Professor Maciej Kupczyk, President-elect of the Polish Society of Allergology, is interviewed by Iwona Schymalla:
Iwona Schymalla: Professor, let us imagine an adult who is generally healthy, cares about her diet, physical activity, does some sports, but one spring she develops allergic symptoms. Is such a scenario even possible? And if so, what are the causes?
Prof. Maciej Kupczyk: Of course it is possible. This is not the most common clinical picture of the development of allergic disease, but for the most part we are not born with all health problems. In the same way that we are unlikely to have coronary heart disease from birth, allergy symptoms can also appear throughout our lives. Most often, the first symptoms of allergy and atopic asthma (i.e. asthma with an allergic origin) appear in childhood. Sometimes we also observe a form of allergy development that we call the allergic march - slightly different problems are observed in children (here food allergy and atopic dermatitis are more common), while adolescents and young adults are more likely to develop allergic rhinitis and atopic asthma. This is the clinical picture of allergy progression in a person with an atopic background, i.e. a genetically determined tendency to develop allergies. Here, there is another very important issue, that is, a healthy lifestyle, healthy eating, sport, a healthy diet, avoiding exposure to harmful agents. Obviously, all these aspects are extremely important from the point of view of public health and keeping the body in optimum condition. In a way, this also translates into reducing the risk of developing allergies, such as exposure to air pollution, smog or cigarette smoke. This is very important because air pollution can damage the respiratory tract, the respiratory epithelium, which promotes allergisation, i.e. the development of sensitisation in a person who is susceptible to it.
Iwona Schymalla: The word 'allergy' has become part of everyday language and is often used to describe symptoms that have nothing to do with allergies. So let us talk about modern methods of allergy diagnosis. What has changed in recent years? Are we now able to diagnose allergies almost perfectly? What has changed for the better in terms of treatment methods for this very troublesome condition?
Prof. Maciej Kupczyk: The word allergy is, no doubt, somewhat overused when it comes to the clinical picture of any hypersensitivity, intolerance or, in general, any clinical symptom that is not necessarily related to allergy in the purely medical sense. Some language purists find this a little irritating. But it is the case that many patients come to the doctor with, for example, skin lesions, features of intolerance to certain foods, which may not necessarily have anything to do with the immunological mechanisms that are responsible for the allergic mechanisms.
Without going into such details, it is worth noting that it is our job as allergologists, as specialists, to help patients understand these problems. And in those groups where a deeper diagnosis is indicated, we certainly have a whole range of state-of-the-art methods. We reach for various exposure tests, e.g. starting with such basic skin tests with allergens, we reach for determinations of specific IgE antibodies (specific for the allergic reaction, dependent on this type of antibody). We have very modern platforms for component diagnostics, i.e. strictly defined allergens rather than allergen groups. This really helps us a lot, especially in severe forms of allergy, in food allergy, in allergy that can be life-threatening in anaphylaxis.
As far as treatment is concerned, there are also huge advances in knowledge in the treatment of allergic diseases from year to year. New symptomatic drugs are introduced, including modern antihistamines, and we have new methods of applying topical drugs. The basis of symptomatic anti-inflammatory treatment is glucocorticosteroids, which inhibit the mechanism of the inflammatory reaction, administered in a minimum dose exactly at the site of inflammation, e.g. to the nasal mucosa or by inhalation. Every year we have more and more modern drugs, more and more modern methods of administration. We also have access to state-of-the-art biological therapies. We have monoclonal antibodies, which we use in the therapy of the most severe forms of IgE-dependent atopic bronchial asthma, for example, i.e. the typical allergic asthma with a very severe course.
Iwona Schymalla: Spring and summer encourage people to be outdoors, but also during this time the risk of insect bites increases, and this in turn increases the risk of anaphylactic shock. Can anaphylactic shock occur in a person without any previous allergy symptoms? And is it true that it mainly occurs in adults?
Prof. Maciej Kupczyk: Anaphylactic shock is undoubtedly the most severe form of allergy. We are keen to recognise this picture of a generalised allergic reaction and to implement the appropriate treatment as soon as possible, as it is a form of allergy that is directly life-threatening. Shock usually manifests itself initially with skin lesions, hives, oedema, swelling of the lips and tongue, swelling of the throat and larynx, shortness of breath, but can end in hypotonia (lowering of blood pressure), cardiac arrest and death. We are therefore keen to recognise this clinical picture as early as possible.
The basic course of action is to call for help, the emergency room, as soon as possible. Patients who have already defined, diagnosed this picture of anaphylaxis, carry so-called oral rescue drugs and, of course, adrenaline. Adrenaline is such a first-line rescue drug that should be given as soon as possible when anaphylactic shock develops.
In terms of patient groups, anaphylactic shock is indeed most common in adults, in young adults, in people aged around 25-50 years. Although, of course, it can happen in children as well as in older people. As the Editor mentioned, there may indeed not be any other allergy symptoms beforehand. It is not the case, for example, that we have allergic rhinitis and this is a significant risk factor for anaphylaxis. Absolutely not. Indeed, a picture of sensitisation to, for example, hymenopterous insect venom, bee venom and wasp venom, can occur in a person who has not previously had any allergy symptoms. And the first such episode may immediately be a picture of just a severe anaphylactic reaction. It is worth recognising this. And here is an appeal to all colleagues, and to all patients: if we have a picture of a generalised allergic reaction that looks like anaphylactic shock, first of all, we must always prescribe rescue medication for such a patient, because there is a risk of a repeat, severe reaction in the future. Such a patient must have rescue medication. Secondly, he should be referred to an allergy centre that deals with the diagnosis and treatment of this type of allergy.
Iwona Schymalla: My understanding is that there is no study that shows whether we are more predisposed to have anaphylactic shock and therefore have life-saving drugs with us at all times.
Prof. Maciej Kupczyk: No, on a population scale this is absolutely not the case, there are no such studies. Here, the risk factor for the development of a more severe anaphylaxis in the future is a recognised generalised allergic reaction (skin symptoms, swelling of the throat, larynx, dyspnoea, because the first reaction does not necessarily have to end in a drop in blood pressure and life-threatening). Here the clinical picture is the key. And such patients should go to specialists. We do not currently have a broad population-based study that can identify this subgroup of patients. Anaphylaxis is not a very common phenomenon. In Poland, we observe about eight such episodes per year per 100 000 hybrids. So it is not a very common form of allergy, but on the other hand, it is the form of allergy that is life-threatening, so we need to diagnose it effectively.
Source: medexpress.co.uk