Allergy - a word that can have a sudden sobering effect on individuals. Each year thousands of children and adults are diagnosed with life-threatening food allergies – When given this diagnosis, many children and adults are left with limited choice of foods. According to Dr. Vandana Krishna, for those suffering from food allergies, avoidance is a key strategy for management, as there is no cure. In the US, food allergies affect approximately 8% or about 2 million children (eggs, peanut, milk, wheat) and 2% adults (shell fish, eggs, and tree nuts such as walnuts and cashews). Incidence of peanut allergy has doubled from 1997 to 2002 (0.4% to 0.8%). Only about 30% of children outgrow nut and seafood allergies, whereas nearly 70% of those with wheat, milk, or soy allergies outgrow them in adulthood. In addition, untreated environmental allergies can lead to complications such as sinusitis, fatigue, and worsened asthma; however, there are precautions and treatments available for these sufferers. A skin test survey estimates that allergies affect as many as 40 to 50 million people in the United States. To discuss some these issues, we talked to Dr. Krishna.

Dr. Vandana Krishna is board certified with the American Board of Allergy and Immunology and works with several prominent professional organizations, including the American Academy of Allergy, Asthma and Immunology. Dr. Krishna completed her fellowship training at the Massachusetts General Hospital, Harvard University and trained under renowned allergists at Children’s Hospital in Boston. Dr. Krishna specializes in Allergy and Clinical Immunology and treats children and adults suffering from asthma and allergies.  She also gives lectures about allergic diseases to other physician groups, professional organizations, school associations, parenting groups, and support groups. Dr. Krishna has her own private practice in Winchester and is affiliated with Winchester Hospital and Hallmark Healthcare Hospitals.

Can you explain to us what allergies are all about?

 An allergy is an exaggerated response to a substance that is not normally considered harmful. The response is an autoimmune response and can be extreme. Anaphylactic shock is an extreme example of an allergic reaction. Allergic reactions can slowly build up and become more extreme. The first time the body is exposed to the substance causing the allergy (allergen), it starts producing histamine and other substances that fight the allergen. The body now has the ability to instantly recognize the allergen and set into motion the defense mechanism. Repeated exposure to the same allergen can produce an increasingly stronger defense mechanism. That is why, with true allergies, the substance causing the allergy should be avoided in future. Inhaled allergens rarely cause life-threatening reactions, even after repeated exposure. Food allergies, however, commonly cause anaphylaxis with repeated exposure.

 
What are the different types of types of allergies that you see?

 Food allergy is just one condition that affects adults and children. In our practice we also see patients suffering from environmental allergies. These include allergic rhinitis (pollen, animal, and mold testing), asthma evaluation and management, sinusitis, food allergies, hives, angioedema (large welts below the surface of the skin, especially around the eyes and lips), eczema (a skin condition characterized by itchy, scaly, red skin), insect or medication allergies as well as evaluation of other allergic and immunological problems.

How does one know whether they have an allergy? What happens to the body after an allergic reaction?

 Many times people who suffer from allergies do not know they have allergies. Symptoms of allergies may include hives, sneezing, runny, itchy nose, and itchy, red, and watery eyes. They may sense a tingling sensation in their mouth. Other clues that you might have allergies rather than a cold are a family history of allergies (allergies are often inherited) or you experience similar symptoms on a reoccurring basis each year. People with allergic tendencies are also prone to eczema and asthma. It is best to see a doctor if symptoms persist for more than a week or become unbearable.

 
Why is it that the first generations Indians do not have as many allergies?

 That is a good question that I am often asked. The first generation Indians have been exposed in their infancy to a variety of infections due to sanitation, hygiene, pollution etc., which their immune system has successfully fought against. Here in the US, because of the cleaner environment, infections are not so common among children and therefore their immune system is more prone to asthma and other allergies.

 In addition, children in our community growing in the US are often introduced to allergenic foods like peanuts and tree nuts early in their infancy. This can lead to an allergic tendency to these foods as their immune system is still developing.

Do immunizations to allergies help?

 Yes, immunizations for many environmental allergies work and are mostly safe. Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to allergens. Allergen immunotherapy involves injecting increasing amounts of an allergen to a patient over several months. Immunotherapy has been shown to prevent the development of new allergies and, in children, it can prevent the progression of the allergic disease from allergic rhinitis to asthma. Allergen immunotherapy can lead to the long-lasting relief of allergy symptoms after treatment is stopped.

 In contrast, there is no immunotherapy available for food allergies. For peanut allergy sufferers, a drug currently being tested called TNX-901 holds some promise. This drug binds to the peanut antibody, thereby decreasing the number of peanut IgE (immunoglobulin E) antibodies, which trigger allergic reactions to peanuts.

 Some people move to different places? Does that help ?

 Not often for allergic individuals. The person may feel a temporary relief but soon the body adapts itself to the new climate and the allergies kick in.

 How safe are the tests done by doctors?

 
The tests performed by allergists are extremely safe. The skin scratch test is simple and effective for determining if the patient has an allergy. It is done on the skin, takes about 15 minutes and the allergist will be able to diagnose whether the person suffers from an allergy to any of more than 100 potential food and environmental allergens.

 Do you have any tips for those with allergies or asthma?

 Avoidance of the offending allergens is the key. Read all labels carefully. Your child may or may not have an allergy but taking precautionary measures the early years can go a long way in preventing onset of allergic reactions. Follow these guidelines, especially if one or both parents have allergies:

1. Wait till one year before introducing cow’s milk and lentils (dals).
2. Wait till 2 years before giving eggs
3. Wait till 3 to 4 years to introduce the child to seafood and nuts

 In the Indian community, I notice that there is a stigma about using an inhaler. It is important that asthma suffers have their inhaler with them at all times.

If you have any questions you can reach Dr. Vandana Krishna at (781) 729-2293.

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