In the US, there are about 30% – 40% of adults and 40% of children living with allergy. When allergy symptoms first start, many OTC medications work well in controlling the symptoms. Later on, it becomes an inflammation process that many OTC allergy medications would not work or only relieve or mask your symptoms temporarily. Untreated allergies or hay fever might lead to more chronic and debilitating conditions like chronic rhinosinusitis or frequent sinus infections, allergic asthma and eczema or atopic dermatitis and many cases of chronic rucurrent hives. There are about 10% of the population living with asthma and of which, 80% asthmatics have environmental allergy. More interestingly, observation in our clinic shows that patient populations that migrated from geographic area without wind-pollinating pollens or mostly tropical regions to the US have a significant increased risk of developing inflammation away from the nasal cavity. Thus, populations like African American, Asian, Middle Eastern, and even Hispanics are prone to develop severe rhinosinus infection, recurrent pharyngitis, ear infection or effusion leading to hearing loss, asthma, bronchitis, pneumonia, halitosis, gut inflammation like bloating and loose stool, then chronic allergic urticaria. European descent does not seem to readily develop those remote allergic inflammation living in the US. It is likely European descent enjoys the protection from thousand years of natural selection from their ancestor in Europe where trees are wind-pollinated there. Fluctuation of allergy symptoms during allergy seasons is also observed in patients with eosinophilic esophagitis, eczema and other gut diseases. Since they are all related, a comprehensive approach is needed to better manage your symptoms.
It looks like the underlying causes of those diseases are allergic inflammation due to the chronic dumping of histamine granules and other inflammatory cytokines that happens to be at several surface areas of the body, e.i. the nose, sinuses, airway mucosa, the skin or might even be at gut mucosa in some cases. It also seems like the most constant and strongest stimulation of those allergy cells are through the airway since it is exposed to the environment constantly through breathing. The same stimulation also is seen in patients with severe eczema where immune cells in the skin are constantly stimulated directly through broken skin barrier.
Types of Allergic Inflammation or Type 2 Inflammation:
- Allergies
- Asthma
- Sinuses
- Bad Breath
- Eczema
- Acne-like Skin Inflammation
- Urticaria
- Gut Inflammation, Leakiness and Diarrhea
- Overactive Bladders, Urge for Frequent Urination
- And more…
Untreated chronic inflammation would eventually lead to infections due to either bacteria overgrowth or the stickiness or leakiness of the mucosal lining seen in the airway and gut, also at the skin. Therefore, patients with this condition have recurrent sinus infection, bronchitis, bronchopneumonnia, skin infection, bad breath due to abundant of bacteria colonizing the airway, and sometimes abdominal pain, loose stool or an urge to evacuate after each meal likely due to irritability of the gut mucosa. This chronic dumping of inflammatory cytokines also induce a cascade of reactions of other immune cells in the body. This might be why when we are unable to control those triggers or in cases when we choose not to control those triggers, the blocking of several inflammatory pathways upstream of the inflammatory process by using biologics works many conditions like asthma, eczema, chronic recurrent hives, or even in some gut diseases. This might explain why one type of biologics work on several allergic inflammatory diseases. For example, the same one that works for asthma, also works very well on controlling chronic recalcitrant urticaria. Similarly, one type of biologics that originally works on atopic dermatitis or eczema also control asthma well. This might also be why a sublingual form of allergy disensitization (SLIT) and low quality testing and treatment phase only see some improvements of nasal and asthma symptoms but not skin symptoms like in eczema and chronic recurrent urticaria or hives. Also, good quality allergy desensitization also shows improvement of gut symptoms.
The allergic inflammation might not just limit to those organs mentioned above since allergy cells, or a type of immune cells also colonize in other parts of the body, like in the blood vessels and many other organs. Similarly, do those allergic cytokines cross into the placenta or if yes, does it cause any problems to the fetus? Those questions are active field of investigation by different groups in the world. Stay tuned for updates!
Please come and discuss with us on how to control your symptoms if you suffer from any of these diseases. After a proper diagnosis is made, variety of methods can be used to control your disease from progressing into a more debilitating conditions. Besides offering quality allergy test and desensitization, our specialized clinic also offers targeted therapies with monoclonal antibodies against several allergy related mechanisms to control your symptoms in severe cases and to minimized systemic side effects. Those can be one or a combination of the methods below:
- Avoidance of allergens
- Disease specific targeting medications to minimize systemic side effects
- Allergy shots to induce tolerance to your environment and suppress allergic inflammations that are seen in many diseases
- Xolair® injection for severe uncontrolled allergic asthma
- Nucala®, Fasenra®, Cinqair® and other biologics injection for severe uncontrolled asthma with eosinophil proliferation
- Immunoglobulin replacement therapy if indicated in certain sinus conditions and in primary antibody deficiency diseases.
- Aspirin desensitization in certain cases with nasal polyps and asthma
- ENT referral for surgical intervention of chronic recurrent sinusitis that fails maximum medical intervention if indicated
