., medi oil, bath oils and aqueous cream, etc. can also be used.

Itch Relief
Anti-itch drugs, often with antihistamine, may help reduce the itch.

 Corticosteroids Dermatitis is often treated by doctors with a prescribed glucocorticoid (a

corticosteroid steroid) ointment, cream or lotion. Prolonged use of these creams can cause the skin
to thin and become fragile.

Immunosuppressants are sometimes prescribed for eczema.

Diet and Nutrition

An individual suffering from eczema has to be particular in his eating and drinking habits. Food
allergy may trigger atopic dermatitis.

Alternative Therapies
Non-conventional medical approaches like traditional herbal medicines have been advocated and
administered for decades. Sulfur has been used for many years as a treatment in the alleviation of
eczema. Swimming in the ocean is known to relieve symptoms and clear up the red patchy scales.
Oatmeal is a common kitchen remedy to relieve itching. It can be applied topically as a cream or as a
colloid in the bath.

Infantile Eczema
It is often known as atopic dermatitis or atopic eczema. It is a chronic relapsing itchy disease of the
skin. Itching may occur as a result of continuous rubbing and scratching of the affected area. This
leads to thickening and discoloration of the skin.
The individual suffering from infantile eczema is often seen to have a family history of allergic
disease, e.g. asthma, eczema or hay fever.

Remedy
Keep the skin moist by using cream or any ointment application.
Antihistamine creams help reduce itching.

 In severe cases steroid creams containing antihistamine derivatives and corticosteroids are useful
applicants.
Avoid excessive mental or physical stress.
In infants avoid histamine releasing foods such as, bananas, strawberries.

Sufferers of eczema are more prone to skin infections, e.g. bacterial, fungal, viral. Oral antibiotics
can be prescribed to treat infected eczema.

Common sites where allergic reactions occur

Eye Allergies
An allergic reaction in the eyes occurs whenever an allergen comes into contact with your eyes. The
allergen activates the mast cells to release histamine and other chemicals which cause the blood
vessels to swell. The eyes then become itchy, red and watery.

The common outdoor airborne allergens are grass, tree and weed pollens. People sensitive to these
allergens suffer from seasonal allergic conjunctivitis. The indoor allergens are normally pet hair or
dander, dust mites and moulds.

Precautions to Avoid Eye Allergies

Stay indoors as much as possible when pollen counts are at their peak, usually during midmorning
and early evening.

Use air conditioning in your car and home. Air-conditioning units should be kept clean.
Wear glasses or sunglasses when outdoors
Avoid rubbing your eyes
Reduce dust mite exposure in your home. Keep the humidity low in your home (between 30 per cent
and 50 per cent).
Clean floors with a damp rag or mop rather than by dry dusting or sweeping.

Replace carpeting with hardwood

Wash your hands immediately after petting any animal.

Medication

 Eye drops that contain antihistamines often help to reduce the itching, redness and swelling.
If the itching and redness do not subside, non-steroidal antibiotic eye drops are often prescribed.

Conjunctivitis
An external layer of loosely bound skin covers each eyelid.
The skin here is the thinnest in the body.
The delicate mucous membrane lining the insides of both upper and lower eyelids extends over the
front of the eye.
Inflammation of the conjunctiva, is a common disease.
It is a painful infection of the eyes which makes them red and makes the eyelids become swollen and
sticky.

Allergic Conjunctivitis
It is often due to common air borne allergens like pollen, dust and moulds. It is also present with hay
fever.

Symptoms
Itching Reddening Watering Swelling
Eyelids get stuck together after sleeping for a few hours. A thick mucous along with crust develops
on the eyelashes.

Precautions
Wear sunglasses
Do not use the towel or handkerchief of a person with conjunctivitis.
Eye drops should be used as prescribed by the Ophthalmologist.

Vernal Conjunctivitis
Swelling (inflammation) of the outer lining of the eyes due to an allergic reaction results in a
condition called vernal conjunctivitis. Vernal conjunctivitis occurs in people with a strong family
history of allergies. It arises commonly during the spring and summer season.

Allergies Related to Contact Lens

A person can also suffer from allergies as a direct result of his or her wearing contact lenses. Pollen,
dust, dander and fungus, can be the allergens. In some cases, it may be necessary to stop wearing
contact lenses and use spectacles instead.

Allergy due to Hair Dye (paraphenylenediamine)

Paraphenylenediamine (PPD) is a chemical substance which is used as a permanent hair dye. It can be
found in textile or fur dyes, dark coloured cosmetics and temporary tattoos. Photographic developer,
lithography plates, photocopying and printing inks, black rubber, oils, greases and gasoline have PPD
in them.
Mild reaction caused by the use of hair dye (Paraphenylenediamine) usually involves dermatitis of
the upper eyelids or the rims of the ears. In more severe cases, there may be marked reddening and
swelling of the face and scalp.

Allergic Rhinitis
Allergic rhinitis or hay fever is a collection of symptoms. It is an allergy involving the nose and eyes,
caused by airborne particles of dust. When these symptoms are caused by pollen, the allergic rhinitis
is commonly known as hay fever.

Medication

 Short-acting antihistamines can relieve mild to moderate symptoms, but can cause drowsiness.
Some of these can be bought over the counter. A pediatrician should be consulted before using these
medicines in children. Medicines causing drowsiness or affecting learning in children, should be
avoided.
Longer-acting antihistamines are available by prescription.
Azelastine (Astelin) is a new, nasal antihistamine that is used to treat allergic rhinitis.
Decongestants are also helpful in reducing symptoms such as nasal congestion. They should not be
used for long periods.
Antihistamines are available for itchy, bloodshot eyes and nasal sprays for treating hayfever.

Complications
With long term use of medication the following complications can occur:
Drowsiness and other side effects of antihistamines
Sinusitis
Nasal polyps

Perennial Allergic Rhinitis

All year around one may see some individuals complaining of a stuffy nose. It may be accompanied
by sneezing and a running nose. Children with these symptoms often develop a habit of wiping their
nose with their hand. This probably gives them temporary relief from the above symptoms.
In the chronic stage of this disease, the nasal membrane appears as swollen and may have mucous
or pus present. Nasal polyps can also develop, which block the nose and make it difficult to breathe.

Medication
Nasal drops containing ephedrine and antihistamine provide temporary relief.

Other treatment
Cauterisation
Removal of polyps through endoscopic surgery

Nasal Polyps
Nasal polyps are growths that result from inflamed mucous membranes in the sinuses and nasal
passages. They can often extend to the opening of the nostrils, down to the throat area and the sinuses.
These growths can block the nasal passages.

Diagnosis of Nasal Polyps is made through nasal endoscopy (a small camera is placed into the
nose to get a better look at the nasal passages). A CT scan (cat scan) of the sinuses may be required.

Treatment
Surgery of polyps followed by medical therapy is recommended
Corticosteroids The use of corticosteroids help to shrink the size of nasal polyps
Antileukotriene Medication
Nasal Saline Irrigation It is helpful in people with nasal polyps and chronic sinus infections.
Allergy Shots They are used to prevent nasal polyps from growing back after surgery.

2 Histamine and Histamine Releasing Foods

Histamine is a natural substance produced by the body. It is released by the body during times of
stress and allergy. Histamine is also present in various types of food. Histamine is a vasoactive amine
that causes dilatation of the blood vessels. The release of histamine can be caused by almost any
allergen, e.g. pollen, dust mite, drugs (penicillin, sulfa, aspirin), stinging insect venoms, and foods
(egg, wheat, milk, fish, etc).

There are many foods containing histamine. Certain types of food make the body release histamine
on their ingestion leading to food intolerance. This is different from food allergy as the immune
system is not involved in this reaction. Foods containing the chemical tyramine can trigger headaches.
Large amounts of tyramine is found in alcoholic beverages, chocolate, fish, soy sauce, cheese,
processed meat and sauerkraut. Fermented foods can also cause allergic symptoms. These foods are
rich in histamine

Some Histamine Rich Foods

Alcoholic beverages, especially beer and wine.

Cider and home-made root beer.

 Avocados and anchovies

Cheese, especially aged or fermented. Various cheese like parmesan or blue cheese.
Dried fruits, e.g. apricots, dates, prunes, figs and raisins (you may be able to eat these fruits without
a reaction, if the fruit is thoroughly washed)
Fish - Mackerel, Sardines, etc
Mushrooms
Processed meats - sausages, etc

Milk products - Sour cream, yogurt, etc

Coffee, cakes and other foods
Vegetables - Spinach, tomatoes, eggplant
Vinegar or vinegar-containing foods

Histamine Releasing Foods

Certain foods after consumption release histamine in the body, e.g.
Alcohol
Fruits - Bananas, pineapple, papayas, strawberries
Fish

Milk
Eggs
Chocolate
Tomatoes

Food Allergy

A food allergy can be defined as an adverse immune response to a food protein.

The most common food allergens are:
Milk
Peanut
Soya
Egg
Seafood
Wheat
Shellfish

Specific Food Allergies

Rice allergy is common in East Asia. In Central Europe, celery allergy is more common. In Japan
allergy to buckwheat flour used for Soba noodles is well known.

Allergy Testing
Skin prick testing is easy to do and results are available in minutes. Different allergists may use
different devices for skin prick testing. A bifurcated needle which looks like a fork with two prongs
can be used. Some allergists do a multi-test, which may look like a small board with several pins
sticking out of it. In these tests, a tiny amount of the suspected allergen is put onto the skin or into a
testing device, and the device is placed on the skin to prick or break through the top layer of the
skin. A small amount of the allergen is placed under the skin. A hive will form at any spot where the
person is allergic. This test generally yields a positive or negative result. It detects allergic
antibodies known as IgE and one can diagnose if a person is allergic to a particular kind of
food.
Blood tests are other useful diagnostic tools for evaluating IgE-mediated food allergies.

Allergy and the Infant

To avoid allergy in infants
At the beginning of weaning your baby (4-6 months old) from breast milk, natural foods should be
given as they are easily digestible. Pureed vegetables should be good for a start.

The following can be given to an infant (4-6 months of age)

 Vegetables (avoid tomatoes, potatoes and peppers)

Fruits (avoid citrus fruits)
Rice, millet, wheat
Pulses and beans

From 9 months of age, a baby can relish

Meat, fish, poultry
Oats, corn, barley, rye
Tomatoes and potatoes, can be included
Yoghurt
Eggs
Soya (Tofu, or soya milk)

From 12 months of age, the following can be included in a childs diet

Citrus fruits
Dairy products
Nuts and seeds (avoid peanuts)
Wheat

Some of the common allergies that occur in childhood are:

 Milk Cows milk is a foreign food protein. Its consumption can result in urticaria, eczema,
diarrhoea or chest disease. Improvement in the childs health after elimination of milk in the diet
would point to milk allergy. Substitution can be done through soya milk.
Egg Egg white contains albumin. This protein can be a source of allergy.
Wheat Next to milk, it is one of the most common sources of allergy. It is often detected only
when the baby is given cereals for the first time. Abdominal colic, diarrhoea or urticaria can be the
result of wheat allergy.
Fish Seafoods, e.g. fish, prawns can be extremely allergic agents.

3 Insect Allergy and Anaphylaxis

The well known stinging insects are
Mosquitoes
Hornets
Wasps and Fire Ants
Bees
Yellow jackets

Insect Venom Allergy

Insect venom allergy results in a harmful reaction to insect stings. This occurs in people who have an
abnormally high sensitivity to insect venom. The reaction is not seen during the first exposure to the
venom, but sensitisation often occurs after the first or subsequent exposures. Allergic reactions to the
venom of some stinging insects, such as honeybee, yellow jacket, hornet, wasp or fire ant can be life
threatening.

People who are severely allergic to the venom of stinging insects should undergo desensitisation.

Desensitisation
Skin testing is performed by an allergy specialist to determine the type of insect that is responsible
for the venom allergy.
These are followed up with monthly booster shots and continued for 3 to 5 years to consolidate the
cure.
The pain and swelling occurring after an insect bite is due to the venom injected. In some
individuals the venom acts as an antigen. An allergic reaction to insects like mosquito or sand fly is a
delayed one.

Remedy
To check itching, sometimes, a tablet of antihistamine may be required.
For stings from wasps, bees, etc. disinfect the affected area.
Keep the bitten area clean and apply ice.
If the swelling increases, antihistamines as well as steroids may be required.
If the sting site becomes infected, antibiotics would be recommended.

An allergic reaction due to insect sting varies from one individual to another. The serious reaction
is called anaphylaxis which can be fatal. Anaphylaxis results in difficulty in breathing, swallowing,
hoarseness, swelling of the tongue, dizziness and fainting. These are signs of a severe allergic
reaction. These types of reactions usually occur within minutes of the sting, but have been known to
be delayed up to 24 hours. Prompt treatment is essential and remember this is an emergency.
Honeybees stingers can be barbed stingers. Often the sting is left behind in the persons skin. If the
stinger is removed by pinching the stinger, more venom is injected into the skin. It is better to remove
the stinger gently by using a finger nail or knife edge to flick the stinger out of the skin. If the sting
is on the limb, a tourniquet should be tied tightly above the sting area. This would prevent the
spreading of the venom from the insect to the whole body.
If the allergy is severe, your doctor may treat it with epinephrine (adrenaline), and prescribe a
medication including an EpiPen.

Insect Remnants

Remnants of insects especially during the rainy season can become a cause of allergy. Thousands of
these insects die after a short lifespan and can cause hypersensitivity in some individuals.

Precaution
To prevent insect bites and stings, avoid the use of flowery colognes and soaps or lotions which
attract insects.

Do not keep open garbage or food that attracts stinging insects.

Wear light, protective clothing with long sleeves whenever you are outside for longer periods of
time.
Make sure any insect nests around your home are removed and destroyed.

Anaphylaxis

It is a severe Type I Hypersensitivity allergic reaction which can be life threatening. The acute
reaction can involve organs and their functions. The term Anaphylaxis comes from the Greek
words ana (against) and phylaxis (protection). Anaphylaxis occurs when an individual is exposed to a
trigger substance, called an allergen, to which he has already become sensitised. This reaction can
occur in animals as well. Anaphylactic reaction involves the whole body after skin contact, ingestion
or injection of an allergen. In rare cases, it may arise after inhalation of an allergen.

Anaphylactic shock
It occurs when an allergic response triggers a quick release of large quantities of immunological
mediators from the mast cells. This leads to a sudden drop in blood pressure. Oedema of bronchial
mucosa (resulting in bronchoconstriction and difficulty in breathing) also occurs. Anaphylactic shock
can lead to death in a matter of minutes if left untreated.

Symptoms/Signs

Polyuria
Respiratory distress (difficulty in breathing, tightness of chest, throat tightness, wheezing)
Rapid or irregular heart beat
Hypotension (low blood pressure)
Unconsciousness
Urticaria (hives)
Angioedema (swelling of the lips, face, neck and throat)
Vomiting
Itching
Diarrhoea
Abdominal pain

Almost all anaphylactic reactions occur within hours of consuming or administration of a drug. A
severe reaction can occur within minutes or even seconds of taking a drug.

Angioedema
Angioedema often involves the deeper tissues of the skin. A painful and burning sensation of the skin
is present.
It is the rapid swelling (oedema) of the skin, mucosa and submucosal tissues which results in
enlarged lips, swollen eyes and distorted face. If the condition becomes severe, a crisis can occur. The
swelling can also affect the respiratory passage. In cases where angioedema progresses rapidly,
affecting the glottis (opening upper end of the windpipe) it has to be treated as a medical emergency.
An epinephrine injection (EpiPen) can be lifesaving if angioedema is allergic in nature.

EpiPen
The EpiPen should be carried by individuals who develop a severe allergy and those who run a risk
of an anaphylactic shock. The EpiPen is self-administered and is fast-acting.

4 Drug Allergy: An Overview

Drug reaction can range from a mild localised rash to serious effects on organs and their systems.
Normally it does not occur the first time you take a medication.
A reaction is much more likely to occur the next time you take that particular medication.
Symptoms of drug allergy are important as they result in a life-threatening situation.

Some drugs which can cause a reaction are

Painkillers (called analgesics) such as codeine, morphine, non-steroidal anti-inflammatory drugs
(NSAIDs, such as ibuprofen or indomethacin), and aspirin
Antibiotics (e.g. penicillin, sulfa drugs and tetracycline)
Antiseizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol)

Drug allergy symptoms

Skin reactions
Rash
Hives
Photoallergy Sensitivity to sunlight following sun exposure, an itchy and scaly rash
Red, raised and itchy patches on the skin that have a shape like bulls eye targets. The may occur
together with swelling of the face or tongue:-

Fever
Muscle and joint aches

 Lymph node swelling

Inflammation of the kidney

Drug Allergy Treatment

In case of a mild allergic reaction, care can be taken at home. For reducing localised skin reactions,
the following can be done:
Take a cool shower or apply a cool compress.
Wear light clothing that doesnt irritate your skin.
Keep your activity level low.
To relieve the itching, apply calamine lotion and take an antihistamine tablet.

Medical Care
Try to stay calm.
If the individual displays any symptoms such as fever or vomiting ask him to stop taking the
recommended medication and contact the doctor.
If the person has difficulty in breathing or his throat is swollen, he may be in the process of
suffering from an anaphylactic reaction. Immediately take him to a hospital emergency. Dont let
him drive.
If a person is feeling light-headed or faint, make him lie down and raise his legs higher than the
head to help the blood flow to the brain.
A cardiopulmonary resuscitation (CPR) should be administered to a person who becomes
unconscious.

5 Asthma, Its Management and Treatment

Asthma is an inflammatory condition of the bronchial airways. Inflammation causes the normal
function of the airways to become over-reactive. This reaction results in production of increased
mucous, mucosal swelling and muscle contraction.

The reactive changes lead to airway obstruction, chest tightness, coughing and wheezing. In severe
cases it can cause severe shortness of breath and decreased oxygen levels in the blood.
However, children suffering from asthma, mostly have reversal of symptoms until some other
allergy triggers the next episode.
Wheezing Wheezing is a high-pitched sound that occurs from forced exhalation across narrowed
obstructed airways.

Causes of Asthma
Some individuals have an inherited predisposition to develop asthma when exposed to allergens
like home dust, pollens, moulds, fungi, etc.
These individuals may not be asthmatic due to a preexisting lung disease, e.g. chronic bronchitis.

 Exercise induced asthma It occurs in certain individuals after exercising. This occurs more
commonly when physical exercise is performed in cold regions or in cold weather.
Inflammation of the airways is a common cause in all asthmatic patients. This inflammation is
produced by allergy, viral, respiratory infections and airborne irritants. Studies indicate that allergic
reactions produce both immediate and late phase (delayed) reactions. It is seen that approximately
half of the immediate allergic reactions due to inhaled allergens are followed by a late phase
reaction.
This late phase reaction often produces serious injury and inflammation to the airway. This airway
inflammation leads to irritability or hyper responsiveness of the airways. In addition, prolonged
inflammation of the airway can cause scarring.
Asthma can start with symptoms of a common cold and then lead to rapid breathing with short
breaths.

Symptoms of Asthma

Coughing
Wheezing or whistling sounds which are audible when an asthmatic person exhales
Shortness of breath or rapid breathing
Night cough is common, as asthma is often worse at night.
Chest tightness with shortness of breath are other symptoms of asthma.
Chronic bronchitis can be present due to acute asthma. This often presents itself with excessive
production of mucous.

Tests to Diagnose Asthma

After discussing your asthma symptoms and possible asthma triggers, your doctor will conduct a
physical examination on you. He will send samples of your blood/ urine for laboratory testing.

Pulmonary Function Tests

Normal values are based upon your age, height, ethnicity, and sex. Normal results are expressed as a
percentage. A value is usually considered abnormal if it is less than 85% of your predicted value.
Abnormal results usually mean that you may have some chest or lung disease.

Spirometry Test

Spirometry is the most frequently performed test of pulmonary (lung) function. The Spirometer is a
device to measure how much air an individuals lungs can hold and how well the respiratory system
is able to move air in and out of the lungs. Spirometry records the entire forced breathing capacity.
The peak flow reading records the largest breathing flow that can be sustained for 10 milliseconds.
Both are often used to detect and manage asthma.

Chest X-ray
It will help your doctor make the diagnosis.

Blood Gas Analysis

It will indicate the status of blood gas exchange in your body. Your medication (inhalers) or oxygen
to be given will be advised according to the results.

Asthma and Drug Interaction

The elderly, are more prone to bruising after taking cortisone medication (oral or inhaled).
Oral cortisone can sometimes raise blood pressure.
Patients taking cortisone (like prednisone) can experience muscle cramps. This can be relieved with
the help of orange juice, bananas, potassium liquid or pills.

 Asthma can get aggravated in individuals using beta-blocking drugs for high blood pressure and
heart disease.

The Elderly with Allergies or Asthma

Any individual over 55 years of age should try the newer anti-histamines. With the earlier
antihistamines the elderly can experience dry mouth, dizziness, prostate problems and sedation.
Calcium and vitamin D should be taken regularly to avoid osteoporosis.
All senior citizens suffering from asthma should receive their annual shot of pneumonia vaccine.

Nocturnal Asthma
A peak flow expiratory flowmeter can be used to record the severity of night time asthma. If an
individuals peak flow reading drops in the morning, then the individual is a morning dipper. Such
individuals are more prone to nocturnal asthma.

Nocturnal asthmatic attacks usually occur between midnight and early morning. Some of the
reasons cited for this are:
Gastric reflux (food or acid regurgitation)
Sleeping mode
At night the fall of circulatory cortisone and epinephrine hormone levels, do not give protection
against allergens.
Exposure to dust mite in the bedroom.
Any individual getting up more than two or three times a month due to nocturnal asthma should
consult his doctor.

Adolescence and Asthma

Asthma in adolescence can be due to the following reasons:
Smoking
Failure to take antiinflammatory medication as prescribed
Overuse of inhalers

Asthmatic Attack
During an asthmatic attack: The lungs fail to function in the normal fashion.
Dry cough and wheezing may be present.
The skin is clammy, and can appear blue (due to lack of oxygen).
The affected individual wants to sit with elbow on the knees (typical posture).
Asthmatics prefer sitting to lying down.
Speech is often difficult.

Asthma in Children

In the western world asthma is the third leading cause of hospitalisation among children under the age
of fifteen. It is the most common cause of school absenteeism due to chronic disease. It also accounts

for one third of all pediatric emergency room visits. Hypersensitive airways result from stimuli,
leading to triggering, narrowing or obstruction of the airways. Several small studies seem to suggest
that tonsillectomy and adenoidectomy may decrease severity of asthma in patients postoperatively.

Causes of Asthma in Children

Exercise Running can trigger an episode in over 80 per cent of children with asthma.
Bronchodilator medications used before exercise can prevent most of these episodes.
Infections Respiratory infections, bronchitis, flu, frequently trigger severe episodes of asthma.
Chronic sinusitis in childhood due to bacteria can be a very stubborn chronic trigger for asthma.
Allergy In many children outdoor asthma is triggered by allergies (pollen, mould). The allergens
involved indoor can be inhalants, such as, dust mites, feathers, moulds; or insects especially
cockroaches; or pets or ingested foods such as, milk, soya, egg, etc. Allergy may be the cause of
unrecognised or hidden asthma.
Drugs like aspirin can trigger attacks of asthma.
Irritants Cigarette smoke, air pollution, strong odours, aerosol sprays and paint fumes are some
of the substances which irritate the tissues of the lungs and upper airways. Passive smoking can
harm children. Irritants must be recognised and avoided.
Weather Breathing cold air can act as a trigger and precipitate asthma in children. Outdoor
inhalant allergens (e.g. pollens and moulds) are dependent upon the weather. During spring, more
allergens are scattered in the air, while a heavy rainfall makes the air clean of these allergens. A
light rain helps wash out pollen but on the other hand may actually increase the mould
concentration.

 Chemicals A number of chemicals can produce occupational asthma. These can be isocynates
which are used for making plastic foam, synthetic inks, paints, adhesives, enzymes used for baking,
hardening agents used for surface coatings, etc.
Pets The type I allergic reaction can be produced by cats. This is due to their hair (tiny particles
of skin that are inhaled). A Skin test can help detect any allergy to the pet animal.

Emotions

Diet and the Asthmatic Child

Asthmatic children do not put on weight easily. The asthmatic child requires more calories/kg body
weight, in comparison with the healthy one. This is due to a higher metabolic rate present in the
asthmatic child. Besides growth and activity this child needs more calories due to a fast breathing rate.
Along with a diet of minerals, vitamins, etc. the carbohydrate and protein intake in such a child
should be increased. The amount of food ingested throughout the day, i.e. breakfast to dinner should
be balanced. To avoid a nocturnal asthmatic attack, dinner should be kept light.

Asthma and Diet

Foods that can trigger asthmatic attacks can be:

 Foods containing additives, e.g. benzoates, sulphites, etc. which are used in cider, wine and beer.
Foods containing yeast or mould, such as bread and blue cheese.

Foods or drinks containing colourings E102, E104 and E110 essence.

Cows milk, cereals (wheat), egg, fish, soya, and nuts (especially peanuts).
Always read the labels on food packages to know the kind of ingredients present. This will help in
avoiding any food stuff which may trigger asthma.

Some foods help in thinning the mucous and opening them up for better breathing. These include
spicy, pungent foods like chili, hot mustard, garlic and onions. Certain foods help control
inflammation of the airways because of their antiinflammatory components. These include onions,
foods rich in Vitamin C and fatty fish oil (which has been proven to be anti-inflammatory and high in
omega 3 fatty acids).

Healthy Foods for Asthmatics

Antioxidants include Vitamin A from foods such as liver; betacarotene from brightly-coloured
fruits and vegetables like apricots, carrots, red or yellow peppers, dark green leafy vegetables such
as spinach; Vitamin C from citrus fruits; and Vitamin E from olive oil help strengthen the lungs by
mopping up free radicals.

 Foods rich in Vitamin B are green leafy vegetables and pulses.

Some good sources of magnesium are sunflower seeds and dried figs.

Did you know that

Linda Gamlin (The Allergic Bible) describes how people allergic to food can be killed by a kiss. She
writes of a young man with fish allergy who required emergency care after being kissed by his
girlfriend who had just eaten mackerel.

Monosodium glutamate and asthma

Individuals suffering from monosodium glutamate (MSG) sensitivity experience facial flushing and a
generalised tingling sensation after eating MSG. Chinese food normally contains this salt so the
condition is described as The Chinese Restaurant Syndrome.

Asthma Induced by Alcohol

It has been seen that half of the asthmatics in Japan wheeze after consuming alcohol. Studies
conducted in Japan have shown that the Japanese people have a genetically determined enzyme defect.
This defect prevents the breakdown of acetaldehyde, a by-product of alcohol. Acetaldehyde in high
levels, trigger the release of histamine from the mast cells. This leads to bronchospasms and
wheezing.

Cockroach Allergy

Cockroach allergy came to be recognised in the 1960s. Cockroach allergen is present in saliva, skin
shedding, faeces and dead bodies of the insects. Cockroach sensitive people are seen to have a
seasonal pattern, with the allergy peaking in the summer months. It was observed that children living
in cockroach infested dwellings were more prone to asthma during those months.

Status Asthmaticus
When a severe asthma attack does not respond to the intake of bronchodilators and becomes
associated with symptoms of potential respiratory failure it is known as status asthmaticus. It is a lifethreatening condition and requires immediate medical attention.

The symptoms may include:

Persistent shortness of breath
Inability to speak.

Status asthmaticus often occurs with few warning signs. It often occurs quickly and can progress
rapidly to asphyxiation. Patients with status asthmaticus often have poor control of allergens or
asthma triggers in the home and/or at the workplace. These people may also have infrequent use of a
peak flow monitor and inhaled corticosteroids. People who have status asthmaticus may have a
history of frequent bad health, which results in poor treatment of asthma. Status asthmaticus may not
respond quickly to routine treatment with asthma inhalers. Continuous use of an asthma nebulizer and
injected medication such as epinephrine and prednisone are often necessary for asthma. To avoid
hospitalisation with a severe asthma attack, it is imperative to begin immediate treatment at the first
sign of symptoms.

Medical Care
Oxygen is the primary therapeutic modality. Oxygen must be provided to any patient who presents
with status asthmaticus. Oxygen is provided through nasal cannula or facemasks.

Medication The appropriate use and dosage of the prescribed medication, should be in
accordance with your doctor s prescription. The more cautious you are about your asthma triggers,

the less asthma symptoms will interfere with your activities.

Management and Treatment of Asthma

Asthma can be controlled with proper management.
Try and make your environment conducive for your health.
Keep your house clean.
While cleaning, wear a mask.
Wash the bedding (sheets, pillow cases, mattress, etc) weekly in hot water and sun dry.

Replace bedding made of down, kapok or foam rubber with synthetic or cotton material
Try and keep the humidity in the house low.
Monitor lung function. Asthmatics can use a peak flow meter. Lung function decreases 2-3 days
before symptoms of an asthma attack. If the meter indicates the peak flow is down by 20 per cent
from your usual best effort, be forewarned of an asthma attack.
Control asthmatic symptoms by avoiding the triggers and start using your required medication.
Immunotherapy (allergy shots) are often given. The process involves desensitizing the patient. The
treatment begins with injections of a solution of allergen. According to schedule, the strength of the
allergen solution is gradually increased.

The Schedule for Hyposensitisation

Pre-seasonal
Injections are started about 3 weeks prior to the onset of season in which the patient develops
asthmatic symptoms. Injections are administered according to a schedule.
Co-seasonal
This schedule is administered to those individuals who present themselves with symptoms just
prior to the pollen season.
Seasonal
Here the schedule of hyposensitisation is administered even after the aggravating season is over.
The injections are given the year round.

Elderly People and Asthma

If an older patient has lost weight, it must be supplemented with a diet to regain weight. A certain
amount of protein as in soya, milk, cheese, pulses is a must. Chicken soup is healthy. Supplementation
through egg and fish can help. If mastication is a problem (due to teeth problem), then food should be
pureed. Carbohydrate supplementation through oats, porridge, semolina is also helpful.

Precaution for Asthmatics

They should not
Overeat

Smoke
Drink
Have fried, fatty or spicy foods

 Expose themselves to the cold

Shake hands with anyone with a viral infection

They Should
Be regular with their food habits
Keep the dinner light
Try and keep a gap of two hours between eating and sleeping time
Keep the room well-ventilated
Get their annual antiflu vaccine shot

Newer Drugs for Asthma

Many new drugs are in the pipeline for asthma. The most promising could be the inhaled cortisone
drug ciclesonide (Aventis). It should be administered to the patient once a day in inactive form. It gets
activated in the lungs.

Hidden Asthma
Until rapid breathing, coughing becomes obvious, the condition of many individuals/children with
asthma goes undetected. Unfortunately hidden asthma produces few recognizable symptoms.
Pulmonary function testing usually reveals these cases of airway obstruction.

Medication for Asthmatic Patients

Long-term control medication is administered daily to maintain continuous control of persisting
asthma. This medication helps to control airway inflammation. The quick-relief medication is taken
to achieve prompt reversal of an acute asthma attack.
Asthma control is mainly done through antiinflammatories and bronchodilators.
Antiinflammatories help to reduce the number of inflammatory cells in the airways. This prevents
blood vessels from leaking fluid into the airway tissue. Reduction in inflammation reduces the spasm
of the airway muscle. Antiin-flammatories also help lessen the risk of acute asthma attacks.

Anti-inflammatory Agents
Antihistamines
Allergic cough in children can be helped by giving a combination of antihistamines with
bronchodilators. This medication is not effective in adults.

Sodium cromoglycate
It is derived from the leaves of a plant. Its action is unique. When it is inhaled as a powder, it helps
coat the respiratory mucous membrane. When an allergic individual inhales an allergen like pollen or
dust, normally these allergens settle on the cells to which are attached the antibodies. Sodium
cromoglycate helps prevent the release of histamine and other chemicals from the mast cells (as it
makes the cell wall strong and stable). As histamine and other chemicals are not released on exposure
to the allergy, the patient suffers no symptoms.

The spinhaler is the special inhaler used for the inhalation of sodium cromoglycate. The effect of a
single inhalation helps against allergens for four to six hours. Repeated inhalation 3-4 times/day can
help avoid an asthmatic attack.

Life Saving Apparatus

Asthma inhalers

An asthma inhaler is a handheld device that delivers asthma medication straight into the airways. The
inhaled medication goes directly into the lungs. This helps relieve asthma symptoms faster and with
fewer side effects. Today, a number of inhalers are available to help relieve or control symptoms of
asthma.

Metered dose inhaler

This inhaler consists of a chemical propellant which forces a measured dose of medication out of the
inhaler. The apparatus consists of a pressurised canister containing medication, a mouthpiece and a
metered valve that dispenses the correct dose of preset medication. The medication is released either
by squeezing the canister or by inhaling. Some metered dose inhalers have counters for you to detect
the number of doses remaining. The chemical propellant in metered dose inhalers are usually of
chlorofluorocarbon (CFC) or of hydrofluoroalkane (HFA).

Dry powder inhaler

In this inhaler the medication is released by breathing in more quickly, as compared to the metered
dose inhaler.
The choice of the right kind of inhaler depends on several factors like your hand-breath
coordination, your dexterity, whether you can take a deep, fast breath, and what type of medication
you need.

Delivery of Medication
Inhalers are used to deliver a variety of asthma medications which assist with long-term control and
provide quick relief of symptoms. Inhaled asthma medications include:

Short-acting bronchodilators
These medication provide immediate relief, e.g. albuterol.

Long-acting bronchodilators
These medication relieve asthma symptoms for longer periods of time.

Cromolyn or nedocromil
These medication are used for long-term prevention of inflammation.

Corticosteroids
They are used to prevent long-term asthma attacks.

Corticosteroid and long-acting bronchodilator

This medication combines a corticosteroid and a longacting bronchodilator. Each inhaler may come
with a slightly different instruction.
It is important for you to use your inhaler correctly so that the medication reaches your lungs. Ask
your doctor, nurse or pharmacist for a demonstration.

Apparatus Useful at Home

Air Purifiers
Air filters are usually classified according to their ability of removing particles of different sizes.
HEPA are the High Efficiency Particulate Air filters which remove particles as small as 3 microns.
They are expensive but nearly 99% efficient.

Dehumidfiers
A dehumidifier removes water vapour/moisture from the surrounding air. This helps reduce the
growth of dust mites and moulds.

 Air Conditioners
They indirectly help lower dust mites and mould as they act as a dehumidifier. Air conditioning in
the bedroom helps the sleeping asthmatic to avoid early morning release of pollen by trees and
plants. The important factor is the regular cleaning of air-conditioners to avoid dust, mould and
pollen build up.

Nebulizer
A nebulizer is a device which administers medication in the form of a liquid mist to the airways of
the patient. It is commonly used in treating cystic fibrosis, asthma, and other respiratory diseases.
Nebulizer usage is usually advised for serious cases of respiratory disease. A nebulizer is designed
for those who cant use an inhaler; such as, infants, young children and those who are seriously ill.

The Current Situation

Asthma remains the most common chronic disease of any sort in childhood and the most frequent
chronic respiratory disorder at any age.

Asthma Predictive Index in Children

The asthma predictive index (API) has given guidelines for the diagnosis and treatment of asthma.
This determines which small children are likely to have asthma in later years. High risk children who
have had four or more wheezing episodes in the past year that lasted more than one day, and affected
sleep, are much more likely to have persistent or lifelong asthma. The following criteria helps in the
predictive index.

Involvement of One Major Criteria of the following:

Parent with asthma
Physician diagnosis of atopic dermatitis (often called eczema)
Evidence of sensitisation to allergens in the air (i.e., positive skin tests or blood tests to allergens
e.g. trees, grass, moulds, or dust mites)

Involvement of Two Minor Criteria of the following:

Evidence of food allergies
>4 percent blood eosinophilia (i.e. increased numbers of white blood cells)
Wheezing apart from colds

Rescue Inhalers
Metered dose inhalers (MDI) like Albuterol are undergoing a change in features.

The new HFA inhalers have the following features:

A different propellant but the Albuterol medicine is the same and there is no change in the kind of
medication.
HFA inhalers might taste different in your mouth
The puff you get from your Hydrofluoroalkane (HFA) inhaler might not seem as strong but the
amount of medicine in the puff is the same, so take only the number of puffs recommended (HFA
inhalers will probably cost more than the Chloroflurocarbon (CFC) inhaler).
Ask your doctor or pharmacist to explain how to use your new inhaler.
Instead of waiting till you get ill, the rescue inhaler (also called Albuterol or quick-relief inhaler)
should be used at the first sign of asthma symptoms. The warning signs may start 24 to 48 hours
before an asthma attack begins, and should be treated as early asthma symptoms.

To treat asthma quickly, note the signs involving the beginning of an

attack:
A cough that doesnt go away, especially at night
Sore throat or throat clearing
Runny or stuffy nose
Dark circles under eyes
Increased tiredness and mood change
Waking up at night

 Eczema flare-up
If any of the warning signs are present consult your doctor.

Managing Your Medication

The Dos and Donts
If you are taking many different types of medicines
Do keep a record of all your prescriptions and over-the-counter medicines.
Do read and save written information that comes with your prescriptions or over-the-counter
medicines.
Do check the label on your medicine before taking it.
Do take your medicine exactly as directed. Using medicines improperly can make your condition
worse instead of better.
Do check the expiry date on your prescription.
Do call your doctor or chemist right away if you have any problem after taking your medication.
Do not stop taking a prescribed medicine just because your symptoms go away.
Do not take medicines prescribed for someone else
Do not give your prescription to anyone else.
Do not use alcohol while taking a medicine.
Do not hesitate to contact your doctor, chemist or pharmacist if you have any questions eventually
its about your health!

Myths and Fact File

Myth
An individual allergic to a particular allergen e.g. pollen, cannot be allergic to any other allergens.

Fact
Individuals allergic to an allergen, can be allergic to pollen, moulds, dust as well. While being treated
for a particular allergen, the individual should be hyposensitised against all offending allergens, as
well.

Myth
Medication for asthma is unsafe due to steroid usage

Fact
Steroids used in treatment of asthma are mainly inhalers. Medically it is shown that steroids are often
essential to reduce and control the asthmatic attack.

Myth
Everyone has the same kind and intensity of asthma.

Fact
Type and intensity of asthma varies from person to person. There is no common kind of asthma like a
common cold or sneezing.

Myth
Allergies are no big deal.

Fact
Many of us suffer from some kind of allergy. Statistics from the United States quotes that 20% of
people have hay fever, which costs $3 billion per year and lost time from work and school.

Myth
I am too old to have allergies.

Fact
You can develop an allergy at any stage of life. Hay fever, drug and food allergies can occur both in
children and adults.

Myth
I can grow out of an allergy.

Fact
May be yes, maybe no. Food allergies can often subside with time, but allergies due to medication and
hay fever normally do not subside.

Myth
Theres not much I can do about allergies.

Fact
See your doctor and get on to individualised allergy programme, it often helps!

Myth
Sports are a strict no-no with asthma.

Fact
This is again another myth that accompanies asthma. There is no need to keep your child away from
sports if your child is asthmatic. Many athletes and swimmers have been asthmatics. What is important
is to understand the precipitation of an asthmatic attack and how to avoid and control it.

Myth
My lungs can grow tough and immune to asthma attacks.

Fact
If you go without medicine, you will only suffer. Asthma occurs due to a chronic inflammation of the
lungs. Not taking any medicine will worsen the condition, and that can be fatal. It is not a fact that a
persons lungs become tough due to avoidance of medicines.

Myth
Cardiac asthma is the same as the bronchial asthma.

Fact
Cardiac asthma is precipitated due to failure of the left ventricle of the heart. The breathlessness here
is primarily due to heart disease.

Myth
Asthmatic children can get cured if tonsils are removed.

Fact

Enlarged tonsils being removed is still a controversial subject. The removal of tonsils may eliminate
a precipitating factor which leads to asthma. This on the other hand, does not alleviate the allergy in a
child. It is the basic cause of asthma which should be dealt with.

Myth
Food allergy is in the mind. If one wants, one may eat and drink anything.

Fact
Allergy to certain foods, in some individuals is scientifically proven. Foods like mushrooms, fish and
other sea foods can sometimes produce a severe reaction, which may sometimes lead to
hospitalisation of the affected individual.