Dr. Vivek Kumar

Opening Hours : Monday to Saturday - 10am to 5pm
  Contact : 844 845 55 45


Egg allergy

Egg also known as Anda (Hindi), Endu (Gujrati), Muttai (Tamil), Mutta (Malyalam), Gruddu (Telugu) is one of the most important allergens in childhood feeding but it’s allergy changes the quality of life.

Egg allergy affects about 0.05% of our population.

  • Egg allergy is mainly caused by 4 allergens of the many proteins present in egg white.
  • 1. Ovomucoid (Gal d 1): is the most allergenic and dominant allergen found in hen’s egg white and reacts from both raw and cooked egg.
  • 2. Ovalbumin (Gal d 2): is the most abundant (58%) protein in the egg white and is 2nd most common allergen causing egg allergy. Patients allergic to Gal d 2 are able to tolerate cooked egg as this protein is heat labile.
  • 3. Ovotransferrin (Gal d 3): are heat resistant.
  • 4. Lysozyme (Gal d 4): are less allergenic.
  • In egg yolk, alpha-livetin (chicken serum albumin, Gal d 5) is the major allergen, also responsible for bird-egg syndrome. Yolk glycoprotein 42 is the another important allergen present in egg yolk.

Cross reactivity: have been reported between hen’s egg and other bird eggs (turkey, duck, goose, seagull and quail). Few egg allergy patients also cross react with chicken meat due to chicken serum albumin.

Symptoms: egg allergy is the 2nd most common food allergy (1st is cow’s milk allergy) and it is the most common allergy in children with atopic dermatitis. Egg allergy is mostly seen in childhood rarely in adults. Children often tend to outgrow their condition in adulthood.

Egg allergy causes conditions such as itching, atopic dermatitis, rhinitis, conjunctivitis, bronchial asthma, angio-oedema, laryngeal oedema, urticaria, allergic eosininophilic gastroenteritis and anaphylaxis.

Bird-egg syndrome is an IgE-mediated hypersensitivity disorder wherein a human develops an allergy to egg yolk, specifically to serum albumin, following sensitisation to inhalant avian antigens derived from sources such as bird’s blood serum, feathers, droppings and dander.

It has been found that eggs heated in the presence of another substance such as wheat have lesser IgE reactivity as compared to eggs heated alone.

Egg- important allergen in childhood
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Milk allergy

Milk known as Doodh (Hindi), Halu (Kannada), Pal (Tamil/Malyaalam), Pala (Telugu) causes allergies in about 0.05% of our population.

Cow’s milk contains around 30-35 grams of proteins/litre of about 25 different varieties. Any of these proteins may act as an allergen. These proteins are broadly divided into caseins (80%) and serum (whey) proteins (20%).

  • The major allergenic milk proteins are:
  • Caseins (Bos d 8, which is a combination of Bos d 9 to Bos d 12)
  • Beta-lactoglobulin (Bos d 5) and
  • Alpha-lactalbumin (Bos d 4)
  • The other characterised allergenic milk proteins are:
  • Caseins: alpha s1 (Bos d 9), alpha s2 (Bos d 10), beta (Bos d 11), kappa (Bos d 12)
  • Whey: bovine serum albumin (Bos d 6), immunoglobulins (Bos d 7), lactoferrin.

Cross reactivity: Cow’s milk allergens cross reactivity with milk of other mammals such as goats, sheep and buffalo. Milk from non/bovid mammals (mare,donkey,camel) shows better tolerance in some patients. Bovine serum albumin (Bos d 6) may cross react with raw beef, but is lost on cooking being heat sensitive.

CMPA (Cow’s Milk Protein Allergy) are amongst the most common food allergies in all age groups. The prevalence of CMPA (estimated) in the first year of life is 1.6-3%, and decreases to less than 1% in children aged 6 years or older. Majority of the CMPA patients outgrow their condition. Children who out grow of their CMPA become tolerant to milk in baked form before fresh milk products as baking reduces protein allergenicity.

Allergy to milk may manifest as an IgE mediated, non-IgE mediated or mixed manifestations. Typical IgE-associated symptoms appear immediately or within 1-2 hours after milk ingestion and affect the skin, the respiratory system, the GI tract and/or appear as systemic anaphylactic reactions in severe cases. Milk is the third most common food after peanuts and tree nuts that causes anaphylactic reactions, accounting to 10-19% of all food-induced anaphylactic cases.

In non-IgE mediated disease the clinical symptoms affect mainly the gastrointestinal system including enterocolitis, proctitis, proctocolitis, enteropathy, irritable bowel syndrome, eosinophilic esophagitis and constipation. Respiratory symptoms and atopic dermatitis may also be seen (less commonly) in this presentation. The clinical manifestations of mixed manifestations may appear as atopic dermatitis and eosinophilic gastroenteropathies (esophagitis and gastroenteritis).

Child having rashes over face with milk bottle visible in background
Hair loss in milk allergic kid (same boy)
Child has outgrown his CMPA with disappearance of rashes and no more hair loss
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Allergen: Aspergillus fumigatus

Aspergillus fumigatus is a fungus found in soil survives on organic debris and plays an essential role in recycling environmental carbon and nitrogen. They belong to

  • Kingdom: Fungi
  • Phylum: Ascomycota
  • Class: Eurotiomycetes
  • Order: Eurotiales
  • Family: Trichocomaceae
  • Genus: Aspergillus
  • Species: fumigatus

A. fumigatus is characterised by green echinulate conidia, 2.5 to 3 micron in diameter, produced in chains basipetally from greenish phialides. It sporulates abundantly, with every conidial head

Aspergillus fumigatus

producing thousands of conidia (asexual spores) which are air-borne.

Once the spores are in the air, their small size makes them buoyant, tending to keep them airborne both indoors and outdoors. Furthermore, their small diameter (2-3 micron) makes it possible for them to reach the lung alveoli.

Outdoor habitat: soil, decaying plant materials, trees, compost, wood chips, hay and crops and stored grains.

Indoor habitat: on dampened building materials (plasterboard, wood, chipboard, ceiling tiles, cardboard and insulation material), on indoor organic substrates such as house dust and other cellulose containing materials, in humidifier, air-conditioning systems and air ducts and filters, as well as on household articles made of linen, leather and paper.

They are perennial in nature present pan over india with peak in summer and rains.

Out of about 23 allergenic proteins derived from A. fumigatus Asp f 1, f 2, f 3, f 4, and f 6 are clinically significant.

They have been shown to cross react with A. flavus, A. versicolor, A. niger and also with other fungal genera like P. notatum, Cladosporum herbarum, Alternaria alternata, Penicillium citrinum, Sacchromyces cerevisiae, Fusarium solani and Candida albicans.

Over 80% of Aspergillus-related conditions, such as extrinsic allergic alveolitis, asthma, allergic sinusitis, chronic eosinophilic pneumonia, hypersensitivity pneumonitis, severe asthma with fungal sensitization (SAFS), and Allergic BronchoPulmonary Aspergillosis (ABPA) are caused by A. fumigatus.

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Allergen: Dermatophagoides farinae

  • Dust mites are the most common allergens all over world. Let’s learn some basics about them! They belong to:
  • Phyllum: Arthropoda
  • Subphyllum: Chelcerata
  • Class: Arachinada
  • Order: Acari
  • Superfamily: Analgoidea
  • Family: Pyroglyphidae
  • Subfamily: Dermatophagoidinae
  • Genus: Dermatophagoides
  • Species: farinae

Commonly known as ‘house dust mite’ or simply ‘dust mite‘

Adult dust mites are barely seen to the naked eye but easily visible under low power microscope and have a size of about 0.2 to 0.4mm

They thrive best at 75% to 80% relative humidity and 25*C to 30*C.

Lifespan: 4-6 weeks

50-80 eggs in lifetime

Dust mites produce about 20 fecal pellets/day, varying in size from 20-40 micron and contain digestive enzyme derived allergens. These fecal pellets easily become airborne by little disturbances like making a bed, walking on a carpet, or moving on a pillow and take 20-30 minutes to settle down.

Dust mites are light sensitive and photophobic, live deep within soft substrates, such as pillows, mattresses, and carpets, where moisture is retained and humidity fluctuations are minimal.

HDM are the most common indoor allergens globally.

D.farinae is a perennial allergen with seasonal variations. Their concentration increased in warm & humid climate.

There are estimated about 30 allergens proteins of which Der f 1 and Der f 2 are most important. Der f 1 originates from the intestinal tract of the mite while Der f 2 is more abundant in the mite body. Both together are responsible for about 80-90% of D.f sensitised individuals.

There is very less cross reactivity with storage mites. Der f 20 protein shows cross reactivity with shrimp, cockroach and other HDMs.

HDM are considered as causative allergens for development of allergic rhinitis, asthma and eczematous lesions.

House dust mite
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ABPA, i.e. Allergic Broncho Pulmonary Aspergillosis is a frequently missed and under diagnosed cause of shortness of breath.

It usually mimics asthma , but is a separate entity. It occurs due to hypersensitivity reactions in lungs to Aspergillus fungus allergen.


1. Either Skin prick test to Aspergillus positive, or Specific IgE against Aspergillus fumigatus more than 0.35 IU

2. Total IgE more than 1000.


Depending on how much lung has been damaged

1. ABPA-S: no damage to lung parenchyma

2. ABPA-CB: Bronchiectasis present

3. ABPA-CB-ORF: apart from Bronchiectasis Other Radiological Features present in chest HRCT


Mainly Oral steroids apart from supportive therapy for concomitant diseases and regular monitoring

Allergen avoidance

Chest physiotherapy

Breathing exercises

LTOT where needed


Patient education on side effects of oral steroids, teaching how to identify early signs, prophylactic measures.


Severe asthma not getting controlled on high dose ICS-LABA.

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World COPD day 2019

A mass awareness program was organised on the occasion of world COPD day 2019, 20th November, Wednesday.

A group of volunteers travelled through the town and distributed pamphlets about means of keeping safe from harmful effects of smoke and how to stay safe during winter.

The bike rally ended by converting into a meeting at Dhanwantari Allergy and Asthma Clinic located at dhaka road, Chhatauni chowk, motihari bihar.

Dr Vivek kumar, gold medalist, allergy & asthma specialist addressed the gathering on this occasion. He focused on the need of certified high quality masks to safeguard from smoke & particulate matters. Other points to prevent the COPD exacerbation are use of vaccines like that of influenza , pneumonia etc. he focused on the use of maintenance therapy of inhalers.

We should discourage use of biomass fuels in kitchen, incentivise use of battery operated bikes & cars, promote use of roof top solar panels.

We all should focus of tree plantation to curb the rising menace of pollution as COPD is being caused mainly by smoke and harmful gases.

It’s high time we change ourselves else 3/4 th of our generation will have COPD in later ages and most of our children will suffer from this dreadful disease.

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