Allergies in both children and adults are due to a departure from nature, inventions and technical progress over the last half century. Allergy is a pathological response of the body's confused immune system to the environment around us. Why do we react so allergically to them - explains prof. Piotr Kuna, allergist.
Allergiescan be very annoying.An allergic reactionmay involve the skin, mucous membranes of the eyes, nose, respiratory tract, mucous membranes of the digestive tract and genitals, i.e. coatings that protect our body against the harmful effects of the external environment. On the skinallergywill take the form of atopic or contact dermatitis or urticaria, in the respiratory tract - allergic rhinitis and bronchial asthma, in the digestive tract - food allergy or severe OAS (Oral Allergy Syndrome) - oral allergy syndrome). In the case of genital organs, we may be not only allergic to a local, e.g. washing powder, but also hypersensitive to our partner's sperm.
Is the mechanism of allergy the same in each case?
Prof. related dr hab. Piotr Kuna: Theoretically, the mechanisms are the same, but belong to the four leading hypersensitivity responses. The allergic process in the skin, eye or digestive tract triggers the same mechanism, the same cells, the same mediators. An allergen - let's say birch pollen - when in contact with the skin can cause hives when it enters the nose, causes a runny nose when it enters the eye - conjunctivitis, when it enters the bronchi - asthma, and when swallowed, it causes symptoms of diarrhea. Another complication is that many allergens give so-called cross-reaction. Birch pollen cross-reacts with e.g. apples, kiwi, bananas. A similar cross-reaction is caused by many vegetables and fruits, including some types of meat, because they have related allergens, and the body cannot distinguish whether it is birch or apple. However, basically the mechanisms of each allergic form are similar, so the drugs used belong to only a few groups. Regardless of whether the disease reaction affects the skin, lungs or digestive system - we use the same drugs, butin various forms.
The tendency to allergies usually manifests itself in the first years of life. What does this result from?
The immune system builds up during the first five years of life, basically from conception. This is where the body learns to recognize what is its own and builds up a tolerance to it. He must also learn to tolerate various other substances and not react to them. Meanwhile, in today's world, every second newborn does not develop tolerance mechanisms. Their organisms no longer tolerate pollen, milk, eggs, animal hair, wheat, rye, house dust mites. Often an allergic reaction to drugs is observed, which is basically normal - the drug is foreign to which there should be no tolerance.
Why are more and more people in the world suffering from various types of allergies?
Most likely it has to do with the fact that modern man broke away from the natural environment and created new ones for himself: he built houses, furnished them with furniture, installed tight windows, his surroundings were saturated with chemicals, he began to conserve food. The natural environment has become alien to him. We drove away from nature so radically about 50-60 years ago. 50 years ago,
in Poland, more or less every third newborn child died, and today less than 5 in 1000 die. This is a huge progress, but its price may be the increase in the number of allergy sufferers, because more of these children also survive, whose immune system is not working properly.
World Asthma Epidemic
WHO, which monitors the epidemiological situation in the world, noticed that the problem of modern man is not infectious diseases such as measles, tuberculosis, smallpox, etc., but chronic non-communicable diseases such as asthma, diabetes or COPD. Already in 1993, it reached an agreement with the US National Institute of He alth and jointly established an agenda - the Global Asthma Initiative. This group of experts from around the world met in Washington and developed the first principles of asthma treatment. Every year, this committee issues an update of its recommendations - new world standards. Any country can take advantage of them.
An allergic reaction is very similar to an inflammatory reaction …
Because it's an inflammatory reaction. Once we are allergic to something, our body produces certain proteins that lead to a chronic inflammatory reaction - the essence of allergy. Each inflammation has its own distinct characteristics: the inflammation in pneumonia is different, the lung inflammation is different in asthma, and the chronic obstructive pulmonary disease (COPD) is different. Pneumonia is the dominant disease in these three diseases, but each is different. Therefore, we need to heal them differently. And that's the essence -know when we have allergic inflammation, when we have bacterial inflammation, when we have viral inflammation etc. These are extremely difficult practical problems. Employees of the university clinic have diagnostic capabilities that allow to distinguish these diseases, but the average doctor working in the primary he alth care facility does not have such possibilities. Doctors mistake asthma for pneumonia and use antibiotics instead of treating it with asthma medications. The same applies to the eye - in allergic conjunctivitis, it would be enough to give an antiallergic drug, and patients are prescribed - unnecessarily - antibiotics and steroids.
Asthma is the most severe among allergic diseases. How can you control if it is well treated?
In asthma, we do not have a laboratory parameter to assess the effectiveness of treatment, such as diabetes (fasting glucose) or hypertension (blood pressure measurement). The asthma control parameter is based on clinical symptoms. What kind? First, it is the ability to exercise without limitations: anyone with asthma who is well-treated can run a marathon. Secondly - a good night's sleep: the patient does not wake up at night due to symptoms of asthma, coughing and wheezing. Thirdly - no exacerbations of the disease during the year necessitating taking a leave of absence from work or school; fourth, correct spirometry: a well-treated asthma patient has normal spirometry. Fifthly - symptoms occur no more than twice a week and disappear after taking one dose of a diastolic drug. Given these five clinical elements, we aim to find the lowest effective dose of drugs that will keep us in control. But it's complicated.
ImportantIt's better to be allergic than cancer!
Allergy sufferers are less likely to die of cancer. Perhaps this type of hypersensitivity offers some protection against cancer - a fatal disease. So maybe allergy sufferers have to survive and develop an allergy in order for us to survive as a species? Many theories explain why there are more allergies today. One is undoubtedly true - civilization and the change of lifestyle with it is one of its basic causes.
prof. related dr hab. piotr kuna, head of the Department of Internal Diseases, Asthma and Allergy
Medical University of Lodz, chairman of the Executive Committee of the National Program for Early Diagnosis and Treatment of Asthma POLASTMA.
In addition, asthma is a variable disease - its symptoms vary in intensity.
This variability applies not only to individual patients, but also to patients with asthma every day, therefore the therapy must be modified. We currently have modern therapies in which the patient becomes partially responsible for the treatment.He is given one inhaler and a general guideline to use it every morning and night, plus as many times as needed. This is the most effective - a therapy that combines medical recommendations (taking the drug permanently in the morning and evening) with admitting the patient to co-treatment (the patient himself decides when to take the drug).
What medications do we have at our disposal to treat asthma?
We have had effective drugs for a long time - systemic steroids (i.e. acting in general). Only they caused serious side effects, sometimes a hundred times worse than the disease itself. Systemic steroids in the treatment of asthma are an absolute necessary evil: they cause diabetes, hypertension, cataracts, glaucoma, and increase the risk of a heart attack five times. So drugs were searched for more effective and safer than them - and found. We already have the so-called a safe steroid with no side effects. When administered in the form of a prodrug, it does not work outside the respiratory system, but only in the respiratory system after reaching the site of inflammation, where it is activated and eliminates inflammation under the influence of enzymes released from the site of inflammation. We use new drug delivery systems that are safer and more effective. They reach every place in the respiratory tract where the disease process takes place, to the smallest structures. Today, apart from extreme cases of poorly treated asthma, in the vast majority of patients we achieve full success without side effects.
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