Allergology is a medical specialty that deals with the development, diagnosis and treatment of allergies. Diagnosis takes place either in vitro or in vivo. In vivo testing procedures on the patient himself are sometimes associated with the risk of allergic shock for the allergy sufferer.
What is allergology?
Allergology is a medical specialty that deals with the development, diagnosis and treatment of allergies. Allergology is a medical specialty. The medical subfield focuses on the diagnosis and treatment of allergies. In the field of research, allergology is also concerned with the individual manifestations and development mechanisms of allergies. German allergists are usually internists, pneumologists, dermatologists or general practitioners. In order to be allowed to bear the title of allergist, they must have undergone appropriate further training in the allergological branch of medicine. The German regulations on this differ from those in other countries. In Switzerland, for example, allergists are required to focus on a specialist degree in allergology already during their medical studies. The term immunology is also frequently associated with allergists. An allergy is an immunological overreaction. Therefore, allergology, in its broadest sense, studies immunological disorders associated with a specific allergen.
Treatments and therapies
Allergy diagnostics is one of the most important subfields of allergology. This field includes all examination procedures that help in the search for an allergy-causing substance and in the elucidation of the causes of its development. The sub-areas of allergy diagnostics are in-vivo and in-vitro diagnostics. In vivo diagnostics takes place on the patient himself. In in vitro diagnostics, on the other hand, the physician takes body fluids from the patient, which are then examined in the laboratory. On the basis of these samples, for example, a determination of the total IgE with radio-immuno-sorbent test takes place. Allergy reactions are dependent on immunoglobulin 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 the evaluation of allergological diseases. The increase of 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 via this test, since all allergies raise the antibody level. A second test procedure in allergology is therefore the determination of specific IgE via the radioallergo sorbent test. This procedure can confirm the suspicion of a specific allergen. In addition to the two diagnostic methods mentioned above, in vitro allergy diagnostics also encompasses the determination of allergen-specific IgG, cellular allergen stimulation tests and histamine release tests. The IgG test allows, for example, the determination of food allergies. This form of allergy is independent of immunoglobulin E and therefore requires the measurement of other parameters. The allergy stimulation test, on the other hand, is intended for the qualitative determination of a food allergy. The procedure is also called leukocyte activation test and is based on the assumption that food intolerances cause inflammatory reactions against certain food components. These reactions are measured in the patient’s blood using the leukocytes that cause inflammation. The measurement is performed in conjunction with the administration of various food extracts. The histamine release test as well as 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 procedures in allergology include the prick test, the rub test, and the intradermal test. In the prick test, the allergist drips the test substances onto the patient’s skin. He then “pricks” these areas of skin to induce an allergic reaction. The rubbing test is mainly used in connection with food allergies. The food is rubbed onto the skin and the patient’s reactions are documented. The intradermal test is relatively non-specific.In this procedure, the physician injects a solution of the allergens to be tested into the skin of the back and waits for allergic reactions. When the allergy is determined, along with its extent and allergen, the allergist treats the hypersensitivity. For this purpose, he has more than 70 different procedures at his disposal. Which one he chooses depends largely on the allergen and the intensity of the allergy.
Diagnosis and examination methods
Allergologic in vitro testing procedures are associated with few risks and side effects for the patient. In vitro tests on the patient himself, on the other hand, 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 testing procedures take place exclusively under supervision. The allergist has in his practice antidotes and medicines that reduce the risks for the patient. Therefore, allergy testing in and of itself is considered safe. However, drug allergies and food allergies are usually tested on an inpatient basis. In the case of food allergies, the allergic reaction is often delayed. It is then important to avoid a collapse of the patient. The inpatient admission for this type of allergy test is therefore a safeguard for the patient. In the case of drug allergies, hardly predictable side effects often occur or circulatory collapse occurs. Therefore, inpatient admission is safer in this case as well. Test procedures such as the prick test are also discredited for provoking allergies in the first place. However, scientists now want to have ruled this out.
