1) Listen to the 6th section of the talk and say what the two «musts» are for allergic people.

2. Listen to the part again and complete the sentences:

1) If the person has allergies from pets he should…

2) If the person has allergies to feathers he must...

3) If a person is allergic to dust or dust mites he may…

4) If people are allergic in the workplace they need....

5) If people are allergic to food they must....

3. Answer the questions:

1) What is the first rule for an allergist?

2) What is the mainstay of allergy medications?

3) What is the drawback (недостаток) of the antihistamines produced and sold in this country (according to Dr.Habenicht)?

4) Why are many people afraid of cortisone?

5) What are the side effects of decongestants?

Key words for the 7th part:

desensitization - десенсибилизация

to have an advantage – иметь преимущество

to test for smth – проверять на (чувствительность к)

Listen to the last section of the talk and say what it is about.

1. Explain the term "immunotherapy".

2. What does Prof. Habenicht say about allergy specialists in Barnaul? Is it true?

3. What does he say in his personal address to the students of the Altai States Medical University?

4. Does the job of an allergist appeal to you? Why or why not?

After listening

Ниже приводится 5 фрагментов текста об аллергии.

1. Просмотрите их содержание. Найдите ответы на следующие вопросы.

2.Пронумеруйте фрагменты так, чтобы их расположение соответствовало последовательности заданных к ним вопросов.

1. What are the common allergy symptoms?

2. Why are some people allergic to some substances and others not?

3. How does a doctor determine the cause of an allergy?

4. What treatment can be given for an allergy?

5. Are there any dangerous allergic reaction?

The doctor usually gets a detailed history from the patient to find the most likely source of the problem, and may then carry out a skin test. A weak solution of the substances that are suspected is injected into the skin. A red reaction indica­tes an allergy to that particular substance. Sometimes a PATCH TEST is done for the same reason.

An allergic reaction to an insect sting or antibiotic drug, such as penicillin, is potentially dangerous and can even be fatal. A mind reaction usually causes a rash. But in a violet one, called ANAPHYLAXIS, patient finds breathing increasingly difficult. This is an emergency condition and a doctor should be consulted urgently. Fortunately, the condition is not common.

A running nose and watering or itching eyes are familiar to many persons who suffer each year from hay fever. In asthma, there is wheezing: with eczema and hives there is itching, red­ness, and lumps. Contact dermatitis, an inflammation of the skin, may occur possibly from wearing rubber gloves or touch­ing a certain chemical, such as some kinds of soap. A reaction to antibiotics, particularly penicillin, may be in the form of rash.

Partly this is due to hereditary factors; some families seem to be more liable to allergies than others, although particul­ar allergies are not necessarily inherited. Sometimes emotional disturbances can have an aggravating effect on the underlying allergic condition, and can cause it to become worse in a way that is not fully understood.

When the cause of an allergy is known, the patient can under­go desensitization with injections of the allergen known to cause the symptoms. Beginning with a weak solution, the dose is gradually increased over a period of weeks until a strong solution is reached and the patient is immune to its effects. If the cause of the allergic reaction is not known, or if the reaction is already taking place, a doctor may prescribe ANTIHISTAMINE pills or corticosteroid nasal and lungs sprays to Control the symptoms.

Text

Hello, I'm doctor Habenicht, a medical doctor from America, a board-certified allergist, and I account this a privilege to able to talk to you today about the area of allergies. I’m sorry that I can’t speak in Russian but your good teacher help you to make this understandable. I do hope.

In my country, allergy is a very important medical problem. We figure that, perhaps some 58 mln. Americans suffer with some form of allergy. That is about one person out of every four. That makes it the most common reason that patient go to see a physician in their office. About 41 mln. of these suffers have upper respiratory allergies that we might call allergic rhinitis, about 10 mln. have bronchial asthma and about 25 mln. have some skin form of allergy like eczema, or poison ivy, or some industrial dermatitis. The total of those, as you can see, is more than 58 mln. But that’s because there is a lot of overlap, and some people can have more then one form of allergy. In fact, we know that 78% of people with bronchial asthma will get hay fever at some time in their life, and 48% of hay fever patients will some time or another become asthmatic. If a baby has asthma before he starts to school, you can be sure that he has had eczema when he was an infant.

Let’s talk about how you can work up the allergic patient. The most important thing to do is take a careful medical history. Let the patient tell you why he is having trouble, and what kind of trouble he has. In fact, there are some very important words that you must use as you take medical history. These are words like “where”, “what”, “when”, “why”, "who"? Let me give you some examples. Let’s start with the word "where". You might say, " Where are you bothered?" and the patient will res­pond "My eyes", and then you say, " what happens there?" And they will answer. "They get red. They tear. They run. They itch I want to rub them." That is important. They may say. " My nose" when you ask "Where?.", and then they will say, "It's plugged up. I can’t breathe. It’s stuffy. I can't sleep at night because I have to breathe through, my mouth. My mouth gets all dry at night. Sometimes the ladies will say “My husband is snoring, and he makes so much noise I can't sleep”, and some will say, "I have to use many tissues, many handkerchiefs, because I blow the nose so much". Sometimes a dentist will send a patient, particularly a child, because their teeth are malformed from so much, mouth breathing. Sometimes, when you ask the word " where", the patient will say , " My lungs", and they will say, "I cough", or "I wheeze", or they will say " My skin bothers me, and then you will know that they have eczema.

Sometimes you have to be a detective and find out what the skin problem is. I remember a young lady who had rashes on her buttocks, and we found out it was the rivets in her Levi's in her jeans that were causing her to have a contact dermatitis. Sometimes there are reactions when the ears had been pier­ced. Sometimes the irons will react because a watch or a bracelet is causing them to have a contact dermatitis to the metal of their bracelets.

The next question we ask after we say "Where?" is "When"; “When do you suffer your problems?” This is a very important clue, to know when they are having trouble. If they say, in America," My nose runs in the month of May or April", then we know it is the trees that are blooming at that time of year. If they say, "I have asthma" or «I have allergic rhinitis in June or July", we know that's when the grasses are blooming. If they say, “my worst problems are in August or September”, then we know that the weeds are the problem.

We have a special weed, only in America, that’s called rag-weed, but it’s the worst pollinator that causes the most difficulty. But as I walked through the streets of Barnaul, and walked down along the Ob River I see many weeds that are a meter high, and I know you must have people suffering with allergies right now, at the end of August. Also, when we say «When?" we must say «What happens when you are around animals?" Do you have trouble when you are around a dog or around a cat?, or we ask "When do you have trouble?" and they may say "When it rains". When people are worse when it's raining, we know that it is the mold that is causing their difficulty.

The next question we ask is "Why do you have trouble?" , and they will say, " I nave trouble when I exercise, and we know that these people have exercise-induced asthma, or they may say " I have trouble when I’m outdoors, and then you can sus­pect it’s more the pollens, or they may say “I have trouble I’m around cigarette smokers”, then we know it is the smoking that bothers them. Others will say “I only have trouble when I’m in my house and then we can suspect it may be a cat or a dog or a pet that is there. Someone will say, “I only have trouble when I am down in the wet, damp basement or in one of the food cellars" and then we know that once again mold is causing the trouble.

The next question we ask is «who? » what people are involved? We must ask about mother and father “Do they have allergies?" We know that the allergy gene which we call the atopic gene is a very important part of all the allergies, it is a recessive gene, which means that it must come from both mother and father. There must be allergy in the family history. This allergy may take the form of asthma, or hay fever or eczema, or food allergies, or medication allergy, or an insect allergy (or sting allergy), it may be a migraine headache allergy. Usually, if one patient... sorry if one parent has allergies, 40% of the children will have allergies. When both parents are allergic, then up to 75% of the chil­dren will have allergies.

Now let’s talk about some basic immunology that’s important to understand allergies. The most important cell for allergies we call lymphocytes which are found not only in the blood, but they also grow out into the tissues where they do most of their work.

There are two kinds of lymphocytes depending on the source where they come from, T-lymphocytes come from the thymus gland, B-lymphocytes come from the mar­row. About 80% of our lymphocytes are T-lymphocytes, 20% are B-lymphocytes.

T-lymphocytes can be divided into helpers and suppressors. These are about twice as many helpers as there are suppressors. Today we're not talking very much about T-lymphocytes. It’s enough to say that they are responsible for poison ivy, for leprosy for tuberculosis, for brucellosis... and AIDS, or the Acquired Immune Deficiency syndrome. In the Human Immune Deficiency Syndrome, virus attacks T- cells, and then destroys them. Since these T-cells regulate the activity of B-cells, the entire immune system comes to a halt with a disastrous result, and always a fatal result.

The B-cells, the ones that come from bone marrow, also from the lymph nodes, make immunoglobulin. Each clone of .B- cells makes just one type of immunoglobulin. The immunoglobulin called Ig-E is a common hemoglobuline. This is the kind of immunoglobulin your doc­tor gives you as that you might not get, hepatitis if you have some contaminated food. Ig-M, the immunoglobulin of the M-type, comes from mother’s milk. Ig-A, the A-type is in saliva and in tears. This is the one, which, when absent, causes much more thymus infection, or even more ear infection, upper respiratory infecti­ons. The absence of the Ig-A is the most common cause of immuno­deficiency. Ig-E is the immunoglobulin that's responsible for allergies, and the rest of this talk is going to be about Ig-E. Ig-E was discovered very recently only in 1966. The same year it was discovered by Drs. Ishisaka at the Johns Hopkins University in America, and Dr. Joe Hanssen at Karolinska institute in Sweden. Dr, Hanssen worked with plasma cell myomas, and Dr. Ishisaka worked with, students from the Student Health Department of the University who suffered with rag-weed.

Ig E causes its damaging effects in allergies when it combines with every specialized cell called a mast cell. We don't know a lot about mast cells, we don't even know where in the body they are formed, but we do know that they line the nasal passages, the lung alveoli, the conjunctiva of the eyes, the gut, and the blood vessels in the skin. And mast cells contain histamine, a little vacuoles wit­hin the cell. All allergy problems come when some Ig-E attaches to a receptor on the surface of the mast cell, causing the mast call to degranulate or to release histamine into the tissues.

When this happens in the nose, we call it allergic rhinitis, when it happens in the eyes, we call it allergic conjunctivitis. When it happens in the lungs or along the surface of the lungs, we call it bronchial asthma. When it happens in the gut, you call it food allergy, whether that may be diarrhea, or cramps, or vomiting, or pain. If this reaction of the mast cell releasing histamine because of the Ig E mechanism, if this takes place in the skin, we have atopic dermatitis or hives or urticaria. The most serious problem in allergy we call anaphylactic shock. This is a massive discharge of histamine in many areas of the body. The blood pressure drops, the pulse becomes weak and irregular, the skin itches all over and giant hives may develop. Wheezing and respiratory ob­struction occur. There may be nausea or vomiting or diarrhea and cramps, even convulsions may take place, and the person has a sense of impending doom. This actually may be a fatal process. This is what happens in the bee-sting reaction, which only in the United States of America kills about 40 mln. people every year. This is also what takes place when people eat peanuts or some other nut that causes them to have anaphylaxis, or it may be from penicillin or from horse serum. People with this serious problem, to pre­vent sudden death rare taught how to use... to teach themselves to administer adrenaline or a penicillin which they carry in a specially packed syringe with them day and night, all time becau­se they may not have the time to get to doctor's office hospital.

What can be done to help these allergic people? The first ru­le is to find the offending antigen. Antigen is the name that we give to the protein in the substance causing the allergies.

Let me give you some examples. If the person has allergies from cats, to avoid this cat will be to get rid of the cat or avoid visiting home where cats are present. The same may be true of a dog or some bird pet if the person is allergic to fe­ather pillow or their down jacket. If the person is allergic to dust mites, they may wish to clean more at home, to use the va­cuum-cleaner more carefully, to take up the rugs from their bed­room floor and put down wood floors or linoleum. It may help to put in air-conditioning system or some filter system. If people are allergic in the work-place, then they need to change jobs or to find a new place to work. And there are always those people who are smokers. This is something that can be got rid of by stop­ping smoking. It isn't only the patient who you need to think of, but the children who live in the homes where there are smokers.

When mother and father are smokers, there are more ear-infections in children, and may be two to five times as many hospitalizations for bronchial asthma. Avoidance may also be ... to avoid some food, such as chocolate or nuts, also a common allergy is to milk, and these people must find other ways to eat besides using milk and cheese and dairy products. Sometimes it's very helpful to have a consultation with an allergist to figure up the details of what to avoid.

After avoidance, though if avoidance is not enough, they may be able to use some type of medication. The mainstay of allergy medication we call antihistamines. These are ones which in Ame­rica will be called Benedrol, or chlorophenilamine, but as I've looked at the pharmacy here in Russia, I see that you have a number of antihistamines as well. Unfortunately, you do not yet have antihistamines in this country that are commonly available, that do not make people sleepy. But we have, in many parts of the world, non-sedating antihistamines that are very helpful.

Another kind of medicine is called a decongestant. The only problem is that decongestants raise the blood pressure, and may increase the heart rate.

There are new sprays of decongestants that should be avoided so because they quickly form a habit and the person becomes addic­ted to their use. There are however, cortisone or steroid nasal sprays which are very helpful for people who suffer with aller­gic rhinitis. There is another medication used in many parts of the world that is called cromalin sodium. This can be used in the nose; it can be used in inhaled form in their lungs for the people who suffer with asthma.

Before I finish talking about allergic medicati­ons, I should say something about, the use of cortisone when used internally. Many people are afraid of cortisone because of the side-effects, but it can be used with care.

When a person has a lot of allergy it is indispensable if you are« having anaphylaxis or severe bronchial asthma. Many times a shot or pills will take off the allergy for several weeks.

The last area I wish to tell you about, which hopefully will be available to you if not at the present then in the near fu­ture is what we call immunotherapy or allergy desensitization. This is where the allergy doctor has greatest advantage because here we can do allergy skin tests and find out what kind of allergy the person has, and actually develop the serum that will be given in injection form on a weekly basis to cure, if you wish to use that expression, the person’s allergy,

Allergy testing is very helpful, we can test for dust, we can test for molds, we can test for cats and dogs, we can test for foods, we can test for plants, and this is helpful to know how to prepare the proper vaccine. I think that it is important when we have more of your students in Russia preparing to help people in the area of allergy I understand that there is one allergy specialist in your whole city here, and I’m sure that she is a very, very busy lady. Perhaps some of you as you listen to this tape will wish to become experts in this area and to become specialists in the area of allergy also.

I do hope that this information has been helpful to you. I’m sorry that I was here visiting during the holidays. I could not meet you personally, and look into your face and get acquainted with you and greet you and learn of your special problems.

Bronchial asthma