I collaborated as faculty for the 1st Allergo Conclave “Newer paradigms in Allergy Management” held on April 24, 2015.. Conclusions were very pertinent.
Allergies are increasing worldwide , human airway disease is an immense economic burden globally.
Correct Allergen identification is of immense importance in planning treatment.
Detailed history is first important step. The history must focus on environment ,occupation,food and drug intake
by any route personal care products , meteorological and geographical variations etc,
Skin prick test is the gold standard in tests if performed with purified allergens with correct technique.
Specific IgE is of value where skin tests are not possible but practice of just doing this in a lab without
expert consultation must be condemned. Total IgE is nonspecific , associated with many other common conditions like parasitic infections , and is not recommended.
Provocation tests , nasal and bronchial should be used to identify major allergens.
Food allergies also have an important role in respiratory allergies.
For Food Allergy double blind placebo controlled challenge test is gold standard.
Poli Sensitisation in different studies is from 27 to 78 percent in respiratory allergies..
Pharmacotherapy and Immunotherapy are methods of treatment.While inhaled steroid is the cornerstone in reducing inflammation, immunotherapy is useful in long term management.
Immunotherapy if done scientifically with purified allergen extracts, after accurate identification of major allergen can help in reducing doses of medicines and is steroid sparing .
Most important step is to select the relevant allergen useful for Immunotherapy.
Relevant allergen is not the one which has maximum positivity on skin test but is the one which has maximum correlation with history and other factors.
European studies do not recommend mixing of allergens.
American studies do not recommend mixing of more than 4 allergens.
While mixing compatibility with each other and degradation of proteolytic enzymes must be considered.
Certain groups like fungi with dusts should never be mixed for immunotherapy.
It is preferable to give single allergens on two arms.
Subcutaneous immunotherapy ( SCIT) and sublingual immunotherapy (SLIT) are two methods in use.
Studies have found SCIT to be superior but SLIT has the advantages of ease of home administration and no harmful effects like anaphylaxis.
Minimum duration of immunotherapy is 3 to 5 years.
Pharmacotherapy is useful in everyday management of patients but Immunotherapy is the only method by which long term disease modification is possible.
Immunotherapy has stood itself on firm scientific grounds , certainly helps in reducing symptom score and medication requirements. It also helps in preventing new sensitization. It stops the march of Allergic rhinitis towards Asthma development.
Health education is most important aspect for better compliance.
