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Allergies

 

Allergies


Endemic disease allergies


The number of the allergy sick person rises in the industrial countries from year to year continuously. Each of us, provided that he is not concerned himself, knows in the family or in the circle of friends at least one allergy sufferer, to the flower pollen, house dust, cat's hair or food the life at times the torture makes.
History of medicine


In the history of medicine exact descriptions of allergic illnesses are found since centuries over and over again amazingly. Thus the doctor Johann Babtist described already in the 16th century from the health disturbances like an assembly-line cold and ocular itch which appeared predominantly during the Blühsaison. The observations which the English doctor Charle Blackley made 300 years later in himself were still more detailed. He identified not only the pollens which led with him to nasal mucous membrane irritation, but also described Hautrötungen which were caused by these pollens if they were ground in the crook of the arm. Nevertheless, the releasing mechanisms which stand behind these illness events were unknown. And thus one called these reactions in the Middle Ages antipathy (in Greek: anti = against; pathie = illness). Then in 1906 the Viennese paediatrician Clemens von Pirquet made the concept Allergy (Greek: allos = differently; terrifically = work) to call the changed responsiveness deviating from the normal of the organism. In the Munich medical weekly periodical of the 7/24/1906 he wrote: "We need new, general, not prejudging word for the state change which the organism finds out by the acquaintance with any organic, living or lifeless poison."


Today's situation

Today allergic reactions already appeared normal case. At least every fifth adult and almost every third child show in Germany symptoms of an allergy. In an investigation from 1999 23% and in Eastern Germany gave in West Germany 17% of the interviewees allergic discomfort. Moreover, the percentage varied according to the age: The more recently the patients were, the allergy rate was the higher. What the dramatic increase of the illness is due in last decades to, one does not know yet exactly. From the big international investigation to the epidemiology of allergic illnesses in the infancy, the ISAAC studies (internationally study of asthma and allergies in childhood), is known that allergies appear as much more frequent than in poorer areas in well-to-do countries. Allergists suppose a connection between the number of the infections infant and the development of an allergic illness. The several times documented differences also brought to this hypothesis in the frequency of allergic illnesses between east country and West Germany. While children have only few brothers and sisters in West Germany mostly, and only at the age of four or five years go to the kindergarten, East German babies were examined already very early in the day nursery. The number of the infections with which to itself the immune system apart pressed had, was much higher there understandable-wise. Because the person not with a completely mature immune system comes into the world, but must be based his tailor-made antibodies (Immunglobuline) only by the contact with damaging substances, would be conceivable probably as an indirectly explanation of the observed allergy frequency in western countries. If the need to react to acute accent infections with the education of Immunglobuline A, G or M is not given, the immune system of a newborn child forms increases IgE, that Immunglobulin which plays the leading role with allergic processes and is to be found in the blood of allergy sufferers in up to tenfold of higher concentration.


Causes


When secure knowledge is valid that beside the environmental factors above all the hereditary factors decide on whether a person develops one day an allergy or not. Thus rises the risk to fall ill for children, e.g., with a hay fever or a Neurodermitis of ordinarily 10-15% on 30-40% if a parent is an allergy sufferer and even on 50-70% if both parents have an allergy. The immunology research has found here two genetic localisations which are coupled with the inheritance of allergy.
With the environmental factors one makes a distinction between the real allergy arrangement (specific environmental factors) and unspecific environmental factors. The latter can make on the one hand the allergens more aggressive and, on the other hand, the human organism more susceptible.

 This appears at the following examples:


Allergens are modified to chemical ones
Pollen with pollutant particles covers
The allergy concentration through well isolated internal rooms raises
Mucous membranes by chronic irritation sensitises faster


The people to which the readiness was left bequeath to the allergy one calls Atopiker (Greek: Atopie = quaintness, strangeness). Their immune system reacts to certain environmental charms (unusually), while the defensive system exactly ordinarily recognises whether a penetrating material is dangerous or not, the immune system of an Atopikers is not able between injuriously and not injuriously made a distinction. E.g., flower pollen with an antigen antibody reaction which is intended for the destruction of dangerous substances reacts to an actually harmless material. Indeed, the kind of the educated antibodies differs: while ordinarily IgG is formed to the defence by causes, produces of the Atopiker IgE as an answer to the allergy contact. And something else is unusual: in spite of the violent defence reactions the allergy sufferer does not become immune against the fought substances. On the contrary, he reacts more and more sensitively, the immune answer becomes stronger and stronger. It comes to a überschießenden IgG production which stimulates in the so-called mast's cell to the emission of large amounts in inflammation substances (e.g., histamine and Prostaglandin). Dreaded symptoms like inflammation, swell or itch appear, and the patient feels really ill.
Prevention possibilities


Although the epidemiology and the basic research at full speed run, no concrete therapy ways which could stop the rising allergies are still recognizable. Hence, researchers and therapists demand a clearly improved prevention (illness prevention) best of all in the form of a three-step model: with the prevention reversible organ damages should be prevented allergy appearance, with the secondary prevention multiple sensitisation and with the Tertiärprävention.
However, in addition all partners would have to move in a rope: the patients would have to change her individual behaviour, offer the therapists a careful patient's clarification and patient's training and the state the environmental conditions improve.
Allergy trigger


Actually, every material can release an allergy, provided, there is a suitable Überempfindlichkeit. Hence, it does not surprise that meanwhile more than 20,000 different substances than allergen have been exposed. However, some of them are especially aggressive, because for ninety percent of all allergy illnesses only 8 are - 10 allergens causally.
Front runners under the allergy triggers are the pollens which cause about 50% of all illnesses, followed by house dust, animal hair, food, chemicals, mould mushroom, medicaments, nickel and latex. Allergens penetrate almost always about respiratory tract, skin or digestive organs into the body. Hence, it is not astonishing that in these organs also most allergies become apparent.
The allergies of the respiratory tract


Universal


Allergic illnesses in the area of the respiration and the respiratory organs appear as a noses-mucous membrane inflammation or asthma bronchial ones. They are released by inhalation of flower pollen, house dust, mould mushrooms, animal hair and others which carry in her surface certain egg white molecules which cause the antigen antibody reaction. Indeed, drugs or food can be also responsible for an allergic asthma. Depending on which substance releases the allergy the discomfort appears as only seasonal or also all year round. Care is offered with an allergic cold stopping for years. Here it comes to about 30 percent of the cases to a so-called floor change. That is the allergy spreads to the bronchi, the patient gets to his hay fever still a bronchial asthma.
Flower time = suffering time


Violent attacks of sneezing, an assembly-line cold, prickle in the nose, scratching in the neck and itch of the eyes are the classical symptoms of the Überempfindlichkeit against pollen for which there are many names. While the doctor speak of Pollinose (seasonally of allergic irritation) or Pollenrhinopathie, it is called in the colloquial language hay fever. Besides, deals the allergic Rhinitis only on the edge of something with hay and a cold in the real sense is not they also.

In Germany above all three groups of pollen are responsible for the allergic nasal mucous membrane inflammation (Rhinitis):
Pollens or early-blossoming trees: Hazelnut, alder or birch (from February to May)
Grass and grain pollens (from May to July or middle of August till the middle of September)
Pollens of certain herbs, before all sagebrush, rare Wegerich, elders, dandelion (from August to September)
Mostly the affected patients react only in a pollen kind allergically. Nevertheless, the Überempfindlichkeit extends in the course of the time often on several flower pollens or other allergens like house dust, so that the discomfort becomes longer and longer phase-wise and in the worst case a whole year cold originates. He develops above all with allergies on house dust, animal hair, mould mushrooms and food.


Allergens avoid


While patients with a Pollinosis during the Blühsaison no chance have to avoid the pollen contact, the allergy sufferers with whom all year round a hay fever symptomatology insists can try to step aside to her allergies: The admission of allergy-releasing drugs or food relatively simply lets itself to avoid, presumed one has identified the culprits. Moreover, cat or dog should not be held in the house if with members of the family a suitable animal hair allergy was diagnosed. The patients who react allergically to mould mushrooms can reduce her discomfort, while they avoid humid walls and are careful with indoor plants, because often mould mushrooms are in the garden mould.
To escape from an allergy on house dust mites, however, is similarly difficult like with a pollen allergy. These 0.2 - 0.5 mm of small little animals who belong to the family of the spiders are with 14% of all allergy sufferers in Germany the cause of the illness. They are in every household, even if still is cleaned so thoroughly. Till this day one has identified 10 a total of 30,000 kinds of the allergy bearers. Because they live on food leftovers, dead insects and human skin scales, they best stay in upholstered furniture, carpets, mattresses and bedclothes. In the morning, therefore, typically for a house deaf mite allergy strong allergic symptoms, in particular asthma, a cold and ocular itch are, on waking or during the night. The allergy is released not by the mite, but by substances in her excrement which is inhaled as a dust component. Even if the house dust allergy counts to the all-year allergy illnesses, stronger symptoms appear in the heating period mostly, because more dust is whirled up. Too warm, badly ventilated rooms raise the allergy risk just as long hair carpets, heavy velvet curtains and wall pendants. Till some years it was recommended to house dust allergy sufferers to move smooth floor coverings which can be wiped regularly humid. Today one advises rather carpeted floor with Kurzhaarflor, because the dust particle are better bound and can whirl not freely in the air. Are especially recommendable beside anti-allergic bedclothes, washable, mite-thick mattress covers which are washed once weekly.
Already 20 - 40 pollens are sufficient to release a hay fever push with an allergy sufferer.
Nevertheless, the offer which makes the nature to us lies around a multiple one higher: one single rye ear produces more than 4 million pollens, a hazelnut shrub even 600 millions. Because the pollens hundreds of kilometres can fly, the townsman also inhales in the Blühsaison daily in 4000 - 8000 pollen bodies.


Asthma


With younger people asthma bronchial is released almost always by an allergy. The intensive contact with the outside world to which the lung is put out makes them an ideal weak point for allergens. Although the bigger components which are inhaled with the air are filtered out by the nose, one succeeds in penetrating still of a huge number of small particles till the ramifications of the bronchi. They release an antigen antibody reaction in the bronchial mucous membrane with which the emission of histamine and other substances leads to a massive mucous membrane inflammation and a narrowing of the bronchial musculature. The exhalation is thereby complicated and walks along with the typical whistle and Giemen. Breathlessness, fits of coughing and suffocation fear are the results. Mostly these are not the big flower pollens, but small dust particle, mushroom spores and animal skin scales which release a breathlessness case (e.g.: Baker's asthma). Indeed, flower pollens also become a dangerous allergen if in the course of the years a "floor change" appears. Approximate every third patient with an allergic long-term cold develops asthma in the course of his life.


Beside the inhalation of allergens food like eggs, nuts and milk products as well as the painkiller also counts Acetylsalicylsäure (aspirin) to the specific bearers who are responsible for the development of a bronchial asthma. In addition, the überreaktive bronchial system of the asthmatic with a narrowing of the bronchi also answered unspecific bearers. Under this one understands environmental irritations like smoke or formaldehyde, breath way infections, humid cold weather conditions and emotional excitement.
Mostly the only single attacks of asthma between which longer or shorter intervals free of symptom lie appear at the beginning of the illness. If the patients are not treated, nevertheless, on time and not properly, a heavy, sometimes even extremely danderous asthma can develop.
Allergic skin illnesses


Universal


Under the concept Skin allergies three widespread skin illnesses are summarised:
Neurodermitis, Urtikaria and contact eczema.
While the contact eczema (skin rash) is caused by direct external contact of the skin with an irritant material, release with the food taken up allergens, so to speak, from the inside, an Urtikaria (skin swell with Rötung and itch). The Neurodermitis is calculated to the Atopien, i.e., she happens on a genetically conditioned, überschießenden reaction of the immune system on certain foreign matters.


In most cases the skin allergy begins with an increased histamine emission. She leads to a Rötung, swell, vesicle education and above all to strong itch. If the allergic reaction fades away fast, no other changes of the skin picture appear. Nevertheless, longer persistent irritations lead to an examathösen change with weeping or scaling skin areas. Moreover, the strong itch often causes bloody Kratzspuren or right skin injuries by which the danger of a bacterial superinfection is big.


Neurodermitis


The Neurodermitis counts like asthma bronchial and the allergic Rhinitis to the atopischen illnesses and is called, therefore, also atopisches or endogenous eczema. She shows the most important allergy in the infancy. Approximate 10 - 15% of all babies and toddlers are already concerned, according to investigations the illness rate further rises.
The first signs of a Neurodermitis appear often already few weeks after the birth. The skin of head, cheeks and forehead is reddened, scaly and dry. Partly the weeping places which dry up later with a whitish scurf also form. The vernacular speaks of milk scurf. Then at the age of 3 - to 4 years the Beugeekzem develops. The skin in the hollows of the knee or in the Ellenbeugen is dry, reddened by which thickens constant scratching and shows a lot of coarser skin profile. Above all at night the small patients suffer from the tantalising itch. Übermüdung and drop in performance are the results.


After the puberty the illness often disappears by itself. Nevertheless, there are increasingly more adults with whom a Neurodermitis is ascertained. Mostly she becomes apparent by skin changes in the cervical area and cervical area.
Typically runs the Neurodermitis chronically, returning. I.E. there is over and over again periods, in which the patients who are nearly free of pain and others in which the illness has completely blossomed. If above all the wintertime belongs to it. The already dry and low-fat skin of the Neurodermitikers becomes even more friable by the cold outside air and the dry heating air than usual. A conscientious base care which supplies enough fat and humidity to the skin is especially important in this time. Moreover, the constant Rückfettung of the skin is one of the best means against the itch.


The cause of the Neurodermitis is not cleared till this day yet. A hereditary factor plays here, nevertheless, a big role. But why not everybody falls ill which has this disposition, one does not know. A row of the so-called Trigger factors which are able to release a Neurodermitis push are known. Food problems belong to it (Wean, beginning of the little glass food), moreover, hormonal conversion, a weak defensive situation, numerous allergens (house dust, pollen, animal hair) and psychic factors like annoyance or permanent stress.


As with the asthma one also supposes with the Neurodermitis that the psyche plays a big role. This thesis is supported by study results which could show that nerves hormone system and immune system communicate with each other. Because a particularly close collaboration were discovered between mast's cells and nerve cells, the modern allergy researchers are persuaded of the fact that the brain must be incorporated in all situations, particularly, however, with the allergy. In the end, it concerns with this knowledge around nothing else than the confirmation the millennium old wisdom of the Hippokrates which went out from a unity of body, mind and soul. Thus must be consulted with the treatment of the Neurodermitis, in addition to allergologischen also psychotherapeutic, educational and food-therapeutic measures.


Tips for an Atopien:


Dry, cracked, badly greased skin, above all in the earlobes
Torn corners of mouth
Red lines will leave Dermographismus (if one strokes the back of these patients with the fingers)
Itch with the sweating
General skin paleness
Woollen delicacy
Double untereyelid fold
Urtikaria (nettle rash)
An allergic-inflammatory skin rash which appears shortly after the admission of an irritant material - drugs, insect bites or food - is called Urtikaria. Within minutes originate red spots or Quaddeln which strongly itch, the affected fabric rises. This can lead in the cervical area to extremely danderous complications. Nevertheless, mostly the skin changes fade away after some days without complications again.


As an extremely dramatic emergency the anaphylactic shock with which it can come as a reaction to a drug, food or insect bite to the unconsciousness, blood pressure rubbish and heart failure must be looked. How fast in this case medical help is necessary, point investigations of the deaths with which 50% of the allergic patients had passed away within the first thirty minutes after the insect bite and more than 70% within the first hours. The most important triggers of an allergic shock are bees, wasp stings, drugs (penicillin, Acetylsalicylsäure = aspirin, and muscle relaxation means) and food. Above all seafood, celery, milk, fruits and nuts is dangerous here. Because it is with an allergic shock about minutes, threatened patients should always carry an emergency set to the immediate therapy on themselves.


Contact eczema


While Urtikaria, allergic Rhinitis and asthma bronchial allergies provided to the IgE of the immediate type belong, the contact eczema shows an allergy of the late type. In this case that is there takes place cellular (T-cell) the provided reaction which becomes apparent only days after the allergy contact in the skin.


The eczema is released by a huge number of the different materials which have direct touch with the skin. Most contact eczemas are due to nickel-containing jewellery. Today one supposes with at least 20% of the population a nickel allergy. But also other metals, cosmetics, plastics, colours, rubber and chemicals cause a very itchy eczema in suitable sensitisation. It is marked by Rötung and swell as well as vesicle, scales and incrustation.
If the skin contact of the allergen is prevented, the irritated skin areas heal within one week without complications. If the irritation continues, nevertheless, comes to a chronic eczema. The skin becomes shining and thick and shows a coarsened profile. At the beginning of a contact allergy inflammatory changes appear only in the immediately affected skin parts, e.g., under the wristwatch, the jeans button or the ring in the finger. With longer clue of these allergic materials, the eczema also spreads to other skin surfaces.


Latex allergy


Elastic-containing materials can release a contact dermatitis (dermatitis). To this allergy of the late type during the last years an allergy of the immediate type on latex-containing substances has come which quickly increases and shows more complications than the contact dermatitis.
Primarily the people who act in the medical area are concerned of it. Sensibly a latex allergy comes along as an itchy skin illness, but also as a Rhinitis or asthma, because latex particle, engaged in the mostly powdered medical gloves can be easily inhaled.
Danger threatens the latex allergy sufferers also from the birch fig. One has found out that this plant evaporates latex juice which binds itself to dust granule and can be inhaled in this manner.
Food allergies


The right diagnosis is often difficult with the food allergy to ascertain. Many stomach bowel illnesses are recognised either not as an allergic reaction, or are called incorrectly allergy, although it concerns a quarrelsomeness reaction. Even heavier it is to be diagnosed a food allergy if the symptoms do not appear at all in the stomach bowel tract, but as a Rhinitis, asthma or Urtikaria. Almost all food can release allergies. Which nutrients appear especially often as allergies, depends on the age and on the habits of the patients. Thus children often react to milk, chicken egg white and soy. With adults, above all if they live on the coast, allergies on shellfish and fish are often found.


One divides the stomach bowel allergies today into gravity degrees:


Degree I: The stomach bowel area is concerned, the symptoms are a failure, flatulence and feeling of sickness.


Degree II and III: It comes beside stomach bowel symptoms also to skin symptoms like Urtikaria and to Asthmaerscheinungen.

Degree IV: The heaviest reactions with anaphylaktischem shock symptom.
Allergic reactions to food are especially often observed with pollen allergy sufferers, because it can come to a cross allergy. Allergies on food additives are much rarer, than in general accepted. Only if the additives to egg white contain, for example, carob flour, a real allergy can originate. Many reactions which are described on colorings or preservatives are mostly quarrelsomeness, so-called pseudo allergies.


Cross allergies


At least 50% of all birch pollen allergy sufferers also react to apples. A guilt for it are the egg white connections in the apple which show similar IgE connection places like certain molecules in the birch pollen. Such common characteristics in the proteins or allergen pattern appear especially often with closely related plants or animal species.
Thus birch pollen allergy sufferers react often also to hazelnut or alders pollen, and grass pollen allergy sufferer on rye pollen. Between the different kinds of the house dust mite cross reactions are also often observed. At the example of the birch pollen allergy sufferer who agrees with the consumption of apples to swollen lips appears that it can also come without kind relationship to cross allergies. It concerns, on this occasion, always a partial (part) allergy, i.e. she can appear, however, does not have to go.


This explains observations that some hay fever patients stand though cherries and carrots, for it, however, no nuts, while it has exactly turned back with other birch pollen allergy sufferers. Also it is not any apple kind which causes allergies. Symptoms are especially often found after the consumption of Golden Delicious or Gloster. Moreover, many patients stand no apples only during the pollen flying time. The remaining year no discomfort appears through.
Most cross allergies are known with birch pollen allergy sufferers. Indeed, cross-reactive quarrelsomeness recently also increases with latex allergy sufferers strongly. Thus food can lead like banana or avocado, and plants like Benjamins with these patients to allergic reactions. To be sure really that it concerns with the patient a cross allergy and not around an independent sensitisation on certain food, the blood tests in which the IgE-antibodies are determined must be carried out.


Cross-reactive allergen
Birch, alder, hazelnut, beech
Sagebrush, camomile
Pollens with pollen
Sunflowers, margin rites
Lilac ash, olive tree
Celery carrot
Food with food
Water melon, cucumber
Flours, e.g. (wheat flour) rye, oat, cornmeal
Rice, sesame, poppy seed
Birch predominantly partially: Fresh fruit like
Pomes and stone fruit, nuts, carrots,
raw tomatoes, celery, kiwi
Pollen-related cross-reactive food allergy
Grass predominantly partially: raw potato,
Soy, peanut, pea kiwi
Sagebrush spices, celery, carrots,
Lychee, onion, camomile tea
Other
Latex banana, avocado, papaya,
Eating chestnut, kiwi, ficus,
Gelatin volume substitute,
Plasmaexpander


Allergy diagnostics


Universal


Condition for a successful allergy treatment is the identification of the allergen. In spite of the numerous test procedures which are available today it is not sometimes easy to find the guilty substances. Not every test procedure is equally expressive for all allergy forms. Moreover, it can come to the wrongly positive or wrongly negative test results with which the symptoms of the patient do not agree with the findings. Almost every third patient reacts to certain materials in the skin test positively, although he develops on it no allergic symptoms in the everyday life. Also the reverse situation is not seldom: the patient reports to the therapist that he does not stand apples, nevertheless, the skin test shows no positive reaction. These discrepancies can have different causes. Many vegetable kinds and fruit kinds in the cooked state possibly cause no allergies because the allergen is heat-unstable and disintegrates with the cooking. On the other hand, sometimes originate only during the digestive process proteins which to the allergen discomfort will prepare and the patient.


Around from these bewildering test results him direct end to be able to move, are necessary sound experience of the therapist and careful own observation of the patient. Therefore, the first step to the diagnosis is the patient's conversation in which the therapist puts to the patient beside general questions to the anamnesis also specific questions. If the suspicion on allergic events has been confirmed, besides, an Allergietestung is recommendable. Best of all one begins with the Hauttestung, because through this inhalation allergens, contact allergens and food allergens can be ascertained.


Test procedures


All skin tests function after the same principle, merely the kind of the realisation is different: on the back or the inside of the arms a small quantity of the suspicious substance is applied and the reaction of the skin is read after a certain time.
As controlling substances serve a 100-percent histamine solution which leads, in any case, to a strong reaction, and a cooking salt solution which should cause no skin change. Skin test are suited above all to the general proof of inhalation allergens. Indeed, it can happen that the results do not agree with the acute symptomatology of the patient, because also materials respond with which no more contact exists (e.g., mould mushrooms which were already removed from the flat) or their sensitisation degree is very low. To be sure that it concerns with the proved allergens the triggers of the discomfort, a provocation test must be connected.
The explanatory power of the skin tests with food allergies is limited, because the sensitisation often concerns not the food, but one of his by-products. Therefore, the result of the Hauttestungen should be always checked by an outlet test or by a searching diet.


1. Pricktest:


On this occasion, the therapist applies in each case a drop of the examining allergen solutions on the before marked skin places and scratches the skin at this point with a Lanzette easily. After approx... twenty minutes the result can be read. A positive allergen proof appears in the form of Rötung, Quaddelbildung and itch. As a comparative value the skin change which has originated under the histamine solution is pulled up.


2. Skratschtest:


It is carried out after the same principle like the Pricktest: the investigator scratch first a scratch in the skin and then applies the allergen in liquid or pulverised form on this place. Because it itself around an allergy acts the result can be read after about twenty minutes.

3. Intrakutantest:


Here the allergen solution is squirted directly in the skin. Because this procedure is from ten to hundred times more sensitive than both other skin tests, it offers of course much more exact results. Indeed, the danger of an undesirable or very strong reaction is also bigger. Therefore, it should not be applied with extreme sensitisation or very aggressive allergens (e.g., insect poison). With such risk patients is suited soonest the grater test which is not very specific, but is safe. Besides, the allergen is rubbed ten times on the inside of the forearm hard. Soon after few minutes the result can be read.


4. Epikutantest:


To the proof of a contact eczema the plaster or Epikutantest is suited. Besides, are stuck to the patient up to twenty sticking plasters with allergen solutions on the back. The result can be read only after from 48 to 78 hours., because it concerns with the contact eczema an allergy of the late type. A positive reaction becomes apparent by Rötung, pimple and eczema. The stronger the allergic sensitisation, the more intensely is the Rötung.
5. Provocation test:
With this test form the organ affected by the allergy (nose, bronchi, stomach bowel tract, connective tissue membrane) is contacted directly with the allergen. It becomes there körperli

 

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