Airborne Threats: Pollutants And Anaphylaxis Risks

Anaphylaxis is a severe and life-threatening allergic reaction that requires rapid diagnosis and management. While it is typically caused by drugs, foods, and insect stings, it can also be triggered by airborne allergens, leading to a rare condition known as airborne anaphylaxis. This occurs when individuals inhale allergens, resulting in allergic reactions that can range from mild to severe and even life-threatening.

Airborne allergens are tiny particles suspended in the air, often derived from plants, fungi, insects, animals, and man-made substances. Common sources of indoor air pollution include dust mites, pet dander, mould spores, and second-hand smoke. Outdoor air pollution is mainly caused by vehicle emissions, industrial activities, and the burning of fuels.

The most common causes of airborne anaphylaxis are foods and medications. Food-induced airborne anaphylaxis can occur through the inhalation of aerosolized food particles, with peanuts, milk, and eggs being common triggers. Inhalation of certain medications and their excipients can also induce anaphylaxis.

While rare, airborne anaphylaxis can be life-threatening and should be promptly recognized and managed. A detailed patient history and specialized diagnostic tests are crucial for accurate diagnosis and subsequent management.

Foods are the most common cause of airborne anaphylaxis

In a study of 1411 Canadian children with peanut allergies, the annual incidence rate of clinical reaction after accidental exposure to peanuts was 12.5%, with 4.8% of reactions related to inhalation. This was confirmed in an experimental study that showed mice exposed to inhaled peanuts twice a week for four weeks developed peanut-specific IgE, IgG1, and IgG2 and showed clinical signs of anaphylaxis.

Inhalation of milk proteins can also cause anaphylaxis, as lactose is a common excipient used in the production of many medications. A child experienced an anaphylactic reaction after the inhalation of Inavir powder (Laninamivir Octanoate Hydrate) as treatment for flu infection. Traces of β-lactoglobulin were identified in the drug.

Inhalation of egg-albumin has also been linked to anaphylaxis. Two children experienced a severe anaphylactic reaction, characterised by acute respiratory distress, after being in the same room where a pavlova mix was being prepared.

Inhalation of lentil particles in cooking fumes has also been reported to cause anaphylaxis. A 22-month-old child with a history of angioedema and laryngeal obstruction after the second assumption of lentils exhibited signs of urticaria and anaphylaxis after inhalation of cooked lentil vapours.

Inhalation of rice steam during cooking has also been reported to cause anaphylaxis in an eight-year-old child.

Inhalation of fig allergens has also been linked to anaphylaxis. A ten-year-old boy experienced upper limb and face itching, eyelid and lip oedema, cough, dyspnoea, and dysphagia while striking figs under a fig tree with a tennis racket.

Inhalation of oyster mushroom spores, known as potent allergens, has also been reported to cause anaphylaxis. A 32-year-old non-atopic farm worker experienced respiratory symptoms 30 minutes after exposure to oyster mushrooms.

Inhalation of herbs used to flavour dishes, such as dill, a spice in the carrot and parsley family, has also been linked to anaphylaxis. A 40-year-old woman with seasonal and perennial allergic rhinitis reported that each time she inhaled foods cooked with dill, she experienced throat tightness, palatal itching, generalised urticaria, vomiting, and diarrhoea.

Parasites of food, such as Bruchus species, common habitual parasites of legumes, have also been linked to anaphylaxis. A study found that inhalation of dust from peas infested by B. pisorum caused hypersensitivity reactions, including contact urticaria, asthma, and anaphylaxis.

Nematodes, such as Anisakis simplex, which infests fish and cephalopods, have also been linked to anaphylaxis. A non-atopic woman developed rhino-conjunctivitis, pruritus, tongue oedema, cough, and dyspnoea after standing in front of a fish store, with diagnostic procedures proving the responsibility of Anisakis through airborne contact.

Drugs are another important cause of anaphylaxis

Drugs are a significant cause of anaphylaxis, with analgesics and antibiotics being the most common causal agents. Drug-induced anaphylaxis can be caused by immunological or non-immunological mechanisms. Immunological anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves the activation of Th2 cells and the cross-linking of two or more specific IgE antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms.

The most common drugs that cause anaphylaxis include non-steroidal anti-inflammatory drugs (NSAIDs), beta-lactam antibiotics, neuromuscular blocking agents, and radiocontrast media. NSAIDs are the most frequent triggers of drug-induced anaphylaxis, with pyrazolones, propionic acid derivatives, diclofenac, and paracetamol being the most common culprits. Beta-lactam antibiotics are the second most frequent cause, with amoxicillin being the most common trigger. Radiocontrast media, which are used in medical imaging to enhance the visibility of internal structures, are also a common cause of anaphylaxis.

The diagnosis of drug-induced anaphylaxis should include a thorough clinical history, skin tests, and in vitro testing. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunological mechanisms are suspected, serum-specific IgE quantification or the use of the basophil activation test can help confirm the culprit drug.

The treatment of drug-induced anaphylaxis involves the administration of adrenaline as soon as possible, which is the first-line treatment. Other drugs such as corticosteroids and beta-2 agonists may also be used to reduce the risk of biphasic and protracted reactions.

Inhalation of latex particles can cause anaphylaxis

Anaphylaxis is a severe and potentially fatal allergic reaction that can be caused by exposure to certain allergens, including airborne pollutants. Latex, a natural product derived from the Hevea brasiliensis rubber tree, is known to cause allergic reactions in some individuals. Inhalation of latex particles, particularly in powdered form, can lead to anaphylaxis, a life-threatening allergic response.

Latex allergy is an allergic reaction to the proteins present in the natural rubber latex obtained from the Hevea brasiliensis tree. This type of allergy usually develops after repeated exposure to products containing natural rubber latex, such as medical gloves, balloons, and condoms. The allergy affects 1-6% of the general population but is more prevalent among healthcare workers, with 10-17% of healthcare workers and 33.8% of dental care workers being diagnosed with latex allergy.

Symptoms of Latex Allergy

Latex allergy can cause a range of symptoms, from mild skin irritation to life-threatening anaphylaxis. Mild to moderate symptoms may include a red raised rash, itching or tingling in the mouth, swelling of the lips, face, or eyes, stomach pain, or vomiting. More severe symptoms indicative of anaphylaxis include difficulty breathing, changes in heart rhythm or blood pressure, swelling in the throat or upper airways, wheezing, sudden onset of fatigue or confusion, and a dramatic drop in blood pressure.

Inhalation of Latex Particles

Inhalation of latex particles, especially powdered latex, can trigger an allergic reaction, including anaphylaxis. The use of powdered latex gloves has been linked to an increased risk of latex allergy, as the powder can absorb latex proteins and become airborne. This can lead to inhalation of the protein particles, causing an allergic reaction in susceptible individuals.

Prevention and Management

For individuals with latex allergy, strict avoidance of latex products is essential. This includes avoiding direct contact with latex items and being cautious in environments where latex products are used, as the particles can become airborne. In healthcare settings, the use of latex-free gloves and medical products is recommended to reduce the risk of exposure.

If an individual with a latex allergy experiences anaphylaxis, prompt administration of epinephrine is necessary to raise blood pressure and reduce swelling. Antihistamines or hydrocortisone cream may be used for mild sensitivity or local reactions.

Inhalation of diesel exhaust particulates can cause anaphylaxis

Anaphylaxis is a severe and life-threatening allergic reaction that can be caused by exposure to airborne allergens. While foods are the most common cause of airborne anaphylaxis, airborne pollutants such as diesel exhaust particulates (DEPs) have also been implicated. DEPs are released from diesel-fueled engines and are known to have adverse effects on respiratory health. Here are four to six paragraphs discussing the link between inhalation of DEPs and anaphylaxis:

Diesel exhaust particulates and their health effects

Diesel exhaust is a mixture of gases and fine particles emitted by diesel-fueled engines, which are commonly found in vehicles, generators, and industrial equipment. DEPs, the particulate matter component of diesel exhaust, have been linked to a range of respiratory and allergic diseases. At high levels, DEPs can act as nonspecific airway irritants, causing symptoms such as nose and eye irritation, lung function changes, respiratory issues, headache, fatigue, and nausea. Even at lower levels, chronic exposure to DEPs can lead to cough, sputum production, and lung function decline.

The impact of DEPs on the immune system and allergy development

In addition to their direct irritant effects, DEPs have been shown to influence the immune system and promote allergic responses. Several studies have demonstrated that DEPs can act as adjuvants, enhancing allergic inflammation and increasing the production of immunoglobulin E (IgE). DEPs may also affect human B-cells, which are involved in antibody production, and skew the immune response towards a T-helper 2 (Th2) phenotype, which is associated with allergy and asthma. This immune-modulating effect of DEPs is particularly pronounced when they are combined with environmental allergens.

Epidemiological evidence linking DEPs and anaphylaxis

Epidemiological studies provide further support for the role of DEPs in allergy development. Children living along major trucking routes or in areas with high traffic density have been found to be at increased risk for asthmatic and allergic symptoms. These studies suggest that exposure to DEPs, especially in combination with allergens, may contribute to the development of allergic diseases, including anaphylaxis. However, it is important to note that the evidence is not conclusive, and more research is needed to fully understand the complex interactions between DEPs, allergens, and the immune system.

Mechanisms underlying the effects of DEPs

The exact mechanisms by which DEPs contribute to anaphylaxis are not yet fully elucidated, but several factors have been proposed. DEPs have a large surface area that allows them to bind to various chemical compounds, including polycyclic aromatic hydrocarbons, which are known to enhance IgE production. Additionally, DEPs may act as carriers for pollen allergens, facilitating their deposition in the lower airways and triggering asthma attacks. The ultrafine particles in DEPs can also penetrate the respiratory mucosa and vascular walls, potentially leading to systemic effects, including increased allergenicity.

Preventive measures and future research

Given the health risks associated with DEPs, it is essential to implement measures to reduce exposure, especially for vulnerable individuals. This includes improving indoor and outdoor air quality, promoting the use of cleaner energy sources, and developing more efficient emission control technologies for diesel engines. Additionally, further research is needed to fully understand the complex interactions between DEPs, the immune system, and the development of allergic diseases like anaphylaxis.

In conclusion, while the evidence suggests a link between inhalation of diesel exhaust particulates and anaphylaxis, more research is needed to fully elucidate the underlying mechanisms and develop effective preventive measures.

Inhalation of volatile organic compounds can cause anaphylaxis

Inhalation of Volatile Organic Compounds (VOCs) Can Cause Anaphylaxis

Anaphylaxis is a severe and life-threatening allergic reaction that requires rapid diagnosis and management. While foods and drugs are the most common causes of anaphylaxis, airborne anaphylaxis, though rare, can also occur due to inhalation of allergens. Volatile organic compounds (VOCs) are a class of chemicals that can act as indoor air pollutants and have been implicated in the development and exacerbation of allergic disorders.

Volatile Organic Compounds (VOCs)

VOCs are organic compounds that have a high vapour pressure and can easily form gases or vapours at room temperature. They are commonly found in household products such as paints, varnishes, cleaning fluids, adhesives, carpets, furniture, textiles, and personal care products. Some common VOCs include formaldehyde, benzene, toluene, and glycol ethers (PGEs).

Health Effects of VOCs

VOCs have been associated with various respiratory and allergic symptoms, including asthma, stuffy noses, and eczema. High concentrations of VOCs can irritate the nasal passages and trigger immune system disorders. Inhalation of VOCs has also been linked to an increased risk of developing allergies and asthma, especially in children.

VOCs and Anaphylaxis

While there is limited direct evidence linking VOC inhalation to anaphylaxis, several studies have suggested an association between VOC exposure and allergic reactions. For example, a study by Erminia Ridolo et al. found that children with higher concentrations of PGEs in their bedrooms were more likely to suffer from rhinitis, asthma, or eczema. Additionally, children exposed to certain VOCs were more likely to test positive for immunoglobulin E, an antibody associated with allergic responses.

Another study by Ulugbek B. Nurmatov et al. conducted a systematic review to investigate the link between domestic VOC exposure and the risk of developing and exacerbating asthma and allergic disorders. They found inconsistent results, with approximately equal numbers of studies reporting increased risks and no detrimental effects. However, the overall quality of the evidence was poor, and more research is needed to draw definitive conclusions.

Preventing VOC Exposure

To reduce the potential risk of anaphylaxis and other health issues associated with VOC exposure, it is essential to minimise indoor VOC levels. This can be achieved by improving ventilation, avoiding the use of VOC-containing products, and opting for low-VOC alternatives whenever possible.

In conclusion, while the direct link between inhalation of VOCs and anaphylaxis requires further investigation, VOC exposure has been associated with allergic reactions and respiratory issues. Taking precautions to minimise VOC exposure, especially for children, is crucial to safeguard health and prevent potentially severe allergic reactions.

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