Living with Allergies, One Breath at a Time: When a Sneeze Isn’t Just a Sneeze

It was a breezy Sunday afternoon when I was at Kavita’s house. She was cleaning up from a playdate with her toddler Tara — windows thrown wide, pollen swirling in the air, jasmine wafting inside. Her eyes were glistening, and she sniffled while speaking.

“Priya, I swear the season hates me,” she said with a joke, but her exhaustion said otherwise. I saw her rub her nose and then her daughter’s back, as the little one coughed from the corner.

Kavita had always attributed her symptoms to seasonal allergies. But now Tara was also developing symptoms — nighttime cough, itchy skin, sneezing fits. As a family physician working in primary care and preventive health, I realize I had to stop brushing this off. What the two of them were going through were not ordinary colds. Those were allergic responses — the immune system misfiring against something harmless.

What Are Allergies?

In medicine, allergy refers to an immune hypersensitivity reaction to a substance called an allergen. These allergens are harmless to a non-allergic individual. For allergic people, though, the immune system produces something called IgE antibodies, which attach to mast cells and basophils.

When it is encountered again, the allergen cross-links the IgE antibodies, causing release of rapid immune mediators such as histamine, prostaglandins, and leukotrienes. These mediators lead to inflammation, mucus production, bronchoconstriction, vasodilation, and other classic manifestations of allergies.

It’s what makes symptoms like:

• Sneezing
• Wheezing
• Skin rashes
• Nasal congestion
• Gastrointestinal upset

Anaphylaxis is a systemic reaction that can occur in severe cases, which includes hypotension, airway edema and shock.

Common Allergens and Pathophysiology

The symptoms of Kavita and Tara indicated aeroallergens, visible components of allergic rhinitis. The likely culprits?

• Pollens: During spring tree pollens are prominent, summer grasses, and fall weedy plants
• Dust mites: Live well in bedding and carpets, over humid sections
• Pet dander: Proteins found in saliva, skin flakes and urine
• Mold spores: From damp walls, mostly in bathrooms

The immune system response starts at mucosal surfaces: nasal epithelium for rhinitis, bronchial epithelium for asthma and gut epithelium in food allergies.

Different Types of Allergies and How They Work

Food Allergies

These reactions, an IgE-mediated immediate-type hypersensitivity, can be life-threatening. The proteins responsible for allergies are typically resistant to digestion, enabling their passage across the GI mucosa and elicit systemic responses.

Common triggers include:

• Peanuts and tree nuts (associated with serious anaphylaxis)
• Cow’s milk, egg, and soy in children
• Shellfish and fish in adults

Environmental Allergies

Primarily Type I hypersensitivity reactions to aeroallergens:

• Pollen: It causes allergic rhinitis and conjunctivitis
• Dust mites: Major indoor allergen; reacts with nasal and bronchial epithelium
• Mold: Long-term exposure can lead to allergic fungal sinusitis or aggravate asthma

Insect Venom Allergy

Depending on the number of stings, this can be IgE-mediated or toxic. Reactions include:

• Large local swelling
• Urticaria
• Systemic anaphylaxis

Drug Allergies

Caused by:

• Beta-lactam antibiotics (penicillin): IgE or T-cell-mediated
• NSAIDs: Non-IgE-mediated mechanisms via leukotriene overproduction

How Are Allergies Diagnosed? A Guide

I told Kavita that guessing is not adequate. We need a clinical approach:

Clinical History

We documented:

• Symptom timeline
• Environmental exposure
• Family history

Skin Prick Test (SPT)

Intradermal: A small volume of allergen is injected intradermally. A wheal and flare appearing within 15 minutes indicates sensitization.

Serum IgE Testing

Additional tests (such as specific IgE to allergens like dust mite or egg white) can confirm exposure.

Diagnostics Resolved to a Component

More recent developments in molecular diagnostics enable us to distinguish between primary sensitizations and cross-reactions.

Patch Testing

Type IV delayed hypersensitivity (e.g. nickel, preservatives, fragrance)

Pragmatic and Verifiable Treatment Options

Tara egg allergic–confirmed once her results came back, along with a house dust mite sensitivity. Here’s how we managed treatment:

Allergen Avoidance

Data is the first line of defense.

• HEPA Filtered Air Purifiers
• Bed linen washed every week at 60°C
• Avoiding allergenic foods

Pharmacotherapy

All the evidence-based medications that work:

• H1 antihistamines (e.g., cetirizine, loratadine): Histamine receptor blockers
• Nasal corticosteroids (e.g., mometasone): Reduce mucosal inflammation
• Leukotriene antagonists (e.g., montelukast): For allergic rhinitis and asthma
• Topical steroids for skin reactions (e.g., betamethasone)

Immunotherapy

I talked about subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) for persistent symptoms:

• Shown to reduce symptoms 60-70%
• Requires commitment of 3-5 years
• Reduces future risk of having asthma

Emergency Preparedness

For food or insect venom allergies, always prescribe:

• Epinephrine autoinjector
• Education on usage and action plan

Preventive Strategies: Living With Less Risk on a Day-to-Day Basis

Kavita took practical steps:

• Put in dehumidifiers to help limit growth of mold and mites
• Limited indoor plants
• Allergen-proof covers for used pillows
• Changed to unscented cleaning products
• Put Tara on vitamin D supplements (associated with better immune function)

Living Life to the Fullest, with Allergies

In our last check-in, Kavita said, “Priya, I think I finally understand my body. And Tara is sleeping through the night. That’s all I needed.”

Allergies are a chronic, but manageable, condition. With the proper tools, patients can take back control. Allergy care consists of awareness, accurate diagnosis, evidence-based treatment, and ongoing support.

Common Questions (FAQs)