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Allergic Rhinitis and Its Causes
Allergic rhinitis is an atopic disease, which is inherited from the parents. If your parents have allergic rhinitis or other respiratory diseases such as asthma, tuberculosis and emphysema, the probability that you will have these types of respiratory diseases is 50%. If one of your parents has respiratory diseases, there is a 25% chance that you will inherit their diseases. If your parents do not have any respiratory disease, your chances of developing respiratory disease are no more than 12.5%. Sometimes what happened during pregnancy can cause allergic rhinitis in the newborn baby. The mother’s immune status during pregnancy can cause the newborn to have allergic rhinitis. Pregnant mothers who smoke, drink coffee and alcohol often have a poor immune status, which can also cause the newborn to have allergic rhinitis or other respiratory diseases. This is because all these acts can cause a high level of IgE antibodies in the umbilical cord blood. Apart from this, the use of bottle feeding to feed milk to the baby, early introduction of various types of food and early exposure to certain allergens and pollutants can cause nasal allergy in the newborn
Symptoms of allergic rhinitis change with age. In the initial stage, children are mostly sensitive to seasonal allergens. After they get older, they tend to become sensitive to perennial allergens. Therefore, after they have overcome the symptom caused by seasonal allergens, they may still have symptoms due to perennial allergens. As children grow older, they may be at greater risk of bronchial hyperreactivity and asthma. Between 17 and 19% of them will have asthma when they grow up. To protect them from asthma, perennial immunotherapy should be used in the initial phase. In addition, the risk of developing asthma does not depend on the age at which allergic rhinitis began, family history of atopic disease, sex, severity of symptoms in the initial period and treatment.
Allergic rhinitis started when the atopic individual encounters antigens that are able to stimulate the IgE response. So, what are the substances that can act as allergens? Allergens are usually particles in the air, which have a molecular weight ranging from 30 to 40,000 daltons and also with a diameter ranging from 2 to 60 µm. Most have a diameter greater than 15 µm, which can be deposited on the nasal, pharyngeal and ocular surface. Chemically, these particles are proteins, which are attached to some small carbohydrate unit. Particles that have this type of character are pollen, acarids, animal dander and fungi.
Pollens released from grasses, weeds and trees during the breeding season often cause seasonal allergic rhinitis. Only light pollens that can be pollinated by the wind can exist in the air and cause a high natural exposure to the patient with allergic rhinitis. Severity depends on the concentration of pollen in the atmosphere. Individuals with allergic rhinitis who live in the suburban area will be severely affected by these seasonal pollens compared to those who live in the city. The surrounding temperature also influences the concentration of pollen in the air. Normally, in a warmer environment, plants release more pollen compared to a cold environment. Most plants reproduce in late spring and summer which is the warmest season. Windy weather will cause pollens to become airborne and this will result in increased exposure to the patient with allergic rhinitis. The best day is the rainy day. Rainwater can wash all the pollen out of the air and carry it to the ground. The air around it becomes cooler and cleaner after the rain.
The main culprit of perennial nasal allergy is house dust mites. The mites commonly found in house dust are Dermatophagoides pteronyssimus and farinae, Euroglyphus maynei and Blomia tropicalis. The substances that are directly responsible for the nasal allergy of these dust mites are their body and their metabolic products. Mites generally grow quickly in a warm, humid climate. So sensitization to acarids depends on where you actually live. Nasal allergy for patients living in tropical and equatorial regions is more likely to be caused by acarids because the climate in these regions favors the growth of mites. House dust mites grow in maximum concentration when the surrounding humidity level is between 70 and 80% and in the presence of high temperature. Nasal allergy symptoms will develop when the dust mite concentration level reaches 2 µg/ga in the air. Conversely, high mountains with dry, cold climates have the lowest level of dust mites because this climate prevents mite growth. Animals are also the other source of aeroallergens. These aeroallergens are present in the animal’s saliva, feces, urine and dander. Therefore, nasal allergy can be caused by domestic animals such as cat and dog and also wild rats and mice.
Air pollutants enhance nasal allergy sensitization by allergens. Air pollutants can be divided into two groups which are outdoor pollutants, which are released from industrial works, car exhaust and home heating, and indoor pollutants such as tobacco smoke, furniture, combustion and the wood and coal heater. Chemically, air pollutants consist of nitrogen oxides, sulfur dioxide, ozone, carbon monoxide and black smoke. It is not entirely clear how air pollutants enhance nasal allergy sensitization. This may be because air pollutants easily irritate the respiratory mucosa and make it prone to allergic sensitization. Air pollutants have a negative impact on the nasal epithelium and ciliary beat, which are responsible for the elimination of allergens. In addition, some pollutants can enhance the release of inflammation-inducing mediators such as histamine, prostaglandins, and leukotriene C-4.
Apart from this, some pollutants can also directly stimulate the synthesis of IgE antibodies. When the allergen binds two IgE molecules on the surface of mast cells and basophils, primary chemical mediator; histamine, will be released and cause nasal allergy. Therefore, we can state that allergens can easily enter our blood stream through our nasal mucous membrane if we have chronic inflammation, not enough IgA antibodies, impaired ciliary beat and also with atmospheric pollutants around us. The IgA antibody is very important to our body because it prevents allergens from penetrating through our nasal mucous layer. Monounsaturated oleic acids, which can be found in extra virgin olive and cold-pressed coconut oil, hazelnut or hazelnut oil (or whole nuts), green and ripe olives, and almonds can increase the IgA antibody in our body. In addition to oleic acids, vitamin A can also increase the IgA antibody, which can be found in cod liver oil, squash, cooked carrots, sweet potatoes/yams, squash, and other yellow or orange vegetables.
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