Allergies prevailing in India and its diagnosis measures adopted
A recent experimental study was conducted for a time period of 2003-2007 among 3389 patients suffering from different allergies in India. Results from the study indicate that among the several allergies asthma, rhinitis and contact dermatitis were found to be more prevalent among the Indian population (Shaikh & Shaikh 2008). Similarly, other allergies which have found prevalence include nickel sulphate and parthenium hysterophorus, penicillins, sulphonamides and non-steroidal anti-inflammatory drug allergies, house dust mite and D farinae allergies.
On the other hand, among the four types of allergies discussed in the previous article food allergies are the least prevalent in India. In addition, a recent report by World Allergy Organization (WAO) concludes that 20 to 30 per cent of Indian population is affected by one of the other forms of the allergic disease (Pawankar et al. 2012). As per the report, 50% of children and 40% of adults are affected by one or many allergies (Pawankar 2014). The rise in the prevalence of complex allergies is due to:
- a rise in pollution and temperature,
- altered biodiversity and lifestyle changes.
Further, being too tidy and hygienic are other aspects deteriorating the indoor environment quality (Jindal 2010).
Diagnostic measures adopted in India
In India, both in-vivo and in-vitro diagnostic technologies are practised for diagnosis (Holgate et al. 2013). Among in-vivo methods:
- skin-prick test,
- prick to prick test,
- intradermal test,
- bronchial challenge test and
- nasal challenge test is followed.
While in terms of in-vitro:
- radioallergosorbent test (RAST),
- enzyme-linked immunosorbent assay (ELISA),
- microarray and immunocap are applied (Singh et al. 2007).
While the in-vitro techniques are more reliable and sensitive than in-vivo one, the latter ones, however, give the results instantaneously.
In the case of in-vivo tests, the fundamental of skin test is the formation of a swollen spot on the skin where the allergen is applied. This also signifies antigen-antibody interaction on mast cells. Nasal Challenge test or Rhinomanometry is confirmation tests. These are used when skin or blood tests are not able to provide specific results about an asthmatic allergy. Similarly, Bronchial Challenge tests are performed specifically to diagnose asthma (Singh et al. 2007).
Radioallergosorbent test (RAST) is an in-vitro test for diagnosing IgE in serum for environmental allergens. Whereas, ELISA gives the amount of IgE circulating in the blood during sensitization by an allergen. In India, ELISA is more favoured than RAST. This is because unlike RAST, ELISA does not require radio-labelling to get the results. Similarly, Microarray and Immunocap are automated diagnostic tools that provide consistent results with different allergens (Weiss et al. 2010).
Though in-vitro tests are more sensitive than in-vivo tests. However, due to their high cost, they are generally not used most of the times for diagnosis (Singh et al. 2007). Among the different techniques, Radioallergosorbent test (RAST) costs twice as much as skin tests. On the other hand, microarray and unicap are labelled as gold-standard in in-vitro techniques. This is because of the fact that they consume less time, require a small amount of sample and are not labour-intensive. Yet, it is suggested that India needs newer diagnostic techniques, which are both sensitive and cost-effective (Prasad 2013).
Treatment measures adopted to treat allergies in India
India faces huge competition with respect to allergic drugs formulators and manufacturers. Introduction of newer under-development treatment technologies like DNA vaccines, modifications of epitopes and advanced immunotherapy will further burden the medicine market (Elshemy et al. 2013).
The commonly prescribed anti-allergic drugs in India are:
|Generic Drug||Function||Type of allergy||Symptoms Relieved||Trade Names|
|Astemizole||Antihistamine||Food and environmental allergy||Chronic idiopathic urticaria and allergic rhinitis.||Acemiz; Alestol; Astizole; Histeese (50 ml).|
|Chlorpheniramine||Antihistamine||Environmental and insect allergy.||Watery eyes; itchiness by insect bites or bee stings; hay fever; sneezing; common cold.||Cadistin; Cesiran; Chloram; Chlorpheniramine; Chlorpheniramine Maleate.|
|Desloratadine||Antihistamine||Food, environment, drug and insect allergy||Allergic reactions in young children||Alerdain; Allerdain; Allerde; Allerede; Desloriv.|
|Dexamethasone Ophthalmic- Otic||Ophthalmic corticosteroid||Environmental and chemical allergy||Irritation, itching, redness and swelling of the eyes.||Dexamethasone Ophthalmic- Otic|
|Epinephrine||Hormone||Food, drug, environmental, chemical and insect allergy||Cardiac arrest (to restart the heart beat); anaphylactic shock; increasing the flow of blood to heart; increase of diastolic blood pressure; dilation of .blood vessels, and controls superficial bleeding.||Alergin; Asmapax Depot; Asthimo; Asthmino; Asthocap; Binikof; Binilon -650; Biodryl; Cofcodyl|
|Epinephrine/ Chlorpheniramine||Antidote||Environmental, food and insect allergy||Asthma; dangerous responses to foods, insect stings and drugs.||Epinephrine/ Chlorpheniramine|
|Flunisolide||Corticosteroid||Environmental allergy||Anti-inflammatory; asthma and allergic rhinitis.||Syntaris|
|Hydrocortisone||Corticosteroid||Chemical and environmental allergy||Severe allergies, multiple sclerosis and skin conditions, asthma and arthritis.||Cort – H; Cortola M; EfcorlinInj; Hisone Tab; Hycoson; Succicort; Unicort ; Wycort|
|Phenylephrin||Selective alpha agonist||Environmental allergy||Nasal decongestant dilating the pupil and constrict superficial blood vessels in eye allergy.||Agrus; Alex Paed; Allegone P; Belrin -D Syrup; C -Floxn; Cadicoff -D; Ceticold.|
|Triamcinolone||Corticosteroid||Chemical and environmental allergy||Severe allergies; asthma; disorders of skin, kidney, blood, thyroid, eye, arthritis and intestine.||Amcort (40 mg); Cinalife (40 mg); Comcort (10 mg)Ledercort (4 mg); Mycort (40 mg).|
- Elshemy, A., Elshemy, A. & Abobakr, M., 2013. Journal of scientific & innovative research. , 2(1), Available at: http://www.jsirjournal.com/Vol2Issue1013.pdf.
- Holgate, Stephen T. Canonica, Giorgio Walter Baena-Cagnani, Carlos E. Casale, Thomas B. Zitt, Myron Nelson, Harold Vichyanond, Pakit Key, 2013. Asthma, Available at: http://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf.
- Jindal, S.K., 2010. Indian Study on Epidemiology of Asthma , Respiratory Symptoms and Chronic Bronchitis ( INSEARCH ) A Multi ‐ Centre Study ( 2006 ‐ 2009 ) Department of Pulmonary Medicine. , (September), p.335. Available at: http://icmr.nic.in/final/INSEARCH_Full _Report.pdf.
- Pawankar, R., 2014. Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organization Journal, 7(1), p.12. Available at: http://www.waojournal.org/content/7/1/12.
- Pawankar, R. Canonica, G. Holgate, S. Lockey, R., 2012. WAO, white book on allergy, Available at: http://www.worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf
- Prasad, R.K., 2013. Allergy Situation in India : What is Being Done ? Indian J Chest Dis Allied Sci, (55), pp.7–8.
- Shaikh, W.A. & Shaikh, S.W., 2008. Allergies in India: An analysis of 3389 patients attending an allergy clinic in Mumbai, India. Journal of the Indian Medical Association, 106(4), pp.220–226.
- Singh, Abinav Kumar Arora, Naveen Prasad, Gbks Singh, B P, 2007. Revisiting in-vivo and in-vitro diagnostic approaches for respiratory allergy. , 21(2), pp.95–102.
- Weiss, Michael E Bernstein, David I Blessing-moore, Joann Cox, Linda Lang, David M Nicklas, Richard A Oppenheimer, John Portnoy, Jay M Randolph, Christopher Schuller, Diane E
- Spector, Sheldon L Tilles, Stephen Wallace, Dana Macy, Eric M Diego, San Cumberland, Kathleen R May., 2010. Drug allergy: An updated practice parameter. Annals of Allergy, Asthma and Immunology, 105(4), pp.259–273.e78. Available at: http://dx.doi.org/10.1016/j.anai.2010.08.002.