Allergies & Asthma

Diagnostic and therapy from one source

Definition (sensitization, allergy, cross-allergy)
Allergy symptoms
Great importance for health
Diagnostics (Prick, RAST, molecular diagnostics etc.)
Allergy therapy
What is (allergic) asthma?
What happens in the respiratory tract?
What if I just try to endure the allergy?
How can an allergic asthma be treated?

 

  

 

 

 

Definition (sensitization, allergy, cross-allergy)

 

Allergies are defined as specific overreaction of the immune system to a specific trigger, fought by the immune system without specific need. A distinction is made between immediate type of allergy like pollen allergy and allergies of the delayed type like contact allergies. The repeated contact to substances (antigenes) mostly provided by the environment, leads to sensitization. Inhaled allergies and nutritional allergies belong to the group of immediate type triggered by Immunoglobulin-E (IgE).
Common allergens are early-flowering tree pollen (hazelnut, alder, birch) from January to May, grass- and rye pollen form May to September, and dust mites perennial. Further-on epithelial tissues of animals (cat, dog, horse, etc.) can cause allergic reactions, as well as mould fungus and their spores and herb pollen in late summer (wormwood, ragweed, ribwort).

Another important groups are nutritional allergies which can occur as cross-allergy with existing pollen allergy, as well as solitary. The reason for a cross-allergy is that the protein structure of some food and the one of certain pollen is so similar that the specific antibodies of the immune system react to both of them. Reasons for the development of allergies are not exactly known. One of the leading theories is the so called hygiene theory. Caused by the more and more hygienic circumstances, especially in the baby phase and childhood, the immune system reacts to different agents like pollen and mites. Approximately 25% of the German population suffer form allergies. This rises by 1% per year what means there are about 800.000 new cases every year. Diagnostics should take place in a qualified center, capable of the whole range of diagnostics and therapy.

 

Allergy symptoms

Clinically there is a huge number of most different symptoms in allergies. A pollen allergy usually causes an urge to sneeze, increased nasal discharge, and significant congestion of the nasal mucosa. Itching eyes, itching of the palate, general itching (pruritus), as well as asthma and a constriction of the bronchial system with severe dyspnea may also occur. A massive urge to sneeze is quite typical but not a mandatory symptom. In many cases patients just suffer form a blocked nose and a dry throat. Especially in cases of house dust allergy, the symptoms of a congested nasal mucosa usually occurs only at night. In the morning the allergic patient deals with blocked nose, a dry mouth and throat and the voice may sound brittle or nasal. Over the day these symptoms are recessive. A house dust allergy, existing for several years can also become chronic. Firstly, because the inflammatory reaction of the respiratory tract does not recede anymore. Secondly, the allergic reactions will cause a permanent hypertrophy of the nasal turbinates (or so-called conchae).

 

Great Importance for health

Allergies are erroneously underestimated in their importance for our health. Often they are just categorized as “a simple runny nose” or anything harmless like that. Actually, an allergy is a chronic inflammation of the respiratory tracts that can lead up to chronic asthma if treated incorrectly or even not treated at all. Allergies can also have a huge impact on life quality. Studies have shown that responsiveness of a allergic patients during pollen season (without adequate therapy) is comparable to a person with a blood alcohol level of 1.0 per mille. In principle, this means that in his season an allergic patient is virtually not able to drive safely a car to work sufficiently. This is why the World Health Organization WHO realized the economic importance of allergies and their treatment and established a focus: the ARIA (www.whiar.org)

 

Diagnostics (Prick, RAST, molecular diagnostics etc.)

Modern allergological diagnostics should include various procedures to give a most precise diagnosis and therapy. The exclusion of an allergy can be as helpful as a concrete diagnosis of a specific allergy. It starts with a detailed allergological anamnesis. The basic examination starts with a skin test, called Prick-Test.  The skin test should be supplemented by specific laboratory tests. The exact amount of specific antibodies (IgE) causing the allergic reaction, can be determined by the chemical RAST (sIgE birch, sIgE grass, sIgE mites, etc). Component determination or molecular allergological diagnostics is of exciting and outstanding importance. Today, it is known that pollen and mites are combined of different individual components. Patients may develop their allergic reaction to only one or to multiple of these components. The clinical importance, however, is very variable. A part of the components, the major allergenes, are responsible for the typical allergenic symptoms. Others, the minor allergenes, can result in an allergenic cross-reaction of a whole food-family. Furthermore a determination of the individual components helps to evaluate the probability of success of a hyposensitization (specific immune therapy). A single allergy test is most often not sufficient, as allergic patterns may vary over the course of a lifetime. Especially with existing allergies an update should be done every 4-5 years.

In our office, all allergological testings are performed routinely. The determination of the RAST-results and the components diagnostic are done in our very own allergy laboratory. Our laboratory uses the leading technology, developed by Phadia Thermo Fisher, which is in use in leading University hospitals all around the world.

 

Allergy therapy 

Gold-standard of global allergy therapy is specific immune therapy (hyposensitization). In general, it can be done by subcutaneous injections (SCIT), drops (SLIT) or in case of very selective allergies also by pills. Medical literature documents the subcutaneous specific immune therapy (SCIT) as the far most successful. The probability of success was proven to be up to 85% by several studies and metastudies. The immune therapy should only be applied by allergologically experienced physicians. It is a safe and well documented method. Nevertheless there exists an immense shortage of allergological treatment, even in a country like Germany.

Acute symptoms should be treated with medications. A huge amount of medications exists that can be easily combined to help allergy patients to remain nearly symptom-free throughout the pollen season. To achieve a taylormade therapy it is important to know the causing allergies and the existing symptoms exactly well. Also the choice of medications should be prescribed by a medical specialist and not by self-medication with over-the-counter medicine. This will help to keep allergy patients active and efficient. 

We recommend to beware of alternative therapies for allergies. For none of these procedures (homeopathy, Bach flowers, acupuncture, etc) exists an evidence of efficacy in professional medical literature. An untreated or insufficiently treated allergy may result in severe subsequent conditions up to chronic asthma. Nevertheless, it is possible to use acupuncture additionally to a proven therapy. This should be discussed with the attending specialist.

 

What is (allergic) asthma?

Asthma is a chronic inflammation of the airway (bronchial system)  in which the respiratory tract is showing a hypersensitive reaction to certain stimuli from the outside (e.g. pollen). Consecutively,  a contraction of the deep bronchial muscles may lead to episodes of dry coughing, typical expiratory wheezing and / or  attacks of breathlessness (dyspnea).

Asthma is a frequent illness: about 10% of children and 5% of adults in Germany suffer from it. About 300 Million people around the world are affected. Frequency of asthmatic illness increased remarkably within the last decade, especially among the industrial nations. While the precise reasons for the development of the illness have not yet been identified, allergic infections of the respiratory tract seem to play a major role. Additional exogenous aspects (e.g. environmental factors, air conditioning or pollutants) are also to be mentioned, beside a genetic disposition.

 

Bronchical asthma responds very well to therapy, nowadays. A normal life without restrictions is possible. Nonetheless, the therapy requires a high degree of responsibility from the patient. It is extremely important for patients to get best possible information about their illness, to understand the pathological processes and to adapt the therapy to the course of their illness.

 

What happens in the respiratory tract?

During ventilation the air flows through nose/mouth, throat and trachea to off-branching main bronchial tubes for the right and left lobes of the lung. The bronchial tubes (latin for branches) continue to ramify into smaller and smaller branches. At the ends of the branches are the air sacs (alveoli) that are the important membranes for gas exchange (oxygen intake). When inflammatory substances are released in the tissue (e.g. by an allergy), the result is a congested mucosa and a muscular constriction of the bronchial system. This leads to a reduced air flow within the lungs and results in a feeling of shortness of breath (dyspnea).

 

What if I just try to endure the allergy?

From our many years' experience we know that many patients often wait to long before they
finally start a therapy. Many allergy patients keep up hope for a mild pollen flight or a spontaneous disappearance of their allergy. Often they just try to avoid a long-term medication (keyword: responsibility). This is why many patients start to late with their therapy and stop to early. Frequently they ask for a medication with only one drug and are critical towards a combination therapy with certain groups of active substances (keyword: less chemicals). Boldly put, the often rightly praised “gut feeling” does not help with allergies. In this case, intuition leads on a wrong track. So the answer to the question above has to be: DON'T! Trying to endure the allergy would be foolish braveness.

 

How can the allergic asthma be treated?

Allergy means that your body is erroneously in a state of alarm. The immune system incorectly assumes that it as to fend a parasitic attack and accepts local damage to the tissue for the sake of the whole organism. This is why the immune reaction often causes more damage than the mostly harmless pollen could ever do. They are not the problem. No matter how you look at it, finally one comes to the scientific conclusion that the (exuberant) allergic reaction is the mistake and the start of the illness.

A consistently anti-allergic treatment is essential to prevent a progressing illness. Target of the therapy is to block the exuberant and fatal inflammatory response within the tissue. For this purpose medicine like anti-histaminic (e.g. Terfenadin, Ebastin, Cetirizin or Loratadin) is used to neutralize the histamine, released by mastocytes as part of the allergic reaction. Leukotriene antagonists (e.g. Montelukast/Singulair) neutralize another messenger substance of the allergic inflammation of the respiratory tract. Corticoids/steroids (derivatives of hydrocortisone) are also used on a regular basis, primarily for inhaling as lung- or nose-spray. When required or in severe cases also as pills or injection. Sprays like Salbutamol, that open up the bronchial tubes are additionally helpful by their muscle-relaxing effects. The application of a systematic immune therapy (so called “hyposensitization”) should also be checked. A treatment with monoclonal anti-IgE-antibodies is possible, too. Diagnosis enables us to assess the prospects for success. 

In conclusion the side effects of the correct medical treatment are weaker, without exception, than the “side effects” of the allergy itself.