Dr. Abe V Rotor
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This paper is part of a lecture Allergy and the Environment presented before the members of Philippine Society of Allergy, Asthma and Immunology on its 11th Biennial Convention, September 9, 2008 at the Sofitel Philippine Plaza in honor of the late Dr. Arturo B. Rotor, first Filipino allergist.
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What is Allergy?
Our body reacts to substances it can’t tolerate, such as pollen and dust. These environmental antigens or allergens are normally harmless, but the immune system of certain persons views them as harmful. There are many types of allergies, such as skin and food allergies, and many different types of allergic reactions, which can range from skin rash to vomiting and diarrhea.
Evolutionarily our immune system is adapted to combat pathogens – viruses, bacteria, fungi – but modern living and modern medicine have greatly eliminated much of these threats on one hand, and rendered our immune system idle on the other. The immune system isn’t challenged in the same way. Instead of developing to target real threats, such as bacteria, the immune system may dysfunction and begins to trigger allergies.
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In fact it has become maverick that it attacks substances, including those secreted by our body, so that by attacking non-harmful substances, it creates more harm, and even death. Thus the hygiene hypothesis explains why there are much more allergy cases in affluent societies than in marginal societies. A case in point is that West Germany where people lived with high standard of living were suffering allergies much, much more than their counterparts living a simple life style in East Germany.
Allergies are a worldwide problem. They are often overlooked by doctors and patients and can lead to serious health problems. It means also needless suffering. Allergies disturbs sleep, adversely affect active life and good disposition. Kids and adults alike are more likely to develop asthma, sinus and ear infections, especially if their allergies go untreated.
Mechanics of Allergy
Here is an example. People who develop allergic rhinitis have an excess of a certain class of antibodies, called IgE, which makes them unusually sensitive to these otherwise harmless substances. All the symptoms of allergic rhinitis are really part of the immune response.
So what really happens in an allergic person? Medically it is explained this way.
“Following the body's first exposure to the allergen, the white blood cells produce antibodies, specifically IgE antibodies, that prepare the immune system for the next encounter with that same allergen. This first exposure to pollen will not produce any outward allergic symptoms, but inside, the IgE antibodies attach themselves to mast cells. Mast cells are cells that can be found in the respiratory system, gastrointestinal tract, and skin.
During the second and subsequent exposures to pollen, this allergen will combine with the IgE antibody and release chemicals, such as histamine, in the mast cells, thus producing the allergy symptoms of a runny nose, watery eyes, and sneezing.” (1)
Anaphylaxis – Fatal Allergy
Anaphylaxis is systemic reaction, during which exposure to an allergen triggers an allergic response throughout the body rather than just near the site.
Anaphylaxis can strike within seconds or minutes of exposure to an allergen. Or it may sneak up slowly, with symptoms delayed up to 2 hours from the time of exposure. Initial symptoms may even disappear, then return full-force within 4 to 12 hours.
It’s a terrifying feeling, you may become flushed, and your skin may become quite itchy and red. The frightening thing is, you begin to feel you’re having difficulty taking a full breath, that you are suffocating. As your blood pressure drops, you feel dizzy and sweaty and become pale. You body is not kidding. Anaphylaxis can kill by suffocation.
It doesn’t take much to trigger this body-wide allergic response – a single peanut or tiny paper wasp can set off the reaction. Egyptian Pharaoh Menes, 3000 years BC, is the first reported victim of Anaphylaxis. During an anaphylactic attack, a rush of chemicals – histamines, leukotrienes, and prostaglandins – is released in an attempt by the body to defend itself. These chemicals are produced by basophiles found in the blood, mast cells found throughout the body, including eyes, noise skin and gastrointestinal tract.
Anaphylaxis may affect many organs, such as the throat, lungs, blood vessels, and intestines. Histamine and other chemicals released by the body may
1. Produce widespread itching, welts, and hives on your skin
2. Cause blood vessels to become leaky, resulting in a drop in blood pressure, swelling of the skin, and fluid in your lungs
3. Bring circulation of your blood and oxygen to a near-standstill as your blood pressure drops
4. Trigger nausea, vomiting, and diarrhea as your gastrointestinal system goes haywire.
5. Anaphylaxis is an allergic reaction that can trigger reactions all over your body, affecting the various systems in the body
6. Cardiovascular: Light-headedness, feeling faint, loss of consciousness (syncope), heart palpitations.
7. Upper respiratory : nasal congestion, sneezing, difficulty swallowing
8. Lower airway obstruction: coughing, wheezing
9. Skin: welts or hives, swelling of the skin (particularly on face and around lips and tongue), flushing
10. Gastrointestinal: bloating, nausea, vomiting, diarrhea, cramps
11. Make it difficult or impossible to breathe as your tongue and throat swell up and your lungs go into asthmatic spasms
12. Metallic taste in the mouth, cramping of the uterus during pregnancy, sudden need to urinate.
Causes of Anaphylaxis: food – peanut, shellfish, crustaceans; insects – fire ant, honeybee, bugs; drugs - more than ½ million serious allergic reaction occur in hospitals (Penicillin); latex – condoms, balloons, gloves; exercise – eating 3-4 hrs before exercising increases risk; narcotics; aspirin; blood transfusions; food additives
Is there a cure for allergy?
Immunotherapy is the only treatment that alters the immune system, restoring the same response to allergens like pollen in normal nonallergic people. Unlike pills and nasal sprays, immunotherapy holds out the possibility of something far better: a cure. The treatment involves identifying the specific culprit that’s causing the problem through a series of skin tests or blood test. Tiny doses of allergen are then injected under the skin in a weekly series of allergy shots to desensitize the immune system.
There are many promising avenues of research. Purified antigens are being tested that can lead to a more rapid desensitization in immunotherapy. There’s interest in putting specific antigens onto viral vectors that will carry them directly to mast cells. Ultimately that could mean that one injection would render people nonallergic, instead of the years of immunotherapy now often required.
And before long, there will be sublingual immunotherapy, which uses antigens that dissolve under the tongue instead of injections. It offers two important advantages. It’s believed to be safe, and one won’t be visiting his doctor. Immunotherapy can be done at home - soon.
Does allergy run in the family?
To a certain extent, yes. If both parents have allergies, a child stands a 75 percent chance of developing them. If neither parent is allergic, the risk drops to 25 percent. The genetic aspects are numerous and overlapping, which means we’re not going to find a single gene that accounts for allergies. And as the percentages suggest, environmental factors also play a role.
Allergy symptoms
Breathing problems
- Burning, tearing, or itchy eyes
- Conjunctivitisred, swollen eyes)
- Coughing
- Diarrhea
- Headache
- Hives
- Itching of the nose, mouth, throat,
skin, or any other area
- Runny nose
- Skin rashes
- Stomach cramps
- Vomiting
- Wheezing
1.Children who grow up on the farm are at much lower risk to allergy than children in the city.
2.Infants on the farm have fewer allergies than those who grow up in sterile environments.
3.Children who grow up with a cat in the house are less likely to develop allergies or asthma.
4.Very few pet owners are allergic to the animals they love.
5.Children who have been breastfed are less likely to have allergies.
6.Milk, soy, wheat, egg, peanut, fish and meat comprise the most common food allergies.
7.Most reactions to food are not allergic in nature, but rather intolerance, that is, there is no allergic antibody involved.
8.Babies exposed late to cereal grains have higher risk to cereal allergy, especially wheat.
9.Regular use of “foreign” materials (e.g. nail polish remover, contact lens, metals) can eventually cause sensitivity and reaction to these materials.
10.Allergy can induce strong and unwelcome mental and emotional reactions, such as altered perception or inappropriate changes of mood.
NOTE: These items are based on facts.
Children raised on the farm have much lower risk of allergy.
What is the connection of Allergic Rhinitis and Asthma.
Both are mediated by an excess of
IgE, a class of antibodies. Twenty years ago we thought asthma was caused by
bronchial constriction. Now we know the main cause is allergic inflammation.
Inflammation needs to be controlled in order to prevent more serious problems
from asthma. Allergists now use the term “unified airway” to describe a new
understanding that the nose, sinuses and lungs aren’t separate systems but part
of the same system.
What goes on in the upper
respiratory tract can exacerbate problems in the lower respiratory tract. And
it’s now clear that treating inflammation in the upper respiratory tract can
help prevent development of asthma. If you have a cough along with congestion
and itchy eyes, it’s wise to see a doctor. A cough can be a sign of asthma. If
you try over-the-counter drugs and they aren’t helping, see your doctor. That’s
especially important for children with symptoms of allergic rhinitis, since we
know that treating the condition can greatly lessen the risk of going on to
develop asthma. Asthma is caused by inflammation in the airways. When an asthma
attack occurs, the muscles surrounding the airways become tight and the lining
of the air passages swell. This reduces the amount of air that can pass by, and
can lead to wheezing sounds.
Approximately 20.5 million Americans
currently have asthma. Many people with asthma have an individual or family
history of allergies.
Contact dermatitis
It may involve a reaction to a substance that you are exposed to, or use
repeatedly. Although there may be no initial reaction, regular use (for
example, nail polish remover, preservatives in contact lens solutions, or
repeated contact with metals in earring posts and the metal backs of watches)
can eventually cause sensitivity and reaction to the product.Some products cause a reaction only when they contact the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as insecticide spray, can cause contact dermatitis. Here are allergens that cause contact dermatitis: Poison ivy, lipang kalabaw plant, Nickel, other metals, antibiotics (topical), topical anesthetics, rubber, cosmetics, fabrics and clothing, detergents, solvents, adhesives, fragrances, perfumes, many chemicals and substances
1. Do you have hay fever symptoms such as sneezing, watery nasal drainage, and nasal itchiness? (4 pts)
2. Do you have chronic nasal congestion, postnasal drip, or both? (3 pts)
3. Do you have sinus problems – frequent “colds” or headaches? (2 pts)
4. Do your eyes itch, water, get red, or swell? (4 pts)
5. Do you have asthma (wheezing), a tight chest, or a chronic cough? (1 pt)
6. Do you have skin problems such as eczema, hives, or itching? (2 pts)
7. Do you have indigestion, bloating, diarrhea, or constipation? (1 pt)
8. Do you have chronic fatigue or tiredness? (4 pts)
9. Are your symptoms seasonal only – or worse seasonally? (4 pts)
10. Do your symptoms change when you go indoors or outdoors? (3 pts)
11. Are your symptoms worse in parks or grassy areas? (4 pts)
12. Are your symptoms worse in the bedroom, after going to bed, or in the morning when you get up? (2pts)
13.Are your symptoms worse when you come into contact with dust when vacuuming or cleaning around thick carpeting, heavy drapes, and so on? (4 pts)
14. Are your symptoms worse around animals? (2 pts)
15. Do you have any blood relatives with allergies: one or both parents, brothers or sisters, or children? (6 pts)
SCORES (Are you allergic?)
If you scored less than 7, it’s unlikely you have allergies.
If you scored between 8 and 12, it’s possible you have allergies.
If you scored between 13 to 30, it’s probable you have allergies.
If you scored more than 31, it’s very unlikely you have allergies.
Key to Allergy Management.
The key to prevention is avoidance,
which is easier said than done. You can eradicate the disease by getting rid of
the allergen that’s causing problems. For dust mites, which live in the
bedroom, wash sheets regularly and keep humidity down to below 50 percent,
which drives down dust mite populations. Remove carpeting and any stuffed
animals from the bedroom, which are also home to dust mites. If you’re allergic
to cats or dogs, don’t let them share the bedroom. Since we spend one-third of
our lives sleeping, reduce your exposure somewhat by targeting the bedroom.
Be prepared for Food Allergies
2. Avoid the culprit foods: Have a checklist at fingertips. Know the most common foods that cause allergy: These are milk, fish, egg, soy, wheat and peanut, and their various products.
3. Read food labels: Ask questions about the ingredients of the food you order in restaurants.
4. Patients with food allergies should always be prepared to recognize and treat their reaction, should one occur. Emergency medical care should always be sought if an allergic reaction to food occurs.
5. Communicate with others: Communicate with members of the family, office mates, school staff, and friends, about your medical condition and knowledge of how to handle allergy cases.
Managing Pollen Allergy
2. Stay indoors and keep your windows closed, especially during heavy pollen times.
3. Avoid outdoor activities during peak pollen time (5 a.m. to 10 a.m.)
4. After going outdoors in pollen, shower, wash your hair, and change your clothes immediately.
5. Close car windows when traveling to avoid pollen.
6. Wear sunglasses when outdoors to protect your eyes from pollen irritation.
7. Brush your dog down when returning indoors, and bathe your dog weekly. Pollen hitches a ride on animal fur and can easily come inside your house.
8. Use Facemasks. There are situations where a multiple sensitive person may want to wear a protective mask.
9. Once you’ve shed your clothes, hop into the shower and thoroughly wash off any allergens cling on the skin and hair.
10. Consult the Pollen Calendar. The late Filipino palynologist (specialist in pollen), Dr. Lolita Bulalacao developed a pollen calendar indicating what (species), when (season), where (location) pollen is likely to be encountered.
Allergen-Proof Your Home
1. Design your home in unity and harmony with natural environment, not the other way around.
2. These are fairly quick, simple, and inexpensive methods of making your home friendlier to your asthma and allergies.
3. Build house on spacious lot and surroundings
4. Free house of carpet and wall paper
5. Knock on wood
6. Prefer shiny floors, materials of low-gas ingredients
7. Provide good natural ventilation
8. Let sunshine in, façade towards the east
9. Integrate house plan with garden
10. Screen out plants that are allergen potential
“Sick Building” Syndrome
1. Install proper air-con and exhaust fans corresponding to the number people, and nature of work.
2. Avoid blocking the air supply and return vents.
3. Clean up water spills and damp places to get rid of molds.
4. Store food properly, and empty the garbage daily.
5. Observe if symptoms are experienced by co-workers, other occupants, visitors.
6. Check equipment and supplies – they may be the source of irritating odor and fumes.
7. Strictly no smoking allowed.
8. Divide area into independent units – office, manufacturing, kitchen or storeroom.
9. Report problem to concerned persons/authorities.
10. Have a regular building maintenance program
Allergy-Free Yard
1. Fix your yard to bring down allergies.
2. Go for plants native to the place (save allergy misery and labor)
3. Maintain a pest-free lawn, naturally (biological control)
4. . Plant ground plants (and minimize mowing of grass lawn – source of allergen)
5. Be a creature of the evening (or early morning when there are fewer allergens)
6. Keep problems outdoors (like pollen)
7. Be vigilant (weed out allergen-causing plants like lipang kalabaw, sabawil
8. Minimize the mold (remove anything that traps moisture)
Allergy-proofing the bedroom
1.Keep pets out.
2. Encase sleeping place
3. Clean sheets with lots of heat
4. Run your air through filter
5. Banish the blinds
6. Steer clear of soft seats
7. Filter the vents
8. Pluck pillows and comforters wisely
9. Stow gewgaws away
10.Wash away the pollen
11.Debunk the mites
12.Give Teddy a bath
Allergy-proofing the Kitchen and Dining Room
1. Roach-proof your food.
2. Put a lid on your trash.
3. Get crumbs where they hide.
4. Don’t let dishes get crusty.
5. Scrub those floors and cupboards.
6. Battle roaches with smarts.
7. Call the pros.
8. Be a fan of your fan.
9. Avoid the cold mold.
10. Choose your cleaners wisely.
11. Cook your food, don’t gas it.
Allergy-Proofing
the Bathroom,Laundry Room,
and Closets
1. Turn on the fan.
2. Harvest piles of damp stuff.
3. Pick a natural freshener.
4. Bring down the curtain on mold
5. Bleach the mold away.
6. Be the squeegee man.
7. Take your washer’s temperature.
8. Wash
permanent-press clothes before you wear them.
9. Opt for smell-free products.
10. Be sure the clothes dryer blows outside.
11. Leave the light on.
12. Air out dry-cleaned clothes.
13. Use wire shelves.
Allergy-Free
Garage and Workshop
1. Start the engines outside.
2. Ditch your damp
possessions.
3. Store chemicals
safely.
4. Moldy rags on the
floor
5. Old chemicals stored on table
6. Paint can not closed tightly
7. Car engine should not be left running in garage
8. Room should have a window or exhaust fan
9. Tools should be cleaned outside
10. Insure good ventilation
Allergy-Free Workplace
1. Carpenters – acrylate (adhesives), amines (lacquers), isocyanates (paint, foam),
anhydrides (plastic), wood dust
2. Farmers, gardeners – pesticides, insects, molds
3. Veterinarians, petshop owners – animal allergens, feeds, disinfectants
4. Hospital and healthcare workers – antibiotics, formaldehyde, latex,
5. Bakers, millers – cereal grain, flour dust, hay, silicates, insects
6. Beauticians – persulfates, ethyl enediamine
7.Janitors, cleaners – Chloramine-T, detergents, dyes
8. Office workers, market vendors, musicians – wide range of allergens
Allergy-Friendly Exercise Program
1.Avoid exercise if you have an upper-respiratory viral infection.
2.Premeditate.
3.Drink plenty of fluids.
4.Perform warm-up exercises.
5.Breathe through your nose.
6.Cool down.
7.Know your limits.
8.Avoid exercising near busy roads.
9.Judge exercise intensity with a “talk test”.
10.Slow down if you feel weak, dizzy.
11.Don a dust mask when necessary.
12.Stay inside during high-pollen days.
A Meal-to-Meal Plan for Fighting Allergies
No single diet is right for everyone. Your nutritional needs are unique to you, because no one else has the same combination of genetic and acquired traits of metabolism, nutrition, and immune status.
1. Breakfast – build your breakfast around
fresh fruits and whole grains. Instant breakfast may be loaded with syrup and
preservatives. If you wish to drink
milk, restrict to fat-free.
2. Lunch – Build around fruits, vegetables
and grains, unless you are growing up or pregnant. If you eat meat, choose the
leanest. Most fat-food burgers contain fat as high as 35%.
3. Dinner – Build around grains, cooked or
raw vegetables, and protein from meat, fish or legumes. Trim off fats. Avoid oils and fats in sauces and
dressing. If you drink, have a glass of
red wine rather than beer or liquor.
4. Snacks – Don’t indulge in snacking at
all, but if you must, take a fruit like mango or pineapple.
Clean Your Home Naturally
1. Instead of disinfectant, use borax (1 cup to 1 gal of warm water) or grapefruit seed extract (10%)
2. Instead of fabric softener, use ¼ cup of vinegar added to the rinse water.
3. Instead of furniture polish, use olive oil with 1 tbsp vinegar poured in 1 liter of warm water. Keep in spray bottle.
4. Instead of glass cleaner, use ½ cup vinegar mixed with 1 gal warm water, place in spray bottle.
5. Borax instead of laundry whitener; Baking powder on sponge instead of scouring powder.
Hydrogen peroxide as stain remover; borax + vinegar as toilet bowl cleaner.
Allergy-Free Stress Busters1. Biofeedback (internal memo)
2. Cognitive Reframing (handling an experience)
3. Guided Visualization (imagination)
4. Humor Therapy (healthy laugh)
5. Hypnosis (hypnotherapy)
6. Journaling (diary, autobiography, literary)
7. Massage, sauna
8. Social Involvement (clubs, parties)
9. Yoga, Tai-chi
10.The Humanities (drawing, singing, drama)
11.Meditation (prayer, communion with nature)
12.Proper grooming.
Sounds that make us sick
o Irritable Sounds activate not only the senses but affect bodily functions.
o Pavlov’s Principle on conditioned learning.
o Adrenaline shoots up, increases blood pressure, challenges us – fight or flight.
o Nausea, headache, other forms of irritation.
o Interrupts present activity, interferes with trends of events.
o Destroys relationship, creates personal impressions.
Worst Sounds
1. Scratching the blackboard with fingernail, similar to a hard chalk creating a grating sound.
2. Air escaping like releasing air from a balloon.
3. Productive coughing
4. Throwing out is the worst.
Why are people healthier and happier in the
countryside?(1)
People feel better and more zestful when they are near mountain streams or
beside the sea. It is the presence of excess negatively charged ions in these
places, which tend to be diminished in buildings, homes and offices. The
average negative ion concretion near a waterfall is 50,000 per cubic
centimeters, in mountain air 5,000 and in the countryside 1500 or so; yet in a
modern office, this figure can fall to as low as 50. What happens to the ions
in buildings?They are electrically precipitated by particles in the air, notably dust, cigarette smoke and fabrics such as synthetic carpet fibers. Modern closed ventilation systems and of course the ubiquitous office computer make the problems many times worse because of the static build-ups.
Accordingly, a good idea is to supplement the environment with negatively changed ions with ionizers. One study showed a remarkable drop in the incidence of headaches and other minor symptoms.
There’s really nothing better
than living in a pristine environment. ~
No period in history has man
influenced the environment as much as what he is doing today in his pursuit for
a higher standard of living, and affluence. Instead of “tailoring man’s
lifestyle to the environment” which his ancestor did for
centuries, man today is “changing
the environment to cope up with affluence.”(8)
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Dr Arturo B. Rotor (1907-1988) served as Executive
Secretary of the Philippine government-in-exile and member of the Cabinet,
first under President Quezon, then President Osmeña. After the second World War he became Director
the UP Postgraduate School of Medicine, and founded allergology as
a field of medicine in the Philippines.
He was instrumental in the founding of PSAAI.
Dr. Rotor wrote several short stories, which earned him the
Republic Heritage Award. His stories are
still used today in high school and college literature, among them Dahong
Palay, Twilight’s Convict, The Wound and Scar and Zita. Ateneo de Manila
University Press compiled ten other stories into a handy book with the title, The
Men Who Play God. On the back cover is a curious brief description
about the author. (5)
To wit: In the Philippine Journal of Science, a new
orchid, Vanda Merrillii variety Rotorii is described by Dr.
Eduardo Quisumbing. In Cecil Loeb’s Practice of Medicine, a new disease,
“Rotor’s Syndrome,” is recognized. Both
the disease and the flower refer to Arturo B. Rotor and highlight the
disparate, often incongruous activities that marked his career. The other side
of Dr. Rotor’s life was one equally rich and fulfilling through the expression
of the wonders of the right brain – as a
naturalist, an ardent lover of nature; and creativity
through the art of music, demonstrating mastery of some of the world’s best
compositions as a celebrated pianist.
(He graduated at the UP Conservatory of Music and UP College of Medicine
at the same time.) Dr Arturo B. Rotor (1907-1988)
---------------------------------------------------------------References
1. Ansorge R and E Metcalf et al (2001) Allergy Free Naturally Rodale Inc NY,
2. Miller GT Jr (2004) Living i the Environment 7th Edition, Wadsworth Publishing, California
3. Radyo ng Bayan Lecture Series (May 2003 to July 2008) Towards Functional Literacy, DZRB 738 KHz. Philippine Broadcasting System, Bureau of Broadcast, QC
4. Raven PH, Berg LR and GB Johnson (2003) Environment 2nd edition Saunders College Publishing NY
5. Rotor AB (1983) The Men Who Play God: A Collection of Short Stories Ateneo de Manila University Press
6. Rotor AB (1983) The Wound and the Scar Cacho Hermanos, National Book Store
7. Rotor AV (2000) Light from the Old Arch UST Publishing House
8. Rotor AV (2003) The Living with Nature Handbook. UST Publishing House
9. Rotor A V (2007) Living With Nature in Our Times, UST Publishing House
10. Time (2007) Global Warming (The Causes. The Perils. The Solutions. Then Actions: 51 Things You Can Do) Time Inc.
11. wikipedia.org/wiki/Allergy
12. www.nlm.nih.gov/medlineplus/allergy
13.www.medicinenet.com/allergy www.allergyuk.org/ ~
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