We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
Vols saber com serà la teva estada a l’Hospital Universitari Vall d’Hebron? Aquí trobaràs tota la informació.
Allergology, General Hospital
Asthma is a disorder of the passage of air through the respiratory tract, particularly in small-calibre bronchial tubes. It causes difficulty breathing and the patient feels like they are drowning and must increase their effort in an attempt to breathe better.
Asthma is a chronic inflammatory disorder of the airways that results in variable airflow obstruction. It often changes throughout the day (it can get worse at night) and improves with treatment and then reappears later.
The illness is basically caused by an inflammatory mechanism.
Three phenomena occur in the airways of patients with asthma:
1. Decreased bronchial diameter, which restricts air flow.
2. Inflammation, with increased thickness of the bronchial wall, which also contributes to restricting air flow.
3. Increased activity in the glands that produce mucus, with increased secretions contributing further to breathing difficulty.
Cells that circulate in the blood are involved in the local inflammation observed in asthma: T lymphocytes, mast cells and eosinophils. These cells are responsible for the body’s normal defence and their activity is increased in asthma. Medication for asthma attempts to regulate this activity.
According to the degree of restriction, the person affected will experience breathing difficulty and a sensation of lack of air. Also characteristic of asthma are wheezing, which is the sharp whistle-like sound of the air as it passes through the smaller airways, and increased bronchial secretion.
Asthma can affect all age groups and sometimes overlaps with bronchitis. On many occasions it can be allergic in origin or come as a result of exposure to an environmental or chemical agent.
Spirometry, chest x-ray, allergy tests.
Some basic questions for diagnosis:
1) Have you ever had a whistling sound in your chest?
2) Have you been coughing, especially at night?
3) Have you had a cough, whistling sound, difficulty breathing at some times of the year or in contact with animals, plants, tobacco or whilst at work or after exercise?
4) Have you had colds that last more than 10 days or are "chesty"?
5) Have you used inhaled medication?
Treatment is based on using bronchodilators, in the form of an inhaler or tablets. Anti-inflammatory drugs also have an important role.
The most common diagnostic tests for asthma are based on:
1) Spirometry: Measures air flow on inhaling and exhaling and detects any restrictions in the airway, one of the characteristics of asthma.
2) Bronchodilator test: Tests if spirometry improves with drugs to dilate the airway.
3) Bronchial challenge test, the same test in the opposite direction with drugs that cause a slight airway obstruction, detected by spirometry.
To prevent asthma, it is fundamental not to smoke and avoid exposure to allergens that precipitate it, which are detected with the allergy tests that form part of the asthma exam.
An exposure test is the controlled administration of a medication or food to diagnose allergic reactions.
Controlled exposure testing with foods or drugs is used for confirming or ruling out allergic reactions, when a conclusive diagnosis could not be reached with the other tests.
The first thing that has to be done when carrying out a controlled exposure test is inform the patient about the test, its usefulness and associated risks. Patients should be provided with an information sheet and asked to sign an informed-consent form.
The tests are carried out in the nursing office, located on the second floor of the Old School of Nursing (Antiga Escola d'Infermeria), where a nurse will carry out the skin tests and some food and medication challenges, or at the Allergology Day Hospital, which has all of the tools for diagnosing and treating any adverse reaction, as well as a doctor and nursing staff who are trained to carry out this procedure.
With drug trials, allergen will be administered through the safest route (orally or intravenously). When necessary, the dose will be divided or the speed of administration reduced, according to the documented adverse reaction and the type of drug being studied.
Once the drug has been administered, patients should remain under observation for several hours so that any delayed reactions can be diagnosed.
Since the procedure is not without risks, the risk-benefit ratio needs to be assessed before an exposure test can be carried out. As for studies with medications, such testing will only be done with important drugs, meaning, in cases where one medication is more effective than other alternatives (if there are any).
Most reactions triggered by the test are mild, and then diagnosed and treated early. However, severe reactions can occur, such as anaphylaxis and anaphylactic shock.
There are no alternatives to exposure tests, since they represent the last stage of a diagnostic process. However, if a diagnosis can be obtained from the previous tests (skin or blood testing), it may not be necessary to carry these out.
Skin tests are important procedures to confirm allergic sensitisation mediated by immunoglobulin E (IgE) antibodies in patients who suffer from rhinoconjunctivitis, asthma, hives, anaphylaxis, atopic eczema or allergies to foods or drugs.
Skin tests are ordered when there is a suspected allergic reaction or disorder after t a medical history has been taken (through questions) and the patient examined. Skin tests, thus, give us an objective confirmation of sensitisation to an allergen, although the relevance of that sensitisation has to be interpreted with the patient’s history borne in mind, so that the appropriate advice on avoidance and treatment can be given.
There are two main types of skin tests:
The results are read after 15-20 minutes. If the patient is “sensitised”, the substance will induce a local reaction with itching, redness, swelling, etc. This reaction is compared with tests done with physiological serum (negative control that should not cause a reaction) and histamine (positive control that should cause a reaction).
The patient should not take antihistamines (anti-allergy medications) for 5-7 days prior to the test.
The risk with these tests is very low. Only in extremely allergic patients, and usually while testing medications, is there a certain risk of their causing a serious and generalised allergic reaction.
In some cases, blood can analysed to assess its sensitisation.
Skin tests are the technique most commonly used to begin diagnosing an allergy. Following a meticulous clinical history, it is decided which skin tests may be useful, depending on the case.
Skin allergy tests serve to find out if a patient is "sensitised" to a particular substance, if their body recognises the substance and reacts when it comes into contact with it. These tests DO NOT DIAGNOSE an allergy. They are only positive if accompanied by one of the symptoms compatible with an allergy, helping a diagnosis to be reached.
There are two main types:
The risk of these tests is very low. Only in extremely allergic patients and usually with drug testing, there is a certain risk of serious and widespread allergic reaction.
In some cases, blood tests can be conducted to assess blood sensitisation.
Simple spirometry is a test to study lung function, which lets us know the amount of air patients can move and how well they do it.
This test is done using a device called a spirometer. The patient must be sat upright with their legs uncrossed. Then, clamps are placed on the nose and the patient is asked to insert a nozzle into their mouth. Once ready, the patient must fill their lungs by breathing in as deeply as they can. The care worker then asks the patient to blow as hard as they can, not stopping until their lungs are empty. The blowing stops when the healthcare professional in charge tells the patient to stop.
Next, the patient is asked to breathe in quickly as hard as they can in order to record their inhalation data.
This can be repeated until three correct readings are taken. Normally the test lasts 10 minutes.
Hereditary angioedema is a rare genetic disease that affects approximately one in 50,000 people. It is usually an inherited disorder and is characterised by the accumulation of fluids outside the blood vessels, causing swelling of the face, hands, feet, extremities, genitals, gastrointestinal tract or the upper respiratory tract. Because it is a low-prevalence disease with symptoms similar to those of other diseases and is therefore difficult to diagnose, it is important for there to be reference centres so that suspected and diagnosed cases can be centralised.
The inflammation that hereditary angioedema causes does not present associated itching and may last for 1 to 5 days. These symptoms are developed as a result of the malfunction of certain proteins that help maintain the normal flow of fluids through the blood vessels (arteries, veins and capillaries).
The seriousness of the disease shows a significant degree of variance. Angioedema episodes may be extremely incapacitating and have a serious effect on the patent’s quality of life. When it occurs in the region of the mouth or neck, the sufferer may die of asphyxia if they are not given preventive treatment.
In most cases symptoms start to manifest in childhood and/or puberty and continue throughout adult life.
There are different types of hereditary angioedema and they are classified according to whether or not they present a deficiency of the C1 component of the complement (C1-INH).
Swelling of the subcutaneous tissue in any part of the body, although it is most commonly found in:
Depending on the affected area, the symptoms may range from local discomfort to invalidity of the affected extremity, discomfort or pain when swallowing, voice changes, loss of voice, or dyspnoea (shortness of breath).
At one time of their life up to 50% of patients may present an episode that affects the throat, which if not immediately treated could lead to asphyxia.
Hereditary angioedema affects people who exhibit a mutation in certain genes, such as SERPING1, F12, PLG, KNG1 and ANGPT1. As it is a dominant autosomal disease, an affected patient has a 50% chance of passing it on to their children. Given that it is a genetic disorder, it is common to find that more than one member of the family is affected.
Depending on the type of mutation, it may affect men and women equally (types I and II) or women more frequently (HAE-nC1-INH). Cases of hereditary angioedema without C1-INH deficiency are usually associated with hyperoestrogenic states, such as pregnancy or the consumption of contraceptives that contain oestrogens.
The Allergology Clinic first assesses patients who present with recurring angioedema episodes and cases in which there are family members who also suffer them. Subsequently, a blood analysis is requested to determine the levels of the components of the complement, including the inhibitor of component C1 (C1-INH) and, finally, the diagnosis is completed with a genetic study.
Treatment depends on the number of attacks, the severity of the symptoms and the degree to which quality of life is affected. Treatment is always on a case-by-case basis and may be acute, which means the subcutaneous of intravenous administration of medication at the time of the angioedema attack, or preventive, to stop attacks occurring so frequently. The latter treatment is usually recommended for the patients who suffer the most episodes.
Angioedema treatments can be self-administered by the patients.
In the case of surgery, endoscopies, tooth extractions or certain dental procedures, treatment must be given in advance to prevent an attack.
Blood analysis normally forms part of the diagnostic procedure. Depending on the treatment, during monitoring it may be necessary to perform an abdominal ultrasound and draw blood for analysis.
Factors known to possibly trigger attacks should be avoided as far as possible:
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