›› Lactose intolerance
What is lactose intolerance?
| Lactose intolerance is very common in Asia and Africa. For people with this disorder, a glass of milk can cause abdominal pain and diarrhoea due to the inability to absorb lactose. |
Lactose intolerance is the inability to absorb lactose - the predominant sugar in milk - into the digestive system. If lactose is not absorbed properly, it ferments and this results in abdominal pain, a bloated stomach and diarrhoea.
What causes lactose intolerance?
Lactose is a disaccharide, which means that it is composed of two other sugars bound together. In order for lactose to be absorbed, it must be split into those two smaller sugars. This split is performed by an enzyme called lactase, which is present in the lining of the small intestine.
If the levels of the lactase enzyme are low or absent, then that splitting does not occur. The lactose is fermented by the bacteria in the large intestine and this produces excess gas and stomach rumbling and leads to diarrhoea.
Lactase activity is high in babies and declines as the amount of milk in the diet decreases. Some people may have very low lactase levels but not have any symptoms. The reason for this is not known.
Who is at risk of developing lactose intolerance?
Most adults in northern Europe and North America are able to absorb lactose. However, the majority of the world's population is lactose intolerant.
- People who have had major bowel or stomach surgery, or suffer from coeliac disease are often lactose intolerant until the underlying condition is treated.
- Many people become lactose intolerant for a few days after they have had diarrhoea. This is because the lining of the small intestine has been slightly damaged by the disease, thereby reducing the production of lactase.
What are the symptoms of lactose intolerance?
- Stomach rumbling, abdominal distension and increased wind.
- Diarrhoea.
- Abdominal colic.
- Nausea.
What can I do to help myself?
- If you are suffering from diarrhoea, or have recently recovered, cut down on dairy products.
How is lactose intolerance diagnosed?
'The domestic method' - avoid eating foods that contain lactose for a couple of days and then drink two to three glasses of milk. If you get a stomachache or diarrhoea within half an hour, you are lactose intolerant.
If you wish to have your suspicions confirmed, you will need one of the following more formal tests.
- The lactose tolerance test - your doctor measures your blood sugar levelsbefore and after you drink a liquid containing lactose. If the blood sugar goes up with this test, then you are not lactose intolerant.
- The breath test - you are given a lactose solution to drink and the doctor analyses your breath for hydrogen gas, which is only present if the lactose is fermented.
- An analysis of a sample from the lining of the small intestine is obtained during an endoscopy, which involves inserting a small tube into the stomach.
How is lactose intolerance treated?
It depends on the severity of the symptoms. People with mild symptoms may feel better simply after reducing the amount of dairy products in their diet.
For those with severe symptoms, a formal lactose-free diet should be adopted. This is best achieved by a consultation with a dietitian, which can be arranged through a GP.
The symptoms of lactose intolerance vary greatly. Some sufferers can easily manage cream in their coffee whereas others get diarrhoea from even a small amount of lactose. Yoghurt may be tolerated by some while other lactose-containing foods may not be.
Lactose intolerance is a harmless condition. If for any reason, you are unable to follow your diet, you are not in any danger, and you will not damage yourself in any way. However, the symptoms may well recur.
Which foods contain lactose?
- Milk, butter, margarine, fermented milk products, yoghurt and cheese.
- Milk powder.
- Bread and other baked goods - read the label to check.
- Prepared foods - again, read the label.
- Chocolate.
- Many types of tablets.
›› House dust mite allergy
What is house dust mite allergy?
House mite allergy is a hypersensitive reaction to proteins in the excretion of dust mites. The protein attacks the respiratory passages causing hay fever and asthma. It will aggravate atopic dermatitis in people who have a tendency to this problem.House dust mites are found in all homes. They are microscopic organisms that thrive in warm and humid houses with lots of food - human skin. The mites prefer to live in beds and, because we spend about a third of the day in bed, we inhale large quantities of dust mite allergens.
How do you become allergic to house dust mites?
The excretion of the mites contains a number of protein substances. When these are inhaled or touch the skin, the body produces antibodies. These antibodies cause the release of a chemical called histamine that leads to swelling and irritation of the upper respiratory passages - typical asthma and hay fever symptoms. The predisposition for allergy is often hereditary.
Unlike pollen, dust mites are present all year round causing constant allergy - 'perennial' allergic rhinitis. The excretion from the mites dries out and can be launched into the air when someone walks over a rug, sits down in a chair, or shakes the bed clothes, giving allergic people immediate symptoms.
What are the symptoms of house dust mite allergy?
- Hay fever, runny nose, itching, sneezing.
- Watering eyes.
- Asthma, difficulty in breathing.
- Infantile eczema (a skin disease) may get worse.
What makes the symptoms worse?
- Air pollution such as tobacco smoke or car fumes.
How does the doctor make the diagnosis?
It is often enough to tell the doctor when, where and how you get the symptoms. Skin tests and various blood tests can be used for confirmation.
Good advice
It is best to do everything possible to avoid hypersensitivity to house dust mites. People who have perennial rhinitis, inflamed mucous membrane of the nose, or are allergic to house dust mites should try to adapt their homes.
- Have as little furniture as possible in which mites can live.
- Clean walls, woodwork and floors with wet cloths. The floor can be polished.
- Only use rugs that can be washed once a week.
- Use bedding that can be washed often, cotton sheets, washable bottom sheets and synthetic blankets or duvets. Don't use woollen blankets or quilts.
- Make sure your chairs are made of wood or plastic.
- If you can, use plastic curtains and dust them daily.
- Use wet cloths and a vacuum cleaner with a no bag vortex and allergen filter to clean the house thoroughly, preferably every day, but at least twice a week.
- Avoid dust traps like teddy bears, cushions, dried flowers, bric-a-brac and toys.
- Wash bedding etc at a temperature of at least 60°C to kill the house dust mites.
- Leave bedding, duvets, pillows and mattress hanging outside for an hour every day or as often as practical.
- Put duvets and pillows in plastic bags and put them in the freezer for 24 hours at least once a month.
- You may want to sleep on a cheap mattress that you can exchange for a new one at least every six months.
- Dust mites hate dry and cold air, so try to air the house every day and don't use an air humidifier, which will only make matters worse. If the lower edge of the window is moist when you wake up in the morning, there is too much humidity in the air.
- Do not spray the house, it may worsen your symptoms.
- Do not touch dusty objects like books and old clothes.
- When you are likely to be exposed to substances that give you a reaction, eg when you are house cleaning, you should wear a mask.
- Don't allow smoking in the house.
What complications are possible?
- You are predisposed to other respiratory diseases.
- You are also predisposed to otitis, inflammation of the ear.
- You may have trouble sleeping and suffer from chronic fatigue.
- Hospitalisation following a severe asthma attack.
Future prospects
If you are allergic to house dust mites, it is important that you don't expose yourself to the dust mite allergen because it increases your chances of developing asthma. The best remedy against house dust mites is described under the heading 'Good advice' above.
Your symptoms can be controlled by treatment, but you can't escape your hypersensitivity. If severe dust mite allergy is the only form of allergy you suffer from, your doctor may want to try hyposensitisation - a 'vaccination' against the allergen. This tolerance treatment involves regular allergen injections in increased doses over a period of five years, but is not routinely given and is not always successful.
What medicine is given?
Medicines for allergies include:
- Antihistamine tablets or syrup (eg loratadine, cetirizine). These lessen the allergic reaction by blocking the actions of histamine. They relieve hayfever symptoms.
- Nasal sprays or drops containing sodium cromoglicate, corticosteroids (eg beclometasone) or antihistamines (eg levocabastine). These can be used to reduce nasal inflammation and control symptoms in the nose.
- Eye drops containing sodium cromoglicate, nedocromil, or antihistamines (eg azelastine) reduce eye inflammation and can be used if eye symptoms are a particular problem.
If the allergy causes asthmatic symptoms, some of the asthma medication below may be used
- Relievers (bronchodilators): these are quick-acting medicines that relax the muscles of the airways. They are used when required to relieve shortness of breath.
- Preventers: these act over a longer time and work by reducing the inflammation within the airways. They should be used regularly for maximum benefit. When the dosage and type of preventive medicine is correct, there will be little need for reliever medicines.
Relievers
There are three groups of bronchodilators.
Beta-2 agonists
Beta-2 agonists cause the airways to relax and widen. Examples of those which act for a short time (3 or 4 hours following a single dose) are salbutamol and terbutaline. These medicines are inhaled from a variety of delivery devices, the most familiar being the pressurised metered-dose-inhaler (MDI). When inhaled, these types of medicines work within minutes to open the airways, making breathing easier.
Longer-acting beta-2 agonists include salmeterol and formoterol. Their action lasts over 12 hours, making them suitable for twice daily dosage to keep the airways open.
Anticholinergics
One of the ways in which the size of the airways is naturally controlled is through nerves that connect to the muscles surrounding the airways. The nerve impulses cause the muscles to contract, thus narrowing the airway. Anticholinergic medicines such as ipratropium block this effect, allowing the airways to open. The size of this effect is fairly small, so it is most noticeable if the airways have already been narrowed by other conditions, such aschronic bronchitis.
Theophyllines and aminophylline
Theophylline and aminophylline are given by mouth and are less commonly used in Britain because they are more likely to produce side effects than inhaled treatment. They are still in very wide use throughout the world.
All three types of reliever can be combined if necessary.
Preventers
There are three main groups of anti-inflammatories.
Corticosteroids
Corticosteroids (or 'steroids') work to reduce the amount of inflammation within the airways, reducing their tendency to contract. They are usually given as inhaled treatment, eg beclometasone, although sometimes oral steroid tablets may be required for severe attacks. Although steroids are powerful medicines with many potential side effects their safety in asthma has been well established. It is also important to balance the problems that arise from poorly treated asthma against the improvement in health which occurs when the condition is well treated.
Cromones
There are two kinds of cromones: sodium cromoglicate and nedocromil. They also act to reduce inflammation of the airways. They tend to be best for mild asthma symptoms and are more effective in children than adults. The medicines are given by inhalation and are usually very well tolerated.
Leukotriene receptor antagonists
Leukotriene receptor antagonists are compounds released by inflammatory cells within the lungs and which have a powerful constricting effect upon the airways. By blocking this effect with these antagonist medicines the constriction is reversed. There are two such medicines currently available: montelukast and zafirlukast.
Most cases of allergic asthma are best controlled with an inhaled corticosteroid, eg beclometasone, which is taken at regular intervals as a preventative measure. A beta-2 agonist, eg salbutamol, is used in conjunction with this to relieve symptoms when necessary. For patients who have associated perennial or seasonal allergic rhinitis (hay fever) the use of an antihistimine, eg cetirizine, is often useful.
›› Hay fever: complementary therapies
Hay fever affects 15 to 20 per cent of the British population. But are you one of many who is prescribed medication, yet struggles to get relief from your symptoms?
| Try alternative treatments. |
We look at whether the natural way is the way forward.
What is hay fever?
Also known as allergic rhinitis, hay fever is caused by an allergic reaction to pollen that is breathed in, or that gets into the eyes.
The pollens that are most likely to cause hay fever are birch pollen, which is released in March, and grass pollen, which starts to appear in late May.
But you can get hay fever at any time of year depending on what type of pollen you are allergic to.
Word of caution
Please note that studies have not established whether alternative treatments are as good or better than conventional medication.
Although some people find them helpful, in general there is conflicting clinical trial evidence as to their effectiveness.
The condition can interfere with your concentration, energy levels and sleep. Many of us resort to antihistamines, decongestants and nasal steroids to get some relief.
But a growing number of drug-free approaches are available for preventing and reducing symptoms.
A recent One Poll survey found that 72 per cent of people prefer a natural alternative to conventional hay fever medicine, such as acupuncture or homeopathy.
What alternative treatments are available?
Herbal remedies
Herbal extracts can improve hay fever and asthma symptoms by reducing the immune systems' allergic response and easing inflammation.
You could try a herb called butterbur petasin (Petasites hybridus), which acts as an anti-inflammatory, a muscle relaxant (anti-spasmodic), and pain reliever (analgesic).
A small study published in the British Medical Journal found that after two weeks the effects of butterbur, compared to the antihistamine cetirizine, in controlling hay fever symptoms were similar. There were also fewer side effects, such as drowsiness.
Homeopathic help
A Vogel Luffa Complex is a nasal spray that contains a blend of seven anti-allergy herbs, including galphimia glauca. There is some evidence that this particular ingredient can ease sneezing and itching of the nose, throat and eyes.
Containing minute traces of red onion, eyebright and sabadilla, Pollenna is a homeopathic remedy designed to relieve hay fever sufferers of sneezing, nasal irritation and a runny nose.
For best results take Pollenna when hay fever symptoms first appear. Suck or chew tablets at two hourly intervals, six times a day, then three times daily until symptoms subside.
'While there isn't any clinical evidence to show the effectiveness of these remedies, they can be effective in relieving and reducing symptoms,' says Dr Flemming.
The best thing to do is visit a registered homeopath or GP pr pharmacist with interest in homeopathy to discuss treatment options.
Infrared light
It may not be the most flattering way of tackling your hay fever, but by placing two probes that emit infrared light into your nostrils, you could help prevent and reduce hay fever symptoms.
Although scientific data behind the hand-held product Medinose is limited, a trial at Tel Aviv University revealed that 72 per cent of hay fever patients reported a reduction in symptoms and an improvement in their overall condition.
Reduce inflammation
' The infrared light consists of wavelengths that have been found to reduce inflammation and trigger healing of the nasal membranes,' explains Dr Flemming.
Membrane protector
Care allergy defence is a cellulose powder that when applied to the nasal passage forms a coating that traps allergens and prevents an allergic response.
Some clinical studies have found Nasaleze effective at reducing itching, irritation and a runny nose.
A study at the University of Stellenbosch in South Africa revealed a 77 per cent success rate in the ability of Nasaleze to control hay fever, with 102 people taking part in the trial (66 female and 36 male).
'Apply this regularly during hay fever season to reduce and prevent symptoms,' says Dr Flemming, GP with an interest in allergies. 'Used in the long-run, this type of treatment may prevent your hay fever or allergies from getting worse.'
Applying a little Vaseline just inside the nose may also be useful for protecting the nasal membranes from pollen.
Nasal cleansing spray
Sterimar is nasal spray that contains pure and natural sea water. It can be used to cleanse and clear the nasal passages, removing pollen, dust and other airborne allergens from the nose and stopping them from causing irritation.
Sterimar is a medical device that can be prescribed on the NHS and is recommended by Allergy UK as one of the most effective ways of relieving hay fever symptoms.
You spray the product into the nostrils two to six times a day, or more if necessary, and allow the excess solution to drain away before blowing your nose.
Two strengths are available; Isotonic 'Nasal Hygiene', which has the same concentration of salt as the cells in your body, and Hypertonic 'Blocked Nose', which has a higher salt concentration and a stronger decongestant effect.
Sterimar can be used on its own, or in combination with hayfever medicines.
The air you breathe
You could try using an air purifier to remove pollen, dust and other potential allergens from the air at home or work.
Air purifiers contain carbon filters to absorb unpleasant odours, filters to remove large particles.
An air ionizer creates ions that remove microscopic particles from the air. By minimising the root cause of hay fever and other allergies, you may reduce your need for medication, although this isn't conclusive.
People who suffer from hay fever often find that their symptoms are worse in rooms that are humid.
In this case, try using a dehumidifier to reduce mould and mildew growth by reducing the moisture in the air.
Immunotherapy
This involves being given low doses of the pollen that causes your hay fever in order to desensitise the immune system to it.
Grasses, rye or tree (Alder, Birch or Hazel) pollen allergies can be treated with injections of Pollinex.
A pill form is also available for reducing the symptoms of hay fever caused by allergy to timothy grass pollen.
Grazax sublingual tablets contain an extract of this particular pollen and are taken once a day, starting at least four months before the pollen season for up to three years.
These prescribed treatments are aimed at people who don't respond to conventional medication.
They will only work for preventing hay fever caused by allergy to these specific pollens.
Your diet
Garlic
Garlic is great for boosting your immune system. A source of quercetin and B-group vitamins, garlic is also a natural antihistamine, anti-inflammatory, antiviral and decongestant, and can help reduce inflammation and excess catarrh.
Local honey
While evidence remains anecdotal, Dr Adrian Morris of the Surrey Allergy Clinic recommends taking a tablespoon of local honey every day to reduce hay fever symptoms, starting a few months before the pollen season.
‘Traces of local pollen in the honey may ‘desensitize’ the immune system so that it doesn’t react as strongly to airborne pollen,’ he says.
Most commercial honey is heat-treated and won’t be local, so is unlikely to have these benefits. Instead, look out for organic, local honey at farms.
Green tea
A cup of green tea contains catechins, which are powerful antioxidants that help maintain a healthy immune system and reduce inflammation. Aim to drink two or three cups a day, especially in the hay fever season.
Fruit and vegetables
By eating your five a day, you’re helping to stock up on allergy-fighting flavonoids as well as vitamin C, which acts as a natural antihistamine.
Aim to eat as much raw or lightly-cooked vegetables as you can.
Camomile tea
This herbal tea contains essential oils bisabolol and chamazulene, which can reduce inflammation and calm allergic reactions. The tea also has calming properties which may help reduce the anxiety that can be linked to hay fever symptoms.
What else can I do?
While there is still insufficient evidence for the effectiveness of the numerous complementary and alternative medicines that are available, there are some basic lifestyle changes that you can make to help minimise your hay fever symptoms.
Try the following:
- keep an eye on the pollen count and stay indoors as much as you can when it's high
- wear wrap-around sunglasses to stop pollen getting in your eyes
- keep car windows closed and switch on the air conditioning to prevent pollen entering the car
- keep bedroom doors and windows closed mid-morning and early evening when pollen levels peak
- avoid areas such as parks or fields, particularly in the early evening when there's a lot of pollen floating at nose level
- get someone else to mow the lawn and don't lie on freshly cut grass
- shower and wash your hair after being outdoors, especially if you’ve been in the countryside.
Firework safety advice
Since the Chinese made the first fireworks in the ninth century, exploding them at New Year to ward off evil spirits, fireworks have continued to provide a spectacular source of enjoyment.
But they can be dangerous, and every year hundreds of people are injured on Bonfire Night.
Displays are getting bigger and more spectacular, but they are also more likely to cause serious harm if fireworks are used improperly.
We talk to John Simpson, a senior London Fire Brigade officer, Rebecca Lefort from the Red Cross, Mr John Grindle, a consultant ophthalmologist and Dr Thomas Stuttaford about how to enjoy the celebration safely.
Preparing for your firework display
| Only buy fireworks from a reputable shop and look for the BS 7114 or CE mark. |
'Fireworks can be thrilling, but they are explosives and can cause injuries if handled irresponsibly,' warns John Simpson.
'A trip to hospital, or wrecked property, will certainly make you remember the 5th November – but for all the wrong reasons! It's safer to attend an organised event.
'But if you are planning your own display, only buy fireworks from a reputable shop and look for the BS 7114 or CE mark, which indicates that fireworks meet British or European safety standards. Don't risk buying fireworks from an unlicensed market stall or car boot sale.'
It can help to have:
- a metal box with a lid to store fireworks
- two buckets of water and earth
- a fire extinguisher
- goggles and gloves.
Instructions can be difficult to read by torchlight – so read them beforehand during the day.
Never attempt to decipher them by lighting a match. Get pets out of the way too, keeping them indoors, with windows and curtains closed because animals get scared by the flashing lights and bangs from fireworks.
'Do check that the base of your rockets have been properly secured before lighting them because they can reach speeds up to 150 miles per hour,' says Dr Stuttaford.
'At a friend's Bonfire Night party, when my children were small, the milk bottle holding a lit rocket tipped because it hadn't been dug deep enough into the sand. The rocket zoomed off sideways and missed a child by inches. If you're planning to set off Catherine Wheels or rockets, build suitable supports and launchers.'
Lighting fireworks
'Never play with fireworks,' cautions John Simpson.
'Only adults should handle fireworks, and even then should light them with tapers at arm's length – then stand well back.
'If a lit firework doesn't go off – don't return to investigate – because it could still explode. Never store them in your pocket, throw spent fireworks onto a bonfire. Don't drink alcohol if you are responsible for letting off fireworks.'
Mr John Grindle warns that fireworks and bonfires give off sparks and debris, which can land in the eye, cause pain and even damage your vision.
'To protect your eyes, wear goggles that fit you properly and conform to European Standard BSEN 166, when lighting fireworks,' he says.
Children and sparklers
| Only give lit sparklers to children over five, and never leave children alone playing with them. |
More children than adults get hurt by fireworks. Even humble sparklers are a major cause of burns as they can reach 2,000 ºC – 20 times the boiling point of water.
To avoid injuries, light sparklers one at a time – preferably wearing gloves. Ask children to stand back whilst you're lighting them.
Only give lit sparklers to children over five, and never leave children alone playing with them.
Once they've been used, dunk the hot end of the sparkler into a bucket of sand. Beware of children's loose clothes, such as scarves, catching alight.
'If someone does get a minor burn, firstly cool the area affected under a running cold tap for 10 minutes,' advises Rebecca Lefort from the Red Cross.
'Then loosely cover it with cling film or a plastic bag to keep it clean.'
Dangers of bonfires
Bonfires can collapse unpredictably – sideways, as well as inwards – so it might be necessary to fence off a boundary, especially if there are small children about.
'Whilst working in Accident and Emergency at a London Hospital, a young child was brought in who had sustained severe burns when a bonfire had collapsed over him because he had been up close looking at the burning Guy,' says Dr Stuttaford.
Also beware of lighting bonfires close to trees.
'On another Bonfire Night, a relative lit a fire in a woodland clearing. Transfixed by the fireworks, we didn't notice sparks setting light to the bough of a nearby tree until the burning branch came crashing down, narrowly missing us – singeing our coats.
'Remember, all clothes, even those labelled low flammability can catch fire.'
| Bonfire Night first aid kit |
|---|
| Plasters in assorted sizes. |
| Sterile wound dressings for minor wounds. |
| Triangular cloth bandages for hand or arm injuries. |
| Safety pins, disposable gloves and scissors. |
| Non-alcoholic cleansing wipes for cleaning hands, cuts and grazes. |
| Adhesive tape to secure bandages. |
| Sterile gauze swabs to clean wounds. |
| Ice pack to reduce swelling and pain. |
| Tweezers to pick out splinters. |
| Thermometer to assess body temperature. |
More information
British Red Cross: easy to learn, easy to remember everyday first aid.
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