Within the last year or two

Within the last year or two, there has been some new focus on the causes of allergies. In our own experience in Pakistan, we have noted some interesting facts. As detailed above, there are many allergenic and non-allergenic triggers of allergies. Not surprisingly, women are more exposed to these influences than are men. Women, while doing housework, for example are more exposed to dust and smoke than men. Women generally react differently, and maybe are more affected, to various emotional stresses than men are. So perhaps that is one reason why women seem to be affected by allergies more than men.

But our experience has also shown us something totally new, an experience being shared by some of the leading allergists throughout the world. That is the relationship between female hormones and allergies. We have observed many patients whose allergy symptoms occur or are aggravated either before their periods or in the middle of their menstrual cycles. These symptoms vary from rashes, urticaria, itching on their body, to increased sneezing, running noses and episodes of asthma. Mood swings and other premenstrual manifestations may also occur. Sometimes allergy symptoms have been noted to have started following disturbances of periods due to any cause, or following an abortion. Similarly allergies are often seen to progress with increased numbers of pregnancies.

Perhaps more interesting is the observation that many female patients present to our clinics with seemingly allergy-like symptoms. On a detailed history one finds out that the lady either suffers from some problem of her menstrual cycles, or may be infertile, may be having recurrent miscarriages or may have some other hormone related disorder.

Treatment of the cause of the reproductive hormonal imbalance may not only cure the allergy like symptoms, but also cure the other defects and regularise the periods or cause conception after years of infertility.

Young girls whose menses have not started, sometimes present with asthma or other allergy symptoms. These symptoms clear up after the start of their periods. Similarly some girls present with allergy symptoms just around the start of their periods. These cure up by the time the periods regularise. Sometimes however, we have noted that the illness which starts at menarche usually may persist throughout life, so would require for the allergy physician to plan longer term treatment measures for the allergy.

Similarly ladies (and gents too) sometimes present with complaints of incurable itching and rashes on their body. A careful and detailed history and examination may point to episodes of high blood pressure as being the cause. These episodes may either be stress related or induced by certain diets etc. Same goes for poorly controlled diabetics, kidney or liver disease patients and sufferers of many other illnesses who run from pillar to post in the search of a cure for their severe itching who may find a better cure in the treatment of their actual problem, rather than mis-labelling the itching as allergy and treating it as such.

While female hormones are so important for the normal functioning of the female body, their imbalance can cause very dangerous results. Ladies should be aware of any increase in the milder manifestations of hormonal imbalance like excess growth of hair on the body, excessive pimples, hot flushes, heaviness in the breasts, mood swings and other premenstrual symptoms. Female hormone changes may result in infertility, and if oestrogen is in excess, in certain ladies may cause weakening of the bones (osteoporosis), bone pains, and maybe even cancer of the breast or cervix.

For the learned allergy physician these symptoms are a sign that in addition to controlling the distress for which the patient has come, one should thoroughly look for and investigate the underlying cause of these illnesses. Often an early diagnosis can prevent a lot of regret later on.

Most breast lumps, for example, are benign which means that they are not dangerous or cancerous (malignant). However it must be remembered that if a cancerous breast lump is discovered by a pre-menopausal lady, the chances are that by the time it is discovered and reported to her doctor, the cancer has probably spread throughout the body. Hence the need for regular monthly self examination of the breasts by every lady, with a periodic examination by a trained physician cannot be over-emphasised. A well trained allergist may be able to make the connection between an asthma attack and an underlying hormonal imbalance.

Allergy is a very new sub-specialisation of the study of our immune system. Even in the west, there are relatively few properly trained and qualified physicians in this new field. A well trained physician with proper diagnostic facilities, a knowledge of the local environment and conditions, a detailed history and examination of the patient, and above all a compassionate and patient hearing of the patient's complaints will go a long way in the treatment of this most difficult and distressing illness.