Why are seasonal allergies getting worse. How does climate change affect allergy seasons. What can you do to alleviate allergy symptoms. How does the immune system respond to allergens. Are masks effective against pollen. Which types of pollen are most allergenic.

The Growing Impact of Seasonal Allergies

Seasonal allergies, also known as allergic rhinitis, have become increasingly prevalent in recent years, affecting nearly 60 million people in the United States annually. The Northeast, in particular, has experienced a significant surge in allergy severity, largely attributed to climate change. This year, record-high pollen counts have led to an earlier onset of allergy seasons, resulting in prolonged symptoms for sufferers.

Dr. Fred Little, a clinical associate professor of medicine at Boston University Chobanian & Avedisian School of Medicine and director of the Boston Medical Center allergy-immunology fellowship, sheds light on the mechanisms behind allergies and the factors contributing to their intensification.

Understanding Allergies: The Immune System’s Overreaction

Allergies are essentially an abnormal immune response to typically harmless substances in our environment. Unlike genetic diseases such as cystic fibrosis or sickle cell anemia, allergies result from a combination of hereditary and environmental factors.

How does the immune system respond to allergens? When exposed to allergens like pollen or cat dander, the immune system mistakenly identifies these harmless proteins as threats. This triggers an immune response, activating certain cells that release substances causing nasal congestion, sneezing, and excessive mucus production. In some cases, this response can lead to narrowing of the airways, resulting in wheezing and asthma symptoms.

Developing Allergies: A Matter of Time and Environment

Interestingly, allergic responses can develop at any stage of life, not just in childhood. Dr. Little notes that patients at Boston Medical Center who grew up in different ecological environments often develop allergies after living in the Northeast for two to three years. This occurs as their immune systems become primed to initiate a maladaptive response to local allergens.

Climate Change: A Key Driver of Worsening Allergies

Several factors contribute to the increasing severity of seasonal allergies, with climate change playing a significant role. Over the past two decades, pollen seasons have lengthened throughout the temperate climates of the United States, primarily due to warmer temperatures and changes in precipitation patterns.

The Impact of Warmer and Longer Seasons

How does climate change affect allergy seasons? Warmer temperatures, especially when they occur earlier and persist longer, lead to increased pollen production. This extended warmth allows plants to pollinate for more extended periods, resulting in higher overall pollen counts and prolonged allergy seasons.

The Role of Drought and Dryness

Dryness during allergy season is another factor exacerbating pollen levels. Rain typically helps to reduce airborne pollen, but drought conditions allow pollen to remain suspended in the air for longer periods, increasing exposure for allergy sufferers.

The Pollen Paradox: Not All Pollen is Created Equal

A common misconception among allergy sufferers is that the yellow pollen visible on cars and in storm drains is the primary culprit for their symptoms. However, Dr. Little reveals an interesting fact: pine pollen, responsible for this yellow coating, is actually less allergenic than pollen from deciduous trees.

Which types of pollen are most allergenic? Pollen from leafy trees such as birch, maple, and oak tends to cause more severe allergic reactions compared to pine pollen. This highlights the importance of understanding the specific types of pollen in your environment and their potential impact on your allergies.

The Mask Effect: An Unexpected Ally Against Allergies

Are masks effective against pollen? While not their primary purpose, masks have provided an unexpected benefit for allergy sufferers. Dr. Little points out that the reduced use of masks compared to previous allergy seasons may be contributing to the perceived increase in allergy symptoms.

Masks offer a physical barrier against airborne allergens, both outdoors and indoors. By filtering out some of the pollen and other allergenic particles, masks can help reduce exposure and potentially alleviate symptoms for some individuals.

Early Onset and Prolonged Symptoms: The New Normal?

Recent years have seen a trend towards earlier starts to the allergy season, particularly for grass pollen. This shift is closely tied to climate change, with warmer springs allowing plants to begin pollinating earlier than usual.

The combination of earlier onset and longer durations means that allergy sufferers may experience symptoms for more extended periods. This prolonged exposure can lead to increased severity of symptoms and potentially impact quality of life for those affected.

Strategies for Coping with Worsening Allergies

Given the increasing severity and duration of allergy seasons, it’s crucial for sufferers to develop effective strategies for managing their symptoms. While completely avoiding allergens may be impossible, there are several steps individuals can take to minimize their impact.

Medication Options

What can you do to alleviate allergy symptoms? Over-the-counter antihistamines like Zyrtec, Claritin, or Allegra can provide relief from common allergy symptoms such as sneezing, itching, and runny nose. For more severe cases, prescription medications or immunotherapy may be recommended by an allergist.

Environmental Controls

Reducing exposure to allergens is key. This can include keeping windows closed during high pollen days, using air purifiers with HEPA filters, and showering after spending time outdoors to remove pollen from skin and hair.

Monitoring Pollen Counts

Staying informed about local pollen levels can help individuals plan their outdoor activities and take preventive measures. Many weather apps and websites now provide daily pollen forecasts, allowing allergy sufferers to prepare accordingly.

The Future of Allergies: Adapting to a Changing Climate

As climate change continues to impact our environment, it’s likely that allergy seasons will continue to evolve. This may necessitate new approaches to allergy management and treatment in the coming years.

Research and Innovation

Ongoing research into allergies and their mechanisms may lead to new treatments and preventive strategies. Scientists are exploring various avenues, including targeted immunotherapies and novel pharmaceutical approaches to modulate the immune response.

Public Health Initiatives

As the prevalence and severity of allergies increase, public health initiatives may need to adapt. This could include increased education about allergies, improved air quality monitoring, and policies to reduce environmental allergens in public spaces.

In conclusion, the rise in seasonal allergies presents a growing challenge for millions of individuals. Understanding the factors contributing to this increase, from climate change to immune system responses, is crucial for developing effective management strategies. By staying informed, taking preventive measures, and working with healthcare professionals, allergy sufferers can navigate this changing landscape and minimize the impact on their daily lives.

Personalized Allergy Management: Tailoring Solutions to Individual Needs

As the landscape of seasonal allergies continues to evolve, it’s becoming increasingly clear that a one-size-fits-all approach to management may not be sufficient. Each individual’s allergic profile and response to various treatments can differ significantly, highlighting the need for personalized strategies.

Allergy Testing and Diagnosis

How can you determine your specific allergens? Allergy testing, either through skin prick tests or blood tests, can help identify the specific substances triggering your allergic reactions. This information is invaluable for developing a targeted management plan and avoiding unnecessary exposure to allergens.

Customized Treatment Plans

Based on the results of allergy testing and the severity of symptoms, allergists can create customized treatment plans. These may include a combination of medications, lifestyle adjustments, and in some cases, immunotherapy to desensitize the immune system to specific allergens over time.

The Role of Technology in Allergy Management

Advancements in technology are playing an increasingly important role in helping individuals manage their allergies more effectively.

Mobile Apps and Wearables

How can technology help allergy sufferers? Mobile apps that track pollen counts, air quality, and personal symptoms can provide valuable insights and help users make informed decisions about their daily activities. Some wearable devices can even monitor environmental conditions and alert users to potential allergy triggers in real-time.

Smart Home Solutions

Smart home technologies, such as automated air purifiers and climate control systems, can help maintain optimal indoor air quality. These systems can adjust based on outdoor allergen levels, helping to create a safer environment for allergy sufferers.

The Importance of Allergy Education and Awareness

As seasonal allergies become more prevalent and severe, there’s a growing need for education and awareness among the general public, healthcare providers, and policymakers.

Public Health Campaigns

Increasing public understanding of allergies, their causes, and management strategies can help individuals take proactive steps to protect their health. This includes recognizing the signs of allergies and distinguishing them from other respiratory conditions.

Healthcare Provider Training

Ensuring that primary care providers are up-to-date on the latest allergy research and treatment options is crucial. This can help improve early diagnosis and management of allergies, potentially preventing the development of more severe symptoms or complications.

The Intersection of Allergies and Other Health Conditions

Seasonal allergies don’t exist in isolation; they can interact with and exacerbate other health conditions, making management more complex.

Allergies and Asthma

How do allergies affect asthma? For many individuals, allergies can trigger or worsen asthma symptoms. Understanding this relationship is crucial for effective management of both conditions. Controlling allergies may help reduce the frequency and severity of asthma attacks.

Allergies and Sleep Disorders

Nasal congestion and other allergy symptoms can significantly impact sleep quality. This can lead to daytime fatigue, decreased productivity, and potentially exacerbate other health issues. Addressing allergy symptoms may improve sleep quality and overall well-being.

The Economic Impact of Worsening Allergies

As seasonal allergies become more severe and widespread, their economic impact is likely to grow.

Healthcare Costs

What is the financial burden of allergies? The increasing prevalence and severity of allergies may lead to higher healthcare costs, including more frequent doctor visits, increased medication use, and potential hospitalizations for severe cases.

Productivity Loss

Allergy symptoms can significantly impact workplace productivity. Absenteeism due to severe symptoms or presenteeism (reduced productivity while at work) can result in substantial economic losses across various industries.

Looking Ahead: The Future of Allergy Research and Treatment

As our understanding of allergies and their underlying mechanisms continues to grow, new avenues for research and treatment are emerging.

Precision Medicine Approaches

Advancements in genetic research and immunology may lead to more targeted treatments based on an individual’s specific genetic profile and immune system characteristics.

Novel Therapies

Researchers are exploring new treatment modalities, including biologics that target specific components of the allergic response. These therapies hold promise for individuals with severe or treatment-resistant allergies.

Environmental Interventions

As the link between climate change and worsening allergies becomes clearer, there may be increased focus on environmental interventions to reduce allergen levels on a broader scale. This could include urban planning strategies to reduce allergenic plant species in public spaces or efforts to mitigate the effects of climate change on plant pollination patterns.

In conclusion, the landscape of seasonal allergies is rapidly evolving, driven by a complex interplay of environmental, immunological, and societal factors. As allergies continue to affect an increasing number of individuals, a multifaceted approach involving personalized treatment, technological innovation, public health initiatives, and ongoing research will be crucial. By staying informed and proactive, individuals can navigate this changing terrain and maintain a better quality of life despite the challenges posed by worsening seasonal allergies.

No, You’re Not Imagining It: Seasonal Allergies Are Getting Worse | BU Today

One reason for the spike in seasonal allergies in recent years? Drier springs and summers mean less rain to tamp down airborne pollen. Photo by Freestocks/Unsplash

Seasonal Allergies

School of Medicine’s Fred Little on reasons for the spikes and what you can do about it

April 27, 2023

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It’s that time of year again—you’re sitting outdoors enjoying the sunshine, when all of a sudden, you start to feel…itchy. Within an hour, that itch has turned into a full-blown sneeze attack complete with watery eyes and congestion, and now you’re running to the nearest pharmacy to buy some Zyrtec.

Seasonal allergies—or an allergic reaction to the tree and grass pollens that float around in the spring and summer, known as allergic rhinitis—affect nearly 60 million people in the United States every year. In recent years, they’ve become particularly bad in the Northeast, which can largely be attributed to climate change, says longtime allergist Fred Little, a Boston University Chobanian & Avedisian School of Medicine clinical associate professor of medicine and the director of the Boston Medical Center allergy-immunology fellowship. And this year, record-high pollen counts have caused seasonal allergies to start even earlier than usual—which means prolonged symptoms for allergy-sufferers.

We spoke with Little about how allergies work and what you can do to cut down on the sneezing, itching, and watery eyes.

Q&A

with Fred Little

BU Today: So, what are allergies, exactly?

Little: Allergies are an abnormal immune response to normally harmless substances that are in the environment. Allergies aren’t like other diseases, such as cystic fibrosis or sickle cell anemia, where there’s a very strong hereditary [component]. Allergies are a mix of heredity and environment. 

What’s basically involved [for nonfood allergies] is that one becomes exposed to allergens in the environments that are part of normal day-to-day living. These harmless proteins—like cat dander and pollen—are seen by the immune system as a threat, which leads to an immune response where certain immune cells are activated and release substances that cause congestion in the nose. That can also lead to sneezing from histamine release in other cells and excessive mucus production in the conducting airways. And there are other cells which release mediators that cause narrowing of the airways beyond what excess mucus does, which is what leads to the symptoms of wheeze and asthma for people that have allergic asthma. 

Allergic responses can develop in adulthood as well as in childhood. We often see patients at Boston Medical Center who grew up in a different ecological environment from the Northeast and may not have had problems with allergies when they were younger. But two or three years after arriving here, their immune system gets primed to start developing that maladaptive response. Over time, that can lead to symptoms of hay fever—the technical term is allergic rhinitis—like sinus inflammation or asthmatic symptoms. So, that’s a general background of how people can be susceptible to developing sensitization to allergens.

BU Today: Why have seasonal allergies been so bad lately?

Little: There are several things that contribute to allergy symptoms being worse in recent years. For one, I think people are wearing masks a lot less compared to previous allergy seasons. Masks obviously provide a little bit of protection from being exposed to allergens outdoors and indoors. 

Last year, the grass pollen counts also started to climb a little earlier in the season than usual. People who are allergic to grass pollen started having symptoms earlier than before. That’s related to climate change, as well as things that contribute to more pollen generation in general (like a warm, wet spring that helps plants grow). I’m not a climate scientist so I can’t get into the nitty-gritty science, but certainly, over the last 20 years, there have been longer pollen seasons throughout the temperate climates of the United States. Warmth is definitely a factor; if it’s warmer—and warmer longer and earlier on—before and during allergy season, that particular area is going to have more pollen production. Drought and dryness is also a factor: dryness during allergy season increases pollen levels just because rain cuts down on airborne pollen.  

One interesting tidbit: pine pollen—the yellow pollen you see on cars and in storm drains—is not actually as allergenic as pollen that comes from deciduous, or leafy, trees, like birch, maple, and oak. People may have a perception that the pollen levels are terrible because they see yellow stuff all over the place, but that doesn’t necessarily correlate with the pollen that is the most allergenic.

BU Today: What can people do to decrease their pollen exposure?

Little: Unlike somebody with a food allergy, who can control their exposure to that food, it’s very hard to control exposure to pollens, as they’re so pervasive. Even indoors: as we come in and out of our houses, we wear the clothes we were wearing outdoors and bring pollens into the house. There are some things that can be done to minimize pollen levels in the house. For one, if you have the resources, keep windows closed during the night and day and use air conditioners to keep the air cool. 

For people with really bad allergies to pollens, they might want to change out of their outside clothes when they come inside and wash them [as soon as possible]. That can be helpful for people who have severe allergies (or live with someone who does) and want to keep the house as pollen-free as possible. But no house or apartment is airtight, so it can be hard to keep the outdoor environment from coming indoors.

BU Today: What about allergy medications? Are there any tips or tricks to remember?

Little: From a medical standpoint, there are medications that people can get used to. A good example is topical decongestants like Afrin [nasal spray]. The active ingredient in those is oxymetazoline, a decongestant that causes blood vessels to constrict [in the nasal passages]. You know, you have a really bad cold and you do a few squirts and you can breathe better. But, those shouldn’t be used for more than three days at a time. After that, there can be a rebound effect where the nasal tissues themselves become accustomed to the spray and almost dependent on it. You can actually end up worse off than you were at the beginning. 

Instead, a mainstay treatment [for congestion] is nasal steroid sprays like Flonase or Rhinocort, which are available both over the counter and by prescription. They can, however, take two or three weeks to kick in and have the maximal effect. If someone uses a spray for a week without noticing a difference in symptoms, it’s not because it’s not working anymore. It’s because nasal steroids take a longer time to modify the abnormal immune response.

An interesting tidbit for allergy sufferers in New England is that our tree pollen season starts before our local trees are even producing pollen. It’s because of all the leafy trees up and down the Eastern Seaboard that pollinate earlier than ours do and send pollen up the jet stream. I’ll often have patients start their nasal sprays in mid-March to prime the pump, so to speak, for immune protection against tree pollen.

Then there are things like antihistamines, which work in a day or two after taking them. There are many patients with mild hay fever symptoms who do fine with just taking Zyrtec or fexofenadine or loratadine once or twice a day. Others with more severe symptoms, particularly nasal congestion, won’t be helped much by antihistamines alone and will need something like a nasal steroid to help control that.

BU Today: One last question: How can you tell the difference between allergies and COVID-19?

Little: The truth is, it can be very difficult to differentiate allergy symptoms from mild COVID symptoms during allergy season. The main differentiators are that people with allergies should not have a fever, and certainly not the high fever that you can get with COVID, nor experience the fatigue that’s associated with COVID. We do have to remember that people who have allergic asthma can also develop respiratory symptoms during their allergy season, which can make it a little bit harder to differentiate. But people with asthma are usually familiar with their asthma symptoms and should be able to tell them apart from COVID-19 pneumonia symptoms.

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High pollen count: Why are my allergies so bad right now?

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 — 

Pollen has exploded to eye-watering levels this spring in some parts of the country after warm weather pushed plants out of their winter slumber much earlier than normal.

In Atlanta, the pollen count sky rocketed to “extremely high” in early March and stayed high through much of April, according to the Atlanta Allergy and Asthma physicians practice. Farther north in Washington, DC, allergy sufferers have been dreading the lime-green film of pollen covering that covers windshields and porches and piles up on streets and sidewalks.

But these aren’t isolated trends. As the planet warms, researchers say allergy season is starting earlier and lasting longer. And a study from the journal Nature published last year found that pollen count is projected to increase by 200% by the end of the century if planet-warming pollution continues to rise.

Climate Central, a nonprofit focused on climate news and research, recently analyzed how warmer temperatures have affected allergy season in 203 US cities since 1970.

It found that on average, the growing season – the period between the last freeze in spring to the first freeze of fall – is lasting 16 days longer in the Southeast, 15 days longer in the Northeast and 14 days longer in the South.

In the West, growing season is 27 days longer on average, Climate Central reported. Reno, Nevada, for example, has seen a shocking increase of 99 days.

And a longer growing season means a longer allergy season.

Growing season in the US has lengthened by 15 days on average, according to a Climate Central analysis.

Climate Central

“Because of climate change, we’re now seeing an earlier and longer growing season for plants, which of course make pollen, which is the enemy of many Americans that suffer from pollen allergies – and mold allergies as well,” Lauren Casey, a meteorologist with Climate Central, told CNN. “Pollen can also trigger an asthma attack, which of course is much more serious for people that suffer from asthma.”

When plants reproduce, typically during the spring, many release tiny pollen grains that are carried by wind. The pollen grains are small enough to be inhaled, and some people’s immune systems react very poorly to the miniscule particles.

More than 24 million people in the US have pollen-induced respiratory allergies like hay fever, according to the Centers for Disease Control and Prevention. The center’s data shows that more than one in four adults suffered from seasonal allergies in 2021.

Growing season has lengthened by 34 days in Atlanta, according to a Climate Central analysis.

Climate Central

Growing season has lengthened by 20 days in Washington, DC, according to a Climate Central analysis.

Climate Central

A longer and earlier start to pollen season could trigger a public health emergency, researchers say. As temperatures get warmer in the South and drought plagues the Southwest, pollen from plants like ragweed or poaceae – a plant that typically grows in grasslands or salt-marshes – is projected to be higher across those regions than in the North.

Wind-driven pollen, which plays an important role in plant fertilization, is closely tied to temperature and precipitation changes. So, as spring seasons get warmer earlier due to climate change, plants could pollinate much earlier and for a longer period of time than they currently do.

Plant pollen isn’t the only trigger of seasonal allergies. Mold, a type of fungi that reproduces with tiny airborne spores, can also be allergenic for some people and can exacerbate seasonal allergies, according to the report.

While outdoor mold is not as well-studied as pollen, according to the report, one thing is clear: Warmer and wetter weather – conditions that many locations are seeing more of amid the climate crisis – is favorable for mold development.

Adobe Stock

Allergy season will start much earlier than normal and be far more intense because of climate crisis, study suggests

“With climate change, we’re seeing increases in warming in all seasons, but particularly the fastest warming season for most locations across the US is the winter season,” Casey said. “So now we’re dealing with mold at a time of year that we typically wouldn’t.”

Casey also pointed out that the climate crisis is making extreme precipitation more likely, which provides that crucial dampness for mold to grow. The report highlights the link between allergens and thunderstorms, which researchers say spread pollen and mold spores through the air more efficiently.

“The problem with pollen grains is that when they get wet, they rupture, and they break into tinier bits called sub-pollen particles,” Casey said. “Those tinier bits are more easily dispersed by the wind when they dry out, and they have an easier time getting into your nasal passages.”

Oak trees are pumping out pollen in the Southeast, contributing to extremely high levels early in the season.

Andrei Zhigaltsov/iStockphoto/Getty Images

Dr. Mitchell Grayson, chair of the Asthma and Allergy Foundation of America’s Medical Scientific Council and chief of the division of allergy and immunology at Nationwide Children’s Hospital, said he has seen pollen allergies arrive earlier than usual.

“In general, we may be seeing people a little earlier in the spring with symptoms – so mid-February from what might have been early March in the past – but there is significant year-to-year variability in this,” he told CNN. “I haven’t seen worse symptoms, but I’m in a hospital that provides specialist care, and we do see people with all ranges of severity.”

CNN Weather

After a record warm February, winter cold is returning

The treatment of allergies won’t change even as the season gets longer, Grayson said. But it’s important to be aware of what you’re allergic to and know where these triggers are in the environment.

Experts recommend:

• Staying indoors, especially early in the morning or late in the afternoon, when most plants release pollen.
• Wear masks outdoors when possible to mitigate the effects, Amiji said.
• Keeping windows closed in your home and car to minimize your exposure to pollen particles.
• Changing air filters more frequently for your A/C and heating systems in your home and car, according to the manufacturer’s instructions.
• Preparing early by stocking up on anti-allergy medications. If you use a steroid nasal spray, Grayson said it’s important to start using it one to two weeks before your allergy season and to continue through the full season.

Casey, the meteorologist, also noted that allergy season could be a financial burden on low-income families, especially those whose members have asthma, due to the “billions of dollars spent a year on the medical costs of asthma and allergies. ”

She said awareness is key, especially as the world pumps more carbon pollution into the atmosphere, which could worsen allergy seasons.

“You know your own body and are aware of what a typical year is going to look like for you, especially if you’re an allergy sufferer,” she said. “But that whole paradigm is changing with this increase in the growing season, so having awareness that you may be suffering now and going forward in times of the year when you typically wouldn’t, so be prepared for that in your daily life.”

Correction: A photo previously included in this article incorrectly identified a plant as ragweed. The image has been removed.

Read online “Allergy” by Alexei Svetlov – Litres

Introduction

Hello, dear readers!

I am glad that you have my next book in your hands. Until now, in my books in the No Incurable Diseases series, I have told you about how to deal with diseases that occur in adults. But as a pediatrician, parents very often turn to me for various tips on treating diseases in babies, so I decided to devote several books to children’s health.

So, this time we will talk about allergies.

Many of us have children. We take care of them, we try to do everything so that they are healthy. After all, it was not without reason that one of the great ones said: “Children are the flowers of life.” We know every mole on a child’s body, every pimple. And we are immediately alarmed by the appearance of some redness, scratching.

The question arises: “Is this an allergy?”.

What is an allergy?

We hear this word so often, but what exactly is meant by it, many do not understand.

Let me tell you a little about allergic diseases and how they manifest themselves in children, what to do if your child has an allergy.

Part I

The concept of allergies

CHAPTER 1

TALK ABOUT ALLERGY

Some 30-35 years ago, allergies seemed irrelevant and of little danger. Now it has reached such threatening proportions (especially in industrialized countries) that it has become one of the main problems of modern medicine. All over the world there is an increase not only in the frequency, but also in the complexity of allergic diseases. Almost every day, we encounter drug and food intolerances and unusual reactions to chemicals in our home and professional environment, including synthetic clothing, jewelry, cosmetics, and more. The development of medicine (the discovery of new antibiotics, sulfonamides, a number of antiseptics) has significantly reduced the number of diseases, many infectious diseases have ceased to be fatal. Others came to the fore, including allergic ones, which depend mainly not on microbes, but on changes in the reactivity of the human body. After all, the basis of allergic diseases is precisely the altered hypersensitivity to a certain substance called an allergen.

First, let’s talk about allergens, the mechanisms of allergy development and the main allergic reactions.

Allergens

Allergens can be various compounds from simple chemicals (bromine, chromium, iodine) to the most complex ones (proteins, polysaccharides) or combinations of these or others. Some enter the body from the outside (exogenous), others are formed in the body itself (autogenous) . Exogenous allergens of non-infectious origin include: household dust, wool, animal dander, drugs, chemicals, plant pollen, animal and plant products, viruses, fungi and their metabolic products, mold. Once in the body, exogenous allergens can cause damage to various organs and systems. Exogenous allergens are divided into the following groups.

Biological allergens

Biological allergens – microbes, viruses, fungi, mold, helminths, serum and vaccine preparations.

The development of many infectious diseases (brucellosis, leprosy, tuberculosis, typhoid fever) is accompanied by allergies.

Such an allergy is called infectious, and a group of diseases caused by microbes is called fungi, or infectious viruses. Often, microbes and fungi, usually found on the skin or in the oral cavity, respiratory tract and intestines, lead to their development. The source of allergies are also foci of infection in the body – carious teeth, inflammation of the paranasal sinuses, cholecystitis and other inflammatory processes. Serums and vaccines injected into the body can cause an allergic reaction – anaphylaxis. Allergy in helminthiases develops in connection with the absorption of decay products and metabolism of helminths.

Drug allergens

Almost any drug can cause an allergic reaction. Thus, complications in the use of codeine are 1.5%, aspirin – 1.9%, sulfonamides – 6.7%, penicillin – up to 16%. Allergic complications that occur in response to the introduction of novocaine, vitamin B ₁ and many other drugs are not uncommon. The frequency of allergic reactions depends on how often and in what quantities the drugs are used. During the period of widespread use of sulfonamides, allergic reactions to them were noted more often than recently, when their use has somewhat decreased. Due to the significant spread of antibiotics, it is they, and primarily penicillin, that most often cause allergic reactions. The frequency of complications increases as the course of treatment is repeated. Penicillin is more likely than other drugs to cause severe allergic reactions, and the dose that causes the reaction can be very small. It must be remembered that taking any medication without a doctor’s prescription is extremely dangerous!

Household allergens

House dust, particles from carpets, clothes, bed linen play the main role among household allergens; fungi on the walls of damp rooms; particles of domestic insects (bugs, cockroaches, bed mites). This group also includes the so-called epidermal allergens – hair, wool, animal dander. Often the allergen is the daphnia crustacean, which serves as food for fish. In recent years, the number of allergic reactions to household chemicals, especially to washing powders, has increased. Household allergens most often cause respiratory diseases (bronchial asthma).

Pollen allergens

Allergic diseases often occur when pollen from wind-pollinated plants that does not exceed 35 microns in diameter enters the body. It causes a runny nose, conjunctivitis and other manifestations of hay fever (allergic diseases). Ambrosia weed pollen, molds that live on the walls of the bathroom, kitchen, and porches have very strong allergenic properties.

Let’s get acquainted with the most common allergic plants and the timing of their flowering.

Table 1. Average flowering time of some allergenic plants

Food allergens

Almost all foods can be food allergens. More often than others cause allergies milk, eggs, meat, fish, crayfish, tomatoes,

citrus fruits, strawberries, strawberries, chocolate. When allergens enter the body through the gastrointestinal tract, a food allergy occurs. If the allergen has entered the gastrointestinal tract in a different way, then such a lesion is called a gastrointestinal allergy. For example, an allergen that enters the body through the mucous membrane of the respiratory tract can cause an allergic reaction in any part of the gastrointestinal tract, the reaction develops very quickly.

For example, if you are allergic to milk, within a few minutes after taking it, vomiting, diarrhea, and a little later, other symptoms (urticaria, fever, itching) appear. Sometimes the first symptoms appear only after a certain period of time. Usually, food allergies develop against the background of disorders of the gastrointestinal tract. In children, overfeeding contributes to its development; often food allergens cause diathesis (exudative-catarrhal) in them. Intolerance to certain foods is not always associated with an allergic reaction. It may be due to a lack of certain enzymes in the digestive juices, which leads to indigestion of food and disorders similar to food allergies.

Industrial allergens

The rapid development of the chemical industry has led to a significant increase in the use of various substances in production and at home, which led to the occurrence of allergic reactions of various nature, mainly in the form of skin lesions – occupational allergic contact dermatitis. Industrial allergens can be: turpentine, mineral oil, nickel, chromium, arsenic, tar, tannins, naphthol and other dyes, varnishes, insectofungicides. Also substances containing bakelite, formalin, urea, epoxy resins, detergents, aminobenzenes, quinoline derivatives, chlorobenzene and many others. In hairdressing and beauty parlors, hair dyes can be allergens; in darkrooms – metol, hydroquinone, bromine compounds.

Physical allergens

A special group of allergens are physical allergens – heat, cold, mechanical irritation. It is believed that in many cases, under the influence of these factors, certain substances are formed in the body that become allergens.

Autoallergy

Autoallergy is an increased and altered ability of the body to respond to its own proteins of tissue cells that become allergens (endoallergens).

The emergence of the doctrine of autoallergy as one of the mechanisms of the development of the disease is associated with the name of the Russian physiologist-scientist IP Mechnikov.

A distinction is made between natural and acquired endoallergens.

Natural endoallergens include some proteins of normal tissues (brain, lens). Acquired – these are body proteins that have acquired alien (allergic) properties during burns, radiation sickness, other processes, as well as when combined with bacterial toxins, drugs. The body is able to distinguish “its” proteins from foreign ones. Under normal conditions, there is resistance to the body’s own components, and body tissues are not damaged, i.e., sensitized lymphocytes and antibodies (autoantibodies) are not formed against them. The essence of this process lies in the fact that the action of protective mechanisms is directed against their own tissues. If the damaging effect of the mechanisms on the tissue becomes sufficiently pronounced, the process turns into an autoallergic disease. These diseases include: hemolytic anemia, myasthenia gravis (severe muscle weakness), rheumatoid arthritis, glomerulonephritis. It is also suggested that autoallergens are involved in the development of rheumatism, ulcerative colitis, and in some cases bronchial asthma.

Allergy mechanism

Even in ancient times, Hippocrates, Avicenna, Galen described cases of intolerance to certain foods, leading to gastrointestinal disorders and urticaria. Allergies have haunted humanity since ancient times, but in the present there are much more allergens due to the deteriorating environmental situation and the abundance of household, food and industrial chemicals.

What is an allergy and why does it occur

Allergy – is a process that occurs in the human body against the background of exposure to an allergen (foreign substance) and is accompanied by tissue damage and the development of inflammation.

It is well known that the body’s immune system protects human health from a wide variety of infections and other external influences. In the body, all people, without exception, produce protective proteins – immunoglobulins of several types (A, M, G, E). Immunoglobulins E involved in allergic reactions are usually not produced too much (for example, they are needed to destroy worms).

But it turns out that absolutely all people react to various external stimuli (house dust, household and industrial chemicals, animal hair, plant pollen and mold) by increasing the amount of immunoglobulins E in the blood.

This need is of a protective nature: immunoglobulins E act as watchdogs, rushing at a stranger, and most do not cause any external manifestations.

But when a lot of immunoglobulin E is produced in the body, allergic reactions that are well known to us all occur.

How it happens

development of inflammatory symptoms. Histamine is released from mast cells, and allergy sufferers experience swelling of the places where the allergen has entered, itching, rash, and discharge, for example, from the nose. A protective biological function arises – the vessels expand and other active blood cells are attracted to the affected area, which also release substances that destroy foreign proteins.

Immunoglobulins are specific when they react only to a certain irritant, for example, plant pollen or some food product (eggs, chocolate).

In order to form antibodies in the body, allergens must satisfy two conditions: they must be large enough to be antigenic, i.e. provoke the production of antibodies, and they must be large enough to pass through the epidermis of the skin, the epithelium of the respiratory tract and the gastrointestinal tract, molecular weight from 40,000 to 50,000 (?).

For the occurrence of a clinical picture (a set of signs of the disease, its manifestations, characteristics) of an allergic reaction, at least 2 contacts of the body with the allergen are required. Upon contact with the first dose (small), the body seems to get acquainted with a foreign substance. The second dose of exposure – a large (permissive) – is accompanied by the development of clinical manifestations of an allergic reaction. Allergic reactions of the immediate type can occur within a few seconds or minutes, or 5-6 hours after repeated contact of the body with the allergen. In some cases, a long-term existence of the allergen in the body is possible. In this regard, it is almost impossible to draw a clear line between the impact of the first, sensitizing, and repeated, resolving, doses of the allergen.

Causes of allergies

Doctors are unanimous that one of the main causes of allergic reactions is certain malfunctions in the gastrointestinal tract. If a child develops dysbacteriosis due to taking antibiotics and other drugs, then large protein allergen molecules (normally they are digested to constituent amino acids and lose their allergenic properties) enter the bloodstream. Then the body begins to respond to the invasion of uninvited strangers with various and sometimes excessive reactions from simple urticaria, itching and runny nose to severe Quincke’s edema and shock. During the day, a person encounters about 120 food allergens, most often without any harm to health. When overeating, when there are a lot of allergens, with poor digestion or inflammation of the intestines, with dysbacteriosis or the presence of parasites in the gastrointestinal tract that secrete waste products that are toxic to humans, the risk of developing allergies is very high.

In a word, everything starts with gastrointestinal pathology or poor functioning of the liver if it does not fulfill its cleansing function, which happens after hepatitis, cholecystitis or giardiasis.

Allergies can also be caused by kidney failure, when the kidneys cannot cope with their excretory function.

In infancy, allergies often develop when breastfeeding is stopped too early and the transition to artificial feeding. Enzyme deficiency can also join allergies, it’s just that a small child did not have time to form and improve the mechanism for assimilation of adult food, and they are already beginning to give him a variety of complementary foods. Doctors admit that it is almost impossible to identify such an enzymatic deficiency. All of them unanimously (although absolutely independently of each other) add that much more often than the notorious enzyme deficiency, which almost always disappears by itself, the cause of allergies, or rather, pseudo-allergies in a child (as well as in adults) is banal dysbacteriosis.

It’s all about the constant self-poisoning of the body by a mass of harmful substances produced by pathogenic bacteria that are present in large numbers in the intestines and produce histamine, which causes a variety of inflammatory symptoms.

Which of the children and adults has never caught a cold in their life? And which of them was not prescribed antibiotics? After such treatment, dysbacteriosis for both a child and an adult is practically guaranteed. It is detected elementarily – with the help of fecal analysis (stool culture). And it is treated very simply – with the help of intestinal antiseptics of a new generation, which selectively destroy harmful flora while maintaining the beneficial one, or with the help of bifid preparations in capsules. Usually bifidobacteria are almost completely digested in the stomach, their “super usefulness” is nothing more than a publicity stunt. Of course, they play a positive role in maintaining a healthy flora in the intestines, but they can hardly cope with bacteriosis.

Unfortunately, hereditary genetic structure is one of the most important factors in the possible development of allergies. If one of the parents suffered from hay fever, asthma, eczema, food allergies, the child is very likely to experience these or other allergic reactions.

The cause of an allergy in a child may also be the non-compliance of his mother with a diet during pregnancy. Doctors advise women who are expecting a baby to refrain from classic allergens (chocolate, citrus fruits, coffee) so that the fetus does not “pick up” antibodies from the mother and the baby subsequently does not have problems. But not all mothers are able to sacrifice their interests and habits for nine months for the sake of the child’s health. Therefore, if a mother often drank coffee during pregnancy, ate eggs and oranges, then the child is found to be allergic to these products. If she was treated for any disease, then antibodies to this medicine (for example, an antibiotic) are transferred to the fetus. Therefore, I advise pregnant women to be as careful as possible: do not overcool, do not smoke (otherwise, the child, in addition to allergies, will have a whole bunch of diseases up to the most severe ones – damage to the heart, central nervous system and various malformations). The next possible cause of allergies in a child and an adult is fungi. They act as an infectious allergen and also like to settle in the intestines, releasing many toxic substances. They are also easy to identify with the help of an analysis for dysbacteriosis.

Fungi are dangerous both when they are in the intestines, and when they just “decorate” the nails or start in dandruff. All this leads to an increase in the overall sensitivity of the body to various substances. The last reason for the occurrence of allergies is the poor ecological situation around us: everything is oversaturated with chemicals. In addition to fertilizer residues, the products contain various food additives, preservatives, flavor enhancers. There is nothing to talk about household chemicals or the harmful effects of chemically active substances in various industries. There are a lot of allergy sufferers in the Donbass, Kuzbass and other coal regions. In large and small cities with enterprises that pollute water and air with industrial emissions.

Much depends on eating habits. So, a diet poor in vitamins, microelements and vegetable fiber with a high content of semi-finished and canned foods dramatically increases susceptibility to allergens. What determines the severity of allergy symptoms? water, food, frequency of use of household chemicals. Any fresh surgical operation (extraction of a tooth, tonsils, trauma, especially burns), all diseases for a long time lead to a weakening of the body, respectively, to an increase in allergic reactions or the appearance of new ones.

How to prevent allergies? What to do if you are allergic to cats, but you really love these fluffy buns and suffer incredibly? Answers to questions from Meduza readers about allergies

Francesco De Tommaso / Unsplash

At the end of April, we invited Meduza readers to ask us what they want to know about allergies. We received more than two thousand questions, chose the most interesting ones and answered them (and clarified some other points related to allergies).

How to prevent allergies?

Brief. Unknown.

Doctors only speculate why an allergy may develop – that is, an inadequate aggressive immune reaction to some foreign substance that does not pose a threat (usually protein, but in rare cases it can also be something inorganic – for example, nickel. ) There are several risk factors, but in most cases a person cannot influence whether he will have an allergy or not.

What’s more, research shows that a complex combination of factors usually leads to allergies. For example, allergic rhinitis often occurs in people with a genetic predisposition to allergies, born during the flowering season of the main allergenic plants, while being born first in the family and receiving antibiotics early. Food allergies are also more likely to develop in a person with a genetic predisposition.

Medical communities do not consider stress, old grudges, unsatisfactory relationships with relatives to be risk factors for developing allergies, despite the statements of individual doctors and psychologists. However, as noted by Olga Zhogoleva, an allergist-immunologist, founder of Everyday Clinic (St. Petersburg), the symptoms of bronchial asthma and atopic dermatitis can worsen against the background of psycho-emotional stress. The risk factors and causes of allergies also do not include chronic infection, adrenal dysfunction or parasites.

Will a dog in the house help protect the child from allergies or, on the contrary, will it harm?

Brief. Leave the dog alone, there are other ways to reduce the risks.

People who had contact with a dog as a child are statistically less likely to develop allergic diseases. There is a hypothesis that the animal adds bacterial diversity to the child’s body. However, doctors do not yet give recommendations to future parents to give away cats, dogs and hamsters or, conversely, to buy: firstly, data on the influence of pets on the development of allergic diseases cannot be called very reliable; secondly, it is impossible to have animals solely for the prevention of allergies in children.

Here are some things parents can do to help reduce their child’s risk of developing allergies:

• Do not smoke during pregnancy and after the birth of a child with it – this increases the risk of developing asthma, and tertiary smoking can also have a similar negative effect.
• Breastfeed only for the first 3-4 months.
• Moisturize baby’s skin. “Dry skin in the first year of life is one of the risk factors for the development of atopic dermatitis,” says Olga Zhogoleva. – In atopic dermatitis, the skin is one of the routes for the formation of allergies. When an allergen gets on dry, permeable skin, a person may become allergic to these proteins due to the malfunction of the immune system. That’s why skin care is so important.”
• Fight dust mites: maintain a relative humidity of 35-50% at home, wash bedding in hot water weekly, use mattresses and pillows with special covers that protect against dust mites, get rid of carpets, vacuum regularly – a vacuum cleaner should have a good filter.

While pregnant or breastfeeding, there is no reason to eliminate popular allergens from your diet. As well as during the start of complementary foods.

By the age of 30, I had no allergies. Am I lucky?

Brief. Not fact.

Allergies can appear at any age, although for most people it does start in childhood. It happens that in adults it occurs during pregnancy or after a viral infection, but the mechanism of this phenomenon is unclear.

In the modern world, allergic diseases have become so widespread that it is easier for people to explain the incomprehensible reaction of their body with allergies. In fact, symptoms similar to an allergic reaction may indicate other diseases or disorders. Here are just a few examples:

• Food intolerance is an unpleasant reaction of the body to food, not associated with the functioning of the immune system, but with difficulties in digesting certain foods. Intolerance is more common in adults than food allergies.
• Other diseases of the gastrointestinal tract. For example, gastroesophageal reflux disease (heartburn), or irritable bowel syndrome – then the body can really react badly to certain foods.
• Mental disorders. “People often confuse panic attacks with allergy symptoms: it’s hard to breathe, there is a lump in the throat, heart palpitations – and the person thinks he has inhaled the allergen,” says Olga Zhogoleva. “Or, it happens that a person feels that he has an intolerance to all foods, medicines in general – such symptoms can go well on antidepressants.”
• Symptoms of an infectious disease or side effects of a drug. Most people with a previously diagnosed allergy to penicillin do not actually have it. Misdiagnosis is made because, for example, the drug caused adverse reactions that just look like an allergy. It happens that a doctor treats a viral infection with antibiotics, and then a rash occurs due to the disease, which would have appeared anyway, but it is mistaken for an allergy to the medicine;
• Skin diseases caused by exposure to ultraviolet radiation. They are commonly referred to as “sun allergies”, although such a reaction is rarely allergic. When it is really an allergy, the allergen is not ultraviolet light, but a substance that has been applied to the skin – for example, as part of a sunscreen (but it happens that the reaction is associated with a medicine taken orally). The sun’s rays only provoke an inadequate response to contact with the substance.

How is atopic dermatitis different from allergies?

Brief. Symptoms.

Atopic dermatitis is a chronic inflammation of the skin that is itchy and cracked. People with atopic dermatitis often have allergies, and in this case, after eating the allergen, other symptoms appear: for example, itchy mouth, runny nose, abdominal pain. But it happens that with atopic dermatitis there is no allergy, although the test results show sensitization to certain allergens. An allergy is a condition in which there is both sensitization and characteristic symptoms. Sensitization in itself is not an allergy and may never lead to one.

Atopic dermatitis can also be confused with allergic contact dermatitis, which, as the name implies, occurs when the skin comes into contact with an allergen: a person puts on a ring or latex gloves, and within hours or days an itchy rash appears on this site. In order to distinguish one disease from another, a competent doctor will do the best.

How can you tell an allergy from a cold?

Brief. With ARVI, everything hurts, with allergies, everything itches.

Although SARS can be confused with allergic rhinitis, sometimes the difference is still noticeable. With ARVI, there is usually a sore throat and muscles, cough, fever, symptoms develop gradually, disappear after a few days. Allergic rhinitis causes itchy eyes.

If there is a suspicion that it is an allergy, then some tests will give an accurate answer. Total IgE, which is often checked in such cases, cannot be called a reliable method: with allergies, this indicator is not increased, and vice versa. Therefore, competent doctors more often use other methods that allow them to determine which allergen leads to the development of symptoms:

• skin tests (prick test) – they are usually used first because they are cheaper and more accurate when it comes to allergies to what enters the body through the nose;
• specific antibody (IgE) blood test – this is usually used if skin tests are not available or if the results are unclear (determining the level of immunoglobulin class G (IgG) does not indicate whether a person has an allergy or intolerance).

All of these methods can be used from any age, but allergic rhinitis is rare before the age of two, because it takes several encounters with the allergen and time for the reaction to develop.

In any case, the tests should be ordered by the doctor after a long conversation in order to determine the most likely allergen. Taking tests for a large number of allergens at once is expensive and unjustified. This can identify sensitization to an allergen that does not actually cause any symptoms.

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How do you deal with allergies yourself?

Brief. None. Contact your doctor.

Without a doctor, there is a risk of wasting time and money. First of all, you need to make sure that the diagnosis is correct and clarify what exactly the allergy is. This will make it easier to avoid contact with the allergen by tracking pollen levels using online services when it comes to allergic rhinitis. On the worst days for you (dry, windy, with a high level of allergen in the air), it is better to close the windows and not leave the house. If this is not possible, then doctors recommend putting on glasses with tight-fitting frames, and after returning home, take off your clothes without going into the bedroom and go to the shower. Theoretically, nasal filters and ointment around the nose can be useful, and there are even small studies with positive results about filters. As for face masks, the recommendations of medical societies do not even consider them as a possible protection option.

If a doctor diagnoses a food allergy, then some product will have to be excluded from the diet. “If you continue to eat these foods, the severity of symptoms is likely to increase,” explains Olga Zhogoleva. “Moreover, this is a lottery: today there may be hives, and tomorrow anaphylaxis.” If you have to give up a whole group of foods, consult a nutritionist – you may need to somehow adjust the diet so that it remains complete.

A doctor is also needed in order to select the treatment in accordance with the symptoms (including during pregnancy and breastfeeding). Do not think that there is one best antihistamine that everyone can take in the morning and not remember about allergies all day. “For pollen allergy, we start basic therapy, regardless of whether there are symptoms, at least two weeks before the start of flowering,” says Olga Zhogoleva. – We select a treatment that can then be used independently from year to year. But if therapy ceases to help, then it is better to consult a doctor to correct it.” Tablets (and even more so first-generation antihistamines) are not always used: for example, in some cases, steroid nasal sprays or other topical preparations can be used.

In Russia, anti-allergic immunoglobulin is sometimes offered for the treatment of allergies, which is not mentioned in American and European recommendations. Homeopathic remedies, blood filtration, fasting, acupuncture, shilajit, Chinese medicine have also not proven effective in treating allergies.

What can I do to prevent allergies from becoming asthma?

Brief. To be treated.

Allergy can indeed develop into bronchial asthma, and, unfortunately, doctors do not have universal advice on how to avoid this, but there is allergen-specific immunotherapy (ASIT) and sublingual immunotherapy (SLIT). This treatment has been reported to prevent the development of asthma in people with allergic rhinitis. The essence of the treatment is that a person is gradually injected with an increasing amount of the allergen using subcutaneous injections (ASIT) or tablets under the tongue (SLIT), and the body gets used to it. For 3-5 years of such treatment, many people have symptoms of an allergic disease disappear. Both methods have pros and cons, and the decision of which one to choose should be made with the doctor.

Immunotherapy can be used for allergic reactions to certain tree and grass pollens, cat and dog dander, dust mites, cockroaches, certain molds and stinging insects. Unfortunately, there are no drugs for food and other types of allergies that have shown their effectiveness. “In Russia, foreign weed allergens are also not registered – there are only domestic ones, and there are no sublingual forms,” says Olga Zhogoleva. — Animal allergens are not registered. There are also no allergens from stinging insects, so in our country you can undergo ASIT with this allergen only at the Institute of Immunology in Moscow.”

According to Dr. Zhogoleva, in Russia (as of spring 2019) there are interruptions in the supply of French-made drugs for injection therapy, but everything should change by the end of the year or at the beginning of the next. Sublingual forms and Russian-made preparations for injection therapy are now available. “With Russian allergens, the problem is standardization: different bottles with the same allergen may contain different amounts of the main molecules,” says Olga Zhogoleva. “That is, you can start therapy with a Russian allergen and, when you change the series of vials, get a different concentration and side effects.”

How to recover from an allergy to cats (“ because you really love these fluffy buns and suffer incredibly ”)?

Brief. Leave Russia, try symptomatic treatment or accept.

Immunotherapy would be a good option in this situation, but there are no drugs registered in Russia to treat cat allergies. Although, according to Olga Zhogoleva, they are promised to be registered in the foreseeable future. So far, such therapy is available only abroad, including in some European countries and the United States.

People who do not qualify for this option may try symptomatic treatment. But not always. “If a person has asthma, while maintaining contact with a cat, there is a high risk that the symptoms will increase,” says Olga Zhogoleva. “And if you consider that asthma is a life-threatening disease, then you will have to consider giving the cat away.” In milder cases, when the symptoms are minimal, Dr. Zhogoleva suggests that her patients who do not want to part with the animal try drug therapy. The drugs will need to be taken continuously. “But I always make it clear: if the symptoms progress, you still have to think about parting with the animal, because asthma always looms with symptoms of respiratory allergies,” explains Olga Zhogoleva.

If you are leaving a pet, it is also a good idea to do your best to minimize contact with the allergen. To do this, as advised by the British National Health Service, it is better to let the animal only into certain rooms (preferably without carpets), not let them into the bedroom, bathe once a week, wash the bed regularly, ventilate the room and use an air purifier.

A hypoallergenic animal will not save in such a situation: they simply do not exist. However, some people notice that they have an allergic reaction to some cats, but not to others. This is due to the fact that in cats, as Olga Zhogoleva says, the secretion of the main allergen (out of eight) is interconnected with sex hormones, so it is less in cats and neutered cats. Such nuances can affect the symptoms. 20% of people, according to Dr. Zhogoleva, can also adapt and develop tolerance to allergens, which, in fact, happens with ASIT. However, doctors cannot predict who exactly this will happen to.

What should I do if I have an acute allergic reaction before the arrival of the doctors?

Brief. Carry adrenaline with you, teach your friends about cardiopulmonary resuscitation.

People who have already had a severe anaphylactic reaction should carry an adrenaline auto-injector with them at all times. Adrenaline, unlike antihistamines, quickly relieves symptoms, which can be critical. However, only one such drug was registered in Russia – in 2017. It is not on sale, there is no information about it on the company’s website, they also cannot say by phone whether it is planned to be delivered. Therefore, now patients have two options:

1. Go abroad, visit a doctor there, get a prescription for such a drug and buy it.
2. Ask your doctor for a prescription for regular epinephrine ampoules and instructions on how to use it. Carrying this kind of “anti-shock kit” (an ampoule and a syringe or, in some cases, a syringe with pre-filled adrenaline) is suggested in Russian clinical guidelines. However, as Olga Zhogoleva notes, the instructions for adrenaline say that it must be stored in the refrigerator.