Allergy

After a late Easter the May holidays are almost upon us and the roads outside Kiev busy with traffic. Some of this annual migration is driven by the sense that Kiev is an allergy hotspot during the start of summer and traditionally many parents took their children out of the city at this time of year to Sanatoria. Its worth looking at some of the science and myths that surround allergy and how this applies to Ukraine.

Kiev is one of the three greenest capital cities in the world so it is hardly surprising that pollen allergies exist as the trees and lilac suddenly burst into bloom and flower and some trees in particular are very allergenic. Pollens and grasses do cause allergy but we are unsure why some people suffer and other’s don’t. Hay fever - traditionally the main allergy of country dwellers was always said to last for about seven years after which the body becomes accustomed to the particular pollens that cause it, however with modern farming methods the genetic basis of plants and grass seeds changes each year producing slightly different pollens and defeating this process.

Some researchers have suggested that the allergic process begins when we are in our mothers’ wombs and that we develop an allergic response to some foods and environmental proteins. It was an attractive idea which unfortunately has not been proven although many mothers still avoid highly allergenic substances such as peanuts during pregnancy. The body has two sorts of allergic response, the first, luckily uncommon,  is an immediate and often life threatening  response to some substances such as peanuts, bee stings and some drugs. The overwhelming allergic reaction needs immediate treatment with adrenaline and patients who have such allergies should carry with them an injectable form of adrenaline that they or a friend or relative can give them.

The second much more common response is a slower process involving certain sorts of white cells that cause the allergic symptoms we all know - sneezing, itching running eyes and nose, an irritating cough and sometimes skin rashes. A similar allergic reaction often induces asthma. A recent and interesting study in Jamaica has suggested it is the presence of a large quantity of free immune cells - you could think of them as immune policemen - in the body that causes allergy and asthma. In Jamaica there has been a huge increase in children with asthma and this has developed in the last five to ten years as domestic conditions in terms of hygiene have rapidly improved. Researchers have shown that traditionally the policemen were fully used in reacting to a simple gastro-intestinal parasite but as this has become less common with improving hygiene the policemen have looked elsewhere and have found immune material which causes asthma. This is an interesting and perhaps important link as western doctors have for some time noticed that asthma is more common in scrupulously clean households. For Ukraine with its dacha culture and most families connected with the soil in some way this of course will not be a problem.

In Ukraine asthma is in fact very uncommon in rural communities and I spent some time on a medical project outside Zaphorizha where asthma was almost unknown. However inside that quite polluted city and in Kyiv it is much more common. Petrochemical pollution plays a huge part in allergies such as asthma and its prevalence is directly linked to population density - highest in the UK and Holland and decreasing as you move eastwards across Europe. Researchers have also suggested that the overuse of paracetamol - panadol - in controlling children’s fevers and aches and pains in some way alters and heightens the allergic response possibly increasing asthma.

Kyiv is particularly prone to petrochemical pollution through heavy traffic congestion and its geographical nature of hills and valleys where pollutants become pooled during hot summer days - a walk down Kreschatik on a balmy Friday afternoon will well demonstrate this. Ukraine adds to the problems by its poor control of vehicle emissions with ancient Ladas and trucks pumping out levels of pollutants that would be banned in most European capitals.

So in Kyiv allergy is not a myth, its lethal combination of greenery, valleys windless summers and huge petrochemical pollution certainly creates a toxic brew that leaves many of us itching, sneezing and feeling unwell as soon as May arrives. In contrast much of the countryside with its slight breezes, rolling geography and lower density of cars provides a relatively allergic free environment.

In terms of preventing allergies and asthma what advice can be given. I think its quite good practice for pregnant women to avoid peanuts and brazil nuts in pregnancy. partly because you can survive without them and more importantly because they are very common in foodstuffs and the allergy to peanuts in children can be life threatening at worse and at best a huge task in sourcing nut free foods. Paracetamol should be used only for high fevers in children in case it also heightens the immune response. Parents should be less anxious about their children getting in contact with mother nature and some of its black soil, but that shouldn’t be done in city parks or where there are a lot of cats and dogs!

Allergy sufferers should avoid polluted areas of the city in summer and parks and gardens if they have specific allergies to say lilac. Don’t drive with the car windows open as this pools allergens inside the car. Antihistamines are safe drugs that decrease allergic reactions and its worth trying several of the different sorts as response is often specific to the individual rather than the drug, nasal sprays and eye drops can also be useful. Long acting steroid injections can be used occasionally - for exams or weddings but their regular use is prohibited. Patients with asthma should consult a physician as the management of this condition is complex yet often effective.

Tuesday, 17 May 2011

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