Allergology

Under the Allergology the physician understands a specialty that deals with the development, diagnosis and treatment of allergies. The diagnosis takes place either in vitro or in vivo. In-vivo test procedures on the patient themselves are sometimes associated with the risk of allergic shock for the allergy sufferer.

What is allergology?

Allergology is a medical specialty. The focus of the medical sub-area is the diagnosis and treatment of allergies. In the research area, allergology is also concerned with the individual characteristics and development mechanisms of allergies.

German allergologists are usually internists, pulmonologists, dermatologists or general practitioners. In order to be allowed to bear the title of allergist, they must have received further training in the allergological sub-area of ​​medicine. The German regulations on this differ from those abroad.

In Switzerland, for example, allergists already have to focus on a medical degree in allergology when they are studying medicine. The term immunology is also often associated with allergists. An allergy is an immunological overreaction. Therefore, in the broadest sense of the word, allergology studies immunological disorders that are related to a specific allergen.

Treatments & therapies

Allergy diagnostics is one of the most important sub-areas of allergology. This area includes all investigation procedures that help in the search for an allergenic substance and in clarifying the causes. The sub-areas of allergy diagnostics are in-vivo and in-vitro diagnostics.

In vivo diagnostics take place on the patient himself. With in-vitro diagnostics, on the other hand, the doctor takes body fluids from the patient, which are then examined in the laboratory. On the basis of these samples, for example, the total IgE is determined using a radio-immunosorbent test. Allergy reactions are dependent on the immunoglobolin E. The immune system recognizes a certain allergen as foreign and therefore wants to drive it out of the body with the antibodies. The total amount of antibodies in the blood therefore plays a role in assessing allergological diseases. The increase in the antibody level allows statements about the strength of the hypersensitivity and confirms the presence of an allergy.

However, no specific allergen can be identified with this test, as all allergies raise the antibody level. A second test method in allergology is therefore the determination of specific IgE using the radio-allergo-sorbent test. This procedure can confirm the suspicion of a specific allergen. In addition to the two diagnostic methods mentioned, in vitro allergy diagnostics also include the determination of allergen-specific IgG, cellular allergen stimulation tests and histamine release tests. For example, the IgG test can be used to determine food allergies.

This form of allergy is independent of immunoglobulin E and therefore requires other parameters to be measured. The allergy stimulation test, on the other hand, is intended to qualitatively determine a food allergy. The procedure is also called the leukocyte activation test and is based on the assumption that food intolerance causes inflammatory reactions to certain food components. These reactions are measured in the patient's blood using the leukocytes that cause inflammation. The measurement takes place in connection with the administration of various food extracts. The histamine release test and the basophil activation test are again cellular allergy stimulation tests. They are based on the observation that allergies are associated with the release of histamine and the activation of basophils.

The most important in vivo test methods in allergology include the prick test, the rub test and the intracutaneous test. In the prick test, the allergist drips the test substances onto the patient's skin.Then he "pricks" these areas of the skin to trigger an allergic reaction. The friction test is mainly used in connection with food allergies. The food is rubbed onto the skin and the patient's reactions are documented.

The intracutaneous test is relatively unspecific. In this procedure, the doctor injects a solution of the allergens to be tested into the skin of the back and waits for allergic reactions. Once the allergy, including its extent and allergen, has been determined, the allergist treats the hypersensitivity. There are more than 70 different methods available to him for this purpose. Which one he chooses depends heavily on the allergen and the intensity of the allergy.

Diagnosis & examination methods

Allergological in vitro test procedures are associated with few risks and side effects for the patient. In-vitro tests on the patient themselves are associated with risks that should not be underestimated.

These risks include, above all, the risk of allergic shock, because all in vivo tests aim to provoke an allergic reaction in the patient. For this reason, in vivo test procedures only take place under supervision. The allergist has antidotes and drugs in his practice that reduce the risks for the patient. Therefore, an allergy test is considered safe in and of itself. However, drug allergies and food allergies are usually tested in the hospital.

In the case of food allergies, the allergic reaction often takes a long time to set in. It is then important to prevent the patient from collapsing. The inpatient admission for this type of allergy test is therefore a safeguard for the patient. In the case of drug allergies, there are often hardly foreseeable side effects or circulatory collapse occurs. Inpatient admission is therefore safer in this case too. Test methods such as the prick test are also discredited for provoking allergies in the first place. Scientists now want that to be ruled out.