Allergy involves an exaggerated response of the immune system, often to common substances such as

foods or pollen.
Allergies can cause a variety of symptoms such as a runny nose, sneezing, itching, rashes, swelling, or
asthma. Allergies can range from minor to severe. Anaphylaxis is a severe reaction that can be life-
threatening. Doctors use skin and blood tests to diagnose allergies. Treatments include medicines,
allergy shots, and avoiding the substances that cause the reactions.
The immune system is a complex system that normally defends the body against foreign invaders, such
as bacteria and viruses, while also surveying for conditions such as cancer and autoimmunity.
Allergens are substances that are foreign to the body and that cause an allergic reaction.
IgE is the allergic antibody.
Although many individuals outgrow allergies over time, allergies can also develop at any age,
including during adulthood.
While the environment plays a role in the development of allergy, there is a greater risk of developing
allergic conditions if a person has a family history of allergy, especially in parents or siblings.
An allergy refers to an exaggerated reaction by the immune system in response to exposure to certain
foreign substances. The response is exaggerated because these foreign substances are normally seen by
the body as harmless in non-allergic individuals and do not cause a response in them. In allergic
individuals, the body recognizes the foreign substance, and the allergic part of the immune system
generates a response.
Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mites,
molds, animal proteins, foods, and medications. When an allergic individual comes in contact with an
allergen, the immune system mounts a response through the IgE antibody. People who are prone to
allergies are said to be allergic or "atopic
Approximately 10%-30% of individuals in the industrialized world are affected by allergic conditions,
and this number is increasing.
Allergic rhinitis (nasal allergies) affects roughly 20% of Americans. Between prescription costs,
physician visits, and missed days of work/school, the economic burden of allergic disease exceeds $3
billion annually.
Asthma affects roughly 8%-10% of Americans. The estimated health costs for asthma exceed
approximately $20 billion annually.
Food allergies affect roughly 3%-6% of children in the United States, and roughly 1%-2% of adults in
the U.S.
The prevalence of allergic conditions has increased significantly over the last two decades and
continues to rise.
The immune system is the body's organized defense mechanism against foreign invaders, particularly
infections. Its job is to recognize and react to these foreign substances, which are called antigens.
Antigens often lead to an immune response through the production of antibodies, which are protective
proteins that are specifically targeted against particular antigens. These antibodies, or
immunoglobulins (IgG, IgM, and IgA), are protective and help destroy a foreign particle by attaching
to its surface, thereby making it easier for other immune cells to destroy it. The allergic person
however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain
normally harmless foreign substances, such as cat dander. Other antigens, such as bacteria, do not lead
to production of IgE, and therefore do not cause allergic reactions. IgE was discovered and named in
1967 by Kimishige and Teriko Ishizaka.
Allergies can develop at any age, but most food allergies begin at a young age, and many are
outgrown. Environmental allergies can develop at any time. The initial exposure or sensitization period
may even begin before birth. Individuals can also outgrow allergies over time. It is not fully
understood why one person develops allergies and another does not, but there are several risk factors
for allergic conditions. Family history, or genetics, plays a large role, with a higher risk for allergies if
parents or siblings have allergies.
The parts of the body that are prone to allergic symptoms include the eyes, nose, lungs, skin, and
gastrointestinal tract. Although the various allergic diseases may appear different, they all result from
an exaggerated immune response to foreign substances in sensitive individuals. The following are brief
descriptions of common allergic disorders.
Allergens may be inhaled, ingested (eaten or swallowed), applied to the skin, or injected into the body
either as a medication or inadvertently by an insect sting. The symptoms and conditions that result
depend largely on the route of entry and level of exposure to the allergens. The chemical structure of
allergens affects the route of exposure. Airborne pollens, for example, tend to have little effect on the
skin. They are easily inhaled and will thus cause more nasal and respiratory symptoms with limited
skin symptoms. When allergens are swallowed or injected, they may travel to other parts of the body
and provoke symptoms that are remote from their point of entry. For example, allergens in foods may
prompt the release of mediators in the skin and cause hives.
The specific protein structure is what determines the allergen's characteristics. Cat protein, Fel d 1,
from the Felis domesticus (the domesticated cat), is the predominant cat allergen. Each allergen has a
unique protein structure leading to its allergic characteristics.
Foods and medications can also cause allergic reactions, some of which can be severe. These reactions
often start with localized tingling or itching and then may lead to rash or additional symptoms, such as
swelling, nausea, vomiting, diarrhea, or difficulty breathing. Here are the two most common allergens
that are ingested:
Foods: The most common food allergens are cow's milk, eggs, peanuts, tree nuts, wheat, soy, shellfish,
finned fish, and sesame. Cow's milk, egg, wheat, and soy allergies are most common in children and
are often outgrown over time. The most common allergens in adults are peanut, tree nuts, and shellfish.
It should be noted that gluten is not a common food allergy, and true gluten hypersensitivity, or celiac
disease, is mediated by another type of antibody (not IgE but IgA) and also leads to a different host of
symptoms (including chronic abdominal discomfort, nausea, vomiting, change in stool, anemia).
Medications: Although any medication can cause an allergic reaction, common examples include
antibiotics (such as penicillin), and anti-inflammatory agents, such as aspirin and ibuprofen.
Food Allergies:
A food allergy is when the body's immune system reacts unusually to specific foods.
In young children, common food allergies include milk and eggs. In adults, allergies to fruit and
vegetables are more common. Nut allergies, including peanuts, are relatively common in both school-
age children and adults.
Symptoms of a food allergy can affect different areas of the body at the same time. Some common
symptoms include:
An itchy sensation inside the mouth, throat or ears
A raised itchy red rash (known as urticaria or hives) swelling of the face, around the eyes, lips, tongue
and roof of the mouth (known as angioedema) vomiting.
Anaphylaxis
In the most serious cases, a person has a severe allergic reaction (anaphylaxis), which can be life-
threatening.
If you think someone has the symptoms of anaphylaxis – such as breathing difficulties, light
headedness and feeling like they are going to faint or lose consciousness.
What causes food allergies?
Food allergies happen when the immune system (the body’s defence against infection) mistakenly
treats proteins found in food as a threat.
As a result, a number of chemicals are released. It is these chemicals that cause the symptoms of an
allergic reaction.
Almost any food can cause an allergic reaction, but there are certain foods that are responsible for most
food allergies.
In children, the foods that most commonly cause an allergic reaction are: Milk, eggs, peanuts, tree
nuts, fish, shellfish.
Most children that have a food allergy will have experienced eczema during infancy. The worse the
child's eczema and the earlier it started, the more likely they are to have a food allergy.
In adults, the foods that most commonly cause an allergic reaction are:
Peanuts, tree nuts – such as walnuts, brazil nuts, almonds and pistachios fish, crustaceans (shellfish) –
such as crab, lobster and prawns
It's still unknown why people develop allergies to food, although they often have other allergic
conditions, such as asthma, hay fever and eczema.
Types of food allergies
Food allergies are divided into three types, depending on symptoms and when they occur.
IgE-mediated food allergy – the most common type, triggered by the immune system producing an
antibody called immunoglobulin E (IgE). Symptoms occur a few seconds or minutes after eating.
There is a greater risk of anaphylaxis with this type of allergy.
Non-IgE-mediated food allergy – these allergic reactions are not caused by immunoglobulin E, but
by other cells in the immune system. This type of allergy is often difficult to diagnose as symptoms
take much longer to develop (up to several hours).
Mixed IgE and non-IgE-mediated food allergies – some people may experience symptoms from
both types.
Oral allergy syndrome
Some people experience itchiness in their mouth and throat (sometimes with mild swelling)
immediately after eating fresh fruit or vegetables. This is known as oral allergy syndrome.
Oral allergy syndrome is not a true food allergy. It is caused by allergy antibodies mistaking certain
proteins in fresh fruits, nuts or vegetables for pollen.
Oral allergy syndrome generally does not cause severe symptoms, and it is possible to deactivate the
allergens by thoroughly cooking any fruit and vegetables.
Treatment
There is no treatment to cure a food allergy. The best way of preventing an allergic reaction is to
identify the food that causes the allergy and then avoid it.
However, avoid making any radical changes to your or your child’s diet, such as cutting dairy
products, without first talking to your GP. You should speak to a dietician before making any changes.
A type of medication called an antihistamine can help relieve the symptoms of a mild or moderate
allergic reaction. A higher dose of antihistamines is often needed to control symptoms.
Adrenaline is also an effective treatment for anaphylaxis.
People with a food allergy are often given a device, known as an auto-injector pen, which contains
doses of adrenaline that can be used in emergencies.
Drug Allergy
Drug allergy is an immunologically mediated response to a pharmaceutical and/or formulation
(excipient) agent in a sensitized person.
Drug intolerance is an undesirable pharmacologic effect that may occur at low or usual doses of the
drug without underlying abnormalities of metabolism, excretion, or bioavailability of the drug.
Humoral or cellular immune mechanisms are not thought to be involved, and a scientific explanation
for such exaggerated responses has not been established (eg, aspirin-induced tinnitus at low doses).
Drug allergy may be classified by the Gell-Coombs classification of human hypersensitivity: IgE-
mediated (type I), cytotoxic (type II), immune complex (type III), and cellular mediated (type IV).
Delayed hypersensitivity type IV reactions are mediated by cellular immune mechanisms.
Drug allergy may also be classified by the predominant tissue or organ involved (eg, systemic,
cutaneous, hepatic), which is useful in light of the difficulty that sometimes occurs in determining the
immunologic mechanism involved.
Pi-concept: The p-i concept (pharmacological interaction with immune receptors) is a recently
described mechanism of drug allergy. In this scheme, a drug binds noncovalently to a T cell receptor,
which leads to an immune response via interaction with a major histocompatibility complex (MHC)
receptor. No sensitization is required, since there is direct stimulation of memory and effector T cells,
analogous to the concept of super antigens. It is not clear what proportion of allergic reactions to drugs,
such as antibiotics, occur via the p-i mechanism vs the hapten mechanism.
Drug-induced allergic reactions can affect numerous organ systems and manifest in a variety of
reactions, including various drug-induced allergic syndromes.
Angio-oedema and acute systemic reactions can occur via IgE-mediated mechanism as in cases of
penicillin, muscle relaxants, insulin and other hormones, while opiates, ACE-inhibitors, NSAIDs,
radio-contrast media and plasma expanders produce angio-oedema or anaphylaxis by non-IgE-
mediated mechanisms.
There are many clinical patterns of skin rash with different underlying immune mechanisms. Because
certain drug eruptions are associated with specific immunologic reactions, it is important to
characterize the type of eruption in order to be able to determine the possible cause, further diagnostic
tests and management decisions.
Type I IgE mediated reactions: Acute urticarial comprises erythematous wheals with individual lesions
lasting 2–12 hours. Immunologically mediated urticaria resulting from type I IgE mediated
mechanisms develop early if there has been previous exposure to the causal drug but less commonly
7–14 days after starting the first treatment course. Urticaria that is not IgE-mediated, e.g. to aspirin,
NSAIDs, opiates, vancomycin or quinolones can come on soon after first exposure
Type IV T cell-mediated reactions: Clinically, type IV T cell-mediated reactions can be similar and
most commonly result from exposure to antibiotics, anticonvulsants, anti-tuberculosis drugs, ACE
inhibitors and NSAIDs.
Type II reactions: They include pemphigus and pemphigoid auto-immune blistering diseases in which
specific autoantibodies target different antigenic constituents of the intercellular attachments in the
epidermis (pemphigus) or the dermo-epidermal basement membrane.
Immune-mediated hepatocellular necrosis has been described with methyldopa, halothane, allopurinol,
isoniazid and gold salts. Haemolytic anaemia can be caused by penicillin and methyldopa. The drug
rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced, multi organ
inflammatory response that can be life-threatening with symptoms of pyrexia, lymphadenopathy,
hepatitis, nephritis, angio-oedema and eosinophilia.