Managing your allergies

Asthma is the term describing a specific type of breathing problem which is due to the narrowing of the airways. This narrowing is caused when the body releases certain chemicals in response to a trigger. This chemical leads to the inflammation of the airways.13


The narrowing that occurs in asthma is caused primarily by three factors – inflammation (swelling), bronchospasm and hyper reactivity or an increased sensitivity in the airways.14 


• The most important factor is the inflammation where the airways or bronchial tubes become red, irritated and swollen. This causes the airway passage to become smaller making it more difficult for air to flow through. The inflamed tissues produce an excess of “sticky” mucous which can clump together clogging the smaller airways.14

• Bronchospasm is caused when the muscles around the bronchial tubes tighten during an asthma attack. This causes the airways to narrow even more. Bronchospasm can occur in all people and can be brought on by inhaling cold or dry air.14

• Hypersensitivity occurs in people with asthma when the inflamed and constricted airways become very sensitive to triggers like allergens, irritants and infections. This causes more swelling and narrowing of these airways.14


There are two types of asthma – allergic (caused by an allergen) and non-allergic (caused by stress, exercise, illness like a cold or the flu, exposure to extreme weather, irritants in the air or some medications).15 


Allergens or substances that can cause an allergy in allergic people, include pollens, dust-mites, moulds, pets and some insects (for example cockroaches). There are many irritants that can also cause asthma and some of them include infections (colds, bronchitis, and sinusitis), medicines like aspirin, tobacco smoke, smog and weather changes, paints and other chemicals, exercise and even emotions like laughing, crying, yelling or distress.14


Asthma can occur at any age but about half of asthma sufferers will have developed it before the age of 10. It can then become less severe in the teenage years but come back later in life. Children are the most likely to outgrow asthma as they get older. Asthma tends to run in families and the chance of developing it is more likely if there is a family history of asthma or allergies. Those people who develop it later in life (from their 30’s) are less likely to have allergic asthma and may just be sensitive to other triggers like chemicals or medicines.13


The most common symptoms of asthma are coughing, especially at night, during exercise or when laughing, shortness of breath, a tightness in the chest, wheezing or a whistling sound in your chest when you breath, especially when you breathe out.15 


Asthma can cause emotional strain and is a leading cause of work and school absenteeism. It can have an impact on livelihood, education and emotional well-being and can be a cause of depression in some. The attacks can happen at any time with mild episodes lasting a few minutes and more severe episodes lasting hours or days.15


If you think you or a family member has asthma, the best way forward is to see your doctor who will do some tests including a lung function test. The doctor will ask you about your symptoms and you will have to breathe into a machine which measures your airflow. He may ask you to then use an asthma inhaler and re-measure your airflow.  If he thinks it is allergy related he may do a skin prick test to find out what you are allergic to.13 


Asthma can be very troubling but there are many people including successful sportsmen and women who have asthma. The majority of people with asthma have symptoms that can be controlled on very little medication but your doctor will advise you on what to do.13


If you have an allergy to pollen you may get a break from your allergy during the winter, but be warned, allergies are not always caused by spring and summer pollens. Spending time indoors during the winter months may also cause your allergy symptoms.16


 If your symptoms of coughing, itchy eyes and throat and a runny nose seem to be lasting longer than a normal cold, and you do not have any aches, pains or fever – you may not have a winter common cold but rather an allergy. You may even be allergic to something in your house. Some common indoor triggers of an allergic reaction are dust mites, moulds and animals.16


Dust mites are microscopic arachnids (they look like really tiny spiders) and are about 1/3 of a mm in length and therefore not visible to the naked eye. The presence of dust mites in your house does not mean that your house is dirty. The usual cleaning methods of vacuuming and dusting do not easily get rid of them. They have tiny sticky pads on their feet which helps them attach themselves to fibres. They do not bite, spread disease or live on humans. Dust mites get their food from human secretions and the skin cells that we shed. They thrive in things such as feather pillows, upholstered furniture and stuffed animals that could have skin cells on them. The most common place for the dust mite is obviously the bedroom, especially mattresses, pillows, blankets, curtains, carpeting and other fabric items.17


Digestive enzymes of the dust mite are discharged into their faeces and this is the most bothersome of the allergens for people who are allergic to dust mites. The mites’ faeces disintegrate to form a fine powder that easily floats in the air when disturbed and is breathed in, causing asthma or nasal allergies. About 10 % of the population is allergic to dust mites and about 80 % of asthmatic children are allergic to dust mites.17


Breathing in the spores (or seeds) of moulds can cause hay fever and asthma. Moulds (or fungi) grow on wet surfaces and can be found both outdoors and indoors. Outdoor moulds are more common in shady areas and they also thrive in soil, grass, dead leaves and haystacks. Spores from these outdoor moulds enter a house through open doors and windows. Indoor moulds are found in damp darker areas of the house and can proliferate in bathrooms, damp cellars, drains, pot plants, cupboards, house foundations and sealed off rooms. If there is a ‘musty’ smell inside your home, this could indicate that moulds are present.17


Pets can also cause allergies in the house. If you suffer from a pet allergy you it is likely that you are not allergic to the fur of the animal, but to the pet dander. Pet dander is the skin sheddings of a pet, much like how we shed skin cells. The allergic reaction is caused by a tiny protein in the animal’s saliva. Dander is sticky and light so even homes without pets may contain dander as it sticks to clothes, shoes and hair. Pet dander can therefore also be found in boardrooms at work and in the school classroom.18


If you think you have an allergy, it is best to see your doctor who will take your personal and medical history, examine you and then do a skin, patch or blood test to see what you are allergic to.18 Once the culprit has been identified, then the best treatment is to avoid that allergen. This is not always possible so it may also be advisable to control the allergy environment.18 The key to controlling the allergens includes cleaning, lowering the humidity level of the environment and minimising contact with the allergens. A good example is to use allergy controlling bedding to cut down on dust mites.18


If you cannot avoid the allergen in your house then antihistamines are a common treatment for allergy symptoms. These medicines block the effect of histamine which is released during an allergic reaction and which causes the symptoms.17


The terms eczema and dermatitis are generally used interchangeably. According to the American Academy of Dermatology – eczema is the term used to describe a skin condition that causes the skin to swell and discolour. The skin is often dry and itchy, and blisters may also be present. The most common type of eczema is atopic dermatitis. Contact dermatitis is also often called eczema.19 Not all cases of eczema/dermatitis are linked to allergy. This is often referred to as the atopic eczema/dermatitis syndrome (AEDS). This condition is not contagious but may occur over a number of years.20


Atopic dermatitis usually starts in childhood before the 5th birthday. 10 % to 20 % of children may develop this condition compared to only 1 % to 3 % of adults. It is more common today compared to about 30 years ago.19 


‘Atopy’ as in ‘atopic’, is the tendency for someone to develop allergic reactions, is inherited and this is common in people with atopic dermatitis.2 In some people, true allergic reactions are responsible for their atopic dermatitis, but in others, skin irritants and psychological influences seem to be contributing factors.20


There are certain influencers which seem to increase the risk of developing atopic dermatitis. These include19:


• A family member who already suffers from atopic dermatitis, asthma or hay fever. If one or both parents have an allergic condition then the child is much more likely to get atopic dermatitis – some children may develop all three (atopic dermatitis, asthma and hay fever)

• Geographical location – children in developed, polluted and colder areas are more likely to develop atopic dermatitis

• Gender – females are slightly more likely to develop the disease when compared to males

• Age of the mother at birth – older mothers have children who are more likely to develop atopic dermatitis

• Social class – atopic eczema seems to be more prevalent in the higher social classes.


Eczema often begins in a baby after about 3 months old, as “cradle cap”. In a toddler, the disease spreads to the face, outer elbows and knees, where the skin becomes crusty and oozes. The eczema then develops on the neck, hands, and inner elbows and behind the knees. Scratching and rubbing makes the skin dry and scaly. In adults, the patches may become itchy lumps which weep. Flare-ups of eczema often start with increased itching, followed by raised red lumps.20


The exact cause of eczema is unknown, but it is believed that there is a link between eczema and allergic diseases such as hay fever and asthma. Up to 80 % of children with existing eczema, will develop hay fever and/or asthma.21


Eczema triggers can make the eczema flare up or make it worse. You should therefore learn what the triggers are.


Irritants can make the symptoms worse, although everyone who has eczema is different. One irritant which triggers your eczema may not trigger someone else’s. Irritants can include soaps, bubble baths, detergents, shampoos, dishwashing liquids, disinfectants and contact with juice from fruit, meat or vegetables.21


If you have inherited genes that make you susceptible to atopic eczema, then certain allergens could be the trigger. Some of the more common allergens are house dust mite, pets (pet dander), seasonal pollens or moulds.21


 Other triggers may include microbes (for example, certain bacteria, viruses or fungi), hot weather, high and low humidity, perspiration from exercise, and some foods. Food allergens that cause atopic eczema usually occur before the age of one and may be due to the consumption of dairy products, eggs, nuts and seeds, soy products and wheat.


Stress is also known to be associated with eczema although it is not fully understood how it affects the condition. Some women also experience flare-ups of eczema with increasing or decreasing hormone levels.21 


The frequent use of emollient creams, ointments and lotions is a common treatment for eczema, as is oils baths and the application of moisturisers. Inflammation would be treated with steroid creams, lotions and/ or antiseptics. Doctors do prescribe oral antihistamines to ease the symptoms usually associated with eczema.20


If you or someone in your family has eczema then your doctor or pharmacist would be the correct person to speak to regarding this condition.