Uncategorized - Padda Institute Center for Interventional Pain Management

How are allergies and pain related?

What is the relationship between allergies and pain?

Allergies can create a generalized inflammatory state with systemic release of inflammatory cytokines, which may present as:

Muscle and joint pain, typically observed in food borne allergens such as gluten or gliaden.

Sinus congestion triggering migraine and cluster headaches, typically observed in aeroallergens such as pollens or molds

Aeroallergens such as dust, ragweed, pollen, and mold impact half of all Americans.   Symptomatic treatment with decongestants, histamine blockers, and steroids do not reduce the allergic potential of the allergen and do not change the course of disease. Many patients treated symptomatically become hyper sensitized and allergic to multiple additional antigens within three to five years, unless a desensitization immunotherapy protocol is initiated. Immunotherapy protocols use a low dose exposure to habituate the immune system to the allergen.

You might have allergies if you have any of the hollowing symptoms:

Sinus related issues (sinus pressure/pain, headaches, sinusitis) Restless sleep, challenges sleeping through the  night, snoring
Re-occurring Seasonal Colds Consistent or Re-occurring coughing
Chronic colds (lasting longer than 2 months) Feeling of fatigue, irritability, & restlessness
Migraine Headaches Asthma

Skin Conditions (dry and/or itchy skin, etc…)

 

Both allergies and pain are associated with overlapping inflammatory processes, with a resulting hypersensitivity of the central nervous system. Reciprocal signalling between immunocompetent cells in the central nervous system (CNS) is associated with pathological and chronic pain mechanisms. Glial cells, including parenchymal microglia, perivascular microglia, astrocytes and oligodendrocytes, constitute > 70% of the total cell population in the central nervous system. Glial cells have been identified as key neuromodulatory, neurotrophic and neuroimmune elements in the CNS. Neuronal excitability can be powerfully enhanced both by classical neurotransmitters derived from neurons, and by immune mediators released from CNS-resident microglia and astrocytes, and from infiltrating cells such as T cells. During autoimmune inflammation of the nervous system, microglia release and respond to several cytokines, including IL-1, IL-6, TNFα and IFNγ, which are instrumental in astrocytic activation, induction of cellular adhesion molecule expression and recruitment of T-leukocytes.

Left untreated, allergies can have a significant impact on an individual’s quality of life and wellbeing. Asthma is just one potential consequence of leaving allergies untreated.

Daily in the United States:

  • 30,000 People have an Asthma attack
  • 5,000 People visit the ER due to Asthma
  • 1,000 People are admitted to the Hospital, with an avg. hospital stay is 4.3 days
  • 11 people die from Asthma

36 states have laws prohibiting driving while under the influence of OTC and prescription antihistamines.

People are 50% more likely to have a work-related accident when using non-prescription sedating antihistamines.

A study in the American Journal of Managed Care reports that workers are 25% less productive for two weeks each year if they use sedating drugs to manage allergy symptoms.

 

 

What are aeroallergens?

Aeroallergens include pollen grains, biogenic waste, mold spores, and occupational allergens. Clinically significant aeroallergens are small proteins or glycoproteins, which are buoyant and able to travel long distances when propelled by wind such as pollen grains, biogenic waste, mold spores, and occupational allergens.

 

Pollen grains

Pollen grains are living male gametophytes (sperm) of plants and are microscopic in size. Ragweed is about 20µ in diameter; tree pollen is 20-60µ; and grass pollen is 30-40µ. High volumes of pollen are produced annually. A single ragweed plant can produce one million pollen grains in a single day. Some trees (conifers, for example) can release so much pollen that the microscopic grains form a cloud and can form a visible carpet on the ground. Ragweed pollen is so light that it can be transported hundreds of miles by the wind and has become one of the most significant sensitizing aeroallergens.

Biogenic waste

Dust mites are highly allergenic and cause significant symptoms of allergic rhinitis, sinus disease and bronchial asthma. Dust mites are tiny (.33 mm) barely visible, eight-legged insects. They eat human skin, animal dander, fungi and anything rich in protein. High humidity and warm temperatures allow dust mites to thrive and are found at their highest concentration in the temperate zones—particularly in people’s beds. They have an affinity for materials such as bedding, drapes, carpets and upholstery. In fact, dust mites are often most numerous right under your nose, as your head rests on your pillow.

German cockroaches are common in cities when apartments are heated. They produce potent allergens that are associated with asthma.

Dog and cat dander occur through desquamation of skin. Dander is skin flakes that contain highly allergenic, water-soluble proteins. Cat dander contains the potent Fel d 1 allergen, while dog dander contains the Can f 1 and Can f 2 allergens. Animal dander often remains in homes for many months, leading to persistent symptoms long after the pet’s removal. Further, dander can remain in air ducts or walls and hidden areas for years.

Mold Spores

Outdoor mold

Outdoor fungi are also called field fungi and thrive on plants decaying in the soil. Their spores are released in the highest numbers between the spring and fall, when humidity is high. Mold exposure is associated with a variety of allergy symptoms. One study indicated that children exposed to fungal spores had a 10% to 30% increase in asthma symptoms for every 1000 spores/m3 of air.

Indoor mold

Aspergillus and Penicillium are often referred to as “storage fungi” since they grow on dead and dying stored grains, rotting fruits and vegetables. These fungi on stored items in basements will appear as green mildew. Black-colored fungi is associated with Rhizopus and Stachybotrys.

Occupational allergens

Allergic reactions to aerosolized allergens in the workplace may result in occupational disability. Identification of occupational allergy early in its development may prevent permanent lung damage and long-term disability.

Although most allergy sufferers experience symptoms at home or outdoors, a smaller group of these individuals encounter potent allergens at work. Knowledge of potential workplace allergens can lead to early detection of occupational allergic disease. At first, symptoms might be mild, but they can progress to produce severe allergies—including permanent lung damage. These allergens are often unique to specific occupations and therefore, one must always consider the workplace as a source for aeroallergen exposure.

How do contact or food allergies effect pain?

For all intensive purposes, imagine the human body as a donut floating in space. The entire gastrointestinal system is a complex sensory monitoring system and a nutrient absorption system, it would be the center hole. The outer ring of the donut would be the skin. Food contact allergens presented to the surface of the donut interact with the surface of this donut, individuals with food allergies to substances such as gluten and gliaden develop a leaky gut by loosening the zonules (anchor point between cells) permitting other large molecules to transfer into the body and at the same time activate a large autoimmune neurological response, which often include pain mediators.

 

Allergy testing

Aero allergies are immediate hypersensitivity reactions caused by an IgE antibody, triggering the release of chemicals such as histamine. Because an IgE antibody causes such allergies, it is possible to perform allergy testing to determine the exact trigger and establish a specific diagnosis. One advantage is that skin-testing shares the same exact allergens used in immunotherapy, assuring that the treatment program incorporates all essential allergens.

 

Immunotherapy

Of all the therapies offered for respiratory allergy, injection therapy or immunotherapy is perhaps the most specific and effective treatment available in preventing recurrent symptoms in a hypersensitive patient. However, immunotherapy is only effective if the offending allergens are identified and incorporated into the allergy serum in adequate concentrations. Half-measures often prove inadequate in stubborn cases. A careful and comprehensive allergy history and skilled allergy testing are the basis for an effective treatment program.

 

Allergy injection treatment is carried out over a long period of time (3 – 6 years in most cases). At first, patients receive weak solutions of allergens. The dose is then gradually increased to induce tolerance without reactions. The goal is to achieve a high enough maintenance dose, which affords the best symptom relief. Improvement in symptoms usually lasts for years after completing a successful course of allergy injections.  85% of people treated with immunotherapy for hay fever may achieve symptom relief within the first year of starting immunotherapy.