Medical English-1“Allergy”

Prof. Dr. H. Barbaros ORAL

Introduction

In this review you will learn how allergy relates to the immune system.

You will begin understanding how and why certain people become allergic.

The most common allergic diseases are discussed briefly in this article.

What does an allergy mean?

An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances.

It is misguided because these foreign substances are usually harmless and remain so to non- allergic people.

Allergy-producing substances are called "allergens."

Examples of allergens include pollens, dust mite, molds, danders, and foods.

To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.

When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it.

When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic.

Therefore, people who are prone to allergies are said to be allergic or "atopic.“

Austrian pediatrician Clemens Pirquet (1874-1929) first used the term allergy.

He referred to both immunity that was beneficial and to the harmful hypersensitivity as "allergy."

The word allergy is derived from the Greek words "allos," meaning different or changed and "ergos," meaning work or action.

Allergy roughly refers to an "altered reaction."

The word allergy was first used in 1905 to describe the adverse reactions of children who were given repeated shots of horse serum to fight infection.

The following year, the term allergy was proposed to explain this unexpected "changed reactivity."

How do allergies develop?To help answer this question, let's look at a common

household example.

A few months after the new cat arrives in the house, dad begins to have itchy eyes and episodes of sneezing.

One of the three children develops coughing and wheezing, especially when the cat comes into her bedroom.

The mom and the other two children experience no reaction whatsoever to the presence of the cat.

How can we explain this?

The immune system is the body's organized defense mechanism against foreign invaders, particularly infections.

Its job is to recognize and react to these foreign substances, which are called antigens.

Antigens are substances that are capable of causing the production of antibodies.

Antigens may or may not lead to an allergic reaction.

Allergens are certain antigens that cause an allergic reaction and the production of IgE.

The aim of the immune system is to mobilize its forces at the site of invasion and destroy the enemy.

One of the ways it does this is to create protective proteins called antibodies that are specifically targeted against particular foreign substances.

These antibodies, or immunoglobulins (IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it.

The allergic person however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances, such as cat dander.

To summarize, immunoglobulins are a group of protein molecules that act as antibodies.

There are 5 different types; IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody.

(In 1967, the husband and wife team of Kimishige and Teriko Ishizaka detected a previously unrecognized type of immunoglobulin in allergic people. They called it gamma E globulin or IgE.)

In the pet cat example, the dad and the youngest daughter developed IgE antibodies in large amounts that were targeted against the cat allergen, the cat dander.

The dad and daughter are now sensitized or prone to develop allergic reactions on subsequent and repeated exposures to cat allergen.

Typically, there is a period of "sensitization" ranging from months to years prior to an allergic reaction.

• Although it might occasionally appear that an allergic reaction has occurred on the first exposure to the allergen, there must have been a prior contact in order for the immune system to be poised to react in this way.

IgE is an antibody that all of us have in small amounts.

Allergic persons, however, produce IgE in large quantities.

Normally, this antibody is important in protecting us from parasites, but not from cat dander or other allergens.

During the sensitization period, cat dander IgE is being overproduced and coats certain potentially explosive cells that contain chemicals.

These cells are capable of causing an allergic reaction on subsequent exposures to the dander.

This is because the reaction of the cat dander with the dander IgE irritates the cells and leads to the release of various chemicals, including histamine.

These chemicals, in turn, cause inflammation and the typical allergic symptoms.

This is how the immune system becomes misguided and primed to cause an allergic reaction when stimulated by an allergen.

On exposure to cat dander, the mom and the other two children produce other classes of antibodies, none of which cause allergic reactions.

In these non-allergic members of the family, the dander particles are eliminated uneventfully by the immune system and the cat has no effect on them.

Who is at risk and why?

Allergies can develop at any age, possibly even in the womb.

They commonly occur in children but may give rise to symptoms for the first time in adulthood.

Asthma may persist in adults while nasal allergies tend to decline in old age.

Why, you may ask, are some people "sensitive" to certain allergens while most are not? Why do allergic persons produce more IgE than those who are non-allergic?

The major distinguishing factor appears to be heredity.

For some time, it has been known that allergic conditions tend to cluster in families.

Your own risk of developing allergies is related to your parents' allergy history.

If neither parent is allergic, the chance that you will have allergies is about 15%.

If one parent is allergic, your risk increases to 30% and if both are allergic, your risk is greater than 60%.

Although you may inherit the tendency to develop allergies, you may never actually have symptoms.

You also do not necessarily inherit the same allergies or the same diseases as your parents.

It is unclear what determines which substances will trigger a reaction in an allergic person.

Additionally, which diseases might develop or how severe the symptoms might be is unknown.

Another major piece of the allergy puzzle is the environment.

It is clear that you must have a genetic tendency and be exposed to an allergen in order to develop an allergy.

Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.

There are other important influences that may conspire to cause allergic conditions.

Some of these include smoking, pollution, infection, and hormones.

Where are allergens? Everywhere

We have seen that allergens are special types of antigens that cause allergic reactions.

The symptoms and diseases that result depend largely on the route of entry and level of exposure to the allergens.

The chemical structure of allergens affects the route of exposure.

Airborne pollens, for example, will have little effect on the skin.

They are easily inhaled and will thus cause more nasal and lung symptoms and limited skin symptoms.

When allergens are swallowed or injected they may travel to other parts of the body and provoke symptoms that are remote from their point of entry.

For example, allergens in foods may prompt the release of mediators in the skin.

We will assume that allergens are defined as: the source of the allergy producing substance (e.g. Cat), the substance itself (cat dander), or the specific proteins that provoke the immune response (e.g. Feld1).

Feld1, from the Felis domesticus (the domesticated cat), is the most important chemical allergen in cat dander.

Allergens may be inhaled, ingested (eaten or swallowed), applied to the skin, or injected into the body either as a medication or inadvertently by an insect sting.