The number of allergens that can set off severe reactions among those who are vulnerable is increasing by the day. There was a time when the culprits were few – pollen, dust, mites, milk, peanuts and shellfish. Now the basket has widened to include some really unlikely agents of allergy – pulses, mangoes, coins, sunlight and even semen.

Why do seemingly innocuous substances – well tolerated by most – irritate others? The answer lies in genetics. “Many individuals are atopic in nature – that is, they have a propensity towards developing allergic hypersensitivity . This is a hereditary trait,” says Dr Ashok Shah of Vallabhbhai Patel Chest Institute in Delhi.

The increased prevalence of pollutants in the air and pesticides in food is believed to further lower the immunity of people who are genetically prone to allergies. According to the World Allergy Organization (WAO), almost 30-40% of the globe’s population suffers from some kind of allergy.

“The number of people reporting allergies keeps increasing every year,” says Ruby Pawankar, president of WAO, who also serves as the president of the Indian Academy of Allergy. She points out that in India, allergies are often dismissed as a nonserious condition. But given the number of people who now react badly to an array of substances — some allergies can even be fatal — that perception is changing.

Sunlight for instance is a fairly prevalent allergen in Rajasthan, says Dr V K Jain, professor and head of department of respiratory medicine at Jaipur’s Mahatma Gandhi Medical College. “The sun’s ultraviolet rays react with skin protein and can cause various reactions like rashes, itchy skin etc.”

Another unusual allergy is to metals – the nickel in some coins may cause a flare-up in some. Ramsharan Singh, a retired civil engineer, who was diagnosed with the condition, says he often developed boils on his fingers while handling money. “The cause was traced to my sensitivity to metals which doctors said was causing the dermatitis.”

Common symptoms of most allergies are asthma, rhinitis – characterized by running nose and frequent sneezing – and skin rashes. Symptoms can be managed by medications like anti-histamines or immunotherapy. But for most patients, managing allergies is often a life-long exercise especially with the list of allergens expanding fast.

“I have seen cases of people who are allergic to mangoes,” says Shah. “Many patients are reporting increased sensitivity to certain legumes like chickpeas and kidney beans. In a recent study, 25% of children with chronic diarrhea showed allergy to cow’s milk.”

A number of patients are also being diagnosed with celiac or wheat allergy – which has for long been accepted in the West as a common complaint – but was never taken seriously in India. “For a predominantly wheat eating population, it is difficult to come to terms with the fact that gluten found in wheat can trigger severe reactions,” says Punam Mograi, whose daughter was diagnosed with the condition.

Doctors say that the availability of screening tests like anti TTG antibody, anti endomysial antibody etc have finally helped create awareness of this allergy. “The number of new cases of celiac is increasing every year,” points out Dr Anil Arora, head of the department of gastroenterology and hepatology at Delhi’s Sir Ganga Ram Hospital.

Semen allergy, or hypersensitivity to semen, though rare is very much a reality. Sexologist Prakash Kothari says that a case was referred to him some years ago by the Indian Council of Medical Research. “The lady showed symptoms of urticaria – skin infection—after intercourse with her partner,” he says. “Her condition improved after he started using a condom.”

Almost 120 cases of semen allergy have been reported worldwide of which three are in India. “The proteins present in semen can trigger allergic reactions in some women,” says Shah. “This can manifest as asthma referred to as post-coital asthma or rhinitis which has been termed honeymoon rhinitis.”

But despite all this, there are very few dedicated allergy specialists in the country. “Allergy is not a speciality in any medical institution or college,” says Dr AB Singh of the CSIR Institute of Genomics and Integrative Biology. “Consequently, patients have to go to organ specialists like pulmonologists, ENT physicians etc.”

Since allergies can manifest in multiple organs, they are difficult to locate, diagnose and treat.

“It’s a serious concern,” says Pawankar. “We are in talks with the ministry of health to introduce a 4-year postgraduate specialization in allergy so that patients with these conditions can be treated comprehensively.”