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Allergies - Environmental - A Guide

Allergy is the word used to describe an adverse (bad) reaction that the body has to a particular substance in the environment. Most substances that cause allergies are not harmful and have no effect on people who are not allergic.

Introduction
Symptoms of allergies
Causes of allergies
Diagnosing an allergy
Treating allergies
Preventing allergies

see also: Allergy - Food

Introduction

The allergic response

Any substance that triggers an allergic reaction is called an allergen. Some of the most common allergens include pollen, house dust mites, mould and pets. Less common allergens include nuts, fruit and latex.

An allergy develops when the body's immune system reacts to an allergen as though it is a threat, like an infection. It produces antibodies to fight off the allergen, in a reaction called the immune response.

The next time a person comes into contact with the allergen, the body remembers the previous exposure and produces more of the antibodies. This causes the release of chemicals in the body that lead to an allergic reaction.

Common allergic disorders include asthma, eczema and hay fever. Symptoms can include sneezing, wheezing, coughing and skin rashes (see Allergies - Symptoms for more information about allergic reactions).

The symptoms depend on how you came into contact with the allergen. For example, you may experience problems with your airways if you breathe in pollen.

How common is it?

Allergies are very common. According to the British Allergy Foundation, one in three people in the UK suffer from an allergy at some time in their lives. The numbers are increasing every year and as many as half of those affected are children.

The reason for the rise is unclear. Some experts believe it is associated with pollution. Another theory is that allergies are caused by living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with. This causes it to overreact when it comes into contact with harmless substances (see Allergies - Causes for more information on the common causes of allergies).

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Symptoms of allergies

Allergic reactions do not happen the first time you come into contact with an allergen, but at a later point of contact. This is because the body's immune system has to develop sensitivity to the allergen before you can become allergic to it.

Typical allergic reactions involve irritation and inflammation (swelling) in the body. Symptoms may include:

  • sneezing
  • wheezing
  • sinus pain (feelings of pressure or pain high up in the nose, around the eyes and at the front of the skull)
  • runny nose
  • coughing
  • nettle rash/hives
  • swelling
  • itchy eyes, ears, lips, throat and palate (roof of mouth)
  • shortness of breath
  • sickness, vomiting and diarrhoea

It is important to remember that these symptoms can also be caused by other conditions, so see your GP for advice if you are not sure what is causing your symptoms.

Anaphylaxis

In very rare cases an allergy can lead to a severe allergic reaction called anaphylactic shock, which can be fatal.

Most allergic reactions occur locally in tissues in a particular part of the body, such as the nose, eyes or skin. In anaphylaxis, the allergic reaction involves the whole body and usually happens within minutes of coming into contact with a particular allergen.

The symptoms of anaphylactic shock can include any or all of the following:

  • swelling of the throat and mouth
  • difficulty swallowing or speaking
  • difficulty breathing
  • a rash anywhere on the body
  • flushing and itching of the skin
  • stomach cramps, nausea and vomiting
  • a sudden feeling of weakness due to a fall in blood pressure
  • collapse and unconsciousness

If you have anaphylactic shock, you will require emergency treatment, usually with an injection of a medicine called adrenaline. See Allergies - Treatment for more information on the treatment of anaphylactic shock.

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Causes of allergies

An allergy develops when the body's immune system reacts to an allergen as though it is harmful, like it would an infection. It produces a type of antibody (protein that fights off viruses and infections) called immunoglobulin E (IgE) to fight off the allergen.

When the body comes into contact with the allergen again, IgE antibodies are released, causing chemicals to be produced. Together, these cause the symptoms of an allergic reaction.

One of the chemicals involved in an allergic reaction is histamine, which causes:

  • tightening of your muscles, including those in the walls of your airways
  • more mucus to be produced in your nose lining, causing local itching and burning

Common allergens

An allergen is any substance that causes your body's immune system to overreact and produce antibodies against it.

There are thousands of allergens, but some of the most common include:

  • house dust mites
  • grass and tree pollens
  • pet hair or skin flakes
  • fungal or mould spores
  • food (particularly milk, eggs, wheat, soya, seafood, fruit and nuts)
  • wasp and bee stings
  • certain medication, such as penicillin and aspirin
  • latex
  • household chemicals

Who is at risk

Some people are more likely to develop an allergy because it runs in their family. If this is the case, you are said to be atopic, or to have atopy. People who are atopic are more likely to develop allergies because their body produces more IgE antibodies than normal.

Environmental factors also play a part in the development of allergic disorders. The exact role of the environment is unknown, but studies have shown that a number of factors seem to increase the chance of a child developing atopy, such as:

  • growing up in a house with smokers
  • exposure to dust mites
  • exposure to pets
  • using antibiotics

Boys are more likely to develop atopy than girls, as are babies who have a low birth weight. The reasons for this are unclear

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Diagnosing an allergy

If you think you have an allergy, tell your GP about the symptoms you are having, when they happen, how often they occur and if anything seems to trigger them. Your GP will also want to know if any family members have similar symptoms, or if there is a family history of allergy.

After asking about your allergy history, your GP may carry out tests to identify the allergen that is causing your symptoms, or refer you to a specialist at an allergy clinic. There are NHS allergy clinics across the UK, so you shouldn't have to travel far.

Even if you think you know what is causing the allergic reaction, you may need to be tested to determine the exact allergen and get a definite diagnosis.

The type of test you are offered will depend on your symptoms, the condition of your skin and any medication you are taking. Possible tests include:

  • Skin prick test. This is usually the first test to be done when looking for an allergen. The skin is pricked with a tiny amount of the suspected allergen to see if there is a reaction. If there is, the skin around the prick will very quickly become itchy, red and swollen. Because the skin prick test introduces such a tiny amount of allergen into the skin, the testing is considered very safe and can be used on almost any age group, including babies. However, it may not be suitable if you have a history of severe reaction to an allergen.
  • Blood test. This is used to measure the amount of IgE antibodies in your blood that have been produced by your immune system in response to a suspected allergen. The results are given on a scale from zero to six: zero indicates a negative result and six indicates an extremely high sensitivity. Blood tests are particularly useful when you are at risk of an extreme reaction or when a rare allergen is suspected.
  • Patch test. This test is used to find an allergen causing eczema (contact dermatitis). A small amount of the suspected allergen is added to special metal discs, which are then taped to your skin for 48 hours and monitored for a reaction. This test is usually carried out at a dermatology (skin) department in a hospital.

The use of commercial allergy testing kits is not recommended. These tests are often of a lower standard than those provided by the NHS or accredited private clinics. Also, allergy tests should be interpreted by a qualified professional who has detailed knowledge of your symptoms and medical history.

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Treating allergies

Wherever possible, the most effective way of managing an allergy is to avoid all contact with the allergen causing the reaction (see Allergies - Prevention for more information).

Medication

Medication cannot cure your allergy, but can be used to treat the common symptoms of an allergy, such as a runny nose, itchy mouth and sneezing. Most treatments are available over the counter but always ask your pharmacist or GP for advice before starting to take any new medication.

Antihistamines

Antihistamines treat allergies by blocking the action of the chemical histamine, which the body releases when it thinks it is under attack from an allergen. Antihistamines can be taken in tablet, cream or liquid form, or as eye drops or nasal sprays.

Nasal sprays can be used to reduce swelling and irritation in your nose, and eye drops will help to relieve sore, itchy eyes. Some sprays and drops are only suitable for adults, so always ask your GP or pharmacist for advice before buying treatments for yourself or your children.

Decongestants

Decongestants help to relieve a blocked nose, which is often caused by hay fever, a dust allergy or a pet allergy. Decongestants can be taken as tablets, capsules, nasal sprays or liquids.


Leukotriene receptor antagonists

Leukotriene receptor antagonists are tablets that block the effects of leukotrienes, chemicals released during an allergic reaction that cause inflammation (swelling) of your airways. They are used to treat asthma when other treatments have failed.

Hyposensitisation (immunotherapy)

Another form of treatment for allergies is hyposensitisation, also known as immunotherapy.
Hyposensitisation works by gradually introducing more and more of the allergen into your body to make it less sensitive to it.

The allergens are usually given as injections under the skin of your upper arm. In the initial stages of treatment you will be given injections at intervals of a week or less, while allergen doses are gradually increased. When you reach the maintenance dose, a dose that is effective in reducing your normal allergic reaction, you will need to continue to have injections of this dose every few weeks for at least two years.

Hyposensitisation is normally only recommended for the treatment of severe allergies (such as hay fever and pet allergies) that have not responded to other treatments, and for specific allergies such as bee and wasp stings.

This type of treatment must only be carried out under the close supervision of a doctor because there is a risk that it may cause a serious allergic reaction.

Treating anaphylaxis

If you have anaphylactic shock, you will need emergency treatment with an injection of a medicine called adrenaline.

If you have an allergy that could cause anaphylactic shock, or if you have had a severe allergic reaction in the past, you will be given an auto-injection kit of adrenaline. This is an easy-to-use syringe that you should carry with you at all times. The brands currently prescribed in the UK are the EpiPen and Anapen.

You might also consider wearing a medical information bracelet or another form of identification that carries information about your condition.

If you suspect that you or someone you know is having anaphylactic shock, dial 999 and ask for an ambulance.

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Preventing allergies

The best way to prevent an allergic reaction is to avoid the allergen that causes it. This is not always easy. Allergens such as dust mites or fungal spores can be hard to spot and can breed in even the cleanest house.

It can also be hard to avoid pets, particularly if they belong to friends and family, and many food allergies are triggered because people do not realise they are eating food they are allergic to.

Below is some practical advice that should help you to avoid the most common allergens.

House dust mites

One of the biggest causes of allergies are dust mites. Dust mites are microscopic insects that breed in household dust. Below are a number of ways that you can limit the amount of mites in your house.

  • Choose wood or hard vinyl floor coverings instead of a carpet.
  • Fit roller blinds that can be easily wiped clean.
  • Clean cushions, soft toys, curtains and upholstered furniture regularly, either by washing or vacuuming.
  • Use synthetic pillows and acrylic duvets instead of woollen blankets or feather bedding.
  • Use a vacuum cleaner fitted with a HEPA (high efficiency particulate air) filter, because it can remove more dust than ordinary vacuum cleaners.
  • Wipe surfaces with a damp, clean cloth, as dry dusting can spread the allergens further.

Concentrate your efforts at controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room.

Pets

It is not the pet fur that causes an allergic reaction, it is exposure to flakes of their dead skin, saliva and dried urine.

If you cannot permanently remove a pet from the house, you may find the following tips useful.

  • Keep pets outside as much as possible, or limit them to one room, preferably one without carpet.
  • Do not allow pets in bedrooms.
  • Wash pets at least one a fortnight.
  • Groom dogs regularly outside.
  • Wash all bedding and soft furnishings on which a pet has lain.

If you are visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you are visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine one hour before entering a pet-inhabited house can help to reduce symptoms.

Mould spores

Moulds can grow on any decaying matter, both inside and outside the house. The moulds themselves are not allergens but the spores they release are. Spores are released when there is a sudden rise in temperature in a moist environment, such as when central heating is turned on in a damp house, or someone dries wet clothes next to a fireplace.

Some ways that you can prevent mould spores are outlined below.

  • Keep your home dry and well ventilated.
  • When showering or cooking, keep internal doors closed to prevent damp air from spreading through the house and use extractor fans.
  • Do not dry clothes indoors, store clothes in damp cupboards, or pack clothes too tightly in wardrobes.
  • Deal with any damp and condensation in your home.

Pollen allergies

Pollen allergies, more commonly known as hay fever, are caused when plants release pollen particles into the air (pollinate). Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring and summer.

To avoid exposure to pollen you can:

  • Check weather reports for the pollen count and stay indoors when it is high.
  • Avoid drying clothes and bedding outside when the pollen count is high.
  • Wear wraparound sunglasses to protect your eyes from pollen.
  • Keep doors and windows shut during mid-morning and early evening, when there is most pollen in the air.
  • Shower, wash your hair and change your clothes after being outside.
  • Avoid grassy areas, such as parks and fields.
  • Get someone else to cut the grass for you if you have a lawn.

Severe allergies

If you have ever had a severe allergic reaction (anaphylaxis), you should carry two EpiPens or Anapens with you everywhere you go.

Wear a MedicAlert or Medi-Tag medallion or bracelet, so people are aware of your allergy in an emergency, and consider telling your teachers, work colleagues and friends so they can give you your adrenaline injection in an emergency and call an ambulance. Following this advice could save your life.

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