Understanding Wheat Dust Allergy

What is Wheat Dust?

Wheat dust एक complex mixture है जो harvest और processing के दौरान generate होता है। इसमें शामिल हैं:

• Grain Particles: छोटे टुकड़े wheat kernels के
• Chaff: भूसी (husk) के particles
• Pollen: Wheat plant का pollen (if flowering stage)
• Mold & Fungi: Stored grain पर grow होते हैं
• Storage Mites: Microscopic insects जो grain में रहते हैं
• Bacterial Endotoxins: Bacteria के components
• Pesticide Residues: खेतों में spray किए गए chemicals

Why Does It Cause Allergy?

Mechanism:

1. Exposure: जब wheat dust inhale होती है
   • Harvesting के समय (cutting, threshing)
   • Loading/unloading grain
   • Storage facilities में
   • Mills में
2. Immune Response:
   • Body की immune system इन particles को “foreign” समझती है
   • IgE antibodies produce होती हैं (allergic sensitization)
   • Mast cells activate होती हैं
   • Histamine और inflammatory mediators release होते हैं
3. Symptoms: Inflammation of airways → symptoms

Types of Reactions:

1. Immediate (Type I Hypersensitivity)

• Within minutes of exposure
• Allergic rhinitis symptoms
• IgE-mediated

2. Delayed (Irritant Effect)

• Direct irritation of airways
• Not true allergy, but inflammation
• Can happen to anyone with heavy exposure

Clinical Features – लक्षण

Nasal Symptoms (सबसे Common)

1. Rhinorrhea (नाक बहना)

• Clear, watery discharge
• खेत में काम करते समय लगातार
• Profuse – रूमाल बार-बार use करना पड़ता है

2. Sneezing (छींक आना)

• Paroxysmal – 10-20 consecutive sneezes
• Dust exposure के तुरंत बाद
• Cannot control

3. Nasal Congestion (नाक बंद होना)

• Feels stuffed up
• मुंह से सांस लेनी पड़ती है
• रात में worse (lying down)

4. Nasal Itching (नाक में खुजली)

• नाक रगड़ना, खुजाना
• “Allergic salute” – upward rubbing nose

Eye Symptoms (Allergic Conjunctivitis)

• Itching (खुजली): आंखों में बहुत खुजली, रगड़ना पड़ता है
• Redness: आंखें लाल हो जाती हैं
• Watering (आंसू आना): Profuse tearing
• Puffiness: Eyelids swell हो जाती हैं
• Photophobia: रोशनी से तकलीफ

Respiratory Symptoms

1. Cough (खांसी)

• Dry, irritating
• Worse during and after work
• Post-nasal drip से भी

2. Wheezing (सांस फूलना, “सीटी” की आवाज)

• Chest tightness
• Whistling sound during breathing
• Exercise से worse
• ⚠️ Sign of asthma developing – serious!

3. Dyspnea (सांस लेने में दिक्कत)

• Shortness of breath
• खेत में काम करते समय
• Can be frightening

Skin Symptoms

• Urticaria (Hives/पित्ती): Itchy wheals on skin
• Contact Dermatitis: जहां dust touch करती है (arms, neck)
• Eczema flare-ups: Pre-existing eczema बिगड़ सकता है

Systemic Symptoms

• Fatigue (थकान): बहुत कमजोरी feel होना
• Headache: Sinus pressure से
• Difficulty Concentrating: काम पर focus नहीं
• Sleep Disturbance: रात को symptoms worse

⚠️ Severe – Anaphylaxis (Rare but Serious)

• Severe allergic reaction – life-threatening
• Symptoms:
  • Sudden severe breathing difficulty
  • Swelling of face, throat
  • Rapid drop in blood pressure
  • Loss of consciousness
• Needs immediate emergency care!

Diagnosis at Prime ENT Center

1. Detailed History – बहुत Important

Occupational History:

• क्या काम करते हैं? (farmer, farm worker, mill worker?)
• कब से symptoms हैं?
• Temporal Pattern: क्या symptoms harvest season में ज्यादा होते हैं? (April-May में?)
• क्या खेत में/mill में काम करते समय worse होता है?
• क्या weekend या holidays पर better होता है? (diagnostic clue!)
• Protective equipment use करते हैं? (mask?)

Symptom History:

• Specific symptoms – nasal, eye, respiratory?
• Severity
• Duration
• Relief से क्या better होता है?

Personal/Family History:

• Past history of allergies? (food, drug, other environmental?)
• Asthma?
• Family members को allergies?

2. Clinical Examination

Nasal Examination:

• Anterior rhinoscopy
• Findings in Allergic Rhinitis:
  • Pale, bluish nasal mucosa
  • Swollen turbinates
  • Watery secretions

Eye Examination:

• Conjunctival redness
• Chemosis (conjunctival swelling)
• Discharge

Chest Examination:

• Auscultation (stethoscope से सुनना)
• Wheezing present?
• If yes → suggests bronchial involvement (asthma component)

3. Allergy Testing – Confirmatory

A. Skin Prick Test (SPT)

Dr. Harshita Singh द्वारा किया जाता है Prime ENT Center में

Procedure:

1. Forearm की inner side पर test होता है
2. Allergen extracts की drops लगाई जाती हैं:
   • Wheat grain extract
   • Wheat flour
   • Storage mites
   • Common molds (Aspergillus, Alternaria)
   • Controls (positive and negative)
3. Lancet से gentle prick (superficial, painless)
4. 15-20 minutes wait
5. Reading:
   • Wheal (raised bump) बनती है = Positive
   • Size measure करते हैं
   • ≥3mm = positive reaction

Interpretation:

• Positive = IgE-mediated allergy confirmed
• Identifies specific allergen
• Guides avoidance और treatment

Advantages:

• Quick (20 minutes)
• Cost-effective
• Multiple allergens test कर सकते हैं simultaneously
• Immediate results

B. Serum Specific IgE Test (Blood Test)

• If skin test contraindicated (severe eczema, on antihistamines)
• Blood sample लेकर lab में test
• Measures specific IgE antibodies against allergens
• Takes few days for results

4. Pulmonary Function Tests (PFTs)

• If respiratory symptoms present
• Spirometry – measures lung function
• Detects airway obstruction
• Assesses severity
• Important for occupational asthma diagnosis

5. Chest X-ray

• If chronic symptoms या infection suspected
• Rules out other pathology

Treatment & Management at Prime ENT Center

🥇 Step 1: Allergen Avoidance – सबसे Important!

कहते हैं “Prevention is better than cure” – allergy में यह सबसे true है। Medicines symptoms को control करती हैं, लेकिन avoidance root cause को address करता है।

Personal Protective Equipment (PPE):

🎭 Mask – Must Have!

• Type: N95 या N99 mask
  • Regular surgical mask काफी नहीं है
  • N95 filters 95% particles >0.3 microns
  • Available in local hardware stores
• Usage:
  • खेत में जाने से पहले wear करें
  • Proper fit important – नाक और मुंह दोनों cover होने चाहिए
  • Wet करके नहीं use करना (reduces filtration)
• Impact: Studies show 60-70% symptom reduction with proper mask use!

👓 Goggles/Protective Glasses:

• Wraparound style – sides से dust enter नहीं होनी चाहिए
• Protects eyes from dust
• Reduces allergic conjunctivitis

👕 Full-sleeve Clothing:

• Covers arms, neck
• Reduces skin contact
• धूल कम लगती है

Work Practices:

• Timing:
  • Early morning या late evening में काम करें when possible
  • Midday – जब धूल सबसे ज्यादा उड़ती है – avoid करें
• Minimize Exposure Duration:
  • Frequent breaks लें
  • Rotate workers
• Wet Methods:
  • Grain को थोड़ा गीला करके handle करें (reduces dust generation)
  • Threshing floor पर पानी छिड़कें
• Mechanization:
  • Modern combines use करें (enclosed cabins)
  • Manual threshing से ज्यादा dust होती है

Post-Exposure:

• Bath Immediately: घर आकर तुरंत नहाएं, clothes change करें
• Nasal Wash: Saline irrigation (नीचे detail में)
• Work Clothes Separate: खेत के कपड़े अलग wash करें

💊 Step 2: Pharmacotherapy – Medical Treatment

1. Antihistamines

How They Work: Block histamine (main mediator in allergic reaction)

Second-Generation (Preferred):

• Non-sedating (नींद नहीं आती)
• Once daily dosing
• Can be taken during day without drowsiness
• Safe for prolonged use

When to Take:

• Daily during harvest season (prophylactic)
• Best taken before exposure
• Controls sneezing, itching, rhinorrhea

2. Intranasal Corticosteroid Sprays

Most Effective for Nasal Symptoms!

How They Work:

• Reduce inflammation directly in nasal mucosa
• Most potent anti-inflammatory effect

Usage:

• Regular daily use (not PRN – “as needed”)
• Takes 2-3 days to show full effect
• Start at beginning of season, continue throughout
• Proper technique important:
  • Head slightly forward
  • Aim towards outer wall (away from septum)
  • One spray each nostril

Side Effects:

• Minimal (topical action)
• Local dryness, occasional nosebleed (minor)
• Systemic absorption negligible

3. Oral Decongestants

• For severe nasal congestion
• Short-term use only (3-5 days max)
• Can cause rebound congestion

4. Nasal Decongestant Sprays

• Quick relief (minutes)
• ⚠️ Warning: Max 3-5 days use!
• Longer use → rhinitis medicamentosa (addiction, worsening)

5. Eye Drops (for Allergic Conjunctivitis)

• Antihistamine eye drops
• Mast cell stabilizers
• Quick relief from itching, redness

6. Leukotriene Receptor Antagonists

• Add-on therapy
• Especially if asthma component
• Oral, once daily

7. Bronchodilators (if Wheezing/Asthma)

• Inhaler form
• Relieves bronchospasm
• Quick-acting for acute symptoms
• Long-acting for regular control

💧 Step 3: Nasal Irrigation – Very Helpful!

Prime ENT Center Recommendation:

• Method:
  • Isotonic saline solution (normal salt water)
  • Use neti pot, squeeze bottle, या syringe
  • Lukewarm water
• Technique:
  • Head tilted over sink
  • Pour/squeeze saline in one nostril
  • Flows out from other nostril
  • Repeat both sides
• Benefits:
  • Washes out allergens, dust particles mechanically
  • Reduces allergic load
  • Moisturizes nasal passages
  • Improves ciliary function
• When:
  • After work (immediate washout)
  • 2-3 times daily during season

💉 Step 4: Allergen Immunotherapy

For Severe/Refractory Cases

What is It:

• Desensitization therapy
• Gradual exposure to increasing doses of allergen
• Immune system “learns” to tolerate allergen
• Only disease-modifying treatment (others are symptomatic)

Types:

• SCIT (Subcutaneous): Injections, clinic-based
• SLIT (Sublingual): Under-tongue drops/tablets, home-based

Duration: 3-5 years

Candidates:

• Confirmed IgE-mediated allergy (skin test positive)
• Moderate-severe symptoms
• Poor response to medications
• Occupational necessity (cannot avoid exposure – यह काम करना ही है)

Available at Prime ENT Center

Complications if Left Untreated

1. Chronic Rhinosinusitis

• Persistent inflammation → sinus drainage blocked
• Recurrent sinus infections
• Nasal polyps may develop

2. Occupational Asthma – Serious!

• 20-30% allergic rhinitis cases develop asthma
• Progressive condition
• May become permanent even after stopping exposure
• ⚠️ Can be disabling – work करने की ability lose हो सकती है

3. COPD (Chronic Obstructive Pulmonary Disease)

• Long-term grain dust exposure
• Irreversible airway damage
• Progressive breathlessness

4. Quality of Life Impact

• Poor sleep → daytime fatigue
• Reduced work productivity
• Economic impact (medical costs, work loss)
• Mental health impact (frustration, anxiety)

Prevention Strategies – Community Level

For Farmers & Agricultural Workers:

• Awareness Programs: Education about occupational respiratory diseases
• Cooperative PPE Purchase: Bulk buying reduces cost
• Government Schemes: Subsidies for protective equipment
• Modern Equipment: Enclosed tractor cabins with filters
• Regular Health Checkups: Early detection

For Employers/Contractors:

• Provide PPE to workers
• Implement dust control measures
• Awareness training
• Periodic health surveillance