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Sneezing Or Coughing Breathlessly? You're Not Alone as Complaints Rise at Hospital OPDs in Delhi

May 09, 2023

As the season of viral infections seems to be fading away, cases of allergic reactions have been picking up at the outpatient department (OPD) of hospitals in Delhi-NCR.

Doctors across India, starting in December, were noticing higher cases of flu-like illnesses with a slightly increased severity blaming the cocktail of viruses including H3N2, Covid-19, and regular influenza.

Now, due to changing weather, complaints of coughing, sneezing, runny nose, watery eyes, and inflammation under the eyes and nose have been rising at OPDs of hospitals and clinics.

Experts believe that air pollution in the capital adds to the severity and longevity of inflammation, resulting in prolonged symptoms, especially wheezing.

Such symptoms raise the suspicion of bronchitis and other ailments pushing the practising physicians to prescribe allergic tests.

However, according to experts, house dust mites and insect allergies are the most common allergies detected in the test.

Doctors also advise to not self-prescribe allergy panel tests – which are heavily advertised by pathology labs during this season – but to take advice from the treating physician.

Treatment for allergic reactions is usually anti-allergics and nebulisation with bronchodilators apart from prescribing no medicine at all but only prevention from the offending allergen.

Dr Sandeep Nayar, head of the department, chest and respiratory diseases, BLK-Max Super Speciality Hospital told News18, "Of late, we are seeing a lot of patients coming to us with allergies, in the forms of sneezing, a cough that is not going despite taking all the medication, and sometimes watery eyes and skin reactions. There is a sudden increase in the number of these patients. Some of them could be related to pollution and some pollutants which are causing allergies or pollen due to changes in weather. People are coming with respiratory problems, breathlessness, an increase in asthma and in rhinitis, watering of eyes, sneezing, etc. In the last few OPDs, we have seen the number has increased, maybe because people have stopped using masks and they are no more protected like they were for the last two to three years."

Another expert, Dr Gaurav Jain, senior consultant, internal medicine at Delhi-based Dharamshila Narayana Superspeciality Hospital, echoed a similar trend.

"Seasonal changes especially in April and September are marked by increased cases of allergic bronchitis, rhinitis, and dermatitis cases. A lot of people with elevated IgE levels are present during this month," he said.

This month, due to consistent rain and cool weather, the cases have continued to come in. Immunoglobulin E (IgE) is an antibody produced during a type I hypersensitivity reaction to an allergen.

"One of the reasons behind showing symptoms such as consistent coughing, sneezing, etc, is the change in the season where pollen or bugs initiate allergies in people," said Jain.

He added that more and more people are showing allergic phenomena as the immune system is hyperactive due to viral and other infections suffered by the body recently.

In fact, Dr Manisha Arora, a senior consultant of internal medicine at Sri Balaji Action Medical Institute, said that "usually, Delhi does not witness flu cases in the month of April, but this time, it has been different. Flu has been very common in the last few months and it has resulted in persistent and irritating coughs in many patients lasting for weeks to months even after the other symptoms of flu settle."

She pointed out that these allergies could be the side effect of viral infections in the previous months. "It is postulated that the virus usually triggers a certain type of reaction or inflammation in the upper airways or lower down in the alveoli that may be allergic or inflammatory in nature."

Allergies or allergic reactions are generally best managed by taking the prescribed medicines, say experts.

According to Dr Anirvan Karmakar, consultant, critical care medicine, Narayana Superspeciality Hospital, people can take preventative measures such as wearing protective clothing and limiting their exposure to particular allergens, but the best approach to avoid symptoms is to "take the necessary medicine".

Another expert, Dr Sourabh Pahuja, consultant, department of pulmonary medicine, at Faridabad-based Amrita Hospitals, explained how different cases of allergy are handled differently.

For instance, patients who have allergic rhinitis – an allergy related to the nose – complain of sneezing and runny noses. Patients allergic to bronchitis or bronchial asthma – an allergy related to the lungs – also come with complaints of cough, shortness of breath, and chest tightness.

"The treatment for allergies is dependent on the particular system of the body involved. So if it is allergic rhinitis that involves the nasal system, you give these patients anti-allergic medicines in the form of nasal sprays as well as anti-allergic tablets," said Pahuja.

If a person is suffering from allergies in his lungs, such as allergic bronchitis or bronchial asthma, Pahuja explained, the kids and old people are usually managed with the help of nebulisers. "In the case of youngsters, they are given inhalers. These are all anti-allergic medications."

Of course, there is no harm in maintaining a disciplined diet and schedule to strengthen the body's immune system.

Experts suggest that a diet high in antioxidants and phytonutrients can help to enhance the body's immune system. Also, one can avoid exercising outside and use a mask especially while doing any outdoor chores.

Also, most importantly, doctors advise patients to avoid certain allergens which are expected to be the offender.

For instance, a person with an allergy can also reduce the symptoms of airborne allergens by merely washing out the nose daily or just removing sources of allergens from home and the workplace to avoid allergies.

Jain from Dharamshila Narayana Superspeciality Hospital said that doctors are now better placed to detect more allergic reactions due to year-on-year experience with the weather and conditions around along with better testing facilities.

Several pathological laboratories have been advertising the allergy panel tests noticing an increase in demand. However, Jain and several other experts believe that not all patients are required to undergo tests.

"Labs are offering allergy tests. A lot of these tests show mild reactions to certain things like silica or pollen which mean that these allergies may not need much treatment," Jain said.

Detailing the tests further, Dr Avi Kumar, senior consultant, pulmonology, at Fortis Escorts, Okhla, New Delhi, said that there are two types of allergy tests available. One is the skin prick test and the second test is phadiatop (serological) test.

Allergies from dust, pollens, insect bite, house mites, and pets can be detected with the skin prick test. "These tests are costly and highly sensitive tests," said Kumar.

As per the treating doctor, these tests give an early indication of allergies.

However, Pahuja from Amrita Hospitals advised patients to not get allergy panel tests done on self-prescription. "I would say that patients should not be encouraged to go directly to the lab and get their allergy testing done. It should be done after consulting a physician or pulmonologist."

He explained that as of now, there are up to 60 allergen tests available in the labs, and sometimes these tests do not give meaningful answers for the management of the patient.

"The test is done when the patient does not respond to anti-allergic medicines. As several tests are available, patients do not understand which test they have to undergo," Pahuja said.

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