The role of environmental factors in allergies

1
The role of environmental factors in allergies

• Prof. Witold Lukas
• Department of Family Medicine, Silesian Medical
  Academy

2
Risk factors increasing probability of allergic
sensitivity

• The time of exposure of internal and external
  factors (pregnancy, the neonatal period, early
  childhood).
• Different exposure (from the ones mentioned
  above) to viral (an increased frequency of RSV)
  and bacterial (a higher incidence of G-negative)
  infections.
• Type and intensity of exposure to pollen (from
  plants or trees), mites, molds or tobacco smoke.

3
Internal risk factors augmenting allergic
sensitivity

• Pregnancy
• Immunity switches from type Th1 to Th2 (at birth
• neonates predominantly have type Th2).
• Breast-feeding
• The milk of women with atopic diseases contains
  decreased amounts of secretory IgA as well as
  polyunsaturated fatty acids.

4
Internal risk factors augmenting allergic
sensitivity

• Newborns with atopic diseases
• Delayed maturation of T and B lymphocytes. In
  some cases excessive production of IgE precedes
  the onset of allergic symptoms.
• Intestinal flora of a newborn
• healthy a predominance of Lactobacillus
  stimulating type Th1 in the immune system
• with atopic diseases a deficiency of
  Lactobacillus

5
Reasons for recent changes in exposure to
different type of viral and bacterial infections

• The consumption (from an early neonatal period)
  of food prepared under sterile conditions.
• Improvement in personal hygiene, a lack of common
  bacteria in the environment.
• Early application of broad-spectrum antibiotics.
• A significant decrease in the incidence of
  infectious diseases, including mostly morbilli,
  caused by the common use of vaccinations.

6
Reasons for recent changes in exposure to
different types of viral and bacterial
infections

• The improvement of household conditions a
  higher standard of living better sealing of
  windows in houses, worse ventilation, the use of
  air conditioning, augmenting exposure to molds.
• Fewer children in families.
• Decreased contact of children with their peer
  groups.

7
The allergic march the life cycle of the
allergy
0-6 mo - Predominance of gastro-intestinal
symptoms possible skin lesions 7-12 mo
- Symptoms of atopic dermatitis of newborns
gastro-intestinal symptoms 2-3 yo - Asthma in
early childhood 4-7 yo - Allergic rhinitis 8-14
yo - Bronchial asthma, allergic rhinitis
8
External risk factors causing allergic sensitivity

• Pollen
• Grass timothy
• Weeds ragweed
• Trees birch, alder, oak
• Animal danders (pets e.g. hamsters, cats)
• Industrial dusts and irritant gases (ozone,
  sulfur dioxide, nitrogen oxide, formaldehyde)
• Automobile engine exhaust

9
Physical signs helpful in diagnosing allergic
diseases

• the allergic salute rubbing of the nose
• A horizontal groove on the nose
• eye shadows
• Denis-Morgan lines on the palpebrae
• an adenoidal face
• secretory otitis media
• paranasal sinusitis
• geographic tongue

10
Signs of allergies of the upper respiratory tract

• Pruritus and tearing (lacrimation)
• Sneezing fits
• Nasal congestion
• Clear exudate rhinitis
• Scratching of the throat
• Laryngeal dyspnea (shortness of breath)

11
Hypersensitivity to pollen

• Pollen seasons
• The end of Jannuary to the beginning of March -
  e.g. alder
• April - e.g. birch, maple
• May to the end of June - e.g. grass (including
  grain)
• August to September - e.g. weeds
• Regional differences occur

12
Hypersensitivity to allergens

• Hypersensitivity to weeds summer
• Hypersensitivity to dust mites perennial, with
  exacerbation during the winter season (due to
  heating)
• Hypersensitivity to animal danders and feathers
  perennial or incidental

13
Allergies to grass tree pollens

• Prophylactic actions
• Avoid sleeping with an open window
• Avoid walking between 1200 and 1500
• Avoid driving with an open window
• Avoid bicycling
• Avoid exposure to smoke (due to burned wood or
  grilled food)

14
Allergies to grass tree pollens

• Recommendations
• Walking after the rain
• Wearing long sleeve shirts and trousers in case
  of skin eruptions
• Daily shower or bath (and washing ones hair) as
  well as changing clothes after walking or outdoor
  activities
• Allowing air flow in the home during and after
  the rain
• Creating a self-monitoring flowchart
• Using Pollen Monitor available online at
  http/www.alergie.info.pl or by using the press,
  radio and/or TV
• Using the European pollen calendar

15
Allergies to grass tree pollens

• Recommendations
• Spending time in places containting
  (theoretically) small amounts of pollen, e.g.
  closed pools, spaces without windows, places next
  to large water reservoirs.
• When planning vacations, taking into
  consideration differences in pollen seasons in
  various geographical regions of the country.
• Avoiding eating honey, drinking herbal teas,
  taking herbal medications or using fragrant
  topical herbal creams or lotions.
• Conveying information about possible
  cross-allergies, e.g. birch pollens.
• Avoiding strong fragrances the elimination of
  bath/shower lotions, herbal cosmetics, hair
  sprays and perfumes.

16
Dust mite allergies

• Signs and symptoms
• Rhinitis
• Nocturnal cough
• Dyspnea (shortness of breath SOB)
• Perennial symptoms, with exacerbation during the
  heating season, i.e. winter(especially at night
  and in the morning).

17
Dust mite allergies - prophylactic actions

• Recommendations for patients
• Reducing high humidity at home and in the
  workplace via installing a high efficiency
  air-filtering system or by keeping proper
  air-flow.
• Changing bed sheets frequently (1x per week),
  freezing bed sheets frequently during the
  winter, using anti-allergic covers over the
  mattress and pillows.
• Avoiding exposure to velveteen fabrics, furs,
  dust-collecting furniture, draperies, wool
  covers, carpets.
• Avoiding being present during house/office
  cleaning and returning only after at least two
  hours post cleaning or dusting.

18
Dust mite allergies - prophylactic actions

• Recommendations for patients
• Avoid staying in the attic or basement.
• Use the Acarex test to identify dust mites.
• Use Acarosan preparation topically on ones
  mattress, furniture fabrics, rugs and carpets
  once every 4-6 months.
• Use Acaril liquid to rinse bed sheets that are
  washed in temperatures up to 60oC.

19
Allergies to fungal spores

• Signs
• Conjunctivitis (perennial with periods of
  seasonal exacerbations)
• Nasal congestion (edema of nasal mucosa)
• Asthma
• Signs and symptoms are perennial.
• Patients allergic to outdoor fungal species
  remain asympthomatic in the winter.

20
Allergies to fungal spores

• Prophylactic actions in the home/flat
• Remove potted plants.
• Remove or frequently change air humidifiers.
• Avoid working in libraries, banks.
• Avoid being present next to construction or
  demolition sites.
• Avoid picking mushrooms or forest walking after
  rain.
• Exclude blue cheese, dry fruit, mushrooms, wine
  and beer from ones diet.
• Avoid staying in green-houses and compost prisms.
• Avoid places with air conditioning.

21
Allergies to pet animal danders

• Mostly related to hamsters, cats or birds
  (parrots, canaries)
• Prophylactic actions
• Removal of these pets/animals, especially from
  the bedroom.
• Wash away cat dander.

22
Food allergy Signs

• Skin
• Utricaria acute recurrent acute
• Respiratory tract
• Rhinitis, wheezing or difficulty with breaching
• Pharyngitis, laryngitis
• Otitis
• Bronchitis, chronic pneumonia
• Asthma

23
Food allergies Signs

• Gastrointestinal (GI) tract
• Recurrent diarrhea or constipation
• Abdominal pain
• Colic pain in the neonatal period
• Gastroesophageal reflux (GERD)
• The nervous system
• Fatigue, increased somnolence
• Attention deficit disorders
• Hyperactivity disorders, aggression
• Headaches
• Epilepsy

24
Food allergies Signs

• The musculoskeletal system
• Pain in ones extremities
• Joints edema
• The urinary system
• Proteinuria
• Hematuria

25
Cross-reactions between pollen and food allergens
(the presence of profiline in pollens and foods)
Pollens and types of foods Grass Raw fruits or
vegetables apples, carrots, potatoes,
tomatoes Alder, birch tree Nuts, apples, peaches,
pineapples, carrots Rye-grass Rye
flour Weeds Celery, melons, parsly,
herbs Latex Bananas, kiwi, avocado
26
Genetically modified food (GMO)

• An allergy to corn with Plant Incorporated
  Pepticide (PIP)
• An allergy to soya with the brasilian nut gene

27
Nutrition for allergyprophylaxis

• Breastfeeding - min. to 6 months
• A hypoallergic diet for lactating women the
  exclusion of
• Milk
• Eggs
• Nuts
• Cacao
• Fish
• Citrus fruits
• A gluten-free and hypoallergic diet to 1 year
• A hypoallergic mix for neonates with a positive
  family history of allergies