BusinessToday speaks to Dr Kavita Reginald, a Senior Lecturer at the Department of Biological Sciences, School of Medical and Life Sciences at Sunway University on the importance of allergies awareness and ways we can tackle them.

1. Why is it important for the general public to know about allergies?

Allergies are one of the most important disorders in our modern society. About 30 percent of Malaysians have some form of allergies. Unfortunately, approximately 90 percent of these patients with allergic conditions are insufficiently treated, impacting both work productivity and quality of life in these individuals.

In a recent survey, the economic burden due to allergic diseases (attributed to loss of work productivity, absence from work and cost of treatment) has been estimated at USD 105.4 billion annually in Asia. Patient education on their allergen triggers, accurate diagnosis and correct treatment would help allergic individuals to better manage their disease, and ultimately have a better quality of life.

2. What will happen if you ignore allergies? Can allergies go away on their own?

It is not advisable to ignore allergies. Allergies that are not well managed or treated risk becoming more severe over time. This is especially true for air-borne allergens, and most food allergens. But there are some food allergens (such as egg and cow milk protein) that seem to resolve when a child grows up. It appears that the child develops tolerance against these allergens over time, and they do not exhibit allergic symptoms at a later age.

3.     What are the most common allergies in Malaysia, what causes them?

In Malaysia, the most common allergies are allergic rhinitis, asthma and food allergies. Most common allergies are to dust mite and cockroach allergens, followed by seafood allergens, such as prawns and crabs. A small proportion are also allergic to fungus and pollens.

4.     Can allergies be cured? If they cannot be cured can they be prevented?

I’ll start with prevention. Allergies may be prevented by avoiding contact with the allergen. This may be easier for certain allergen sources, such as food, pet dander or latex, but nearly impossible for inhaled allergens such as dust mites or pollen. As mentioned earlier, children affected certain food allergies able to outgrow them, and this has been attributed to the tolerance mechanism – meaning the body just tolerates these foods after a while, and does not over react to them. One form of treatment, called immunotherapy, employs the principle of tolerance.

A small dose of the offending allergen is given to the patients over a period of time. These doses are steadily increased over time. Research has shown that a person who receives immunotherapy changes the way the body reacts to an allergen – from an allergic reaction, to a tolerant reaction. More excitingly, the effects of immunotherapy (improvement of symptoms, reduced use of other pharmaceutical therapies) have been reported last a few years after the immunotherapy protocol is finished. However, there are two main limitations pertaining to immunotherapy – first it is only available for limited allergens, and second – adverse allergic reactions have been noted for about 10% of immunotherapy patients.

One part of my research at Sunway University is to develop safe immunotherapy molecules by genetically engineering allergens to not cause an allergic reaction (therefore prevent any anaphylactic outcome). I have successfully identified new immunotherapy molecules from dust mites, which has shown promising results in mouse model studies. Currently, I am developing safe immunotherapy molecules against seafood allergies in collaboration with allergy specialist and biotechnology experts in Malaysia.

5.     How does one recognize an allergic reaction? When does one need to see an allergist?

The symptom of an allergic reaction is variable according to the location. For example, an allergic reaction on the skin would manifest as an itchy rash, but an allergic reaction in the lungs would manifest as shortness of breath and wheezing. If you have a reaction to a certain non-toxic agent, or uncertain if your reaction is actually an allergic reaction, a visit to an allergist would help to diagnose it. By understanding your clinical history, together with simple clinical tests, an allergist would be able to diagnose any possible allergies, and propose the right treatment to best manage it.

6.    Do allergies weaken your immune system, increasing susceptibility to other illnesses? Can they cause long-term damage?

Allergies do not weaken the immune system, but they are a form of an “over-reactive” immune system. There are no reports that point to allergies increasing the susceptibility to other illnesses. If not managed correctly, allergies can lead to long term damage in terms of loss-of-function in certain tissues or organs. For example, an asthmatic patient who does not treat his asthmatic conditions would find that his lung tissues are permanently changed to function less well, compared to if it would have been treated. Similarly, for eczema, without treatment, the simple itch would evolve to form open wounds that can be further complicated by bacterial infection, and ultimately cause more severe symptoms to the patient.

7.    What are the most severe outcome of an allergic reaction and how can one prevent this from happening?

Allergic reactions can manifest in a range of severity, from a simple localized rash, to difficulty breathing, or even anaphylactic shock. Anaphylactic shock is the most severe outcome of an allergic reaction, as it involves multiple body systems all at once, which can result in a fatal outcome. Certain triggers such as bee stings, peanuts and seafood are more prone to cause anaphylactic reactions. Individuals who have severe allergic reactions and with a high probability of suffering from anaphylactic shock maybe prescribed with an adrenaline auto-injector, so that they could self-administer the adrenaline, which provides rapid relief from the anaphylactic symptoms.

8.    How does one strengthen one’s immune system against allergies?

This is an interesting question. Allergies are an “over-reaction” to common environmental agents – be it certain foods, pollen, animal fur and even dust mites. For allergic symptoms to manifest, one needs to first be genetically susceptible (i.e. have certain “risk” genes) and be expose to sufficient environmental trigger (allergen). Some new research on probiotics and prebiotics are suggesting that these may help to reduce certain allergic symptoms. These research findings are fairly new, so we would need to wait for more data on these studies before actually making any specific claims.

 9. Allergic reactions from Covid-19 vaccinations has been highlighted across the world. Should people be afraid about the vaccination? What are the steps being put in place to prevent severe reactions? 

The various Covid-19 vaccines have been proven to be effective in preventing symptomatic disease. Only a very small proportion of individuals (10 per million doses) may have serious allergic reactions (anaphylaxis) to certain components of the vaccine, such as polyethylene glycol (PEG) or Polysorbate-80. As most anaphylaxis events occur within 15 minutes of immunization, the current protocol of 30 minutes of observation at the immunization center post-vaccination would be able to identify and manage any possible allergic adverse effect. If you have had anaphylaxis to a previously injected drug, or to certain allergens such as food, latex, or venom, it is recommended to for you to seek medical advice from your allergist prior to your Covid-19 vaccination.

Dr Kavita’s research interests lie in the area of immunology and allergy. After obtaining her PhD in Allergy from the National University of Singapore, she undertook two post-doctoral fellowships at prestigious institutions in Austria and France to further her knowledge in this area. Upon her return to Malaysia, she established the Allergy Research Laboratory at Sunway University. Currently, her research is focused understanding why allergic diseases occur, and identifying innovative solutions to treat this disease.

Dr Kavita is also an active member of the Malaysian Society of Allergy and Immunology, which s a non-governmental organization that aims to promote the improvement of patient care and quality of life among allergy sufferers.