These diseases occur when substances called “allergens” stimulate the immune system and create an exaggerated response in individuals with a genetic predisposition (atopic). Allergy symptoms vary according to the affected tissue and organ. Diseases called “allergic rhinitis” when the nose is affected, “allergic conjunctivitis” when the eye is affected, “allergic asthma” when the respiratory system is affected, and “urticaria” (hives, urticaria) or “eczema” when the skin is affected develop. In the event that more than one system is affected, a clinical picture called “anaphylactic shock” and requiring immediate intervention occurs. In this life-threatening condition, low blood pressure and loss of consciousness, as well as urticaria, respiratory distress and abdominal pain occur. Sometimes the swelling in the throat obstructs the airways and results in death.
The main symptoms in patients with allergic rhinitis are sneezing, runny nose and throat (like water) and itching. Conjunctivitis, characterized by tearing and itching in the eyes, develops in some of the patients. The causative allergens are mostly mold fungi and mites indoors, and pollen outside the home. If allergic rhinitis is not diagnosed and treated early, it can progress to a more severe disease, asthma. Asthmatic patients have complaints of coughing, difficulty breathing and wheezing. During the crisis, these symptoms become more severe, spasms occur in the respiratory tract, causing a feeling of suffocation and panic. This situation, which is defined as an asthma attack, requires urgent treatment.
Urticaria, which manifests itself with the formation of itching and swelling on the skin, mostly develops in food and drug allergies and insect bites. However, parasitic diseases, thyroid diseases and some systemic diseases (rheumatic diseases, blood diseases, cancers, etc.) that can cause urticaria should also be investigated. Another allergic disease observed on the skin is eczema, in which fluid-filled blisters occur. Itching is one of the typical complaints in eczema. Over time, flaking, thickening and shedding of the skin occur. The reason is mostly clothing, jewelry, device, etc. that the skin comes into contact with. are substances.
Atopic dermatitis is a skin disease that mostly develops in children. This disease also occurs due to allergic reasons and its most characteristic features are itching, dryness, tenderness, redness, scaling, bleeding and inflammation in certain areas of the skin (cheek, neck, elbow, knee). This disease has a close relationship with food allergies. Although it is difficult to treat, the severity of signs and symptoms decreases by revealing the triggering factors and taking precautions. Taking a bath with warm water, using natural soap, choosing cotton clothes, avoiding the sun and going to the doctor on time are some of these precautions.
While food and drug allergies often cause skin rashes with different characteristics, sometimes it develops a picture of “anaphylactic shock”. Anaphylactic shock is also the most feared situation in bee allergies. For this reason, such serious allergies should be diagnosed and treated beforehand and precautions should be taken.
Diagnosis of Allergic Diseases
Diagnosis of allergic diseases is made by the patient’s history, physical examination and some laboratory tests. Laboratory tests are mainly divided into two as tests performed on the patient and blood tests.
Tests applied on the patient:
Skin tests:
Tests applied on or inside the skin:
These are the tests that are still shown as the gold standard in the diagnosis of allergy. It is made by applying standard test solutions prepared from pollen (grass, grass, tree, grain), mold fungus, mite, animal skin rash, rubber, food and bee venom extracts on or inside the skin. For this purpose, special needles that create a small scratch on the skin or allow the allergen to be injected under the skin are used. Evaluation is made 15 minutes after allergen solutions are applied to the skin. The allergen responsible is determined according to the size of the swelling on the skin.
These tests are also used in drug allergies. The main drugs investigated for this purpose are antibiotics (beta lactam), drugs used in local or general anesthesia, muscle relaxants, narcotic pain relievers, epilepsy drugs, chemotherapy drugs, substances used in radiological examinations and biological agents.
Patch test:
It is performed by sticking a standard test material containing allergens on the back with vaseline. The test material used for this purpose includes more than 20 allergens (perfumes, drugs, preservatives, antioxidants, sweeteners, cosmetics, plastics, adhesives, miscellaneous chemicals, etc.). Evaluation is made 48-72 hours after the application. The allergen responsible is determined according to the degree of redness, itching and watering on the skin.
Pulmonary function tests
It is performed in patients with suspected allergic asthma. For this purpose, a device called “spirometry” is used. According to the result, the degree of influence of the respiratory tract and lung capacity is revealed. This test is sometimes done some time after administration of drugs that open the airways (15-20 minutes or 15 days). In this way, it is evaluated whether the lung functions improve with the drug.
Provocation tests
It is done to determine if a certain allergen is causing the patient’s complaints. It is generally used to reveal sensitivity in the respiratory tract or to detect the allergen (drug, food) responsible. For this purpose, the suspected allergen is administered through the mouth, nose, eyes or respiratory tract “depending on the organ affected by the disease”. It is a risky method for the patient. For this reason, it is done in the company of experts and by taking the necessary measures for emergency response.
Blood tests:
These are tests designed to detect the allergen responsible for the disease. The basic principle here is to show the antibodies developed against the allergen in the blood. For this purpose, 3-5 milliliters (1 small tube) of plain blood taken from the patients’ veins is sufficient.
Treatment
The first advice given to patients with allergies before starting treatment is to avoid the responsible allergen. Medication comes later; Depending on the affected organ and the disease, different types of drugs and methods are used. These are the treatments in the form of tablets, sprays, drops and injections taken by mouth, nose, eye, skin and respiratory tract. While such drugs relieve symptoms in the short term, they have a partial curative effect in the long term.
Vaccine treatment, called “immunotherapy”, is applied to patients who cannot get results with conventional treatments. This method is the only treatment method that can cure allergic diseases. For this purpose, standard allergen extracts are used and injected under the skin at certain time intervals. The treatment is carried out in 2 stages as initial and maintenance therapy. In the initial treatment, increasing doses are administered at frequent intervals (1-2 injections per week), while in the maintenance treatment a certain dose of allergen is administered at wider intervals. In traditional immunotherapy protocols, treatment takes 3-5 years. In recent years, shorter duration protocols have also been developed.
The most common side effects of vaccine treatment are itching and redness at the injection site. However, sometimes life-threatening serious reactions (anaphylactic shock) also develop. Therefore, patients should be observed for at least half an hour after vaccination.
Another method of immunotherapy is the sublingual administration of allergens in the form of drops or tablets. Although this method has become increasingly common lately, it is not an alternative treatment to vaccine treatment.
