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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.
This test is used for assessing secondary involvement in this disease and ruling out similar processes. It may also help to find trapped peripheral nerves that usually result from overloading of the joints and, in particular, the upper limbs.
For helping to confirm diagnoses.
Through electrical stimulations with surface electrodes and electrodes inserted into muscles with very fine needles.
Secondary pain during the procedure and a little bleeding (haematoma).
There are no other techniques that can replace EMGs in diagnosing poliomyelitis and post-polio syndrome.
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.
Blood smear, making a small prick in a finger, in order to assess cell morphology. This prick is used to conduct a morphological examination of blood cells, allowing a first approximation and examination of possible diagnoses.
A blood smear or peripheral blood test is performed by obtaining a blood sample through a finger prick (a puncture in the fingertip with a very fine needle) or a venipuncture (extraction from a vein), and carefully spreading a drop of blood on a glass slide until it forms a very thin film. The cells are then stained and the morphology of the cells is analysed under an optical microscope.
Microscopic study of a peripheral blood smear allows the cells present in the blood sample to be seen directly and their morphological characteristics analysed (shape, size and cell organelles such as the nucleus or granulation characteristic of some cells, and also inclusions, deposit of substances, and even microorganisms such as parasites or bacteria).
Using this test, we can check if the cells have a normal or altered appearance. If any alterations are detected, they can be described and an overall interpretation of the exam can be drawn. This allows the suspicion of various diseases to be ruled out or confirmed, both blood and non-blood-related conditions. It also allows observation of the effects that other conditions within the body have on blood cells, such as infections, haemorrhages, trauma, etc.
If the blood smear suggests the presence of a blood or bone marrow disease, it may be necessary to conduct bone marrow aspiration and/or biopsy to confirm the diagnosis.
This is a puncture and aspiration of the bone marrow using a fine needle under local anaesthesia. Bone marrow material is aspirated through the needle (in the case of aspiration) or a small, cylindrical sample is obtained from the bone marrow inside the needle (in the case of biopsy).
The area is sterilised with iodine and then local anaesthesia is applied. A fine needle puncture is then performed and the bone marrow (material from inside the bones) is aspirated. It is a simple technique that is usually practised on the hip bone (iliac crest) or the sternum. The aspirated material is subjected to different diagnostic procedures such as smears to assess cell morphology, microbiological cultures, immunophenotyping techniques, cytogenetic and molecular studies.
This technique serves to study the bone marrow. It is essential for the diagnosis and monitoring of many blood diseases, as well as screening for other conditions. A bone marrow exam enables diagnosis of bone marrow or blood cell diseases such as leukaemia, lymphoma, myeloma, myelodysplastic syndrome, as well as non-haematological diseases that may affect the bone marrow, such as tumours from other origins, deposit diseases, etc. Following treatment of these diseases, bone marrow exams also help to evaluate treatment efficacy.
Aspiration and biopsy are simple techniques that are performed as out-patient procedures (they do not require admission to hospital) and under local anaesthesia and/or sedation. The total duration of the procedure is approximately 30 minutes, and at the end the patient can go home, needing only minor oral analgesia in case of local discomfort. A small bruise may occur at the puncture site, but this is not common.
A procedure that, by introducing a flexible tube (bronchoscope) into the nose or mouth, allows the bronchial tree to be viewed, for diagnostic and/or therapeutic purposes.
There are various diseases or situations that may require this diagnostic test, such as lung cancer, lung transplantation, hemoptysis, diffuse interstitial lung disease, and lung involvement in immunocompromised patients, among others.
To examine the bronchial tree and obtain samples of secretions or tissues for analysis with the aim of gaining an aetiological diagnosis of the causative illness. It can also be a therapeutic test, allowing suction of secretions or clots, extraction of foreign bodies, permeability of the airway in lung tumours and treatment of complications resulting from lung transplant.
With the patient normally lying down and consciously sedated, the bronchoscope is introduced into the airway, administering local anaesthesia in the passageways (larynx, trachea and bronchi). After examining all the bronchi and identifying any possible lesions, samples are taken, which may include: bronchial aspiration, bronchoalveolar lavage, bronchial brushing, transbronchial puncture, bronchial biopsy or transbronchial biopsy.
Minor undesirable effects may appear, such as snoring, cough, fever, localised pain, nausea or sickness and coughing up small amounts of blood, which are usually self-limiting and present no risk to life. Less commonly, major complications may occur, such as haemorrhage, low blood pressure, high blood pressure, pneumothorax (entry of air into the thorax outside the lung). In very rare cases, complications such as arrhythmia or arrest of the heart, respiratory depression or arrest and acute stroke, may be severe and require medical or surgical treatment, including a small risk of death.
Rigid bronchoscopy, CT-guided needle lung biopsy, mediastinoscopy, surgical lung biopsy.
The thyroid gland actively captures iodine for the synthesis of thyroid hormones. If radioactive iodine is administered, the weak radiation released can be detected and reveal information about the gland’s condition.
The test takes advantage of the affinity that the thyroid gland has for iodine. This affinity is increased in the case of hyperthyroidism, which is the situation in which scintigraphy is most useful.
To determine the shape, size and location of the thyroid gland. It can also detect nodules or areas of hyperactivity or hypoactivity.
A slightly radioactive isotope of iodine is injected intravenously. When it is captured by the thyroid gland, a gamma camera detects the gamma radiation from the iodine taken in by the thyroid gland and gives us an image of the gland and its more and less active areas.
Although a radioactive substance is used, the level of radiation is very low. It is not recommended in pregnant women.
An ultrasound can be useful in detecting nodules, but it does not given an idea of the level of activity in the same way as scintigraphy does.
Electroencephalography (EEG) records the electrical activity in the brain. During an EEG various electrodes are placed on the patient's skin to record brain activity.
An EEG can be performed under different conditions: With the patient asleep or even subjected to stimulus such as a flashing light, or after breathing deeply to introduce metabolic changes that reveal an area of the brain with unusual brain activity.
Sensors (electrodes) are placed on different parts of the head. This usually takes a few minutes and, as it is non-invasive, can be repeated as often as necessary.
There are different types of waves in the EEG; according to their frequency and amplitude. The normal EEG of a healthy person shows the so-called alpha waves with a frequency of 8 to 12 Hz, and a voltage of 50 microvolts. In the same way, beta or delta waves are described and detected that correspond to different pathologies.
The neurological diseases that benefit from the EEG are:
An EEG is a routine test that poses no risks and can be repeated several times during a neurological illness.
Brain imaging tests are also useful and may allow more accurate diagnosis and treatment when combined with an EEG.
Kidney disease has a noticeable effect on a patient's general health and can also be detected by the blood and urine tests taken. Imaging tests (renal ultrasound, CT scan and nuclear magnetic resonance imaging) provide information for diagnosing kidney disease, but the essential and indisputable test to be able to reach a diagnosis of kidney disease is a kidney biopsy.
This consists of extracting a very small sample of kidney tissue, just a millimetre or so in size, with a special needle. The needle is guided by ultrasound and under local anaesthetic with or without sedation, depending on the characteristics of the patient.
The sample obtained is processed by the Pathological Anatomy Department for observation using optical microscope, fluorescence microscope and electronic microscope techniques. This enables different parts of the kidney to be observed: the glomerulus, the tubule, and the blood vessels. Special liquids can also be used to reveal infections and toxicity produced by different medicines.
This is very useful both for diagnosing disease in the kidneys themselves, as well as a test to monitor a kidney transplant.
Although a kidney biopsy is not without complications worth mentioning, they rarely occur and can be resolved. Urine may contain blood, for example, although this generally stops by itself. Renal haematoma may also occur, which also does not require treatment. Accidental communication between an artery and a vein may also occur, which can be repaired via catheterization to close the anomalous communication.
Kidney biopsy is a common procedure in the Nephrology Department and complications occur in around 1-2% of cases, which are subsequently resolved. It is therefore considered a safe routine procedure.
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