At 60, Radha (name changed) knew the routine by heart whenever she faced persistent cough and breathing difficulties – go to the nearby clinic and take medications for relief. It was only when she experienced severe and uncontrollable breathing issues that she decided to screen for asthma. “After we came to know about her frequent symptoms, we looke at her history and realised that she was being exposed to the dust from curtains and smoke from burning incense sticks. After testing, we told her to reduce her exposure. Since asthma was identified, we started inhalers too,” recollects Dr Sujith Varghese Abraham, consultant pulmonologist at KIMSHEALTH, Thiruvananthapuram.
After a few months of treatment and reducing her exposure to triggers, Radha now rarely experiences coughs or breathing difficulties.
Continuous sneezing, recurring skin rashes, watery eyes or breathing difficulties after exposure to dust are often dismissed as minor inconveniences. However, doctors warn that allergies are becoming increasingly common and can significantly affect a person’s quality of life if left untreated.
“Allergy occurs when the body’s immune system misidentifies harmless substances, mostly proteins, as a threat and reacts to them. The substances causing allergies, or allergens, enter the body through the skin, nose, eyes or lungs, resulting in sensitisation of the immune system, which later causes symptoms that may affect these organ systems. Symptoms occur in episodes and can be triggered by factors such as dust, fumes, weather changes, stress and exposure to certain environmental conditions,” says Dr Elizabeth Sunila, consultant pulmonologist at Aster Medcity.
According to Dr Sujith, an impaired immune system can cause allergic diseases that are systemic disorders. “One major factor that causes an allergy is genetic susceptibility. Some people are born with an immune system that tends to overreact (often called atopy). The chances of being diagnosed with an allergy are high if the family has a strong history of asthma, allergic rhinitis, or eczema,” he says.
Studies have also found that allergic diseases affect millions worldwide and that avoiding triggers is one of the most effective ways to manage symptoms. According to the study – ‘Allergic Diseases: A Comprehensive Review on Risk Factors, Immunological Mechanisms, Link with Covid-19, Potential Treatments, and Role of Allergen Bioinformatics’ – it may be difficult to avoid offending allergen exposure if the causative allergen is rare or unknown. Allergic patients can, however, minimise symptoms by avoiding allergen exposure, states the study, published in November 2021.
“Approximately 30-40% of the global population suffers from some form of allergy, with rates continuing to rise. The chances of developing allergies depend heavily on genetics – having one allergic parent results in a 30-50% chance, which jumps to 60-80% if both parents are affected. A patient presenting with first-time wheeze or rhinitis in their life may not be called a patient with asthma or allergic rhinitis, but when there is an episodic recurrence, tests should be carried out to identify whether it is allergy,” says Dr Elizabeth, adding that allergies can be variable in nature in terms of seasons, day and night, diurnal variability and so on.
“Symptoms may appear only on exposure to specific substances, or in particular environments, due to this variability. The promising prognosis of allergy is remission, not a cure. While treatment can lead to periods of remission, allergies can recur due to multiple disease-related and host-related factors. Factors such as infections, humidity, environmental conditions and changes in the immune system can influence these relapses,” she emphasises.
Managing allergies works when trigger identification (cause control) and medication (symptom control and inflammation control) are combined.
“Identifying triggers and avoiding exposure is essential. Once identified, you can avoid or reduce exposure, which directly lowers symptoms. A complete elimination is very difficult, and medications are needed for treating acute symptoms (relievers) and preventing asthma attacks (maintenance medications),” says Dr Sujith.
‘Most people unwilling to accept they have asthma’
Inhaler therapy is the best-known method of treating asthma. It helps in delivering the medications directly to the lungs, avoids systemic side effects, and requires only a low dose. Health experts believe that among the allergic conditions, asthma is frequently misunderstood.
According to Dr Sujith, most people are unwilling to accept that they have asthma. “People think asthma has severe symptoms like what we see in films. When we get a cough or breathing issues in a particular season, or following a fever and exposure to dust, people don’t accept it as asthma. People are unwilling to take treatment. There is a stigma around using an inhaler, too. However, reliever treatment and preventive maintenance medications can help in managing the condition in the long term,” he adds.
Asthma is an allergy affecting the lower respiratory system. “Generally, in asthma, the goal of treatment is to reduce symptoms and to reduce lung damage. Like any other allergies, treatment responses are generally good but also might be variabile. Not everybody requires the same duration of treatment. Generally, minute doses of inhaled corticosteroids (ICS) are the drug of choice used to control the condition. As the medication acts locally, the systemic side effects compared to oral or injectable steroids are extremely low. Once it is controlled, the doses can be reduced and may be stopped when in remission. Not everyone will have to use an inhaler for a lifetime,” points out Dr Elizabeth.