Anaphylaxis - Fatal Allergy

Dr Abe V Rotor
avrotor.blogspot.com

What I am going to relate is a true story about anaphylaxis. It happened to my youngest son, Leo Carlo when he was in the elementary during a family vacation in our ancestral home in San Vicente, Ilocos Sur.

Our dish for dinner was a fine, big talakitok, broiled on charcoal. I noticed that Carlo particularly liked the egg mass. By the way this prized fish was freshly caught in the estuary of San Sebastian river. It was a family feast. And we were all very happy to settle for the night.

By midnight Carlo crept to wake me up. His face was swollen, his eyes nearly shut. His skin was red, and his voice was a whisper. "I can't breath, Papa." His heart was racing, and his whole body seemed to be shaking.

I assured my family not to panic as I prepared the car to take Carlo to a hospital to Vigan, three km away. Luckily I had Antihistamine tablet in my pocket, and I gave it to him immediately as a palliative measure. At the hospital he was given an injection that brought him relief, then he fell asleep. 

Our vacation was cut short. That same evening we drove back to Manila where Carlo was further diagnosed and treated. It took him a week to fully recover and return to school.

Anaphylaxis can strike within seconds or minutes of exposure to an allergen. Or it may sneak up slowly, with symptoms delayed up to 2 hours from the time of exposure, Initial symptoms may even disappear, then return full-force within 4 to 12 hours.

••It’s a terrifying feeling, you may become flushed, and your skin may become quite itchy and red. The frightening thing is, you begin to feel you’re having difficulty taking a full breathe, that you are suffocating. As your blood pressure drops, you feel dizzy and sweaty and become pale. You body is not kidding. Anaphylaxis can kill by suffocation.

Anaphylaxis – systemic reaction, during which exposure to an allergen triggers an allergic response throughout the body rather than just near the site.

1. It doesn’t take much to trigger this body-wide allergic response – a single peanut or tiny paper wasp can set off the reaction.

2. During an anaphylactic attack, a rush of chemicals – histamines, leukotrienes, and prostaglandins – is released in an attempt by the body to defend itself. These chemicals are produced by basophiles found in the blood, mast cells found throughout the body, including eyes, noise skin and gastrointestinal tract.

3. Anaphylaxis may affect many organs, such as the throat, lungs, blood vessels, and intestines. Histamine and other chemicals released by the body may produce widespread itching, welts, and hives on your skin.

4. Cause blood vessels to become leaky, resulting in a drop in blood pressure, swelling of the skin, and fluid in your lungs.

5. Bring circulation of your blood and oxygen to a near-standstill as your blood pressure drops.

6. Make it difficult or impossible to breathe as your tongue and throat swell up and your lungs go into asthmatic spasms.

7. Trigger nausea, vomiting, and diarrhea as your gastrointestinal system goes haywire.

Anaphylaxis is an allergic reaction that can trigger reactions all over your body, affecting the various systems in the body

1. Cardiovascular: Light-headedness, feeling faint, loss of consciousness (syncope), heart palpitations.

2. Upper respiratory : nasal congestion, sneezing, difficulty swallowing

3. Lower airway obstruction: coughing, wheezing

4. Skin: welts or hives, swelling of the skin (particularly on face and around lips and tongue), flushing

5. Gastrointestinal: bloating, nausea, vomiting, diarrhea, cramps
6. Elsewhere: metallic taste in the mouth, cramping of the uterus during pregnancy, sudden need to urinate.

Facts about Anaphylaxis
90% of adults didn’t even tell their doctors about their anaphylaxis reactions.

• Chances are: If you are have had anaphylaxis in the past, the odds are you will have it again. (from 380 anaphylaxis patients)
• 25% had just 1 episode
• 18% had 2 episodes
• 57 % had 3 or more
• Keep a diary of your allergens and avoid them. Weed out your refrigerator, cupboard, drawers. Allergens may appear in an unsuspecting product.

Causes of Anaphylaxis

• Food – peanut, shellfish, crustaceans,
• Insects – fire ant, honeybee, bugs Drugs – more than ½ million serious allergic reaction occur in hospitals (Penicillin)
• Latex – condoms, balloons, gloves
• Exercise – eating 3-4 hrs before exercising increases risk
• Narcotics
• Aspirin
• Blood transfusions
• Food additives

References
Dr R Ansorge R and Dr E Metcalf et al
Hampton JK (1991) The Biology of Human Aging, Wm C Brown Publishers 343 pp
Jacobson E (1964) You Must Relax, McGraw-Hill 270 pp
Rotor AB (1983) The Men Who Play God: A Collection of Short Stories Ateneo de Manila University Press 147 pp
Rotor A V (2007) Living With Nature in Our Times, UST Publishing House 318 pp.

Global Allergy Epidemic Looms

Global Allergy Epidemic Looms
Re-print: Response delivered by Abercio Valdez Rotor, Ph.D., on the 13^th Biennial Convention, and 40^th (Ruby) anniversary of the Philippine Society of Allergy, Asthma and Immunology, PSAAI.  

Dr Abe V Rotoravrotor.blogspot.com
Dr Arturo B Rotor, first Filipino Allergist and director of Philippine General Hospital, author of short stories (The Men Who Play God and Other stories, Ateneo de Manila Printing Press), former executive secretary of two past presidents - Manuel Quezon and Sergio Osmeña. 

Dr Agnes Gonzalez-Andaya (Over-all Chair of this Convention),

Dr Linda Lim-Varona (President, PSAAI),

Dr Madeleine Sumpaico (Dr Arturo Rotor’s lecturer for this 13^th Biennial Convention, and 40^th (Ruby) anniversary of PSAAI),

Members of the organizing committee and advisory council, and Board of Directors, ·         
Participants, guests, ladies and gentlemen.  

Your theme in this convention, “Issues and Controversies in Allergy and Immunology: Solution for the Clinicians.” is a very timely one.  It is complementary with the theme  of 2008 11^th biennial convention when I was invited to be your lecturer and talked of  “Understanding Allergies across the Specialties.”

In my lecture then I stated that no period in history has man influenced the environment as much as what he is doing today.  For instead of “tailoring" his lifestyle to the conditions of the environment, as what his ancestors did for centuries, he is modifying the environment in order to meet his growing affluence.

Dr Madeleine Sumpaico’s paper, "The truth about allergy shots and the emerging modalities," addresses the need to combat increasing cases of allergy and asthma .  As people lived in closed quarters and communities, as they move to cities, as the levels of pollution get higher  on land, in water and in the air – allergy is likely to grow into epidemic proportion.  Since there are no true boundaries of the earth,  the epidemic will continue to spread to both progressive or marginal communities.

Allergy does not only pry on poor living conditions, in fact it is the other way round.  During the Cold War which lasted for 45 years, scientists found a disturbing fact that cases of allergy in the highly progressive Western Germany far outweighed those in rural and less developed Eastern Germany.

Today as progress is patterned after the Western model – that of the US and Europe which West Germany adopted, it is expected that the allergy (and asthma) epidemic will be the most important health concern of everyone.  It reveals that affluence is a major cause of allergy and asthma.   

In a number of times Dr Arturo B Rotor expressed warning of this growing threat in his book The Men Who Play God.  The subject of a mysterious disease in Santiago’s Syndrome, where a patient cannot be readily diagnosed  is characteristically that of allergy.  In another, The Boy Who Always Sneezed Three Times, gives us a scenario of an unhealthy atmosphere in which superstitious belief breeds. The MD and the Faith Healers tells us of two cases of healing that are different, yet aimed at a common ailment.  This is the case when the situation presents itself to not only one possible solution.  Here the patients are divided in  their belief to be healed – where choice is set aside in favor of whatever cure is effective. 

There is something in Dr Arturo Rotor’s revelation on why he stopped writing, the prolific, award-winning short story writer that he was.  To quote:

“I am no longer young, and because when I entered the practice of medicine I discovered suddenly that I did not possess the vocabulary to record or describe what I saw.  I could write vividly enough about characters which existed in my imagination.  But when I saw them in my clinic and noted the caught breath or measured the quickening pulse, I found myself inarticulate.  I knew then what I had written before was written neither with understanding nor with compassion.  And so I am learning how to write all over gain…”

The message of this confession may be subtle, but in the final analysis it is a wakeup call, not only in medicine but in all professions or vocations.  To all of us.  Imagination takes us into the realm of many possibilities, of theories incapable of generating their own proofs, of knowledge inapplicable to practical test, of plans and programs drawn on executive desk. It speaks of the energies of youth seeking expression, yet unguided into the priorities of the real world. Of imagined strategies far from the battlefield.  How romantic can be reality, excused at the end for the sake of art.  But life is more than art. “Caught breath, quickening pulse…” as Dr Rotor revealed is reality.

It is no wonder then when he delivered before the first Congress of Filipino Writers’ League in 1940, after receiving the Republic Heritage Award, he “accused” Filipino writers in English of lacking social consciousness and advocated for a dynamic proletarian literature to offset the timid and anemic literature being produced then by local writers.  He lamented their art-for-sake attitude and their emphasis in form and pattern that have blinded them to the vital issues that affected themselves and their country.

He continued to say that, “while the rest of the country is talking about the slums of Tondo and the peasants of Central Luzon,” he said, “our poets still sing ecstatically about the sunset in Manila Bay.

The calm scholar, the classic pianist, the green-thumb horticulturist, the little president of Quezon and Osmena unleashed  a Markham call for action.  For an Idea that soon unfolded after his time. The birth of media that rides on both literature and journalism.

What could be the implication of his call today?

1. Out there are children whose conditions are aggravated not just by the lack of medical attention, but by predisposing conditions to allergy and other diseases.

2. Survivors of medical breakthroughs and not by Natural Selection imposed by the environment, who are now heavily dependent of medical care, perhaps for life, many of them incapable of  contributing something significant in return.

3. Senior citizens increasing by the thousands every year as longevity all over the world further widens the golden years of life, yet golden to not to many people and families.

4. Victims of calamities – The recent Intensified monsoon,  and even rare catastrophes like tsunami,  Fukushima nuclear meltdown , and diseases – Cambodia flu, virulent Dengue, leptospirosis, chicken flu, H1N1 and now Coronavirus Pandemic (COVID-19) – these, and many more challenge us with the reminder of Dr. Arturo Rotor’s wake up call.

-     "Of caught breath and quickening pulse … and neither written with understanding and compassion...  The country talking of slums in Tondo and poor peasants in Central Luzon … and writers  writing about  beautiful Manila Bay."

-     What a disparity! Dance Music on one hand and Twilight’s Convict on the other. Santiago’s Syndrome and Club Euthanasia.  Indeed Dr Arturo Rotor’s book, The Men Who Play God speaks not that we have intruded into the realm of highest knowledge, but our failure in applying that knowledge, translating it into practical wisdom for the patient, the slum dweller, the poor peasant, and today's millions suffering or predisposed to the greatest pandemic of our postmodern world – allergy and its complications. 

On behalf of  Dr Arturo Rotor,  the Rotor clan wishes to express their deep gratitude to PSAAI and its members and supporters for keeping his memory alive, and with it, the renewal of a great resolve,  the cause for which he lived, for which he dedicated unselfishly his valuable works. ~ 

Awareness is key to allergy control

Awareness is key to allergy control

Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis.

Dr Abe V Rotor

Living with Nature - School on Blog

1. Asthma - As the sawmill operator slices the tree trunk into boards amid a shower of sawdust, he feels the familiar chest tightness of an approaching asthma attack.(10% asthma cases worldwide linked to workplace)

2. Skin Problems – After the hairdresser gives yet another permanent to a customer, her itchy, burning hands start to give her fits. (occupational skin diseases account for up to 20% of all reported work-related diseases)

 Polluted water of Manila Bay

3. Allergic Rhinitis – the graduate student sneezes as she looks through itchy eyes at the laboratory rats in cages surrounding her. Better known as hay fever, AR strikes with symptoms like runny nose and congestion, sneezing, itchy watery eyes, triggered by allergens like perfumes, fumes, dusts, chemicals, and many more linked with the workplace.

Heavy air pollution in a dumpsite in India blocks the setting sun and attracts predators and scavengers.  

A guide to deal with allergies -

1. How do you differentiate Common Cold from Allergy Rhinitis?

• Duration: Colds - 3 to 5 days (rarely more than 10); Allergy Rhinitis - 2 to 3 weeks (or more)
• Nose Symptoms: Colds - colored or cloudy discharge, stuffiness; Allergy Rhinitis – clear, water-like discharge, sneezing and itchiness.
• Other Symptoms: Colds – sore throat, fever; Allergic Rhinitis – red, itchy eyes

2. Sources and causes of allergy

• Allergy on seafoods in common noticeably exhibited by sudden reddening of the face and other parts of the body, accompanied by increased blood pressures, pulse rate and other symptoms.

Pollen allergy from flowers like adelfa. Nectar of adelfa flower also contains a substance that may affect breathing when sipped. 

• Pollen allergy is most common during the months of October to December, the flowering period of Cereals (Family Poaceae) Staminate flower of corn, Zea mays
• Nearly microscopic in size, plant lice (Psylla) form colonies so huge they can destroyed entire plantations of ipil-ipil. Allergic reactions have been reported from their skin castings. The nymphal stage is completed after four to five moultings.

3. Mystery of the Marble Dust

• Marble is metamorphic limestone
• It has a natural finish; it is durable, hard and brittle.
• When ground and polish dusts fill the air, and reach the lungs even through aircon.
• Under the microscope, marble dust is a miniature abrasive particle.
• It hurts the lungs and being Calcium compound, “cake” in the alveoli and tracheal linings,
• Allergy symptoms may start as allergy rhinitis, often mistaken as bronchitis and asthma attack.
• Use mask marble dusts collector, shift to wet process of grinding.
• Refrain from exposure.

4. A short list of causes of Allergies

• Drug
• Dust Mites, Roaches and Other Insect Allergies
• Food allergies and intolerances
• Hay Fever
• Latex
• Mold
• Nickel
• Pet
• Poison Plants
• Stinging and Biting Insects
• Sinusitis

Common Allergic Symptoms

• Runny Nose and Sneezing
• Coughing and Wheezing
• Skin Problems
• Eye Problems
• Ear Problems
• Other Symptoms

B. Hidden Allergy Connection

• Attention Deficit Hyperactivity Disorder
• Candidiasis
• Chronic Fatigue Syndrome
• Depression
• Headaches
• Inflammatory Bowel Disease
• Multiple Chemical Sensitivity

5. Obesity-Allergy Connection

Which come first? Chicken-or-egg question.

• Smaller airways
• Shallower breathing
• More time indoors
• Stomach problems

6. Easing Childhood Eczema
Avoidance of the following:

• Dust mites, pollen, and certain foods.
• Certain non-allergic irritants such as soaps, wool, synthetic fabrics, or other clothing 
• Overheating and sweating.
• Creams and ointments
• Scratching

7. Potential allergy-provoking problems in the garage and workshop

• Start the engines outside.
• Ditch your damp possessions.
• Store chemicals safely.
• Moldy rags on the floor
• Old chemicals stored on table
• Paint can not closed tightly
• Car engine should not be left running in garage
• Room should have a window or exhaust fan
• Tools should be cleaned outside or in an area with good ventilation

References: Living with Nature AVRotor, Internet

Live naturally. Too much Hygiene does more harm than good.

Live naturally

Too much Hygiene does more harm than good. 

Recent studies question the validity of Hygiene Hypothesis.

                                                                    Children of Nature, photo by AVR

Dr Abe V Rotor

The Hygiene Hypothesis endorses cleanliness and sanitation as a way to healthy living. The prescription of some doctors includes avoidance of certain food and environmental allergens.

Recent studies question the validity of Hygiene Hypothesis. By cleaning our children constantly, discouraging them from getting dirty, pumping them full of antibiotics every time they get sick, using anti-bacterial soaps, and the like - we are not encouraging their immune systems to develop fully. The Westernized lifestyle makes them more susceptible to allergic conditions.

Children raised on farms around animals have lower levels of allergy and asthma than their urban counterparts - those unexposed to pets, confined in day care centers, and spotless homes.

To what extent does nature provide immunity? Fortunately as children grow to maturity, particularly so under natural environment, they acquire the defense the body systems need against a host of health problems from allergy to physiologic and pathological diseases, albeit adaptation to emotional and psychological stress.

• Ever wonder what it means to enjoy childhood outside of the confines of air conditioned room?

• Many children look forward to the first rain in May.

• Boy scouts and girl scouts look forward to the next jamboree.

• Athletes participate - and are not merely spectators - in field games.

• Develop those muscles while you are young.

• Grow tall naturally, not by taking growth hormones.

• Shake off those lazy bones. Keep your blood pressure and pulse rate normal and steady the natural way.

• Walk. Run. Meet sunrise. Stay and watch the sun set. Be active physically. Have outdoor hobbies.

• Go and live with Nature. She is the best doctor, teacher and friend.~

Natural Farming Models

Dr Abe V Rotor
Living with Nature School on Blog

 Rice-based farming, monoculture, one crop a year .  Painting by AVRotor. 

Let me give you scenarios of natural farming.

1. Zero tillage. Ratooning of sugarcane requires no plowing, new shoots from previous crop are raised with irrigation and fertilization. Tillers of rice may also comprise the second crop. Pineapple farms are sustained by subsequent suckers.

2. Payatak method (Samar) - This is a local version of zero tillage. No plowing, no harrowing. A herd of carabaos trample of the soil until it turns puddle, then the one-month old seedlings are transplanted. No spray, no fertilizer. This is natural farming in the marginal sense, a carryover of traditional farming.

3. Mixed orchard (Zambales) - A mixture of several kinds of trees, orchard, firewood trees, forest trees grow together without any apparent planning. Yet these trees follow a natural pattern of arrangement. They have no common pest, they need soil fertility differentially, they have their own space niche, they make up several storeys. Management is very little. Nature takes care of everything.

4. Multiple cropping model (Sta. Maria. Bulacan) - Here the farmer engages in the production of three commodities. For Narciso Santiago, national outstanding farmer, his 2.5-ha farm produces frults, vegetables and rice. He has several heads of carabao and cattle grown on homelot, pastured between the orchard trees. A pond supplies irrigation, as it produces tilapia and mudfish. Why three commodities? It is because they are closely integrated. This is the key to natural farming where there are a number of products to be desired. 

First the animals produce, other than meat and milk, manure for the plants, the plants produce food for the family and market, and they together with their residues give feeds to the animals. The pond is source of irrigation for the plants, principally rice and vegetables. It is a waterhole for wildlife for biological control. Because of its integrated structure and management. the farm itself becomes a balanced system. This is the key to sustainable production. This is ecological. farming.


5. Sloping agricultural land technology or SALT (Bohol) Call this natural farming even if the farm is a logged area. Precisely the idea is for the farmer to return the land to its natural state as much as possible. How does he do it? 

Agro-ecology model, watershed area. Painting by AVRotor 

If one sees the model, the land has a grade of 20 to 40 degrees. The steeper the grade the more difficult it is to apply the system. 

Over and above 45 degrees the model may not work at all.) Here the contour of the slope is marked and outlined so that the sole of the plow, so to speak, will be level at all times. The contours are spaced uniformly, and the rows which follow the contour are planted at interval of annual and permanent crops.

6. The idea is for the permanent crops like fruit trees and firewood trees to sandwich the annual crops like peanut, rice, corn vegetable. The herbage of, say ipil-ipil, is used as organic fertilizer. Neem tree is used for pesticide. Lantana is a natural pest repellant, so with Eucalyptus. Legume intercropping and crop rotation replenish the soil of Nitrogen.

7. Modified models (rice and corn areas). Rice farming can be modified to suit the conditions of natural farming. There are farms today that rely entirely on homemade or commercial organic fertilizers. These are contracted farms to supply organically grown rice.

An equally important aspect of successful farming is cleanliness. This means no weeds, trimmed waterways, properly disposed farm wastes, efficient drainage, well arranged rows, properly scheduled farming activities, and the like. All this requires but low technology that is also affordable, and contributes to good health to both producer and consumer, and the whole community.

Genetically resistant varieties are chosen. Proper time of planting and harvesting is needed. We should know that clean farms, healthy plants and good management, are basic. What we are saying is that the use of chemicals is dispensable. To a single farmer, this is easier said than done. There is a need for collective and community effort, in which case farming , especially if it intends to shift to organic, likewise becomes more efficient as cost of production can be brought down.

8. Coconut farms (Southern Tagalog and Bicol). Seldom do we hear of coconut cultivation that follows the agronomic practices of other major crops like sugar cane or corn. Perhaps there is no plant more resistant than coconut. It is because it perfectly fits our soil, climate and latitude. It is indigenous to us. In fact it evolved with our islands and our culture. Evolutionarily and historically what I am saying is that natural farming is not new. And more importantly, it is a product of long years of development. It is not just acclimatization. It is co-evolution.

The message is that let us explore the richness of our biodiversity and our culture as a people to be able to understand the working of nature. Nature shows us the way. Nature, the way our ancestors knew then, is the nature we know today, except that we have embraced many changes in farming as well as in life style. Many of these changes had not passed the test of time.

In Laguna and Quezon, coconut is the dominant species of an ecosystem. The presence of man in the ecosystem has modified it to suit to his needs. For example, he has chosen only the trees and plants that grow between the coconut trees. Unknowingly he raises animals, which reduce the richness of plant species diversity.

We still see around well-established, stable coconut areas where man's intervention is kept low, but my fear is the current practice of logging old coconut trees for lumber.

Natural farming then is important as a way of farming. It is also important in sustaining economic production, and above all, the continuity of our ecosystems that we have placed in our hands. Given these premises the farmer today faces a new challenge worthy of the title, "the backbone of the nation."~