Assessment and treatment of allergies

Allergic illness is common, and is increasing worldwide. About 30–40% of the population has a predisposition to develop an allergy.

The term itself comes from the Greek and means "reaction to what is foreign". Seen immunologically, an allergy is a hypersensitive reaction of the body to a particular, usually natural, substance. An allergy is not an immune deficiency but instead a misguided overreaction on the part of the immune system.

In the absence of a previous immunological reaction to a substance, various intolerances or pseudo-allergies also can produce similar symptoms on the skin or in the mucous membranes.

Symptoms

The interaction between allergens and specific antibodies triggers a reaction in the body. The allergic infection that results can have quite varied symptoms, ranging from inflamed skin, hives (nettle rash), eczema, itchy or runny eyes, sneezing attacks, a dripping or blocked nose and coughing to impaired breathing, stomach pains, diarrhea and even circulatory shock.

Medical condition

  • hay fever (allergic rhinitis), perennial rhinitis
  • bronchial asthma
  • food allergies and intolerances
  • drug allergies and intolerances, latex allergies
  • insect venom allergies
  • neurodermatitis  (atopical eczema)
  • hives or nettle rash (urticaria) and skin swelling (angioedema or Quincke's edema)

Assessment

Only through a comprehensive, in-depth conversation can we try to establish together what the possible causes or triggers for the symptoms or illness might be. This information is key, as it provides a guide for conducting the appropriate medical tests, which can include:

  • various skin tests
  • lab tests
  • nasal, oral, conjunctival provocative tests
  • nasal air resistance measurement (rhinomanometry)
  • tests of the sense of smell
  • endoscopies
  • lung function measurements (FeNO, spirometry)

Treatment

In addition to a comprehensive assessment and consultation, treatment can proceed either by addressing the causes or by treating the symptoms. The goal is an appropriate therapy that is not only individually tailored but also effective and which has  few side-effects. Various hyposensitization or desensitization therapies (also called allergy-specific immune therapy or SIT) are promising avenues for building immunological tolerance and treating the causes of allergies. Depending on what triggers the allergy, a classic therapy (either by subcutaneous injection or by administering a medication under the tongue) may also be carried out.  In particularly severe cases, injections with antibodies against immunoglobulin E are a newer therapeutic alternative.

The goal of a symptom-oriented therapy is to become symptom-free and to also avoid side-effects or complications in the course of the therapy.

Clinical immunology addresses what are often complex and chronic responses by the body's defense system. Treatment often involves working in an interdisciplinary manner with diverse medical specialists. Patients' symptoms are reduced (or even eliminated) in 80–90% of all who are treated.