13.3 Diagnosis and management of allergies

Allergies can be tricky to diagnose and manage, but there are several tools in our arsenal. From skin pricks to blood tests, doctors use various methods to pinpoint what's causing your sneezes and sniffles. Once identified, allergens can be avoided or treated with meds.

Managing allergies is all about strategy. Avoiding triggers is key, whether it's dust-proofing your bedroom or checking food labels. When avoidance isn't enough, medications like antihistamines and corticosteroids come into play. For long-term relief, immunotherapy can help your body build tolerance to allergens.

Diagnostic Methods and Interpretation

Methods of allergy diagnosis

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• Skin tests assess immediate hypersensitivity reactions
  • Prick test applies allergen solution to skin then pricked revealing results within 15-20 minutes
  • Intradermal test injects allergen under skin providing more sensitivity than prick test
• Blood tests measure IgE antibodies
  • Specific IgE test quantifies allergen-specific IgE antibodies in blood (allergen panels)
  • Total IgE test evaluates overall IgE levels indicating atopic tendencies
• Provocation tests directly challenge body with suspected allergens
  • Oral food challenge involves controlled ingestion of suspected allergen (peanuts, milk)
  • Bronchial challenge assesses respiratory response through allergen inhalation (dust mites, pollen)
  • Nasal provocation test applies allergen to nasal mucosa evaluating local reactions (pet dander)

Interpretation of allergy test results

• Skin test interpretation relies on visible reactions
  • Positive result manifests as wheal and flare reaction (raised, red, itchy area)
  • Wheal size correlates with sensitivity larger wheal suggests higher sensitivity
• Blood test interpretation focuses on IgE levels
  • Specific IgE levels indicate sensitization to particular allergens
  • Higher levels suggest increased likelihood of clinical reactivity
• Provocation test interpretation based on symptom reproduction
  • Positive result confirmed by reproducible symptoms upon controlled exposure
• Management implications guide treatment strategies
  • Positive tests inform allergen avoidance strategies (air purifiers, diet modifications)
  • Results help select appropriate pharmacotherapy (antihistamines, corticosteroids)
  • Identify candidates for immunotherapy based on specific sensitizations

Allergy Management Strategies

Principles of allergen avoidance

• Allergen identification forms foundation of management
  • Patient history and diagnostic tests pinpoint specific triggers
• Indoor allergen control targets common household triggers
  • Dust mite prevention utilizes allergen-proof bedding covers and regular hot water washing
  • Pet allergen reduction employs HEPA air filters and frequent vacuuming
• Outdoor allergen management minimizes exposure
  • Pollen avoidance during peak seasons reduces symptoms
  • Monitoring pollen forecasts allows for proactive measures
• Food allergen avoidance requires vigilance
  • Label reading ensures awareness of hidden ingredients
  • Cross-contamination prevention protects against accidental exposure
• Occupational allergen control addresses workplace risks
  • Workplace modifications reduce exposure to occupational allergens
  • Personal protective equipment provides additional safeguards

Pharmacological treatments for allergies

• Antihistamines block histamine effects
  • H1 receptor antagonists alleviate itching, sneezing, and rhinorrhea
  • First-generation (sedating) and second-generation (non-sedating) options available
• Corticosteroids suppress inflammatory responses
  • Topical formulations (nasal sprays, creams) target localized symptoms
  • Systemic options (oral, injectable) address widespread inflammation
• Leukotriene receptor antagonists block pro-inflammatory mediators
  • Effective in managing asthma and allergic rhinitis symptoms
• Mast cell stabilizers prevent degranulation
  • Preventive treatment for allergic conjunctivitis and rhinitis
• Immunotherapy induces long-term tolerance
  • Subcutaneous (SCIT) and sublingual (SLIT) options available
  • Gradual desensitization offers potential for lasting remission

Mechanism of allergen-specific immunotherapy

• Gradual administration of increasing allergen doses builds tolerance
• Induction of allergen-specific regulatory T cells modulates immune response
• Immune shift from Th2 to Th1 response reduces allergic inflammation
• Increase in blocking IgG4 antibodies neutralizes allergens
• Administration methods offer flexibility
  • Subcutaneous immunotherapy (SCIT) involves injections in clinical settings
  • Sublingual immunotherapy (SLIT) uses tablets or drops taken at home
• Potential benefits extend beyond symptom relief
  • Reduction in allergy symptoms and medication use improves quality of life
  • Prevention of new sensitizations broadens protection
  • Disease progression modification alters natural course of allergies
  • Long-lasting effects persist after treatment cessation
• Candidate selection ensures appropriate use
  • Patients with IgE-mediated allergies benefit most
  • Inadequate response to conventional treatments indicates need
  • Commitment to long-term therapy (3-5 years) necessary for optimal results
• Safety considerations require vigilance
  • Risk of systemic reactions higher with SCIT necessitating close monitoring
  • Need for close monitoring during treatment ensures patient safety