Speaker script, episode 6: Defences on the Wrong Track
Newsreader: "The pollen report, forecast to Wednesday evening. Due to the high
intensity of solar radiation, there will be a rise in the amount of grass pollen in the air.
The allergenic count for mugwort and rye pollen will also be high."
When plant life is thriving and blooming, many people would, if they had their first
choice, put nature's beauty far behind them. One out of every five Germans has an
oversensitive reaction to pollen. People who nevertheless dare to go out into "hostile"
nature can protect themselves with masks which enable the allery sufferers to breathe
pollen-free air. Filters prevent the microscopically small tormenters from coming into
contact with the mucous membranes of the nose, the eyes or the respiratory system.
The tiny particles, often no more than a few thousandths of a millimetre in size, have
no effect on most people. But hay fever sufferers react to the pollen of one or more
flowering plants. The bizarrely shaped structures are fought by the immune system as
if they were pathogenic parasites. A wide range of symptoms such as coughing or
difficulty in breathing, along with a runny nose, swollen mucous membranes and
watering eyes, make life difficult for allergy sufferers.
When certain cells of the immune system, the mastocytes, come into contact with the
pollen, histamine is poured into the system. This substance, which is also contained in
stinging nettles, causes the inflammation with its annoying symptoms.
Animated
film
(length:
1:56 min)
When allergens such as pollen enter the human body, some people react
oversensitively, others do not have any reaction at all. It is not known exactly why. On
the other hand, we do know how allergies develop. Cells in the skin or mucous
membrane which have taken in the allergens display parts of them on their surface. If
T-helper cells recognize presumed pathogens in these "wanted" descriptions, there is
a false alarm.
The T-cells divide and organize the production of the appropriate antibodies. These
IgE antibodies dock onto the mastocytes and start receiving signals like an antenna.
Now this person has been sensitized to a particular allergen. Whenever there is
further contact with the allergen, the defence goes off on the wrong track. The
mastocytes become active.
If the allergen bridges two neighbouring antibodies, the mastocyte releases the
messenger histamine in order to get rid of the annoying intruders. The mucous
membrane turns red and swells. One possible therapy: antihistamines block the
messengers, the symptoms disappear.
The simplest way to prevent allergic reactions is to avoid contact with the allergens.
No matter whether they are of natural origin, from traffic emissions or from industrial
production.
Quite a number of shut-down salt or mineral mines have been turned into places of
escape for allergy sufferers. The spa facilities in the small town of Aalen in BadenWürttemberg have also equipped themselves to handle the oversensitive clientele.
The underworld of the miners offers a valuable commodity. Pure air, free of allergens.
In the damp, cool tunnels below the earth, there is natural ventilation which quickly
transports any substances in the air to the outside. Such favourable conditions are
otherwise found only in the mountains or at the seaside.
The patients, who usually come for a three-week course of treatment, suffer primarily
from hay fever, asthma or neurodermatitis. They spend two hours a day in the healing
tunnels. For many of them, the allergy symptoms improve within the first week. As the
therapy continues, they often disappear to such an extent that it is possible to stop
part of the medication. The effects of the treatment last for a long time after the
course of treatment has finished. But when the exposure to allergens exceeds a
certain threshold, the symptoms of the sickness return.
Scenes from the Middle Ages. By today's standards, our forefathers lived in extremely
unhygienic conditions. People and animals shared the same simple housing.
Parasites, viruses and bacteria were everywhere and constantly challenged the
immune system. Allergies were rare.
As the standard of living has risen, allergies have increased dramatically. Some
scientists view the "sterile life style" in today's world as being the cause. Defence
mechanisms against parasites are never pushed to their limits and turn against
harmless substances instead. Several factors would seem to verify this theory. For
allergies seldom appear in countries at a low level of development. The human
immune system which has evolved over the course of eons is oriented to a life in
nature. Various defence strategies have been developed, depending on whether
bacteria, viruses or parasites need to be fought.
The immune system has not yet adjusted to a modern industrialized society with few
parasites. One hypothesis presumes that environmental pollution has made a major
contribution to susceptibility to allergies. Suspicion falls on air pollution substances
which damage the respiratory paths, allowing pollen to come into contact with the
immune system more easily. As plausible as the explanation may sound, there is still
a lack of hard facts and there are counterarguments.
The opening of eastern Europe provided a curious bonus for scientists. The fall of the
borders in 1989 did more than bring freedom to the East Germans. When the wall
came down, a new field for research opened up. Physicians examined pre-school
children who grew up under substantially worse environmental conditions in the old
German Democratic Republic. Surprisingly the children suffered far less from
allergies. In comparison with children in western Europe, East German children
attended day care centres at a much earlier age. Infections trained the immune
system. This is how some researchers explain the lower susceptibility to allergies.
Consultation at a dermatology clinic. Reddened, itching places on the inside of the
arm come from neurodermatitis. Patients with this form of allergy usually display an
oversensitive reaction to a number of substances. Questions about living conditions at
home and when the symptoms appear can turn up indications as to what substances
might possibly be the trigger for the allergy.
Patient: „Well, mainly in spring, that's why I'm here now, because it has become
worse since March."
Doctor: „Is it only in spring, or in summer and autumn, too?"
Patient: „Mainly in the spring, but I also notice it in the summer, it never goes away
completely except when I'm at the ocean.."
Solutions containing allergens from pollen, mite excrement or animal hair in the purest
form possible help in the detective painstaking work of seeking clues. Based on
information from the patient, the doctor puts together a kind of "perpetrator profile"
which contains all the substances suspected of triggering the allergies.
In a prick test, drops of the selected extracts are placed on pre-numbered spots on
the skin where some of the immune reactions later become visible. So as to be really
effective, the substances are scratched into the skin. It takes about half an hour until
the results of the histamine emissions become visible. Swelling shows which
substances have caused an allergic reaction.
Doctor: „Your histamine control is positive, then you have a reaction to cat hair, you
reacted strongly to cattails, to rye and to mugwort."
While the mugwort pollen is found only in nature, other allergens come from the
immediate home environment. Many people do not realize that there could be dust
mites in their bedrooms whose excrement triggers allergies particularly frequently.
Such troublesome tenants also include cockroaches which generally make their home
unnoticed in the house. They are seeking warmth and nourishment. Their excrement,
stirred up by the vacuum cleaner or the air conditioning, becomes a problem for
sensitive people.
Pets, especially cats, are a further source of allergens. The problems are caused by
protein substances in the skin and hair. Less common are intolerances of urine or
saliva. Allergies in the work environment are also increasing. The farmer's lung is
widespread. Dust, kicked up while making hay or threshing, can lead to dangerous
inflammation of the pulmonary alveoli. More than one farmer has had to give up his
job because of it.
The man with the mask is baker Josef Krieger. Thanks to the comfortable mask which
always keeps a supply of dust-free air available to him, he can still practice his
profession. Josef Krieger is allergic to rye flour. That was almost the end of the
business, which has belonged to the family for generations. Josef Krieger loves his
profession. When the asthma attacks became more and more frequent, the doctors
gave him the usual recommendation.
Baker: „That meant that re-training was the only possibility, away from my profession.
But since I was absolutely against that, I looked for a way out and found one, wearing
this mask, which I have now been wearing for six years whenever I work. And the
results are improving from examination to examination, I don't have any problems
today and can also continue to work in my profession, which is very important for me,
because it is a question of my existence."
Naturally substances which float in the air around us head the list of common
allergens. But second place is held by substances found in foods, most of them
unrecognized. They can cause gastro-intestinal problems, headaches, skin reactions
or even life-threatening shocks.
Every food is made up of a number of individual building blocks. Often the same
components are found in a number of foods. Some products contain chemical
additives. All of this makes it more difficult to uncover the factors which actually trigger
the allergies. Milk is contained in many products. The sooner children begin to drink
milk, the more likely they are to develop an intolerance. Babies should therefore
continue breast-feeding as long as possible. That generally reduces the risk of
allergies.
Wasps are normally harmless annoyances. But they can be dangerous, even lifethreatening, for some people. The following scene, which takes place in Switzerland,
gives an impression of how violent allergic reactions can be. The immune reaction
sets in immediately after the sting. Histamine from the mastocytes and other
messengers floods the body. First there is a tingling in the hands, then massive
disruption of the circulation.
Chaos breaks out in the body. The blood vessels expand so fast that the blood
pressure falls dangerously. It is only a question of seconds until everything turns black
in front of the man's eyes. He displays all of the symptoms of anaphylactic shock
which, if left untreated, can result in death. Every minute is important in such a serious
case. The best thing to do is to call the doctor immediately. Every year, help comes
too late for some patients.
The first priority is to get the circulation moving again and to stop the extreme
production of histamine. There are proven substances which will do this and which
rescue teams always have with them. Basically, any allergy can cause a shock. The
most common victims are the ones who suffer from food and medicine allergies.
Knocking and sucking, these are the typical hand movements of a rare profession.
The insect hunters are after wasps or, to be more precise, their most important
weapon. The stings and venom sacs are removed from the insects in the laboratory.
The reward for this tedious work benefits everyone who reacts with extreme sensitivity
to wasp stings. The masks prevent the workers from breathing in the venom and
becoming allergic to the substance themselves.
The allergen used for hyposensitization is derived from the wasp venom. Beginning
with small doses which are gradually increased, the patient builds up a tolerance to
the venom over the course of years. The treatment re-programs the immune system.
Other parts of the immune system which react less violently to the allergen gradually
take over the defence. A test with a living wasp shows if the therapy has been
successful. Its sting does not have any effect. It's not yet clear how hyposensitization
works, but it is successful for many types of allergies.
Prof. Schöpf: „It is highly sensible, in the case of serious pollen allergies, for
example, to perform a hyposensitization at a relatively young age, because this can
prevent the pollen allergy from completing a so-called level change, i.e., it doesn't only
cause hay fever, which is comparatively harmless, even if unpleasant, but expands to
the deeper levels of the bronchia in the form of pollen asthma. And then, of course, it
becomes dangerous. And in many cases this can be prevented with a
hyposensitization."
In these drawers can be found a few examples of human inventiveness: substances
which enrich our daily lives, but which we can also thank for some of the attendant
problems. When cosmetics, washing powder, paints or solvents come into contact
with the skin, then the immune system sets off an alarm in some people. If a contact
allergy is suspected, only a test can finally determine which substances are not
tolerated.
While the allergens previously considered - pollen or wasp venom - trigger an
immediate reaction, the immune response to contact allergies is delayed. The itching
eczema does not show up until weeks after the oversensitive person comes into
contact with the substance. The patients would like to shed their very skins.
The skin, which modern Homo sapiens likes to dress up with all kinds of fashionable
items, is more than just a simple protective cover. It forms a fantastic early warning
system, but one which frequently sends out a false alarm in allergy sufferers.
Jewellery, perfumes, cosmetics or clothing, everything which comes into direct contact
with the skin, may cause inflammation. Any sufferer who pays attention to these
symptoms and rigorously avoids contact allergens will soon feel comfortable in his or
her skin again.
Neurodermatitis. More and more small children are affected by it. Besides genetic
factors, a breast-feeding period which is too short and exaggerated hygiene contribute
to this form of allergy. Silja Beckman has also suffered from neurodermatitis since her
earliest childhood. Typical for the chronic illness: it comes in phases, often without a
clearly identifiable cause. In the case of neurodermatitis, psychological problems and
external influences which one can frequently not avoid work together. Stress, heat,
water or the person's own perspiration can aggravate the infection of the skin. As with
Silja Beckmann, people suffering from neurodermatitis usually exhibit an intolerance
to a number of allergens.
Animated
film
(length:
1:37 min)
Every human being's skin contains star-shaped Langerhans cells. These guardians of
the immune system use their antenna-like antibodies to identify foreign intruders. Skin
examinations have proven that neurodermatitis patients have an extremely high
number of docking stations for IgE antibodies. This high number of receivers makes
the Langerhans cells extremely sensitive. They detect the smallest traces of a
substance.
Just a few allergens are enough to activate the Langerhans cells. They fire off
messenger substances which promote inflammation. In addition, "wanted" posters of
the allergen are presented. If a T-helper cell recognizes such a allergen fragment, it
docks and is armed. The cell divides, sends out messenger substances and alarms
additional elements of the immune defence. This overreaction makes the
inflammation worse and damages the skin.
Pollen, food or contact allergens trigger increasingly powerful attacks of the illness in
neurodermatitis suffers, including Silja Beckmann.
Patient: „What bothers me the most is the itching, which is especially bad whenever I
am in a situation which makes it particularly disturbing, if I am in a stress situation or
something like that. Restrictions, situations which you simply avoid also weigh on you.
I'm talking about things like not going to swimming pools, because water irritates the
skin and it starts to itch again, or you notice when you sweat in summer that it gets
worse, and you try to stay home where it is cooler. And then, another thing is that
neurodermatitis, just because it's an illness which you can't hide, is something you are
forced to deal with again and again, because it's something visible."
Neurodermatitis sufferers are trapped in a vicious circle. Constantly itching eczema
increases stress, and stress aggravates the symptoms.
Prof. Schöpf: „We have long known that allergic reactions, especially for
neurodermatitis, but also allergic asthma, we know that they are aggravated by
psychological stress situations. In the meantime, we know several substances which
are released in psychological stress situations, so-called neuropeptides, which in part
activate the immune cells which play the leading role in allergic reactions and thus
aggravate an allergic reaction. On the other hand, stress situations cause the release
of neurotransmitters such as adrenaline which tend to slow down allergic reactions.
This is always a question of balance in the organism."
The salty water in the Dead Sea promises relief for a number of skin diseases. In the
case of neurodermatitis, howeber, the success is rather doubtful. Heat usually
aggravates the symptoms, and the pure sunlight increases the risk of cancer.
Cold-light therapy has proven effective for many patients. A part of the sunlight
spectrum, namely the long-wave UVA radiation, is created artificially. The light calms
the overactive Langerhans cells in the skin and inhibits the undesired defence
reaction. Inflammation and itching which rob many patients of their sleep decrease.
Filters hold back not only the heat rays, they also block the part of the UVA light which
is regarded as carcinogenic.
Doctor: „You can see here that the skin is much smoother, hardly any scratch marks,
all in all much smoother than it was six, eight weeks ago.."
Patient: „"I found out about the cold-light therapy by chance, and it is actually very
successful. The skin is regenerating, the itching is less severe. You feel completely
different, you are a different person, when your skin is healthy again. You can dare to
wear short-sleeved clothing again, so I am highly satisfied."
Allergy research still has a lot of room for new discoveries. Some of the processes
which take place in the immune system have not yet been adequately explained.
Doctors can often only treat the symptoms, but not the causes.
Scientists around the world are working at influencing the misguided immune system
of allergy sufferers more specifically than before. The use of genetic technology could
make it possible to put the defence system back on the right track.
Prof. Schöpf: „One major path of exploration is the better identification of the
chemical structure of the allergens which is responsible for triggering the allergies.
This also has great consequences for the hyposensitization therapy because vaccines
can be produced which contain the triggering allergen, highly specifically and
completely clean, so to speak, in its chemical structures. The second major direction
is the manipulation of the immunglobulin E production in our bodies. Our genetic
disposition as allergy sufferers causes us to produce excess, too much immunglobulin
E, when, after being sensitized, we come into contact with allergens. And this excess
IgE production can be repressed and slowed down today in certain animal models by
substances which are already available. And I believe that in the next few years we
can expect therapeutic developments for humans as well."