• Immunology specialist dons Prof. Chandima Jeewandara and Dr. Thushali Ranasinghe emphasise importance of physicians seeking patients' allergy history during routine medical consultation
• Raised awareness essential among healthcare professionals and the public

The past few months saw a renewed and a rather controversial national-level discourse on allergies and the quality of medicines available in Sri Lanka, as  allegedly, the medicine-related allergic reactions, especially instances that happened  in public hospitals, were blamed for several deaths that occurred in questionable conditions. Probes, including those led by health authorities and experts, were also launched, leading to more questions about the authorities’ future steps.

While the country deals with that situation, it is important to note that allergic reactions are not a health concern that is confined to the abovementioned events. Allergic reactions are an everyday threat, and being aware of their causes and impacts could save many lives. Explaining this, Professor in Allergy and Immunology at the University of Sri Jayewardenepura, Prof. Chandima Jeewandara, who was a member of the Government appointed expert committee that looked into the alleged medicines related allergic reactions, and also a Lecturer at the Allergy, Immunology and Cell Biology Unit of the same University, Dr. Thushali Ranasinghe, stressed that awareness and facts based precautions are key in this discussion. In a conversation with The Daily Morning, they extensively discussed certain misconceptions surrounding allergic reactions.

Below are excerpts from the interview:

 What is an allergy?

An allergy occurs when the immune system of the body has an exaggerated or abnormal response to a protein (allergen) that is generally harmless to the body.

Apart from naturally occurring allergies, are there allergies that could be caused by reasons such as environmental factors?

Allergies occur as an interplay between genetic and environmental factors. Therefore, there are many reasons that cause allergies. They can be caused by natural products as well as artificial products.

Can allergies be temporary? And, can the nature and effects of an allergy change during a person’s lifetime?

Some allergies can be temporary, and it is possible that the nature and effects of an allergy change during a person’s lifetime. However, this varies from person to person. People can have a variety of presentations from mild to severe, life threatening anaphylaxis. For example, some children will outgrow their allergy to cow’s milk or eggs. 

What are the most common types of allergies?

Food, dust mites, pollen, pet dander, mould, medications, insect venom and latex are some of the most common allergens.

How can a person who has never experienced an allergic reaction find out whether that person is allergic to something?

Patients who have not had an allergic reaction are not tested. You can only know whether you are allergic to something once you experience a reaction. As mentioned earlier, becoming allergic to something can vary according to many factors, and therefore, even if someone did an allergy profile, it will not be valid for their lifetime.

Can certain habits or mistakes increase the risk of allergic reactions, and what precautions can you recommend for the general public in that regard?

Smoking, alcohol consumption, increased stress, sleep deprivation and the use of drugs can increase the risk of a person manifesting an allergic reaction. Poor indoor air quality also can increase the risk of an allergic reaction. If a patient is known to have asthma and allergies, not taking the prescribed medication or not managing the disease can lead to severe reactions if exposed to an allergen. In case an allergen has already been identified, being careless and not avoiding this allergen can lead to serious allergic reactions. Not informing the health care providers about known allergies, especially to medications, can lead to serious reactions. In addition, the overuse of antibiotics can disrupt the right balance of good bacteria in your body, which leads to an increased risk of developing allergies. As precautions, it would be good for the public to address the habits mentioned above, and deal with them to reduce the risk of allergies. If an allergen has been identified, it would be important to avoid the known cause, and read labels, especially before consuming food or medication. It would also be beneficial to maintain good hygiene and be conscious to maintain good air quality of one’s surroundings. Factors that can be controlled such as stress should be addressed. In addition, it is very important for those known to have allergies to carry their allergy medication with them wherever they go.

In Sri Lanka, when prescribing drugs, we do not generally see physicians checking whether the patients have allergies, and also patients do not seem to understand the importance of voluntarily revealing any allergies that they have. What is the international standard regarding such background checks as a mandatory practice, and are there good practices we can learn from the world?

All medical schools emphasise on the importance of seeking the allergy history of a patient, and ideally, it should be a part of the routine medical consultation. If physicians are not doing this, I think raising awareness regarding the gravity of allergies among health care professionals and the public would help. Public workshops regarding allergic diseases should be done island-wide. Internationally, allergy bracelets are available for all patients with allergies. This would be a good practice that Sri Lanka could adopt as this would help to easily identify patients at risk and to be mindful when prescribing medication. At the same time, such initiatives would help to keep others aware, especially regarding how to respond in the case of an emergency.

There is generally a huge concern about the misuse of antibiotics, especially over-the-counter antibiotics. Can antibiotic misuse contribute to allergies?

There is a major concern regarding antibiotic misuse in Sri Lanka. We can only develop allergies to medication that we have already consumed, and therefore, the more antibiotics that we are exposed to, the more chances that we have of developing an allergy. Furthermore, antibiotics destroy the healthy microbiome (beneficial bacteria) in the body that helps in immune regulation. Therefore, with the misuse of antibiotics, the microbiome is altered, leading to a higher risk of developing allergic diseases.

What are the common misconceptions about allergies?

 There are many misconceptions about allergies. One misconception is that allergies are not serious. Although some allergies may only cause mild symptoms, there are others that can be life threatening. For example, the condition known as anaphylaxis, which is a severe allergic reaction, can lead to a loss of consciousness, difficulty in breathing, and even death, if not treated promptly. Another misconception is that all allergies are the same. Allergies can have a variety of presentations and severities. Various substances, such as food, pollen, dust mites, insect stings, or medications, can trigger allergies, and their symptoms can range from mild itching and sneezing to severe hives, bad asthma attacks, or even anaphylaxis. Some think that allergies occur only in children. You can develop allergies at any age, and there are some who may not experience them until they are adults. Although many childhood allergies improve or disappear with age, some can persist throughout a person's life. Some also think that all allergies will be outgrown. As mentioned above, although some children may outgrow certain allergies, such as those to milk or eggs, there are those who will not. Allergies are highly individual dependent, and outgrowing it will depend on personal factors and the allergen. One very common misconception is that allergy and intolerance are the same. Allergies and intolerances are two very distinct conditions. Allergies involve the immune system's response to a specific allergen, and can even be life threatening. Intolerances generally involve digestive issues, and do not trigger an immune response. Lactose intolerance is an example of an intolerance. It is not an allergy. Yet another misconception is that allergy testing is always accurate. Allergy testing, like skin prick tests or blood tests, is helpful in identifying allergens, but they are not always accurate. False positives and false negatives can occur. The results should always be interpreted by a healthcare professional who takes into account the patient's medical history and symptoms. The belief that allergic reactions are always immediate is also a misconception. Certain allergies can occur several hours after exposure to an allergen. Therefore, a 24 hour recall of the day’s events would be helpful in evaluating a patient with allergies. There is also a misconception that allergy panel tests will help to identify your allergies. It is important to note that the presence of Immunoglobulin E (IgE) antibodies to foods or any substance alone does not necessarily indicate an allergic reaction. We see that many patients and physicians rely on allergy panel tests. Patients are advised to avoid foods unnecessarily without proper testing and advice. Skin tests provide more reliable information to confirm an allergy.