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Mama's masks amuse Samanvay.
Today she has a cucumber face mask. There are days when she greets him with turmeric or orange peel masks. When she takes him out, she wears big hats and scarves and carries funky umbrellas, even though it hardly rains in Bangalore.
Sanyukta Gupta, four-year-old Samanvay's mother, has been playing hide and seek with the sun ever since she was diagnosed with sunlight allergy seven years ago. "I used to roam around freely in the sun," says the 30-year-old. "One day, when I was out my skin was burning. I got rashes and my hands became itchy. I consulted a dermatologist when I had a lot of freckles and sun burn marks on my hands after being exposed to sunlight. Apparently, there is no cure for sunlight allergy. So I've been advised to take precautions while going out. It is not like some other allergies where you pop in a tablet and forget everything."
Not being able to enjoy the sun bothers the freelance photographer from Jaipur quite a bit. "I used to swim and play cricket and football. But since I developed the allergy, I have cut down on all those outdoor activities. I just stay back in the room when my family has a beach holiday. Since I'm passionate about photography, I haven't given it up totally. I don't go for outdoor shoots, as much as I used to earlier. I'm forced to stay indoors, and being an outdoor person, I feel really suffocated." When she has to venture into the sunny world, Sanyukta lathers herself with sunscreen, drinks lots of water and protects herself with suitable clothing—linen scarves for summers and woollen ones for winter.
Anything can be an allergen. Even the seemingly harmless rubber and nickel can sometimes trigger allergic reactions. Then there are common allergens like dust, pollen, insect bites and a wide range of  food allergens like peanuts, prawns, eggs, soya beans, chickpeas, fenugreek and milk. The Indian Journal Of Medical Research says that wheat allergy caused by a protein in wheat called gluten can be an impending epidemic in India. It can affect children as well as adults.
Why do some people have skin rashes, diarrhoea, breathlessness, low blood pressure and life-threatening conditions because of an apparently innocuous allergen? It is an interplay of genetics, the immune system and the environment, which leads to the development of allergic reactions. "Allergic diseases are generally hereditary. In patients who suffer from allergies, the immune system that is normally meant to protect the body from harmful substances hyperacts to otherwise harmless substances in the environment like pollen from trees and grass, dust mites and pet dander," says Prof. Ruby Pawankar, president, World Allergy Organisation. "Exposure to allergens or substances causing allergic reactions results in the increased production of an immunoglobulin called IgE in their body. IgE interacts with cells like the mast cells to release proteins like histamines and leukotrienes. These proteins in turn lead to the manifestation of allergic symptoms."
Allergies can sometimes turn fatal. There have been instances in the US where children who suffer from peanut allergy were forced to eat peanuts by their bullying peers, leading to severe reactions and even death. Those having food allergies should be careful while eating out and check with the waiters what the ingredients in the dishes are, warn experts. Unfortunately, there is very little awareness about food allergy in India.
And this lack of awareness can prove costly, as in Neelima's case. Crab meat featured in her list of weaknesses. Despite indications of allergy like itching and swelling on the lips, the 32-year-old from Vijayawada chose to ignore it. On November 31, 2006, she ate crab and was breathless in a few minutes. "We reached the hospital in 10 minutes, but by then she had collapsed," recalls her father, Radhakrishna, 60. She was hooked to a respirator and she passed away three days later. "We were told that one shot of epinephrine would have saved her life, but it was not available in India," says her mother, Sobharani, 55.
"It is an unmet need. The World Allergy Organisation is in talks with the ministries in countries like India to make epinephrine available to patients suffering from anaphylaxis, a life-threatening condition," says  Pawankar. "Those having food allergies can keep the epinephrine auto injectors with them and inject the medicine laterally into the thigh, in case the symptoms of allergy are manifested. The condition can be further managed in a hospital. It can save many lives." Pawankar suggests food labelling laws should be stricter as even traces of food substances can cause anaphylaxis in some people.
Besides food, drugs and insect bites can also trigger anaphylaxis, which is often under-diagnosed. The symptoms of anaphylaxis include dangerously low blood pressure, nausea, sweating, fainting, diarrhoea, vomiting, breathing problems, swelling of the face and wheezing.
There is considerable stigma associated with allergic disorders like asthma, which tend to occur more in children. "Parents feel shattered when a child is diagnosed with asthma. They just don't want the child to be called asthmatic and, hence, they don't take him or her to the hospital for further treatment," says Dr Randeep Guleria, head of department of pulmonary medicine and sleep disorders, All India Institute Of Medical Sciences, New Delhi. "If asthma is properly treated, the child can lead a normal life. But if left untreated, it can become chronic."
Besides rescue medicines, an asthmatic needs to take preventive medicines as well. But due to the stigma, patients refuse to use inhalers, though they have advantages over tablets. "Inhalers are the first line of treatment as far as asthma is concerned. They act directly into the lungs, so the action is very fast. Since it goes only into the lungs, the side effects are less, when compared to tablets which get dissolved in the blood, go all over the body and then reach the lungs. But because of the stigma, patients still prefer tablets to inhalers," observes Guleria.
It is estimated that there are around 20 million people with asthma in India. The prevalence rate among children is 8-10 per cent, whereas it is 5-8 per cent among adults. Experts point out that, by and large, the incidence of asthma is increasing over the last few decades probably due to factors like changes in lifestyle and increasing exposure to allergens.
You can even have a mid-life allergy crisis. New allergies may come as unpleasant surprises when you are in your thirties or forties.
Keeping her home in Bangalore sparkling clean was on top of Preetha Eldo's list of everyday chores. That was before she was diagnosed with allergic rhinitis two years ago. "I have symptoms like itchy runny nose, sneezing, itchy watery eyes, reduced sense of smell, clogged ears, itchy palate. I have been tested positive to 20 basic allergens including dust, pollen, animal dander, insects droppings, bedbugs, cotton fibre… to state a few," says the 39-year-old. "Initially, I couldn't breathe through the nostrils because of the blocked nose and would end up being sleep deprived and tired in the mornings. I used to find it hard to get my children ready for school after a sleepless night."
With medication, Preetha's health improved, but the steroids in the nasal sprays have wreaked havoc in her body. "My body is very sensitive to steroids,” she says. “I've had side-effects like hormonal imbalance, poly cystic ovarian syndrome and excessive hair loss due to which I stopped the medicines.”
Preetha now pops anti-allergic tablets when the allergy episodes flare up. "In allopathy, there is no cure for allergy. Doctors say for some people it is a life-long struggle. But some are lucky enough to recover eventually," says Preetha, who has switched to homoeopathy and does yoga for better management of her allergy.
Sometimes allergies have unusual triggers. Seminal allergy, once considered a myth by gynaecologists, is now a well-documented phenomenon, says Dr Ashore Shah, professor of respiratory medicine, Vallabhbhai Patel Chest Institute, University of Delhi, and president, Indian College of Allergy, Asthma and Applied Immunology. "Nearly 100 cases of human seminal plasma allergy have been documented worldwide since its first report in 1958. We first reported it at the 1985 convention of the Indian College of Allergy, Asthma and Applied Immunology and have published the three cases documented from India so far," says Shah. "The allergic reactions to semen can manifest with local symptoms like redness, swelling and pain as well as systemic symptoms like asthma, rhinitis and skin allergies. It can also lead to life-threatening anaphylaxis with low blood pressure."
Dr Prakash Kothari, founder adviser to the World Association for Sexology, conducted a simple diagnosis test when a patient with semen allergy was referred to him by the Indian Council of Medical Research. "She was allergic to her husband's semen and the allergic reactions manifested soon after the intercourse. I asked the couple to try with the husband wearing a condom. The woman didn't have any allergic reactions then," he says.
But there are patients who are allergic to semen as well as latex, which makes sexual intercourse a nightmare. "Condom-induced asthma can occur in men and women," says Shah. Experts say that those allergic to latex may be allergic to fruits like kiwi because of the cross reactivity between allergens.
Sexual intercourse triggers allergy in some people because of post-coital seminal transfer of allergens like food items and medication. Sexercise asthma and honeymoon rhinitis, caused by anxiety in patients with asthma and rhinitis, were documented in India by Shah in 1991. "Asthma associated with coitus can easily be overlooked due to patient embarrassment and lack of physician awareness, especially in our societal conditions and busy out-patient departments," says Shah.
Advancements in medicine offer hope to people suffering from asthma and certain forms of allergies like rhinitis. Among them are  immunotherapy, which involves desensitising a patient to the triggering allergen, or anti IgE monoclonal antibodies for people who have severe uncontrolled asthma and don't respond to conventional treatments.
Meanwhile, efforts are being made to develop tailor-made treatments called precision medicine and to move from conventional treatments to biologics, which target specific molecules or bio-markers. Researchers say that early intervention to prevent the development of disease by identifying high-risk parents who are likely to have allergic children is a hope for the future. Vaccines to prevent asthma also may be developed.
It means a lot to those who don't dare to breathe.


I have cut down on all my outdoor activities. I just stay back in the room when my family has a beach holiday.
Sanyukta Gupta

Freelance photographer, who  was diagnosed with sunlight allergy seven years ago


Care to manage

Lifestyle modifications are very important in the effective management of asthma.
* Keep your rooms relatively dust-free to avoid exposure to allergens.
* Carpets, indoor plants and pets are known triggers of asthma.
* Clean the filters of the air conditioners and coolers often.
* Asthmatics should avoid strong perfumes and mosquito repellents.
* Sudden change of temperature like going from a warm room to a cool one can cause breathing problems.
* Patients should be careful about indoor and outdoor air pollution. Stay away from crowded residential areas during Diwali as the level of air pollution goes up during that time.


I have been tested positive to 
20 basic allergens including dust, 
pollen, animal dander, insects droppings, bedbugs, cotton 
fibre….
Preetha Eldo
Bangalore homemaker, who was diagnosed with 
allergic rhinitis two years ago


The World Allergy Organisation is in talks with the 
ministries in countries like India to make epinephrine available to 
patients suffering from anaphylaxis, a life-threatening condition.
Prof. Ruby Pawankar
President, World Allergy 
Organisation



Living with it

Living with an allergy requires you to take extra care... every moment

What is allergy?
In an allergic reaction, the body releases 
chemicals like histamine to attack the allergen.
Symptoms of exposure to an allergen range from localised itching to severe anaphylactic shock, which could cause death.

Most common allergies
Dust
The most common in India, it affects five out of every 5,400 people. Carpets, curtains and even pillows house dust mites.
Molds
Fungi found in damp places in the house, could cause sneezing, irritation and even asthma.
Cosmetics
Redness, swelling or dryness of the skin are the common symptoms.
Pollens
Cause sneezing, headache and irritation in the throat.
Animals
A certain protein excreted by the animals causes wheezing, which could lead to asthma.
Perfume
It could result in skin rashes.
Cockroach
Contact with a roach or breathing the allergens from one could cause rashes.


Symptoms
Mild allergy
Sneezing, runny nose, watery eyes, headache and fatigue.
Severe allergy
On exposure to peanuts, shellfish, latex and insect stings, seek medical attention if you experience a mix of the following symptoms:
*  Breathlessness
*  Wheezing
*  Anxiety
*  Slurred speech
*  Swelling
*  Trouble swallowing
*  Severe sweating
*  Dizziness
*  Palpitation
*  Nausea
*  Diarrhoea
*  Abdominal pain
*  Rapid or weak pulse rate
*  Pale, cold, moist or reddish skin
*  Blueness of skin
*  Loss of consciousness



What to do...
when you are allergic to:
Shellfish: Avoid it completely.
Pets: Do not keep them if close contact causes rashes.
Pollen or molds: Avoid outdoors on windy days. Do not hang laundry out to dry. Close car windows when you drive.
Grass or molds: Do not cut grass and avoid outdoors when others are mowing their lawn. Do not attempt to remove molds from your home, as it could cause severe allergy.
Visit your physician regularly and know your allergies.


Rare allergies
Semen allergy
Caused by a particular protein in semen. One way to find out if you have semen allergy is to use a condom during intercourse. If the symptoms appear only after intercourse without a condom, it is semen allergy.
Fortunately, there is an effective desensitisation treatment. Diluted solutions of semen are placed in your vagina every twenty minutes until you are able to tolerate undiluted semen. The couple has to have intercourse once every 48 hours to maintain the desensitisation.
Water allergy
It is a rare condition in which water of any temperature causes intensely itchy and painful hives. Regular activities like showering become extremely difficult for people who suffer from this allergy.
Sun allergy
It is caused by the ultraviolet radiations that react with the skin's protein.
Underwear allergy
Chemicals and fabrics of underwears can cause irritation. The latex in the waistbands is often the culprit.


First aid
*  Calm the person having the reaction, as anxiety can aggravate symptoms.
*  If the allergic reaction is from an insect sting, do not squeeze or use tweezers.
*  Apply cool compresses on the itchy rash.
*  Check the person's airway, breathing, and circulation. A dangerous sign is a very hoarse or whispered voice when the person is out of breath. If necessary, begin rescue breathing and CPR.
*  Avoid oral medication if the person is having difficulty breathing.
*  Take steps to prevent shock. Have the person lie flat, raise the feet about 12 inches. Do not place the person in this position if a head, neck, back, or leg injury is suspected or if it causes discomfort.
*  Do not place a pillow under the person's head as it can block the airways.
*  In the event of anaphylaxis, seek medical attention immediately.


Food allergy
Another common allergy. Almost any food can trigger an allergic reaction at any age.
Common allergens are:
Milk, egg, wheat, soy, tree nuts, fish
Peanuts and shellfish are the most common causes of anaphylaxis, especially in children.
Preventive measures:
Avoid eating out.
Children should avoid sharing food.
Read label on food packets for ingredients.
Wash hands often to prevent secondary exposure.


Drugs that kill
Penicillin and aspirin cause anaphylactic reaction in those allergic to these drugs.
Drugs that cure
Allergies in adults are treated with antihistamines, antileukotrienes and nasal corticosteroid sprays to reduce inflammation. Oral immunotherapy vaccination and allergy shots are used for the resistant cases.
Adrenalin is used to treat anaphylactic reaction. It constricts blood vessels and raises blood pressure, thus reducing tissue swelling.

Weird allergies
Beer allergy
A protein called LTP found in barley, used in beer, is the culprit.
Cold allergy
Exposure to cold air or water causes itchiness, swollen skin or hives.
Shoe allergy
It is caused by a formaldehyde resin used to treat leather products.
Technology allergy
People with electrosensitivity are allergic to the electromagnetic field. They need to keep away from gadgets such as cell phones and microwave. A group of sufferers has even moved to an area of southern France that is free of electromagnetic fields.
Money allergy
Nickel in the coin is the trigger.
Research: Anushree Chakraborty; Graphics: Sujesh K.



Expert view

Don't rub your eyes

By Dr Rohit Shetty

Allergy of the eye is one of the more common causes of referrals to eye hospitals. More than 20 per cent of patients who come to the OPD have symptoms of allergy, which include redness, irritation and increased sensitivity to light. Allergy of the eye is more commonly found in the age group of 10-30. Wash your eyes regularly and keep your hands clean, rubbing the eyes is a no-no. If the irritation becomes serious, anti-allergic or steroid drops may be necessary.
Shetty is vice-chairman, Narayana Nethralaya, Bangalore.


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