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Allergology
Parc Sanitari Pere Virgili
Angiology, Vascular Surgery and Endovascular Surgery
Infectious Diseases, General Hospital
Grup de Recerca de l'estat epilèptic i crisis agudes
Grup de recerca translacional del càncer gastrointestinal no colorectal
Genitourinary Tumours of the CNS and Sarcoma
Prova prova prova
Títol Unitat de Referència
Associació del Pacients Toc Toc
Symposium 'Career Day'
Programa 'Reunió de famílies amb distonia mioclònica i altres distonies (tercera edició)'
MAPA
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.
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