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GLUTEN SENSITIVITY OR INTOLERANCE
Gluten is a protein in cereals such as wheat, barley, and rye. A person with gluten intolerance or sensitivity may experience pain and bloating after eating foods that contain gluten. Research indicates that around 1% of people in the United States have celiac disease, 1% have a wheat allergy, and around 6% have gluten intolerance — also known as non-celiac gluten sensitivity. People with celiac disease must avoid gluten, as it can cause intestinal damage and prevent the body from absorbing essential nutrients. Those with a wheat allergy must avoid all wheat products, as consuming any could even be immediately life threatening. Gluten intolerance can lead to discomfort, but it is unlikely to cause severe symptoms that require emergency care. An individual with gluten intolerance will develop symptoms after consuming foods containing wheat, barley, or rye. The symptoms of gluten intolerance may include: tiredness bloating abdominal pain diarrhea nausea constipation a general feeling of being unwell The following symptoms though non-specific might be associated also: anxiety headaches brain fog confusion numbness joint or muscle pain skin rashes A person with a wheat allergy within minutes to a few hours of consuming wheat can develop: hives/urticaria swelling/angioedema breathing difficulties, including wheezing & in severe cases, anaphylaxis may develop. Evaluating for Gluten Intolerance requires careful history taking, asking about symptoms and carrying out a physical exam. Then we will perform laboratory tests or a biopsy to rule out celiac disease and other gastrointestinal conditions. We then recommend a plan that allows them to monitor the person’s diet, elimination diets and any ill effects of various foods. Researchers have yet to find any specific biomarker of a gluten intolerance. At present, before diagnosing gluten intolerance, we will need to rule out other gluten associated disorders.
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X-LINKED AGAMMAGLOBULINEMIA (XLA)
X-linked agammaglobulinemia or Bruton agammaglobulinemia, is an inherited immunodeficiency disease caused by mutations in the gene coding for Bruton tyrosine kinase (BTK). The disease was first elucidated by Bruton in 1952, for whom the gene is named. X-Linked Agammaglobulinemia (XLA) is an inherited immunodeficiency in which the body is unable to produce the antibodies needed to defend against bacteria and viruses. A genetic mistake in the BTK gene, prevents B cells from developing normally. B cells are responsible for producing the antibodies that the immune system relies on to fight off infection. The most common bacteria causing infection in XLA are Streptococcus, Staphylococcus and Haemophilus. XLA often becomes apparent in infancy once the maternal antibodies wane off, due to recurrent and severe bacterial infections including: • Ear infections • Sinusitis • Pneumonia • Diarrhea due to a parasite called Giardia Diagnosis of XLA can be made through screening tests that measure immunoglobulin levels or the number of B cells in the blood. There is no cure for XLA, but the condition can be successfully treated. Immunoglobulin replacement therapy under the watchful monitoring & guidance of an Allergist-Immunologist is a life-long and life-saving treatment that restores some of the missing antibodies. In addition, some people benefit from courses of oral antibiotics to prevent or treat infections.
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YEAR ROUND ALLERGIES
Perennial allergies or Year Round Allergies may occur at any time of year—unrelated to the season—or may last year-round. Perennial allergies are often a reaction to allergens in household dust. House dust may contain mold and fungal spores, fibers of fabric, animal dander, dust mite droppings, and bits of insects. Substances in and on cockroaches are also the cause of allergic symptoms in some individuals. These substances are present in houses year-round but may cause more severe symptoms during the cold months when more time is spent indoors. (Substances that trigger an allergic reaction are called allergens) Usually, perennial allergies cause nasal symptoms (allergic rhinitis) but not eye symptoms (allergic conjunctivitis). However, allergic conjunctivitis can result when allergens are inadvertently rubbed into the eyes due to itching. Symptoms of Perennial Allergies The most obvious symptom of perennial allergies is a chronically stuffy nose. The nose runs, producing a clear watery discharge. The nose, roof of the mouth, and back of the throat may itch. Itching may start gradually or abruptly. Sneezing is common. The eustachian tube, which connects the middle ear and the back of the nose, may become swollen. As a result, hearing can be impaired, especially in children. Some may also develop chronic ear infections. Some people have recurring sinus infections (chronic sinusitis) and growths inside the nose (nasal polyps). When affected, the eyes water and itch. The whites of the eyes may become red, and the eyelids may become red and swollen. The skin under the eyes can become dark (allergic shiners). Many people who have a perennial allergy also have asthma, possibly caused by the same allergy triggers. Diagnosis Besides a careful history and thorough examination we need to conduct allergy skin testing which can help confirm the diagnosis and identify the trigger for symptoms (such as house dust mites or cockroaches). For these tests, the allergen extracts are placed into the uppermost layers of our skin. We then watch to see if there is a wheal and flare reaction (a pale, slightly elevated swelling surrounded by a red area). An allergen-specific immunoglobulin (IgE) blood test is done if results of the skin test are unclear or need confirmation. Then Avoiding or removing the allergen, if possible, is recommended, thus preventing the development of symptoms. Antihistamines, Anti- inflammatories, topical Corticosteroids & occassionally decongesants make up the medical therapy for perennial allergies. Ultimately Allergen Immunotherapy could potentially help resolve these chronic diseases.
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