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   DAWN

11th September 1991

3rd June 1996

14th June 1998

30th March 2001

Miscellaneous - 1.

-14th June 1998   

The city of Islamabad which is known for its lush green foliage has also gained a reputation as the capital of allergies. The last five years or so has seen a sudden increase in respiratory allergies in and around Islamabad during the spring season. These affect sensi­tive individuals with sneezing and runny nose, itchng in the eyes and on the skin, and bouts of cough leading eventually to difficulty in breathing and asthmatic attacks.

As one drives out of Islamabad or as the season nears its end, this problem miraculously disappears, and the patients return to normal­cy as if nothing ever happened to them.

Seasonal allergies, especially in spring and early summer, are com­mon all over the world. They are caused by the pollen grains flying in the air. In England, the disease is so well known that it has gained a separate and common name "Hay Fever".

Pollens are small particles shed from the male species of certain plants, which travel to the female species to produce seeds. The pollen grains, which we usually see in the center of a beautiful flower, are bright yellow and sticky. These are carried by the bodies of insects, as they come to feed on the attrac­tive flower. But some pollen grains are very light and are carried by the wind. Such small pollen grains while flying in the air, may enter the breathing passages (nose and throat) of a person and cause an allergic reaction. These generally come from bushes and trees whose flowers are not usually seen.

Not all pollen grains cause aller­gy, and not all persons are affected either. Persons who have inherited a tendency to develop allergies, or those who are exposed to large quantities of pollens, are usually affected more. So although every­one in a particular area is breath­ing the same air, not everyone suf­fers from allergy.

In Islamabad, there is an excess of vegetation and a lot of wild plants which produce their pollens at different times of the year, usu­ally from early spring till late autumn. However there is a peak of pollen allergies in spring and in late summer. Pollen allergies also occur all over the world, in differ­ent seasons, and with different intensities.

Indigenous research carried out in Islamabad has shown that there are two main allergy seasons here. The first, more local season is from mid-March till mid-April and a Sec­ond season is from the end of June till early September. This covers an area that is more widespread rang­ing from Hazara in the northwest to Sargodha in the southeast. Although pollens from different plants especially grasses of all types, contribute to causing these allergies, patients suffering from the more severe form of illness, like asthma, etc are usually found to be allergic to the pollens of Paper    Mulberry    trees (Broussonetia Papyrifera) wild Bhang (Cannabis Staiva) in sum­mer. The geographic spread of this disease correlates well with the physical presence of the plants causing them. High humidity dur­ing cloudy and rainy periods fur­ther contributes to the severity of this illness.

Unfortunately during the last few years the entire problem of seasonal allergies in Islamabad has been blown out of proportion. Poorly informed and publicity hunger doctors, sensation seeking press and money hungry specialists all played their role, surmounted by various government and non-government agencies issuing differ­ing statement to cover up their ignorance. This was the case till the spring of 1996.

Since then, different government agencies were ordered to find out the cause of their problem, but to no avail, as either they did not possess the required expertise, or if they did have the relevant experts,they did not have funds.To make things worse, in the wake of professional jealousies, Pakistan's only Full Fledged Allergy and Clinical immunology Department at Pakistan Institute of Medical Sciences, Islamabad, was closed down at a time when it was most needed, and had just begun indigenous research on allergy and other health related problems in Pakistan. The pretext for its clo­sure was that a doctor who was a Pathologist headed the department, and it was thought that only physicians should see patients. The fact that this was one of the highest profit earning departments at PIMS and with a very good public image was of no consideration, neither was the fact that hundreds of patients were being successfully treated at this

Center, with very good results. Patients' protests too, at the clo­sure, went unheeded.

The problem of allergy still remains. Although the plants caus­ing severe allergy have been iden­tified, the most important question still remains; and that is the ascer­tainment of the exact number of people in Islamabad suffering from this illness.

In many developed countries, 10 to 20 per cent of a population may suffer from a particular pollen allergy. It is only when the exact magnitude of the problem is identi­fied can the remedy be worked out If the affected population is small, then medical intervention is suffi­cient but if it is very large, only then should cutting down of the offending trees be considered. But then again, not every Paper Mulberry tree is to be blamed. It is only the male plants, whose long hanging berries give rise to the problem The female plants which out number the male 10 to 20 times, do not cause allergy. They merely receive the pollens flying about. So eventually, even if cut­ting of male Paper Mulberry tree does become justified, a very small fraction of plants will actually ever

be reduced. Dr Jennifer Bennet and her team at the Sustainable Development Policy Institute

(SDPI) looked at this problem in six villages surrounding Islamabad and found that 33% of the total study population was suffering from more than one type of pollen allergy. Prevalence of allergies was higher in females than in males ,a finding supported by the Allergy

Clinic, Islamabad.

The real reason why allergies rise in selected days of spring sea­son is that not only are there a large number of Paper Mulberry trees in Islamabad, but all the male

plants shed their pollens at one particular time. There is a sudden peak of pollen counts in the atmos­phere, which results in dramatic onset of the allergy syndrome.

Patients rush to hospitals, doctors and different types of healers, only to find that they are not adequately trained or equipped to cope with this onslaught.

The prevention of respiratory allergies, like all other types of allergy, is to avoid the offending agents. Several general measures can be taken to purify the air, which the patient is going to breathe. If these are not sufficient, medication directed at treating the allergy as well as symptomatic treatment is required. In extreme cases, if all other measures fall and the severity of the illness contin­ues to progress, only then should specific immunotherapy (Allergy Vaccination) be considered.

Unfortunately, this form of treatment has gained a considerably bad reputation in Pakistan,   because it is either not done properly or done by untrained doctors. This is beneficial and safe only when a properly qualified and experienced special­ist carries it out. Otherwise the treatment may end up causing more damage then benefit, in the long run.

First of all, the exact cause of the allergy has to be ascertained. This is done by allergy tests. Allergy tests comprise of series of small skin pricks in which a very concentrated form of an extract of the pollens and other substance thought to be causing the allergy, is injected into the skin. As this is very concentrated, even skin test­ing itself can make the patient's condition worse. Hence as recom­mended by the World Health Organization, allergy testing should NEVER be done when the patient is suffering. So Free Allergy Test Camps, as frequently advertised, during pollen seasons, may end up causing dangerous results.

After thorough testing for aller­gy, if required, allergy vaccines may be tried for treatment. These have to be prepared specifically for every patient. It is only then that the vaccines are effective and safe. Some institutes make gener­alized vaccines without properly identifying the cause of the aller­gy. This again can cause serious long term problems. Just saying that the allergy is due to "pollen" or "dust" means nothing, until the exact nature of the pollen or type of dust has not been identified.

Vaccines are beneficial only when the treatment is nearing completion, and the season is often over by then. Hence patients should avoid starting any new allergy vaccines for any pollen in its season. For allergy, as in all health related problems, indige­nous medical research is essential in identifying the causes of dis­eases and finding their best possi­ble solutions, according to the resources, facilities and expertise available in the society.

The killer Pollen stalks again

ISLAMABAD, March 29: One fateful night in spring last year, six-year old Aisha woke up at her residence gasping for breath. She was immediately brought to a hospital but died soon after.

The city is well into its annual spring allergy season once again. The residents, who suffer from severe allergy to the pollen of the lush trees and plants that beautify Islamabad, live through the months of March and April wondering whether they would be the next to fall victim to a fatal asthma attack this year, like little Aisha, last year.

Others who are fortunate enough to suf­fer milder allergy symptoms like sneez­ing, running nose, itchy eyes, throat and skin, cough and tightness of chest, sit out these two months staying mostly indoors with windows shut air-conditioners switched on  and donning masks whenever they have to go out.

For some allergy sufferers, this is the time of the year when they make their annual pilgrimage out of Islamabad for two to three months.

But how many asthma and allergy-stricken residents in Islamabad can afford the luxury of owning and running an air purifier or an air-conditioner twenty-four hours a day, or moving out of the city annually for a couple of months?

Seasonal allergies are common all over the world, especially in spring and sum­mer when the flowers bloom and their pollen is shed. It is known in the West as hay fever. What is so special about the allergy season in Islamabad?

Although no study has yet been done to find out how many people in the city suffer from spring allcrgy, a study completed sevcraI years ago by the Sustainable Development Policy Institute found that some 33% of the residents of six villages around Islamabad may be suf­fering from pollen allergy.

This figure is higher than that of many developed countries, where some 10 to 20% of the population of any one place may be suffering from pollen allergy.

Although many allergy-causing plants exist in Islamabad, a study done way back in 1993 by the then Department of Allergy and Immunology of the Pakistan Institute of Medical Sciences had identified the pollen of the mulberry variety of trees as the main cause of severe asthma attacks in Islamabad during the spring season.

According to this study, more than 90% of the patients having serious asthma attacks during the spring season were allergic to the pollen of Paper Mulberry White Mulberry and Red Mulberry. Although a larger number of patients were found to be aIIergic to the smut or fungus  of common grass, this did not cause serious illness, unlike the mulberry.

The reason is that there is a very large number of mulberry trees in the Islamabad region, both planted as well as grown naturally. Most of these trees shed their pollen at the same time, resulting in extremely high concentrations of this pollen.

The results of this study on the mulber­ry were confirmed later by independent studies done by a local allergy clinic. This clinic has irrefutable scientific evidence that the pollen of the mulberry trees causes asthma in spring.

Although these studies underline the seriousness and magnitude of the allergy problem in Islamabad, it is strange that nothing substantial has so far been done by the authorities to alleviate if not eradi­cate the problem.

So long as these deadly plants continue to beautify Islamabad , allergy patients will be living through the spring months every year wondering when they would suffer the same fate as little Aisha.

HEALTH  BY SHEHLA K. FATAH  Islamabad' s  po11en allergies

It was February 1994 and I was visiting Islamabad on a vacation. A friend of mine in government service was desperately trying to get himself transferred from the beautiful city that picturesquely nestles in the lap of the glorious Margalla Hills.

Reason? Bouts of severe asthmatic attacks had made his life miserable. But would getting transferred solve the problem?  Couldn't these attacks occur elsewhere as well? I wondered. Apparently not! They were part of the innumerable localized pollen allergies  contracted  in Islamabad and  adjoining areas, which play host to more than 250 species of .plants and trees responsible for the mala­dy.

This year in springtime, while visiting Sargodha and then Islamabad, my mother developed a strange type of breathing problem, followed with uncontrollable attacks of coughing. The terrible wheez­ing that simultaneously per­sisted made it seem that the condition might become fatal. Ultimately, after having tried a number of cough syrups and expectorants, she was admit-ted to a hospital, where a bar­rage of inhalers, nebulisers, drips, steroids and injections of cortison were administered, but nothing could be diagnosed! Tests for bronchitis, asthma, and even tuberculosis were conducted, but to no avail!

The extensive doses of cor­tison left her so frail and weak that let alone walk. she could not even talk. Swellings developed on her feet while her hands began to shake (after effects of the steroids). When nothing could be diag­nosed at the hospital, she was referred to a senior chest spe­cialist, who prescribed anoth­er long list of medicines (much to the delight of the pharmacist) which further weakened her condition.

Finally, a CT Scan was sug­gested (another expense of 5000 rupees). Just by chance I took her to the only allergy specialist (who every second person in Islamabad seems to visit), who, after a thorough check-up, diagnosed that she had an allergy and did not need the dreaded CT Scan.

For the benefit of others, I decided to write on the prob­lem faced by my mother and

       requested the doctor to pro­vide some useful material per­taining to the symptoms, pre­cautions and requisite treat­ments available to counter

       These horrible allergies that attack the skin, chest and other organs of the body. He has provided this information in the accompany­ing write up.