Allergies are an everyday topic in family practice. Until the beginning of this millennium, it was assumed that about one third of the western population suffers from an allergy, be it skin, respiratory, medication or even insect venom allergy. Recently, new epidemiological data from Austria and Germany have shown that more than half of the population is sensitized to an inhalant allergen such as pollen or house dust mite, respectively. IgE antibodies against specific proteins.
The diagnosis of allergy is based on history, skin tests, detection of specific IgE antibodies in serum and, if necessary, provocation tests. The history is the most important part of the diagnosis and this also determines whether a positive skin or serological finding is clinically significant or not. Thanks to molecular allergy diagnostics, allergy is now better understood in that primary sensitizations can be distinguished from cross-reactions or, based on antibody detection, potentially dangerous proteins can be distinguished from less dangerous ones. Furthermore, component-based allergy diagnostics can be used helpfully in the indication of specific immunotherapy (SIT). Now a clinical entity such as birch pollen nutstone/pome fruit syndrome or house dust mite shellfish syndrome can be scientifically explained.
There have also been some innovations in therapy, although topical corticosteroids and antihistamines form the basis of symptomatic treatment in both adults and children. In addition, the only causal therapy to date, namely SIT or desensitization – although recognized by the WHO – still has a wallflower existence in Switzerland. Among pollen allergy sufferers, just under 2% benefit from SIT. The indication for SIT should be made by an allergist, on the other hand, it can be performed by the family doctor. Since the patient is at the center, it should be possible for the primary care physician and specialist to work hand-in-hand.
Although the two articles reflect only partial aspects of allergology practice, they are intended to help the family physician better understand allergology interpretations or procedures.
Enjoy the reading!
Prof. Arthur Helbling, MD
HAUSARZT PRAXIS 2014; 9(2): 10
