Vol 2 Issue 1013

Ahmed Elshemy et. al. http://www.jsirjournal.
com
VOLUME 2 ISSUE 1
ISSN: 2230-4818
JOURNAL OF SCIENTIFIC & INNOVATIVE RESEARCH

RESEARCH ARTICLE
Allergic Reaction: Symptoms, Diagnosis, Treatment and Management

Ahmed Elshemy*1, Mohammed Abobakr1
1. Department of Pharmacy, International Islamic University Chittagong, Chittagong, Bangladesh
ABSTRACT
Allergies cause a wide range of symptoms, from the common problems that everyone has heard of such as a runny
nose, nasal congestion, sneezing; watery, itchy, red eyes; and itchy ears, to less obvious problems like a tickle in the
throat, cough, asthma, wheezing, and shortness of breath, hives, eczema, bee sting reactions, and so forth. Fatigue is
also common in allergy season. The older antihistamines which cause drowsiness didn't help with fatigue but now
the newer antihistamines generally don't cause drowsiness. People develop allergy problems because of an overactive
immune system in which certain gamma globulins are overproduced by the body. Gamma globulins are normally
present to fight bacterial infections. In the case of allergies, one of the gamma globulins (called IgE) functions
abnormally and views the allergens (e.g. cat dander) as being foreign bacteria - so the IgE attempts to "kill" it. When
IgE attaches to the pollen, a barrage of chemicals including histamine are released into the body from cells called
Mast cells, and as a result patients are left with allergic symptoms.
Keywords: Allergy, Allergens, Eye Allergy, Food Allergy, Medication.
INTRODUCTION and the annual cost of dealing with them is
Allergy is one of the most widespread diseases of estimated at $18 Billion. Every individual has his
the modern world. More than 25% of the or her own immune system; the stronger the
population in industrialized countries suffers from immune system, the healthier will be the person.
allergies.1 According to the Asthma and Allergic Allergies, also known as hypersensitive reactions,
Foundation of America (2002), allergies are the occur when the immune system overreacts to
sixth leading cause of chronic diseases in the U.S, substances that do not affect most people. These
Address for correspondence: substances, also known as allergens, could be

Ahmed Elshemy* pollen, animal dander, chemicals, fungi, dust mites,
Department of Pharmacy, International Islamic
or foods such as nuts, eggs, shellfish, fish, and
University Chittagong, Chittagong, Bangladesh.
E-mail: [email protected] milk.
January-February 2013 | Vol 2 |Issue 1 Journal of Scientific & Innovative Research 123
Ahmed Elshemy et. al. http://www.jsirjournal.com
Different people show different symptoms of IgE attached to the mast cells and basophils.
allergies, which can be mild (runny nose) to severe Binding of two or more IgE molecules to mast cells
(anaphylaxis). Symptoms generally depend upon (crosslinking) is required to activate the mast cells.
the part of body contacted by the allergen, e.g., These activated cells result in the release of certain
pollens from the air enter the respiratory tract via chemicals, such as histamine, serotonin,
the nose and cause respiratory symptoms such as proteoglycans, serine protease, leukotriene C4 and
cough, itchy and runny nose, and nasal congestion, heparin, that will further bind with their receptors
sneezing, and wheezing. present in other cells (e.g., histamine receptors of
blood vessels) and lead to inflammation, irritation,
Food allergy related symptoms include vomiting,
redness and other allergic symptoms.
nausea, abdominal pain, and diarrhea. Skin allergy
symptoms are lesions, rashes, blisters, redness and The primary function of our immune system is to
itchiness, and so on.2 defend against infection; however, during an
allergic reaction the immune system responds
The Immunology of Allergies
against a substance that is harmless to most people.
The immune system protects our body against There are two subpopulations of T helper cells, Th1
pathogens and other foreign substances by and Th2. Th1 cells are helpful in protecting against
producing a kind of glycoprotein known as invading microbes and other particles by producing
immunoglobulin (Ig) or antibodies from plasma interferons and some cytokines. Th2 cells are
cells or B-cells (a type of lymphocyte). Antibodies responsible for triggering allergies by the
are mainly of five types, each one having a overproduction of IgE, and are also involved in the
different function; the type involved in allergy is struggle against parasitic worms. Th2 cells produce
immunoglobulin E (IgE). cytokines like interleukins (such as IL-5) that
enhance the production of specific IgE antibodies
Immunoglobulin E (IgE) is overproduced during an
by B cells and result in hypersensitivity, eosinophil
allergic response. On the very first exposure to an
activation, mucus production and IgE secretion.3
allergen, an allergic person becomes sensitized by
producing allergenspecific IgE that binds with IgE
receptors on mast cells (in tissues) and basophils
(in circulation). If the sensitized person has another
exposure to this specific allergen, then this allergen
will bind to the antigenic determinant site (Fab) of
The white blood cells produce an antibody

specific to that antigen. This is called
"sensitization."
The job of the antibodies is to detect and
help destroy substances that cause disease
and sickness. In allergic reactions, the
antibody is called immunoglobulin E or
IgE.
This antibody promotes production and
release of chemicals and hormones called
"mediators."
Mediators have effects on local tissue and
organs in addition to activating more white
blood cell defenders. It is these effects that
cause the symptoms of the reaction.
Histamine is one of the better-known
mediators produced by the body.
If the release of the mediators is sudden or
extensive, the allergic reaction may also be
sudden and severe, and anaphylaxis may
occur.
Figure: The Allergic Cascade
Allergic reactions are unique for each
ALLERGIC REACTION CAUSES 4 person. Reaction time to allergens can vary
widely. Some people will have an allergic
Almost anything can trigger an allergic reaction.
reaction immediately, for others it will take
The body's immune system involves the time to develop.
white blood cells, which produce Most people are aware of their particular
antibodies. allergy triggers and reactions.
When the body is exposed to an antigen, a Certain foods such as peanuts, strawberries,
complex set of reactions begins. shellfish, shrimp, dairy, and wheat.
Babies can also have food allergies. There Often, the specific allergen cannot be
are more than 160 allergenic foods. identified unless you have had a similar
Common foods that can cause allergic reaction in the past.
reactions in babies include milk, eggs, nuts, Allergies and the tendency to have allergic
and soy. Talk to your pediatrician if you are reactions run in some families.
concerned about food allergies in your Many people who have one trigger tend to
baby. have other triggers as well.
Food intolerance is not the same as food People with certain medical conditions are
allergies. Allergies are an immune system more likely to have allergic reactions:
response, while food intolerance is a severe allergic reaction in the past asthma.
digestive system response in which a person
ALLERGIC REACTION SYMPTOMS AND
is unable to properly digest or break down a
SIGNS 2, 4
particular food.
Vaccines and medications (antibiotics like The look and feel of an allergic reaction depends on
penicillin, amoxicillin, aspirin, ibuprofen, the body part involved and the severity of the
iodine), general anesthesia and local reaction. Some reactions may be localized and
anesthetics, latex rubber (such as in gloves limited, while others could involve multiple body
or condoms), dust, pollen, mold, animal systems. Reactions to the same allergen vary
dander, and poison ivy are well-known among individuals.
allergens. Other known allergens can
Anaphylaxis is the term for any
include detergents, hair dyes, and the ink in
combination of allergic symptoms that is
tattoos.
rapid, or sudden, and potentially life-
Bee stings, fire ant stings, penicillin, and
threatening. Call an ambulance immediately
peanuts are known for causing dramatic
if you suspect anaphylaxis.
reactions that can be serious and involve the
One sign of anaphylaxis is shock. Shock has
whole body.
a very specific meaning in medicine. The
Minor injuries, hot or cold temperatures,
organs of the body are not getting enough
exercise, stress, or emotions may trigger
blood because of dangerously low blood
allergic reactions.
pressure. Shock may lead rapidly to death.
The person in shock may be pale or red,
sweaty or dry, confused, anxious, or through your genes. (Thanks a lot, Mom and Dad!)
unconscious. However, just because a parent or sibling has
Breathing may be difficult or noisy, or the allergies doesn't mean you will definitely get them,
person may be unable to breathe. too. A person usually doesn't inherit a particular
Shock is caused by sudden dilation of many allergy, just the likelihood of having allergies.
or large blood vessels. This is brought on by
ALLERGENS 5
the action of the mediators. If the drop in
blood pressure is sudden and drastic, it can Some of the most common allergens are:
lead to unconsciousness, even cardiac arrest
Foods: Food allergies are most common in infants
and death.
and often go away as people get older. Although
Symptoms and signs of an allergic reaction
some food allergies can be serious, many simply
include any, some, or many of the
cause annoying symptoms like an itchy rash, a
following:
stuffy nose, and diarrhea. The foods that people are
Skin: irritation, redness, itching, swelling,
most commonly allergic to are milk and other dairy
blistering, weeping, crusting, rash,
products, eggs, wheat, soy, peanuts and tree nuts,
eruptions, or hives (itchy bumps or welts)
and seafood.
Lungs: wheezing, tightness, cough, or
shortness of breath • Insect bites and stings. The venom (poison) in
Head: swelling or bumps on the face and insect bites and stings can cause allergic reactions,
neck, eyelids, lips, tongue, or throat, and can be severe and even cause an anaphylactic
hoarseness of voice, headache reaction in some people.
Nose: stuffy nose, runny nose (clear, thin
• Airborne particles. Often called environmental
discharge), sneezing
allergens, these are the most common allergens.
Eyes: red (bloodshot), itchy, swollen, or
Examples of airborne particles that can cause
watery or swelling of the area around the
allergies are dust mites (tiny bugs that live in house
face and eyes
dust); mold spores; animal dander (flakes of scaly,
Stomach: pain, nausea, vomiting, diarrhea,
dried skin, and dried saliva from your pets); and
or bloody diarrhea
pollen from grass, ragweed, and trees.
Other: fatigue, sore throat
• Medicines. Antibiotics — medications used to
The tendency to develop allergies is often
treat infections — are the most common type of
hereditary, which means it can be passed down
medicines that cause allergic reactions. Many other • Keep family pets out of certain rooms, like your
medicines, including over-the-counter medications bedroom, and bathe them if necessary.
(those you can buy without a prescription), also can
• Remove carpets or rugs from your room (hard
cause allergic-type reactions.
floor surfaces don't collect dust as much as carpets
• Chemicals. Some cosmetics or laundry detergents do).
can make people break out in an itchy rash (hives).
• Don't hang heavy drapes and get rid of other items
Usually, this is because someone has a reaction to
that allow dust to accumulate.
the chemicals in these products. Dyes, household
cleaners, and pesticides used on lawns or plants • Clean frequently (if your allergy is severe, you
also can cause allergic reactions in some people. may be able to get someone else to do your dirty
work!)
AVOIDANCE 5
• Use special covers to seal pillows and mattresses
In some cases, like food allergies, avoiding the
if you're allergic to dust mites.
allergen is a life-saving necessity. That's because,
unlike allergies to airborne particles that can be • If you're allergic to pollen, keep windows closed
treated with shots or medications, the only way to when pollen season's at its peak, change your
treat food allergies is to avoid the allergen entirely. clothing after being outdoors — and don't mow
For example, people who are allergic to peanuts lawns.
should avoid not only peanuts, but also any food
• If you're allergic to mold, avoid damp areas, such
that might contain even tiny traces of them.
as basements, and keep bathrooms and other mold-
Avoidance can help protect people against non- prone areas clean and dry.
food or chemical allergens, too. In fact, for some
DEALING WITH ALLERGIES
people, eliminating exposure to an allergen is
enough to prevent allergy symptoms and they don't So once you know you have allergies, how do you
need to take medicines or go through other allergy deal with them? First and foremost, try to avoid
treatments. things you're allergic to!
Here are some things that can help you avoid If you have a food allergy that means avoiding
airborne allergens: foods that trigger symptoms and learning how to
read food labels to make sure you're not consuming
even tiny amounts of allergens. People with
environmental allergies should keep their house Headache from sinus congestion
clean of dust and pet dander and watch the weather
Beyond more obvious symptoms, you also may feel
for days when pollen is high. Switching to
fatigued and could suffer from lack of sleep.
perfume-free and dye-free detergents, cosmetics,
and beauty products (you may see non-allergenic Causes Eye Allergies
ingredients listed as hypoallergenic on product
Many allergens are in the air, where they come in
labels) also can help. If you're taking medication,
contact with your eyes and nose. Airborne allergens
follow the directions carefully and make sure your
include pollen, mold, dust and pet dander. Other
regular doctor is aware of anything an allergist
causes of allergies, such as certain foods or bee
gives you (like shots or prescriptions).
stings, do not typically affect the eyes the way
EYE ALLERGY 6, 7 airborne allergens do. Adverse reactions to certain
cosmetics or drugs such as antibiotic eye drops also
Eye allergies often are hereditary, and occur due to
may cause eye allergies. Some people actually are
processes associated with other types of allergic
allergic to the preservatives in eye drops such as
responses. When an allergic reaction takes place,
those used to lubricate dry eyes. In this case, you
your eyes may be overreacting to a substance
may need to use a preservative-free brand.
perceived as harmful, even though it may not be.
These substances are called allergens. For example, Eye Allergy Treatment
dust that is harmless to most people can cause
Avoidance
excessive production of tears and mucus in eyes of
overly sensitive, allergic individuals. Allergies can The most common "treatment" is to avoid what's
trigger other problems, such as conjunctivitis (pink causing your eye allergy. Keep your home free of
eye) and asthma. Combined nasal and eye allergies pet dander and dust and keep pets off the furniture.
create a condition known as rhinoconjunctivitis. Stay inside with the air conditioner on when a lot of
pollen is in the air. Use high quality furnace filters
Allergy Symptoms and Signs
that trap common allergens and replace the filters
Common signs of allergies include: frequently.
Red, swollen or itchy eyes Make sure you wear wraparound sunglasses to help
Runny nose shield your eyes from allergens, and drive with
Sneezing and coughing your windows closed during allergy season.
Itchy nose, mouth or throat
Medications eyes. Decongestants clear up redness. They contain

vasoconstrictors, which make the blood vessels in
If you're not sure what's causing your eye allergies,
your eyes smaller, lessening the apparent redness.
or you're not having any luck avoiding them, your
They treat a symptom but not the cause of eye
next step probably will be medication to alleviate
allergies. In fact, with extended use, the blood
the symptoms.
vessels can become dependent on the
Over-the-counter and prescription medications each vasoconstrictor to stay small. When you
have their advantages; for example, over-the- discontinue the eye drops, the vessels actually get
counter products often are less expensive, while bigger than they were in the beginning. This
prescription ones usually are stronger and may be process is called rebound hyperemia, and the result
more effective. is that your red eyes could worsen over time. Some
products have ingredients that act as mast cell
Eye drops are available as simple eye washes, or
stabilizers, which alleviate redness and swelling.
they may have one or more active ingredients such
Mast cell stabilizers are similar to antihistamines.
as antihistamines, decongestants or mast cell
But while antihistamines are known for their
stabilizers that inhibit inflammation.
immediate relief, mast cell stabilizers are known
Antihistamines relieve many symptoms caused by
for their long-lasting relief. Antihistamines,
airborne allergens, such as itchy, watery eyes,
decongestants and mast cell stabilizers are available
runny nose and sneezing. Decongestants help
in pill form, but pills don't work as quickly as eye
shrink swollen nasal passages for easier breathing.
drops or gels to bring eye relief. Nonsteroidal anti-
RELIEF FOR WATERY, ITCHY EYES 6, 7 inflammatory drug (NSAID) eye drops may be
prescribed to decrease swelling, inflammation and
Common causes of excessively watery eyes are
other symptoms associated with seasonal allergic
allergies and dry eye syndrome — two very
conjunctivitis, also called hay fever. Prescription
different problems. With allergies, your body's
corticosteroid eye drops also may provide similar,
release of histamine causes your eyes to water, just
quick relief. However, steroids have been
as it may cause your nose to run. It may seem
associated with side effects such as increased inner
illogical that dry eye syndrome could cause watery
eye pressure (intraocular pressure) leading to
eyes. But sometimes an underlying dry eye
glaucoma and damage to optic nerve. Steroids also
condition stimulates your tear glands to
have been known to cause the eye's natural lens to
overproduce the watery component of your eye's
become cloudy, producing cataracts Check the
tears as a protective response, leading to watery
product label or insert for a list of side effects of can build up over time and cause or
over-the-counter medications. For prescription heighten allergy-related discomfort.
medication, ask your doctor. In some cases,
When to Seek Medical Care
combinations of medications may be used. You
may benefit from immunotherapy, in which an Because allergic reactions can progress and worsen
allergy specialist injects you with small amounts of in minutes causing complications, medical attention
the allergen to help you gradually build up is always recommended for all but the most minor
immunity. and localized symptoms. If the symptoms of your
reaction worsen over a few days, or if they do not
Eye Allergies and Contact Lenses
improve with recommended treatment and removal
Even if you are generally a successful of the allergen, call your health-care provider. Tell
contact lens wearer, allergy season can your health-care provider if you have any allergic
make your contacts uncomfortable. symptoms after using a drug or other treatment
Airborne allergens can get on your lenses, prescribed for you (see Drug Allergy).Allergic
causing discomfort. Allergens also can reactions can be dangerous. Sudden, severe,
stimulate the excessive production of widespread reactions require emergency evaluation
natural substances in your tears, which can by a medical professional. Call an ambulance if you
bind to your contacts and cause blur and or someone around you has any of the following
additional discomfort. Pollen maps can help with an allergic reaction:
you determine when allergens are present.
sudden, severe, or rapidly worsening
Ask your eye doctor about eye drops that
symptoms
can help relieve your symptoms and keep
exposure to an allergen that previously
your contact lenses clean. Certain drops can
caused severe or bad reactions
discolor or damage certain lenses, so it
swelling of the lips, tongue, or throat
makes sense to ask first before trying out a
wheezing, chest tightness, loud breathing,
new brand. Another alternative is daily
trouble breathing, or hoarseness of voice
disposable contact lenses, which are
confusion, sweating, nausea, or vomiting
discarded nightly. Because you replace
widespread rash or severe hives
them so frequently, these types of lenses are
lightheadedness, collapse, or
unlikely to develop irritating deposits that
unconsciousness
Allergic Reaction Diagnosis • Do not attempt to treat or "wait out" severe

reactions at home. Go immediately to a hospital
For typical allergic reactions, your health-care
emergency department.
provider will examine you and ask questions about
your symptoms and their timing. Blood tests and X- • If no one is available to drive you right away, call
rays are not needed except under unusual an ambulance for emergency medical transport.
circumstances.
• Use your epinephrine auto-injector (Epi-Pen) if
In case of severe reactions, you will be evaluated you have been prescribed one by your doctor due to
quickly in the emergency department in order to previous allergic reactions (see "prevention"
make a diagnosis. The first step for the health-care below).
provider is to judge the severity of the allergic
Slight reactions with mild symptoms usually
reaction.
respond to nonprescription allergy medications.
Blood pressure and pulse are checked.
• Oral antihistamines.
An examination determines whether you
need help breathing. • Loratadine (Claritin or Alavert),
Often, an IV line is placed in case you need cetirizine(Zyrtec), and fexofenadine (Allegra) are
anti-allergy (antihistamine) medications nonsedating antihistamines that can be taken over
quickly. the long term.
If you can speak, you will be asked about
• Diphenhydramine (Benadryl) can also be taken
allergy triggers and previous reactions.
but may make you too drowsy to drive or operate
Allergic Reaction Treatment machinery safely. It can affect concentration and
interfere with children's learning in school. These
Self-Care at Home
medications should be taken for only a few days.
Avoid triggers! If you know you have an allergic
• For rashes or skin irritations, an anti-
reaction to peanuts, for example, do not eat them
inflammatory steroid cream such ashydrocortisone
and go out of your way to avoid foods prepared
can be used.
with or around peanuts (see Food Allergy).
For small, localized skin reactions, use a cold, wet
Self-care at home is not enough in severe reactions.
cloth or ice for relief. Apply a bag of frozen
A severe reaction is a medical emergency.
vegetables wrapped in a towel as an ice pack.
Allergic Eyes occur in non-allergic people. Typical hive

symptoms are:
Allergic eyes (allergic conjunctivitis) is
inflammation of the tissue layers (membranes) that • Raised red welts
cover the surface of the eyeball and the
• Intense itching
undersurface of the eyelid. The inflammation
occurs as a result of an allergic reaction and may Allergic Shock
produce the following symptoms:
Allergic shock (anaphylaxis or anaphylactic shock)
• Redness under the lids and of the eye overall is a life-threatening allergic reaction that can affect
a number of organs at the same time. This response
• Watery, itchy eyes
typically occurs when the allergen is eaten (for
• Swelling of the membranes example, foods) or injected (for example, a bee
sting). Some or all of the following symptoms may
Allergic Eczema
occur:
Allergic eczema (atopic dermatitis) is an allergic
• Hives or reddish discoloration of the skin
rash that is usually not caused by skin contact with
an allergen. This condition is commonly associated • Nasal congestion
with allergic rhinitis or asthma and features the
• Swelling of the throat
following symptoms:
• Stomach pain, nausea, vomiting
• Itching, redness, and or dryness of the skin
• Shortness of breath, wheezing
• Rash on the face, especially children
• Low blood pressure or shock
• Rash around the eyes, in the elbow creases, and
behind the knees, especially in older children and Shock refers to the insufficient circulation of blood
adults (rash can be on the trunk of the body) to the body's tissues. Shock is most commonly
caused by blood loss or an infection. Allergic shock
Hives
is caused by dilated and "leaky" blood vessels,
Hives (urticaria) are skin reactions that appear as which result in a drop in blood pressure.
itchy swellings and can occur on any part of the
FOOD ALLERGY 8, 9
body. Hives can be caused by an allergic reaction,
such as to a food or medication, but they also may
It doesn’t take much to trigger a reaction in 3. Avoid food products that bear a precautionary
someone with a food allergy — ingesting a tiny statement naming an allergen that you are allergic
piece of peanut or unknowingly eating pasta to; for example, precautionary statements like “may
containing shrimp in a restaurant. In someone with contain X” (where “X” is the name of a commonly
a severe allergy to these items, this can be life- known allergen).
threatening. It’s estimated, based on clinically
4. Avoid food products that don’t list their
documented cases, that about 1.8 million Canadians
ingredients or food products that contain an
may be affected by food allergies, Health Canada
ingredient you don’t recognize.
said in a recent release. Some studies show these
numbers are increasing, especially among children. 5. When eating at a friend’s or in a restaurant, tells
Peanuts, tree nuts, sesame seeds, soy, seafood, your host/server about your food allergy, and asks
wheat, eggs, milk, mustard and sulphites are the specific questions about the food being served.
food allergens most commonly associated with
6. If an allergist prescribes an
severe allergic reactions in Canada. When someone
epinephrine/adrenaline auto-injector, learn how to
ingests even a tiny amount of an allergen, a
use it and carry it all the time.
reaction may develop quickly and can become very
serious. The most dangerous symptoms include 7. Wear a Medic Alert identifier so that, in case of
breathing difficulties or a drop in blood pressure an accident, others know about your allergies and
with shock, which may result in loss of reactions.
consciousness, anaphylaxis and even death. There’s
8. Look out for allergens listed by other names;
no cure for food allergies. Avoiding an allergen is
food allergens and their derivatives are sometimes
the only effective way to prevent allergic reactions.
found in food under different names.
Here are some tips from Health Canada on how to
protect yourself if you have a food allergy: Treatments under Development
1. Read product labels carefully as manufacturers 1. DNA vaccines

sometimes change the ingredients used in familiar
Several types of new allergy treatments are under
products.
development. Because they are not proteins and
2. Avoid food products that contain the specific can’t translate into proteins to become allergens in
allergens and/or derivatives of the specific allergic persons, DNA vaccines can be used to
allergens to which you are allergic. reduce allergic reactions. DNA vaccines can be
developed by one of three approaches: (i) using the attenuates hypersensitivity reactions.12 Leung et
naked DNA of allergens (ii) using hypoallergenic al.13 also humanized an IgG1 monoclonal antibody
derivatives of allergen DNAs by modification of for peanut related allergies called TNX-901 that
nucleotides; or (iii) fragmenting allergen DNA and recognizes and masks an epitope in the IgE
fusing with ubiquitin, as fragmenting the antigen responsible for binding to the FcεRI on mast cells
destroys its native structure. and basophils. Their results indicate that a dose of
450mg of TNX-901 significantly increases the
Based on their Th1-promoting properties, DNA
threshold of sensitivity to peanuts from a level of
vaccines balance Th2-mediated immune reactions,
178mg (1/2 a peanut) to 2805mg (9 peanuts).
a quality which renders them a promising
alternative for immunotherapy against allergies.10 3. Modification of the epitopes
2. Anti-IgE antibodies Modification of IgE binding sites, i.e. epitopes of

allergens, could be another approach to attenuate
Binding of IgE antibodies to specific high affinity
hypersensitivity reactions. Epitopes of allergens
receptors (called Fc epsilon receptors, or FcεRI) on
can be created by modifying allergens and their
basophils and mast cells triggers the release of 14
hypoallergic derivatives. Singh and Bhalla have
histamine and other mediators that result in allergy
demonstrated that the anaphylactic potential of rye
symptoms. Thus developing anti-IgE antibodies
grass pollen can be reduced by introducing a few
against IgE could be a potential therapeutic option
point mutations in their allergens before using them
for allergy treatment. Various such antibodies have
for immunotherapy. In the shrimp allergen
been developed. An anti-IgE monoclonal antibody
tropomycin, eight IgE epitopes were identified and
termed BSW17 peptide has been synthesized that is
mutated. These mutations had no effect on their
nonaphylactogenic, predominantly blocks binding
secondary structure (in other words, did not change
of IgE to FcεRI, recognizes IgE already bound to
the basic structure of the IgE) but the allergic
FcεRI, and interferes with the function of IgE-
response was reduced by 90-98%, so this mutant
sensitized basophils and mast cells.11
could be helpful for therapy.15
Another such humanized monoclonal antibody is
4. Target mast cells and basophil cells
Omalizumab, which not only inhibits the binding of
expressing FcεRI
IgE to FcεRI but also decreases FcεRI expression
on mast cells and basophils. It also reduces the Another possible option to reduce IgE related
synthesis of IgE by B plasma cells and thereby hypersensitivity reaction is to directly kill the mast
cells and basophils expressing high affinity to peanuts. The researchers found that these mice
receptors (FcεRI) for IgE. Human originated showed lower histamine release and fewer peanut
apoptosis-inducing proteins can be used, as these specific IgE antibodies, and that allergic symptoms
will be less toxic or less immunogenic than the were reduced. Thus, their results suggest that
proteins produced in a different animal or plant. immunotherapy with peanut protein and HKML
From two human apoptosis-inducing proteins, Bak could treat peanut allergic patients.
and Bax, new chimeric proteins termed as Fcε-
6. Harvesting nature
Bak/Bax have been synthesized that induce
apoptosis in FcεRI-expressing mast cells and Aqueous extract of the plant bugleweed (Lycopus
basophils.16 Also, these chimeric proteins do not lucidus) decreases allergic response by reducing
degranulate mast cells. In birch pollen allergic histamine, TNFα and interleukin (IL-6) release
people, the degranulation of mast cells releases from mast cells.19 The same effect was reported by
enzymes such as α-chymase and other serine using hop, Humulus lupulus, extracts on rat mast
proteases.17 Interestingly, the chymase cleaved IgE- cells of rats and human basophilic cells.20
binding epitopes of profilin giving profilin no
7. Reducing the allergenicity of food crops
chance to react with IgE and thus attenuated mast
cell activation. Destruction of IgE binding epitopes Scientists are trying to develop methods to reduce
of profilin with chymase could further limit pollen plant allergenicity. Generally it is believed that
allergic reaction in sensitized individuals. environmental stress to plants due to pollution,
fertilizers, pesticides, heavy metals, etc., reduces
5. Immunotherapy
their vitality and makes them produce various
Immunotherapy (biologic therapy) is indicated for defense molecules (Thi and De Blic, 2005); these
people who are extremely allergic to specific defense molecules could be active allergens.21
allergens. Immunotherapy is done by gradually Malkov et al.22 have reported that soil treatment
exposing the patient to lower doses of allergens to with silicate breaking bacteria (Bacillus
reduce the sensitization. It relies on the progressive oligonitrophilus KU-1) in apples and strawberry
production of the blocking antibody IgG and plants can attenuate plant allergenic potency. The
reduction in excessive production of IgE. Li et al.18 bioavailability of silicon produced by B.
developed a new chimeric peanut protein and co- oligonitrophilus KU-1 increases the vitality of
administered it with adjuvant heat-killed Listeria plants and reduces the production of allergens. So
monocytogenes (HKLM) to mice that were allergic soil treatment with B. oligonitrophilus is a simple
and inexpensive method for reducing the allergenic triggering substances (allergens). These
capacity of food crops. medications are generally taken on a daily
basis as part of asthma treatment. Examples
MEDICATION 23-29
include fluticasone (Flovent Diskus, Flovent
Allergy medications are available as pills, liquids, HFA), budesonide (Pulmicort Flexhaler),
inhalers, nasal sprays, eye drops, skin creams and mometasone (Asmanex Twisthaler),
shots (injections). Some allergy medications are beclomethasone (Qvar) and ciclesonide
available over-the-counter, while others are (Alvesco). Side effects are generally minor
available by prescription only. Here's a summary of and can include mouth and throat irritation
the various types of allergy medications and why and oral yeast infections.
they're used. Corticosteroid eyedrops are used to treat
severe eye irritation caused by hay fever
Corticosteroids
and allergic conjunctivitis. Examples
Corticosteroids help prevent the release of include dexamethasone (Maxidex, others),
symptom-causing chemicals during an allergic fluorometholone (FML) and prednisolone
reaction. Most corticosteroid medications require a (Pred Forte, Pred Mild). These medications
prescription. may cause blurred vision. Prolonged use
may increase your risk of eye infections,
Nasal corticosteroid sprays prevent and
glaucoma and cataracts.
relieve signs and symptoms of allergies
Corticosteroid skin creams relieve allergic
such as allergic rhinitis (hay fever). These
skin reactions such as scaling and itching.
medications can help with nasal stuffiness,
Some low-potency corticosteroid creams
sneezing, and itchy, runny nose. Examples
are available without a prescription, but talk
include fluticasone (Flonase), mometasone
to your doctor before using a topical
(Nasonex), budesonide (Rhinocort Aqua),
corticosteroid for more than a few weeks.
triamcinolone (Nasacort AQ) and
Examples include hydrocortisone (Cortaid,
beclomethasone (Beconase AQ), fluticasone
others) and triamcinolone (Kenalog, others).
(Veramyst) and ciclesonide (Omnaris). Side
Side effects can include skin irritation and
effects can include unpleasant smell or
discoloration. Long-term use, especially of
taste, nasal irritation and nosebleeds.
stronger prescription corticosteroids, thins
Inhaled corticosteroids are used to relieve
the top layer of the skin, resulting in easy
symptoms triggered by airborne allergy-
bruising where the cream has been applied. prescription. Fexofenadine (Allegra) is
Corticosteroids are available in liquid form available both over-the-counter and by
that can be useful for skin conditions prescription. Some oral antihistamines may
involving the scalp. cause dry mouth and drowsiness. Older
Oral corticosteroids (pills and liquids) are antihistamines such as diphenhydramine
used to treat severe symptoms caused by all (Benadryl), chlorpheniramine (Chlor-
types of allergic reactions. Examples Trimeton) and clemastine (Tavist) are more
include prednisone (Prednisone Intensol) likely to cause drowsiness and slow your
and prednisolone (Prelone, others). Because reaction time. These sedating antihistamines
they can cause numerous short- and long- shouldn't be taken when driving or doing
term side effects, oral corticosteroids are other potentially dangerous activities.
usually prescribed for short periods of time. Antihistamine nasal sprays help relieve
Long-term use can cause cataracts, sneezing, itchy or runny nose, sinus
osteoporosis, muscle weakness, stomach congestion, and postnasal drip. Prescription
ulcers and delayed growth in children. Oral antihistamine nasal sprays include
corticosteroids can also worsen azelastine (Astelin, Astepro) and
hypertension. In some situations, olopatadine (Patanase). Side effects of
corticosteroids may be given as a shot antihistamine nasal sprays may include
(injection) rather than pills. bitter taste, dizziness, drowsiness or fatigue,
dry mouth, headache, nasal burning,
Antihistamines
nosebleed, nausea, runny nose, sore throat,
Antihistamines block histamine, a symptom- and sneezing.
causing chemical released by your immune system Antihistamine eye drops are often combined
during an allergic reaction. with other medications such as mast cell
stabilizers or decongestants. Antihistamine
Oral antihistamines (pills and liquids) ease
eyedrops can ease symptoms such as
symptoms such as swelling, runny nose,
itching, redness and swollen eyes. You may
itchy or watery eyes, and hives (urticaria).
need to use these medications several times
Over-the-counter oral antihistamines
a day, because the effects may last only a
include loratadine (Claritin) and cetirizine
few hours. Over-the-counter examples
(Zyrtec). Desloratadine (Clarinex) and
include ketotifen (Zaditor, Alaway, others)
levocetirizine (Xyzal) are available by
and pheniramine (Visine-A, Opcon-A, anxiety, tremors, and increased blood

others). Prescription examples include pressure.
emedastine (Emadine) and olopatadine Nasal decongestant sprays and drops relieve
(Patanol, others). Side effects of these nasal and sinus congestion. Examples
medications can include red eyes, watery include phenylephrine (Neo-Synephrine,
eyes, mild stinging or burning and others) and oxymetazoline (Afrin, others).
headache. Antihistamine eyedrops increase Nasal decongestants can cause dryness,
the risk of eye inflammation when you're burning or stinging inside the nose, runny
wearing contact lenses. nose, and sneezing. Taking too much of a
nasal decongestant can cause irritability,
Decongestants
fast or irregular heartbeat, dizziness,
Decongestants are used for quick, temporary relief insomnia, headaches, anxiety, tremors, and
of nasal and sinus congestion. You may need to increased blood pressure. Don't use a
avoid decongestants if you're pregnant, if you're an decongestant nasal spray for more than a
older adult or if you have high blood pressure. week or so, or you may develop severe
Check with your doctor to see which medications congestion as soon as you stop taking it
are safe for you. (rebound congestion).
Decongestant eyedrops (or combined
Oral decongestants (pills and liquids)
decongestant-antihistamine eyedrops) can
relieve nasal and sinus congestion caused
temporarily ease symptoms such as red,
by hay fever. Many decongestants are
itchy eyes. Available over-the-counter,
available over-the-counter. A common
examples include tetrahydrozoline (Visine
example is pseudoephedrine (Sudafed,
others) and naphazoline (Clear Eyes,
others). A number of medications contain a
others). Side effects include persistent eye
decongestant such as pseudoephedrine
redness and damage to blood vessels in the
combined with other medications. Claritin-
eye when overused. In rare cases,
D, for example, contains pseudoephedrine
decongestant eyedrops can cause a type of
and an antihistamine. Oral decongestants
sudden (acute) glaucoma.
can cause a number of side effects,
including irritability, fast or irregular Other allergy medications
heartbeat, dizziness, insomnia, headaches,
A few other medications work by blocking (Alocril). These medications don't usually cause
symptom-causing chemicals released during an significant side effects.
allergic reaction.
Immunotherapy
• Montelukast (Singulair) is a prescription
Immunotherapy injections (allergy shots) may
medication that blocks symptom-causing chemicals
relieve hay fever symptoms or allergic asthma that
called leukotrienes. This oral medication relieves
doesn't improve with medications. Injections may
allergy signs and symptoms including nasal
also be an option if you aren't able to take oral
congestion, runny nose and sneezing. Side effects
allergy medications without having side effects.
can include upper respiratory infection in adults,
Over a period of three to five years, you receive
and headache, ear infection and sore throat in
regular injections containing allergen extracts. The
children. The Food and Drug Administration
goal is to stop your body from reacting to specific
(FDA) has warned that in some people,
allergens and decrease or eliminate your need for
leukotriene-blocking medications could possibly
medications. Immunotherapy may be especially
cause psychological symptoms, such as irritability,
effective if you're allergic to cat dander, dust mites,
anxiousness, insomnia, hallucinations, aggression,
or pollen produced by trees, grass or weeds. In
depression, and suicidal thinking or behavior.
children with allergic rhinitis, immunotherapy may
• Cromolyn (Nasalcrom) is an over-the-counter help prevent the development of asthma. Rarely,
nasal spray. It prevents the release of histamine and immunotherapy injections can cause a life-
other symptom-causing chemicals during an threatening allergic reaction (anaphylaxis).
allergic reaction. This medication works best when
SEASONAL ALLERGY TREATMENTS 30-36
you take it before your symptoms start. Some
people need to use the spray three or four times a Seasonal allergy treatments come in several forms
day. Side effects may include nasal stinging or — for example pills, liquids, nasal sprays, eye
sneezing. drops. No known medicine can “cure” allergies. So
the goal of allergy treatment is to help relieve
• Mast cell stabilizer eyedrops prevent the release
symptoms.
of symptom-causing chemicals such as histamine.
These prescription medications reduce allergy What seasonal allergy medication works best for
symptoms such as red, itchy eyes. Examples you can often depend on your symptoms and the
include cromolyn (Crolom), lodoxamide severity of those symptoms. Your doctor can help
(Alomide), pemirolast (Alamast) and nedocromil
you decide what seasonal allergy treatment is right Immunotherapy, commonly called “allergy
for you. shots,” may help in cases of persistent
seasonal allergic rhinitis. Allergy shots are
Different Types of Seasonal Allergy Treatments
given regularly over a period of years and
Allergy treatments come in different forms and contain allergen extracts. The goal is to
work in a variety of ways. Here are some examples. reduce your sensitivity to specific allergens
so that you are less likely to react or to react
Antihistamines are one of the most
as strongly to them.
commonly used types of allergy
medications. They block histamine, a CONCLUSION
chemical that is released by the body’s
The treatment goal is to relieve symptoms and
immune system. Antihistamines are
prevent a severe reaction. Treatment may include:
available in several forms; for example,
Antihistamines relieve mild symptoms such as rash,
pills you swallow or as nasal sprays. Some
hives, and itching Bronchodilators such as albuterol
antihistamines may cause drowsiness.
to reduce asthma-like symptoms (moderate
Decongestants relieve congestion in the
wheezing or cough). Corticosteroids applied to the
nose and sinuses. They work by constricting
skin, given by mouth, or given intravenously
blood vessels in the nose. However,
(directly into a vein).Epinephrine by injection to
decongestants may sometimes lead to an
treat anaphylaxis. An allergist has advanced
increase in blood pressure. For this reason,
training and experience to properly diagnose your
and others, decongestants should be used
condition and prescribe an allergy treatment and
with caution in people with certain common
management plan to help you feel better and live
medical conditions, including high blood
better.
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JOURNAL OF SCIENTIFIC & INNOVATIVE RESEARCH

Allergic Reaction: Symptoms, Diagnosis, Treatment and Management

Keywords: Allergy, Allergens, Eye Allergy, Food Allergy, Medication.

INTRODUCTION and the annual cost of dealing with them is

Address for correspondence: substances, also known as allergens, could be

The white blood cells produce an antibody

Medications eyes. Decongestants clear up redness. They contain

Allergic Reaction Diagnosis • Do not attempt to treat or "wait out" severe

Allergic Eyes occur in non-allergic people. Typical hive

1. Read product labels carefully as manufacturers 1. DNA vaccines

2. Anti-IgE antibodies Modification of IgE binding sites, i.e. epitopes of

and pheniramine (Visine-A, Opcon-A, anxiety, tremors, and increased blood

31. Zock JP, Plana E, Jarvis D "et al." "The use of

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