The Gen XY Lifestyle
Singapore’s Allergy Challenge: A Doctor’s Perspective
Over the past two years, I have seen a definite increase in the number of patients coming to my clinic for allergy-related concerns. It is not uncommon to see two to three new patients per week, most of whom are teenagers or young adults seeking allergy tests and treatment.
This trend aligns with broader reports, such as the alarming 60 percent increase in paediatric food challenge(*1) sessions at NUH and KKH from 2022 to 2024.
Although this rise may be partly due to greater parental concern and awareness, it highlights allergies as an emerging and significant health issue affecting both children and adults in Singapore.
Understanding Common Allergies and Their Challenges
In Singapore, common allergies are often triggered by environmental factors that thrive in our warm and humid climate. House dust mites are a prevalent allergen, capable of causing a range of symptoms from respiratory issues like a runny nose and itchy eyes to skin conditions such as allergic and contact dermatitis.
The high humidity also encourages mold growth in places like bathrooms and air-conditioning units, with mold spores being particularly potent allergens for asthma sufferers.
Furthermore, air pollution, especially during regional haze seasons, can act as another significant trigger for respiratory allergies.
While all allergies can impact a patient’s quality of life, skin-related allergies are particularly difficult to treat and manage. This is because symptoms tend to be more persistent, and it can be extremely challenging for patients to completely avoid the allergens that trigger their skin flare-ups.
Food and drug allergies, on the other hand, often present a more serious risk. While environmental allergies can be fatal due to poorly controlled asthma, food and drug allergies can quickly lead to anaphylaxis—a life-threatening reaction that affects breathing and blood pressure. Common food culprits include seafood, nuts, and eggs, while drug allergies often involve NSAIDs.
Separating Fact from Fiction: Common Misconceptions
There are several widespread misconceptions about allergies that can hinder proper diagnosis and management. The first is the idea that children will always outgrow their allergies. While this can happen, many allergies, especially to things like nuts and shellfish, can persist well into adulthood.
Another common belief is that “natural” products are safe for everyone. This is a dangerous assumption, as many natural foods, such as honey and peanuts, are potent allergens.
Patients are often surprised to learn that you can suddenly become allergic to a food or substance you’ve been exposed to for years. Our immune system is constantly adapting, and sometimes it decides to overreact to a familiar protein.
A comprehensive allergy test is the best way to get an accurate diagnosis. It is also important to remember that allergy tests are not 100 percent accurate, and there is a possibility of false negatives. Therefore, if you suspect a particular food or substance is a trigger, it is always safer to avoid it, even if a test comes back negative to prevent recurrent or persistent allergic symptoms.
The ‘Why’: Factors Contributing to the Surge
The rising number of allergy cases can be attributed to several factors. Increased awareness among parents and healthcare providers, combined with improved diagnostic tools, means that more cases are being identified and reported than ever before.
However, there are also broader changes in our lifestyle and environment at play. Diets which are low in fibre and high in ultra-processed foods, may disrupt our gut microbiota and immune system, potentially leading to a higher incidence of allergic conditions.
Additionally, living in a densely populated, urban environment has its own set of challenges. We are constantly exposed to indoor allergens like dust mites and mold, which thrive in our high humidity. Air pollution, especially during seasonal haze, can also be a significant trigger for respiratory allergies. These lifestyle and environmental changes have created a “perfect storm” that contributes to the increasing prevalence of allergies in Singapore.
Managing Allergies and Minimising Flare-ups
For those living with allergies, the main goal of management is allergen avoidance. This starts with an accurate diagnosis through a blood test or skin prick test, which can identify the specific triggers. If a flare-up occurs, mild symptoms can often be managed with over-the-counter antihistamines.
However, if symptoms include difficulty breathing or dizziness, it is crucial to seek immediate medical attention by going to the emergency department. Patients with known severe allergies should always carry an Epi-pen.
In the long term, for external environmental allergens like dust mites and pets, treatments like Sublingual Immunotherapy (SLIT) is available. This is a unique treatment as it is the only one capable of addressing the root cause of the allergy. It works by desensitising and down-regulating the body’s reaction to a specific allergen. This is accomplished by intentional and regular exposure to the specific allergens administered via a spray under the tongue, which gradually modifies the body’s allergic response over time.
SLIT has been shown to improve a patient’s quality of life, reduce the need for medications, and lower the risk of developing asthma and new allergies in the future. Clinical studies have shown success rates of up to 80 percent with SLIT, particularly for inhaled allergens. Patients can see an improvement in their symptoms as early as two to three months after starting the therapy. The recommended duration of treatment is three to five years, so a firm commitment from the patient is necessary for the success of the treatment.
Ultimately, the best approach is to be proactive. Understand the symptoms, get tested if you have concerns, and work with your doctor to create a plan for management.
* 1. Oral food challenges are clinical evaluations of food allergy status, where patients are exposed to specific allergens under the supervision of clinically trained staff.
Article contributed by Dr Tan Wei Jie from DTAP Clinic.
