How to spot and treat allergies: top tips from an expert

The sun is shining, flowers are in bloom and noses are running. Feeling torn about the arrival of spring, people with pollen allergies look on red-eyed as the season unfolds. And in this country, there are more than just a few of them. According to the aha! Swiss Allergy Centre (report in German), three million people in Switzerland are affected by allergies and intolerances. The organisation has reported that twenty per cent of Swiss residents are allergic to pollen, while 15 per cent of the population has asthma.

Allergies aren’t harmless. In fact, their ability to affect all four organ systems (the skin, respiratory tract, gastrointestinal tract and cardiovascular system) can make them life-threatening, as the Bern-based aha! Swiss Allergy Centre’s Noemi Beuret confirms.

The good news is that only a few allergies actually fall into the life-threatening category. Most are easy to treat and get under control. Beuret sheds some light on typical allergy symptoms, treatments and the current state of research, and why people who’re allergic to animals really shouldn’t get a pet.

1. If runny noses and scratchy throats are symptoms of both, how do you tell the difference between an allergy and a cold?

«The typical symptoms of respiratory allergies, such as mould or pollen allergies, are bouts of sneezing, a blocked or runny nose, itching at the roof of the mouth, hoarseness and coughing. As is especially true of a dust mite allergy, the symptoms occur at night or early in the morning. Unlike the common cold, however, the secretion produced by an allergy tends to be watery. But the main difference is itchiness in the roof of the mouth.»

Dust mite allergies, by the way, aren’t all that easy for parents to spot in young children. The allergy might manifest as just a stuffy nose (without the scratchy throat) – and let’s face it, young children in particular get those often. The most important thing when it comes to a dust mite allergy, incidentally, are good encasings, i.e. special covers for mattresses and, ideally, pillows. When buying one, you should make sure it has double-covered zippers – a sign of high-quality encasings.

2. What’s a cross-allergy?

«A cross-reaction occurs when a person who’s actually allergic to pollen eats certain foods. The proteins these foods contain are so similar to the allergens in pollen that the immune system can’t distinguish between the two. That’s why cross-allergies are also known as secondary food allergies. They result in oral allergy syndrome, usually characterised by a tingling sensation in the roof of the mouth when eating the food in question. Cross-reactions usually occur with raw foods; processed or cooked foods are often better tolerated because the allergen is heat-labile. Cross-allergies are very common in Switzerland – about 70 per cent of people allergic to birch pollen are affected.»

According to the aha! Swiss Allergy Centre, there are various forms of cross-reactions:

• Birch, alder and hazel pollen allergies: cross-reactions to pome and stone fruit (apples, pears, plums, apricots, cherries, nectarines, etc.), hazelnuts, walnuts, almonds, carrots, celery, kiwis, soy, mung beans, peanuts
• Mugwort (Artemisia) pollen allergy: cross-reactions to celery, carrots, fennel, camomile, pepper, mustard, dill, parsley, coriander, caraway, anise, sunflower seeds, lychee, mangoes, grapes, peaches, cashews
• Hemp allergy: cross-reactions to fruits and vegetables

In rare cases, it’s other respiratory allergies, not pollen allergies, that cause cross-reactions to food:

• Dust mite allergy: cross-reactions to shrimp, lobster, crayfish, snails, insects (when eaten)
• Latex allergy: cross-reactions to avocados, bananas, sweet chestnuts (vermicelles, chestnuts), kiwis
• Bird feather allergy: cross-reactions to chicken eggs (the yolk)
• Cat allergy: cross-reaction to pork

3. How can I tell if I have an intolerance and how does it differ from an allergy?

«Allergies develop in the blood. The body produces antibodies that dock onto immune cells. Any time the person comes into contact with the allergen, the antibodies are activated and release histamine, causing typical allergy symptoms. In the case of food intolerance, the reaction takes place in the gastrointestinal tract. The body is unable to fully process a certain substance. Although the symptoms are troublesome, they’re not fatal. Another difference is that intolerance reactions occur after a bit of a delay, so not within minutes. For instance, it usually takes about half an hour before symptoms of a lactose intolerance become noticeable. When it comes to allergies, however, there’s usually an immediate reaction.»

While we’re on the subject of food intolerances, it feels like everyone is affected by them these days. This makes it all the more important to be able to distinguish them from allergies – and to know the numbers. As a matter of fact, food allergies – i.e. a defensive reaction in the body to plant or animal proteins – are only clinically detectable in about 2–8 per cent of the Swiss population. These are commonly allergies to chicken eggs, cow’s milk or nuts. The situation is different, however, when it comes to food intolerances. Depending on the type of intolerance (for example, coeliac disease i.e. gluten intolerance, or lactose intolerance), up to 20 per cent of people in Switzerland are affected.

4. What kind of people are most seriously affected by allergies and what role do genetics and environmental influences play?

«Genetics plays an important role. You’ve a higher likelihood of developing an allergy if it runs in your family. For instance, if both parents have allergies, the risk of a child developing one increases to 60 per cent. Nevertheless, people can also develop allergies without having a family history of them. Around 12 per cent of allergy sufferers fall into this category. Allergies can develop at any time in life, and there’s no definitive explanation as to why. There’s the hygiene hypothesis, which stipulates that the more hygienically we live, the more susceptible we are. These days, our immune systems are confronted with pathogens such as parasites, viruses or worms less often than they were in the past, so they rail against harmless substances.

Environmental factors also play a role; the climate is changing, pollen seasons are getting longer, new plant species are becoming native, and pollutants in the air are making pollen more allergenic.»

5. Can you grow out of an allergy?

«That’s an outdated assumption that’s not quite true. Allergies can appear and disappear at any age. It’s impossible to predict how old someone will be when this happens. People often react to several allergens at once, which can become weaker or stronger over time – but we don’t exactly know how they interact. There are allergies that take root in childhood and develop over time, with food allergies being one example. A nut allergy is more likely to last a lifetime than, say, a chicken egg allergy, which you’re more likely to grow out of. This is where genetics plays a significant role.»

6. How harmful is long-term exposure to allergens? Should people who’re allergic to pet dander really steer clear of pets?

«If you constantly come into contact with allergens, you’re constantly triggering symptoms. The body counters each time with an overreaction, releases messenger substances and ends up in a permanent state of inflammation. This can worsen and develop into asthma if left untreated, so people in this situation should do immunotherapy and reduce contact with allergens. Those with pet allergies especially usually experience severe symptoms, with the slightest contact with the allergen enough to trigger them. Allergens on animal hair also remain on your clothing, in house dust or on furniture for a long time, which keeps on causing symptoms. It’s advisable to avoid contact, refrain from getting any new pets, and keep any animals you have already outdoors instead of indoors. If this doesn’t help, the pet should be rehomed – as difficult as that may be. We are talking about people’s health, here.»

If having furry or feathered friends are out of the question because of your allergy, you could perhaps go for a turtle or a tank of fish. Although turtles live to be very old, they spend half of their lives asleep, and won’t be much of a burden to you (or later, your grandchildren). While fish might not be the pets that win people’s hearts, they’re entertaining all the same. Just recently, for example, cleaner wrasses passed the mirror test, indicating that they’re able to recognise themselves not only in the mirror, but also in photos. That’s more than can be said for cats. Meanwhile, trained goldfish can use their movements to control a robot that moves their tank. Others can play Pokémon and even go on online shopping sprees.

7. Besides treating the symptoms, how can allergies be dealt with in the long term?

«With allergen-specific immunotherapy. This is available for respiratory allergies and insect venom allergies, and has a positive effect. Indications are that the therapy offers very good protection – up to 95 per cent – against insect venom allergies. When it comes to pollen allergies, immunotherapy offers up to 80 per cent relief of symptoms. This has a huge impact on a person’s quality of life and possible secondary illnesses. Immunotherapy takes three to five years depending on the person. Studies indicate that this gives you 10 years of good protection, after which symptoms usually gradually return.»

When undergoing immunotherapy, patients have the choice between injections or tablets, which are used to administer the allergens over a three-year period. Injections are given by a doctor on a monthly basis, while tablets are taken daily at home. Many patients, however, lack the staying power. In a Dutch study with almost 6,500 subjects, only 7 per cent continued taking the tablets until the end. Among those who had injections, the figure was 23 per cent.

8. What’s the current state of allergy research? Will there be a vaccine or immunotherapy for all allergies in the future?

«That won’t be possible across the board. Allergies are as individual as we are. The microbiome is currently playing a very important role in allergy research; the link between the microbiome and allergies is being investigated. Growing up on a traditional farm, for instance, has been found to be beneficial to children’s immune systems, with children who grow up in such settings less likely to have allergies and asthma. A new drug has been developed on this basis, but it hasn’t yet been approved in Switzerland.

There’s also a lot of research being done on food allergies. As the condition is lifelong, there are drugs that have already been approved for peanut allergies. Oral immunotherapy attempts to help the person towards a tolerance threshold, allowing them to be able to tolerate a certain amount of the allergen in the long run. There have been very successful studies in this – in 80 per cent of those treated, hyposensitisation is successful. However, it’s still unclear how long this protection lasts once the patient is no longer taking the drug.»