Immunology => Allergy
Allergy, a condition of hypersensitivity in certain people or animals to substances harmless to most individuals. Some people have characterized allergy as immunity "gone wrong". In the immune reaction, contact with a disease-producing micro-organism or a toxin prompts an individual to build up antibodies (proteins related to globulin serum) against the offending organism or toxin so that he or she will be protected against further exposure. All normal people are able to produce such protective antibodies, but in some the capacity to differentiate potentially harmful substances from harmless ones is absent. These people produce antibodies against one or many inoffensive substances and thus are said to be allergic. When an antibody reacts with an antigen (a substance that stimulates the formation of antibodies) an allergic reaction results. The symptoms of that reaction will depend on where it takes place. If it occurs in the nose, it may cause sneezing and running of the nose, giving rise to hay fever. In the air passages it may cause contraction, leading to wheezing, coughing, and difficulty in breathing, as in asthma. In the skin, it may produce itching spots, hives, or welts (urticaria). If the reaction takes place in the circulating blood, a severe reaction known as serum sickness may ensue. Rarely, it can result in anaphylactic shock and a sudden severe fall in blood pressure, which can be life threatening. The allergen, the substance producing the reaction, is usually a protein or protein-carbohydrate complex. It may be inhaled, as dust or pollen; it may be eaten, as eggs or shellfish; it may be injected, as penicillin; or it may act by mere contact, as wool, adhesive tape, or metal.
The variety of substances to which a person may be allergic is almost infinite; diagnosis involves discovering the particular substance or substances to which the patient is hypersensitive (reacting excessively). A careful history of the development of the allergic reaction may give a clue, particularly when it is seasonal, when it is associated with an exposure to a specific substance, or when it occurs only in a particular place. Often it is possible to remain unaffected merely by avoiding the particular allergen concerned, but common allergens such as dust or pollen cannot easily be avoided.
An allergic individual may develop new hypersensitivities, or old hypersensitivities may die out. Allergies usually first appear in childhood, adolescence, or early adulthood, but may develop for the first time later in life. Sometimes psychological factors, stemming from emotional conflicts, play an important role in allergy so that some allergies can be classified as stress-related disorders.
The mechanism of allergic reactions is not fully understood. Most probably the antigen becomes localized in a particular tissue, such as the cells lining the nasal passages or the bronchial tubes. The antibody reacts with the antigen at these sites, causing the release of certain chemical substances, including histamine, which mediates, or brings about, the reaction. Sometimes, testing the skin with a wide variety of common allergens can pinpoint the specific allergen or allergens that are causing the difficulties.
The simplest and best treatment is, when possible, to avoid contact with the allergen. A person allergic to feathers, particular pollens, foods, or medicines, for example, should avoid them. Where this is not feasible, because the allergen is unknown, because it affects more than one part of the body, or because too many allergens are present, drugs such as antihistamines or, in more serious cases, adrenal cortical steroids may be used to decrease the reaction. In other cases desensitization (the process of making the patient able to tolerate the antigen without having a reaction) may be accomplished by giving injections of antigen, first in minute doses and then in gradually increasing doses as tolerance builds up. Skin testing is always needed when desensitization treatment is being considered. Symptomatic treatment, such as the administration of drugs to relax spasms in the walls of the bronchi in asthmatics, decongestants for hay-fever sufferers, or local ointments to relieve itching for hives may also be useful. Anaphylactic shock is a medical emergency, requiring an injection of adrenaline.