Friday, April 27, 2007

Allergies

This year the pollen count is already skyrocketing. Predictions are, it may be the worst pollen season in recorded history.

All the infection issues I've dealt with over the past few years have obscured the fact that my initial and underlying disabling condition is, simply: allergies.

We usually think of an allergy attack as a response to a particular exposure. A discrete, rather than continuous, event.

Superallergics - hyperhypersensitives, those with Ideopathic Allergy Syndrome, whatever the current buzzname is - live in a continuum of allergic response. Treatment requires a whole different approach.

I've been in a continuous state of allergic reaction since 1990. It ebbs and flows, generally following the content of inhalant allergens in the air. Sometimes the allergic condition is not that noticeable - although even then, it's only because of the huge load of immunosuppression, antihistamines, Vitamin C, and environmental controls I use.

Other times it's so severe, even under the maximum controls available, it's completely debilitating. I get dizzy, lose my balance, pass out. Sleep copiously, often 18 hours per day; lose my voice; develop cognitive impairment that makes it difficult to think, to express thoughts, and especially to make even simple decisions. I can't drive safely. Sometimes I'm fine when I leave the house, but become impaired enough after outside exposure that the only right thing to do is ditch the car and have friends or a cab drive me home.

I switch to nocturnal life, because sleeping through the peak pollen daylight hours helps. I have much more function that way, and under the height of allergic response, function is the focus.

Not to mention: my control over the allergic response is tenuous at best, so keeping it as controlled as possible is important for safety's sake. I say I have one foot in anaphylactic shock and the other foot on a banana peel.

If I slip, I die.

There are several ways to die from an allergic reaction. Anaphylactic shock is one, but it's extremely rare. Literally, it can kill a person in just seconds. Anaphylactic-type reactions are more common, and usually slower; there's a bit of time there. Time to find an Epipen, an injection of epinephrine, like adrenaline, to save a life. Both these reactions are dramatic and frightening, with a display of symptoms that boggles the mind.

Here, I'm going to talk a little bit about how allergies work.

I got rheumatoid arthritis when I was eight years old. Serious RA runs both on my father's and my mother's side of the family, and allergies run on my father's. We also tend toward longevity, often living well into our 90's or 100's.

So we live forever - limping and sneezing all the way.

Immune response is remarkably variable and complex. We develop different types of antibodies, *attack* cells, to specific substances like viruses and bacteria, and sometimes to perfectly harmless or even necessary things like food. Sometimes an immune response comes in the form of enzymes rather than antibodies. Another way we combat illness is simply by fever. Higher body temps that we can survive can kill off germs, who can't take the heat. That's also why inflammation is a part of rheumatoid arthritis, which is autoimmune; and of infected cuts, where antibodies have gathered to fight the foreign invaders causing infection.

The immune system is like an army, like any armed service. It has spies, detecting the presence of invaders. Navigators, to direct the warriors to the battle. Foot soldiers who'll lay down their lives on a suicide mission to kill. Others who'll simply bombard a perceived enemy with artillery or poisons. It has secret weapons it only pulls out under special conditions.

When an immune system attacks one's own body, it's called being *autoimmune,* immune to your own self. When it attacks perfectly harmless substances like eaten or smelled peanut butter, that's an allergic response. Various types of allergic responses are called hypersensitivity reactions. There are at least four major types.

For many of us, these *Immunity Gone Wrong* conditions run together. Our immune systems, confused but still powerful, attack both our own bodies, and benign *foreign* substances like foods or pollens or mold.

I like to anthropomorphise all this. It entertains me, and clarifies the action for my poor befuddled brain.

So here's how I'll think: HELLo!, says immune system, waking up to a certain smell, sensing a presence that sets off its alarm bells. It goes: Oh! Whatzzat? check it out! It must be…I think that's…hey it's, it's PNEUMONIA!!! WWWHHHAAARRRGGGHH!!! aTTACK!!!

And it gathers up its friends and relatives, its army of soldiers and tacticians and supply sergeants and camp followers, and rushes to the scene, bravely vanquishing…my knee.

Yup. Not pneumonia there, Mr. Immune System. You just ate my knee, and now it's all full of arthritis and red and swollen and warm, inflamed. You threw everything you had at it. Gee. Thanks. Great job, there. You got everything right except identifying the enemy. Another blatant IFF failure. A Friendly Fire Incident.

Tilting at windmills.

One thing in common among various allergic reactions is the release of histamine. Cells have at least two receptor sites for histamine, called H1 and H2. Antihistamines usually act by blocking the receptor sites for H1 - classically, Benadryl (diphenhydramine). A fascinating accidental discovery lead to an H2 receptor blocker, Tagamet (cimetidine). Made from jalapeno peppers, Tagamet was originally developed to treat acid reflux disease. It's helped some otherwise untreatable allergics since its H2 receptor block characteristic was discovered.

Histamine itself is an antigen, a substance that triggers further allergic reaction. Sometimes, while getting allergy tests, a doctor will order a histamine reaction test too, as a control of some sort. The one time this was done on me, it quickly sent me into such a profound reaction I nearly died.

Good old histamine. I'm superallergic to histamine itself. Talk about a vicious cycle...!

Histamine is the culprit that gives us our runny eyes and nose and even ears, and the itching and rashes and hives and so forth. When the cognitive impairment befuddles me, I say histamine is blocking my synaptic gaps. Balance and speech and thought impulses just can't get through - there's no room in there. Histamine's hogging all the space.

I know we produce it for a reason. But since the erroneous release of histamine has destroyed much of my life, I have a special place in hell for it. Fair of me? Perhaps not. But, there it is.

Docs tell us that it takes two exposures to develop a specific allergic reaction. The first exposure triggers the formation of antibodies to a particular substance. The second exposure sends the new antibodies on the attack.

The initial antibody-developing exposure could be the first time you encounter that substance, or the millionth. That's why some of us develop allergies later in life, the *adult onset* variety. Many people will experience that for the first time this year.

But there's another way to get antibodies: we can also be born with them. The name for this is *atopic.* In days past, doctors used to inject penicillin to combat serious infections like pneumonia. A first exposure to penicillin *shouldn't* cause an allergic reaction. But, if you're atopic, you're already allergic at the first exposure. Too many children died from injected penicillin, and today, injecting any antibiotic is done with great care.

In my family, with a known history of allergies through the generations, we're clearly atopic. We not only have a wide variety of inherited allergies, we're far more susceptible to developing new ones throughout our lives.

My brother showed his allergies as a child. Me? I didn't display the usual symptoms. But I am atopic, and looking back, I may have been showing lesser-known symptoms at a younger age than anyone realized at the time.

This year, many of you will either experience bad allergic reactions, or see them in people around you. Already, I'm way sick, far more this year than I have been for several seasons. If there's any good to be found in what's happened to me, it will lie in my ability to help other affected people understand what's happening to them. And, of course, how to deal with it and feel as much better as they can.

I'm no doctor and I never ever forget that. I am a patient. As a patient, there are things I can explain and questions I can answer. As much as I can, I will.

I'll start with a post about the first time I had a known allergic reaction. Unfortunately, that first time almost killed me. Fortunately, I survived. I lived to tell the tale, and it's time to tell it to you.

20 comments:

Morris said...

Wow, K, I count myself lucky that all I have to deal with is hay fever..

sue said...

Wow. Just wow.

Granny J said...

Jeez, k!!!

k said...

Hay fever ain't nothin' to sneeze at, Morris. ;-)

Seriously, though: Any allergic reaction is a miserable thing. In some ways I'm better off being a full-time allergic person, because I use full-time anti-allergy techniques. They aren't sufficient to give me a normal life, but on the other hand, I don't usually get sneeze attacks. And I never get unanticipated bad days - it's all built in to my life's routine. It's expected. That, by itself, really helps.

You get used to it. I've decided that people can adapt to just about anything.

Livey said...

I think you should be a doctor! You certainly know more than most of them! My eyes swell, I hate it.

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