Allergology
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Recerca:
The section regularly participates in clinical trials both in relation to the introduction of new drugs in respiratory allergies and new therapies and guidelines in specific respiratory immunotherapy. The results are presented in national and international communications and the most relevant are published in medical journals.
We carry out this task in the Hospital’s Multipurpose Clinical Research Unit (UPIC), which provides facilities and personnel dedicated to carrying out clinical trials of phases I, II, III and IV as well as observational studies, independent promotion or industry. Thanks to these facilities we managed to lead in many trials the recruitment of patients . This fact has allowed to carry out research contracts in members of the Service once the residence is over.
We participate in several multidisciplinary projects:
- Asthma Grave Unit where allergologists, pneumologists, pediatricians, ORL and immunologists collaborate to offer the best multidisciplinary care for those patients with more complex and less controlled asthma. The SEAIC (Spanish Society of Alergology and Clinical Immunology) has accredited this unit as a unit of excellence and as a teaching unit to provide face-to-face practical training in severe asthma. The Unit is coordinated by Dr. Maria Basaga.a. Each year an Asthma course is held aimed at both Primary and Specialists
- Multidisciplinary Chronic Urticaria Unit where allergologists, dermatologists and immunologists collaborate. Protocols for the management of this pathology are created in accordance with the Network of Urticaria of Catalonia and the Balearic Islands. The Unit is coordinated by Dr. Nathalie Depreux.
- Atopic Dermatitis Unit where allergologists and dermatologists collaborate. A protocol for the management of this disease has been created and has facilitated the introduction of Dupilumab as a biological treatment for the disease. Dr. Yanina Jurgens participates.
- Toxicothermy Unit where allergologists, dermatologists and pharmacologists collaborate. A circuit has been created for the study of this pathology. Dr. Yanina Jurgens participates.
The current research projects of the Section are:
- The Doctoral Thesis called “Factors of Prognostic Eosinophilic Fat in Eosinophilic Severe Asthma” within the Grey Asthma Unit.
- Together with the Cutaneous Allergy Committee of the Catalan Society of Allergology and the Department of Nutrition of the UB, work is being done on the project in scientific progress on the aetiology, diagnostic parameters and dietary management of food histamine intolerance. Winning project of the 2020 Call “R&D&i Projects” modality oriented to the challenges of society.
- Grant from the Health Research Fund in Allergy to Beta-Lactams together with Pharmacy and Vall d'Hebrón Hospital.
In addition, we have been awarded on several occasions by the Germans Trias Talents Grants, which has allowed us to introduce the induction of oral tolerance in pediatric patients with persistent allergies and poor prognosis in cow's milk or egg as a care activity and carry out a thorough study on eosinophilic asthma.
Presentation:
Allergy is an abnormal and exaggerated response of the immune system of certain people to a series of very diverse agents that come from the outside, harmless to most people and which are called allergens.
Allergology is the medical specialty that studies diseases related to allergic processes. And the allergy specialist is the doctor in the diagnosis and treatment of allergic diseases (asthma, rhinoconjunctivitis, food allergy, atopic dermatitis, latex allergy, hymenoptera poison allergy...) and all those diseases related to the immune system.
The Allergology Section of Germans Trias offers a comprehensive vision of the specialty and provides all the necessary methods for the prevention, diagnosis and treatment of the different allergic diseases, both in adult and pediatric population.
We are pioneers in the territorial plan of Barcelonès Nord and Maresme. We approach the patient according to the complexities of the pathologies and thus make a more careful attention to our patients.
The facilities of the Germans Trias Hospital are the right environment to carry out all the necessary and more complex diagnostic techniques, as well as specific treatments.
In the same way, patients can be visited in the specialized care centers of the area for milder pathologies in Dr. Barraquer in Sant Adrià de Besòs, Dr. Robert and Gran Sol in Badalona and CAP Carrer Major in Santa Coloma de Gramenet.
The section works in coordination with the professionals of Primary Care and the hospitals of Badalona and Santa Coloma de Gramanet.
Tipus Servei: 1
Correu: alergia.germanstrias@gencat.cat
Docència:
Postgraded teaching
According to the National Specialty Commission, Allergology is a medical specialty that is based on the knowledge, diagnosis and treatment of the pathology produced by immunological mechanisms, with the techniques that are its own.
It is a transversal specialty that evaluates and treats the patient as a “systemic disease” since allergology can affect an organ or be manifested in a multiorganic way. Therefore, knowledge of different specialties such as Dermatology, Pneumology, Immunology or ORL among others is essential during the rotation of residents.
Official designation of the Specialty: Allergology and Clinical Immunology
Duration: 4 years
Previous degree: Medicine and Surgery
The Specialty Training Programme is in line with the Specialty Training Programme for Allergology published in the B.O.E (order SCO/3081/2006 of 20 September).
The Allergology Section of Germans Trias is one of the few that teaches the specialty in Catalonia and of the first that was accredited (2006), so it enjoys great experience in this field. It does so by integrating theoretical and practical clinical teaching, as well as laboratory, for the diagnosis of allergic diseases. It is a tutored learning based on scientific evidence, with an equitable distribution of training and care tasks and a total integration of Resident Internal Doctors (MIR) into scientific tasks.
It currently has capacity for one resident per year.
As it is a multidisciplinary specialty, the training period includes the following rotations (table content in catalan):
Continuing education
An annual training program is carried out to update allergology accredited by the Catalan Council for Continuous Training of Health Professions.
Information for residents
- See the Teaching guide.
- Find out what our residents think about the Allergology service of the Germans Trias.
Equip mèdic
Cap de Secció d’Al·lergologia
Metgessa especialista
Metgessa especialista
Metgessa especialista
Metgessa especialista
Metgessa especialista
Anna García Sala
Metgessa resident
Raquel Sánchez Peña
Metgessa resident
Ana Maria Aguirre
Metgessa resident
Sabrina Marcellina Pelizzo
Metgessa Especialista. Licenciada a la Universitat Central de Veneçuela (Caracas- Veneçuela)
Equip d'infermeria
Yolanda Romero Ramírez
Supervisora d’Infermeria a consultes
Nereida Albert Yecora
Equip d'infermeria de consultes
Mireia Gómez Fernández
Equip d'infermeria de consultes
Yolanda Mota Rodriguez
Supervisora d'Infermeria als Centres d'Atenció Especialitzada Dr. Robert i Gran Sol de Badalona
Miguel Ángel Martínez Gómez
Supervisor d'Infermeria als Centres d'Atenció Especialitzada Dr. Robert i Gran Sol de Badalona
Ma Carmen López Dosouto
Equip d'infermeria del Centre d'Atenció Especialitzada Doctor Robert
Marta Bolós
Equip d'infermeria del Centre d'Atenció Especialitzada Santa Coloma de Gramanet
Laura Folch Munuera
Equip Infermeria Centre Atenció Especialitzada Dr. Robert
Allergy is an abnormal and exaggerated response of the immune system of certain people to a series of very diverse agents that come from the outside, harmless to most people and which are called allergens.
Allergology is the medical specialty that studies diseases related to allergic processes. And the allergy specialist is the doctor in the diagnosis and treatment of allergic diseases (asthma, rhinoconjunctivitis, food allergy, atopic dermatitis, latex allergy, hymenoptera poison allergy...) and all those diseases related to the immune system.
The Allergology Section of Germans Trias offers a comprehensive vision of the specialty and provides all the necessary methods for the prevention, diagnosis and treatment of the different allergic diseases, both in adult and pediatric population.
We are pioneers in the territorial plan of Barcelonès Nord and Maresme. We approach the patient according to the complexities of the pathologies and thus make a more careful attention to our patients.
The facilities of the Germans Trias Hospital are the right environment to carry out all the necessary and more complex diagnostic techniques, as well as specific treatments.
In the same way, patients can be visited in the specialized care centers of the area for milder pathologies in Dr. Barraquer in Sant Adrià de Besòs, Dr. Robert and Gran Sol in Badalona and CAP Carrer Major in Santa Coloma de Gramenet.
The section works in coordination with the professionals of Primary Care and the hospitals of Badalona and Santa Coloma de Gramanet.
It is one of the most common allergic diseases: it affects almost a quarter of the population. It causes nasal, ocular, pharyngeal and ear symptoms. The most common causes in Catalonia are environmental exposure to dust mites, tree and plant pollen, fungi and epithelia of domestic animals, especially cats and dogs. We are usually exposed to allergens by respiratory means, but only in susceptible people, that is, allergies, this symptomatology occurs that can appear at any age. Discomforts can manifest immediately when breathing what the patient is allergic to, but also delayed: after a few hours of inhaling it. This explains why many people have the discomforts early in the morning or in the morning, not at the time of breathing the allergen. Allergic rhinitis is a risk factor for the development of bronchial asthma, sinusitis or serous otitis (a mucus cluster in the ear). That is why it is important to diagnose it soon.
In the diagnosis, it must be clarified whether it is really this type of allergy or other forms of rhinitis, so it is essential that a specialist in Allergology does so and collaborates with the Otorhinolaryngology Service. The diagnosis is based on symptoms and allergy tests: skin tests to pneumoallergens, conjunctival provocation with allergen, peak-flow (flow measurement) nasal inspiration and in vitro analytic (in the laboratory).
Asthma is an inflammatory disease of the airways (bronchi). The main cause is respiratory allergy: 80% of asthmatics are allergic. But there are other factors that can cause it: hereditary, environmental, infectious, or even premature births or passive smoking since childhood. Asthma can start at any age of life, and when it appears before the age of three it is generally not associated with allergic cause. Allergic asthma that appears in first or second childhood and in youth is usually accompanied by rhinoconjunctivitis, a history of childhood eczema or food allergy. It is a disease conditioned by the inhalation of allergens and with a tendency to persist for a long time. It causes dry cough, usually in attacks and especially at night. When this happens we talk about broncospasm, because the bronchi close and do not let the air pass. It may be mild or require urgent medical attention. At the same time, it can be intermittent or habitual and persistent. The diagnosis is based on symptoms, lung capacity tests (spirometry or peak flow) and allergy tests. The most common allergens as a cause of bronchial asthma are the same as for rhinoconjunctivitis: dust mites, tree and plant pollen, fungi and pets.
For the correct identification of the cause, a doctor specializing in Allergology makes a study that includes: skin tests to pneumoallergens, respiratory function tests (single spirometry and with bronchodilation test) and evaluation of bronchial inflammation. In addition, in collaboration with the services of Pneumology and Pediatrics, complete pulmonary function tests and bronchial provocation tests are carried out.
The Grey Asthma Unit has also been created where allergologists, pneumologists, pediatricians, ORL and immunologists collaborate to offer the best multidisciplinary care for those patients with more complex and less controlled asthma. The SEAIC (Spanish Society of Alergology and Clinical Immunology) has accredited this unit as a unit of excellence and as a teaching unit to provide face-to-face practical training in severe asthma.
Patients who have presented an anaphylaxis or any other type of allergic reaction in which the involvement of a food is suspected must be assessed by an allergy specialist to identify the responsible food and prevent new episodes. The way to confirm or rule out the involvement of suspicious foods is through: food skin tests (prick-test), fresh food skin tests (prick by prick test), food epicutaneous tests (patch-test), food provocation or tolerance tests under hospital supervision and analytical study in the laboratory.
Between 4 and 8% of the child population suffers from food allergies and the foods that cause it most frequently are eggs, milk, nuts, fish, seafood, legumes and fruits, in this order, according to the SEICAP (Spanish Society of Pediatric Clinical Allergy and Immunology).
Those caused by milk and egg are the ones that cause the most problems due to their usual presence in our food.
Until now, the only widely accepted treatment to avoid symptoms of food allergies is the elimination diet.
Oral immunotherapy (OCT) with food is being established in recent years as an alternative to conventional treatment.
ITO consists of the administration of increasing doses of the food involved until reaching the highest dose tolerated or representing the usual ration for age (for example, 200ml of cow's milk or an egg).
The basic objective of ITO is to avoid allergic reaction, especially anaphylaxia, after exposure to the food that causes allergy. Some patients achieve tolerance or the maintained area (sustained unresponsiveness), that is, they can freely take the food without the need for regular consumption. On the contrary, other patients need the regular prey of the food to not present a reaction, they are the desensitized patients.
This procedure has been carried out in the Paediatric Day Hospital for more than 5 years in a care manner.
Els medicaments poden provocar efectes indesitjats o adversos, una minoria dels quals són causats per l’al·lèrgia al fàrmac. En aquest cas, la persona crea sensibilitat de tipus al·lèrgic a la substància química del medicament, de manera que quan el pren apareix una reacció. Les al·lèrgies en què intervenen els anticossos Immunoglobulina E (IgE) apareixen de manera immediata a la presa del medicament, normalment amb la primera o la segona dosi, i es poden manifestar amb erupció cutània pruriginosa amb inflamació o també com a anafilaxi, és a dir, com a reacció al·lèrgica generalitzada que pot posar en perill la vida del pacient. Un exemple és l’al·lèrgia a la penicil·lina. També hi ha altres tipus d’al·lèrgies a medicaments en què no intervenen les IgE. Per exemple, algunes persones tenen al·lèrgies de tipus retardat de contacte, com ara els èczemes després de l’aplicació de cremes. Els medicaments més freqüentment implicats com a causants de reaccions al·lèrgiques són: antibiòtics (penicil·lines, cefalosporines, quinolones, macròlids, sulfamides); antiinflamatoris; contrasts iodats; quimioteràpics; anestèsics locals i generals; corticoides, i anticonvulsionants.
Després que el pacient hagi tingut una reacció adversa a un fàrmac, el seu metge de capçalera el derivarà a un especialista en Al·lergologia en cas que consideri necessari confirmar si hi ha intervingut un mecanisme al·lèrgic i trobar fàrmacs alternatius. Des de la Secció d’Al·lergologia es faran proves cutànies (prick-test, epicutànies i intradermoreacció), proves d’exposició controlada a fàrmacs sota supervisió mèdica hospitalària, i estudi analític al laboratori.
Les proves de tolerància a medicaments es realitzen al Hospital de Dia Polivalent en el cas d’adults i en el Hospital de Dia Pediàtric a la planta de Pediatria en el cas de nens. Allí el pacient és monitoritzat (es realitza el control de les constants vitals) i se’l manté amb una via venosa permeable, per administrar la medicació d’urgència en cas de necessitat en els adults. Aquestes proves es realitzen durant 4-5 hores on s’introdueix el medicament sospitós o alternatiu en dosis creixents.
És important saber que la prova diagnòstica no està exempta de riscos. Ara bé, també és cert que les estrictes mesures de seguretat del centre hospitalari on es fa la prova estan perfectament preparades per atenuar els efectes, en cas que n’hi hagi, d’una reacció al·lèrgica. Aquestes reaccions, però, són molt pocs freqüents i, en general, lleus.
Des de l’AEMPS s'encoratja a fer una farmacovigilància activa per la detecció de reaccions adverses medicamentoses, entre les quals hi ha les reaccions al·lèrgiques, i així derivar als pacients amb sospita de reacció al·lèrgica per avaluació al·lergològica.
Per la detecció activa de possibles reaccions adverses a la vacuna s’ha passat un qüestionari de detecció precoç a la pagina web del nostre hospital i en el cas de possibles reaccions suggestives d’al·lèrgia s’ha creat un circuit ràpid entre Medicina Preventiva i la Secció d’Al·lergologia per l’estudi d’aquests casos liderat per la Dra Padró.
Per a l’estudi d’aquells pacients que presentin un risc alt abans de la primera dosi de vacuna o que hagin presentat reaccions greus o suggestives de ser IgE mediades després de l’administració de la primera dosi, es procedirà a la valoració per part d’un al·lergòleg i a la realització de test cutanis tant amb els adjuvants de la vacuna a estudiar com amb els adjuvants de vacunes alternatives.
Una vegada realitzats els test cutanis, es pot valorar l’administració de la segona dosi sota observació i supervisió d’un al·lergòleg donat que aquest és el procediment “gold estàndard” en el diagnòstic d’al·lèrgia a fàrmacs.
La picada d’un insecte pot produir una reacció local amb vermellor, dolor, picor i inflamació més o menys important. Si la persona picada és al·lèrgica al verí inoculat, pot presentar reaccions generalitzades. Aquesta resposta anomenada anafilaxi és la forma més greu de reacció al·lèrgica i sol consistir en una combinació de símptomes: dificultat respiratòria, baixada de la tensió arterial, pèrdua del coneixement, inflamació a la gola amb dificultat respiratòria, picor i inflamació generalitzats, urticària, aturada cardiorespiratòria. La reacció sol aparèixer passats pocs minuts i posa en perill la vida del pacient. La reacció anafilàctica greu sol presentar-se en persones que ja han estat picades prèviament (60% dels casos). És important, per tant, contactar amb el metge de capçalera si s’ha presentat una reacció al·lèrgica a una picada, ja que les reaccions que es puguin presentar amb picades posteriors (incloent l'anafilaxi) poden ser evitades amb tractament específic que s’administraria a la Unitat d’Immunoteràpia de la Secció.
El làtex és una proteïna natural que s’obté de l’arbre Hevea brasiliensis i que s'utilitza àmpliament en la fabricació de productes de cautxú. Algunes persones presenten hipersensibilitat a aquesta proteïna. La majoria de vegades la hipersensibilitat es manifesta de forma immediata com a urticària de contacte, asma o rinoconjuntivitis.Quan hi ha una exposició massiva, per exemple amb material medicoquirúrgic durant la pràctica d’exploracions mèdiques o d’intervencions quirúrgiques, el quadre pot ser greu. Davant de la sospita d’al·lèrgia a làtex, es fan tests cutanis (prick-test), tests d’exposició i un estudi al laboratori.
La tècnica ALEX (Allergy Explorer de Macroarray Diagnostic)La tècnica Immuno Solid-phase Allergen Xip (ISAC) és una prova de diagnòstic in vitro avançada per a la determinació simultània de la presència a la sang d’anticossos Immunoglobulina E davant de més d’un centenar de proteïnes al·lergògenes presents en més de 50 fonts d’al·lèrgens: aliments, inhalants i verins. Es tracta d’una tècnica molt útil, que ajuda a millorar diagnòstics de les causes i a evitar errors terapèutics en les vacunes al·lergèniques, així com a detectar sensibilitzacions no sospitades, entre d’altres.
La Secció d’Al·lergologia disposa d’una infermera i d’un metge especialistes per iniciar i controlar tractaments amb immunoteràpia sublingual, intradèrmica o subcutània.
La immunoteràpia o vacunació amb al·lergògens és l'únic tractament etiològic de processos de causa al·lèrgica com la rinitis, l'asma, al·lèrgia a LTP ( aliments vegetals) i l'al·lèrgia a verins d'himenòpters. La seva eficàcia ha quedat plenament demostrada en múltiples estudis doble cec i meta-anàlisi. La immunoteràpia ha d'utilitzar-se exclusivament en malalties a les que es demostri que un mecanisme al·lèrgic intervingut per la IgE és bàsic en la seva patogènia. La vacunació consisteix en l'administració de dosis progressivament creixents d'un extracte al·lergènic davant del que el pacient està sensibilitzat, amb la finalitat de millorar els símptomes associats a l’exposició posterior a aquest al·lergen.
La Unitat d'Immunoteràpia, acreditada amb grau d'excel·lència per la SEAIC (Sociedad Española de Alergología e Inmunología Clínica), consta d'un espai físic i personal específicament entrenat, dedicats a l'administració de les dosis de les vacunes d'al·lèrgia i el seguiment correcte de les pautes de vacunació.
En general, les dosis de les vacunes d'al·lèrgia es toleren bé donada la bona qualitat dels productes comercials disponibles, sempre que se segueixin les normes adequades per a una administració correcta.
L'administració de les dosis de vacunes realitzades en un centre amb personal competent i amb els recursos necessaris per tractar una possible reacció minimitza dràsticament el risc d'una reacció greu. També s’estableix una relació malalt-equip sanitari més sòlida i de confiança i existeix la possibilitat de seguir pautes d'administració més ràpides.
A la nostra Secció participem de manera multidisciplinar amb Dermatologia en la Unitat d’Urticària Crònica, la Unitat de Dermatitis Atòpica i en la Unitat de Toxicodèrmia. D’aquesta manera els pacients es poden beneficiar d’una visió integral de la malaltia a nivell immunològic.
Des de l’hospital realitzem interconsultes a nivell de les plantes i d’Urgències. La majoria d’elles es centren en l’al·lèrgia a medicaments. Es realitzen tests cutanis ( intradermoreacció i prick test), tests de tolerància o desensibilitzacions a medicaments fonamentals si són necessàris. També avaluem possibles reaccions adverses a medicaments com poden ser IgE mediades o toxicodèrmies. De la mateixa manera aclarim dubtes sobre possibles al·lèrgies alimentàries.
Respiratory allergy
Many symptoms, a single disease
The mucosa of the nose, eyes and bronchi have similarities in their response to allergens in allergic people, which is explained if respiratory allergy is considered to be a systemic immune disease that manifests itself in different organs.
Some data: allergic rhinitis (that is, the reaction of the membranes of the mucosa of the nose in the form of sneezing, aqueous secretion, congestion, tears and itching in the eyes and throat) is at least three times more frequent than asthma, and different studies have shown that it is a significant risk factor for the development of asthmatic disease. Asthma can affect 20-50% of patients with allergic rhinitis. And most asthmatic patients have rhinitis (70-95%).
All these facts have therefore put on the table the concept of a respiratory route, a single disease.
Allergens
It is necessary to know the possible allergens responsible for the immune reaction that triggers inflammation of the respiratory mucosa and clinical manifestations at the nasal, bronchial or ocular level. The most common aeroallergens in our area are domestic dust mites (D. pteronyssinus, D. Farinae), pollen (grains, olive, shade banana, cypress and parietary, among others), epithelia (dog and cat fundamentally) and fungi (Alternaria, Cladosporium, Penicilium).
Diagnosis
To diagnose the cause of allergic respiratory diseases, we have skin tests, laboratory tests (determination in a blood sample of antibodies called Immunoglobulins E) and provocation tests (generate direct contact) in the nasal, conjunctival or bronchial mucosa.
Skin tests and laboratory tests are those that allow to demonstrate awareness of the allergen, but it must be taken into account that the fact that they are positive to an allergen does not necessarily mean that it is responsible for the patient's clinical manifestations.
Treatment
If it is possible to identify the allergen or allergens responsible for the symptoms, the disease can be treated comprehensively through its avoidance and through the use, when indicated, of specific immunotherapy as a treatment of the causes of respiratory allergy.
Immunotherapy is an effective and safe treatment supported by an international consensus promoted by the World Health Organization (WHO), but only if it is applied in a personalized way and if it is based on the diagnosis of an allergyologist. It is, in fact, the only treatment capable of modifying the course of the disease.
In evolution
Allergology, as a medical specialty, is undergoing very important changes in recent years in parallel with scientific advances in molecular biology. Thus, before we talked about allergic patients to the dust of the house, then to the mites of the dust, later to fecal particles of the mites of the dust and currently in some cases it is known exactly what molecule produces the allergic reaction.
Today, thanks to the characterization of allergens at the molecular level, the concept of Component-Based Diagnosis has been developed, which is based on detecting in the laboratory the presence, in a blood sample of patients, of specific immunoglobulin E antibody for the protein really responsible for the allergic response. At Germans Trias, thanks to the collaboration of the Allergology Unit with the Immunology Service, we have this new diagnostic tool that, in certain cases, allows us to better understand the profile of patients and provide them with more adjusted treatments.
Documents of interest for patients with respiratory allergies (content of the documents in catalan):
- Information for patients with mite allergy.
- Information for patients allergic to fungi.
- Information for patients with allergy to olive pollen
- Information for patients allergic to the pollen of the parietary
- Information for patients with allergy to the epithelium of domestic animals
- Information for patients with allergy to grass pollen
- Information for patients with allergy to pollen in altommyrrhea
- Information for patients with cypress pollen allergy
- Information for patients with birch pollen allergy
We are currently experiencing an increase in respiratory allergic pathology in industrialized countries and the World Allergology Organization (WAO) wants to make the population aware that one of the causes of this worsening is climate change.
Between environmental pollution and the increase in allergic diseases, especially respiratory, a direct relationship has been described with greater incidence in the population residing in urban areas. Check this page where you will find information on how climate change affects respiratory allergies.
Food allergy
Food allergy is a major public health problem that affects children and adults and has increased in recent decades in industrialized countries. Confirmation of their diagnosis may be problematic, as it may produce localized or more general symptoms such as anaphylaxis, which may be of vital risk. Therapeutic strategy is to avoid food or food that produces food allergy and treat symptoms.
It is three times more common in children than in adults (8% and 2-3%, respectively). The foods that are most often involved depend on the eating habits of the population and, therefore, on age and geographical area. In our environment, the most common up to 5 years are milk, egg and fish. Then, legumes, fruits, nuts, seafood and spices.
Especially in children, food allergy can be the first manifestation of allergic disease, and can be followed or coexist with other allergic pathologies in a process we call “allergic gait”. Patients in whom asthma and food allergy coexist are more at risk of serious asthma crises.
Symptoms
The possible clinical manifestations are:
- Anaphylaxis: Fast-starting serious reaction that can be deadly. It affects at least two organs.
- Exercise-induced Anaphylaxis: It is produced after having eaten some foods that without exercise would not cause any problem. It is more common in adolescents.
- Oral allergy syndrome: Prune into the oral cavity and sometimes inflammation of the lips. Normally by ingestion of foods of plant origin (fruits and fresh vegetables) and seafood. It causes itching of the mouth, tongue, palate, pharynx and, occasionally, edema (inflammation due to accumulation of liquids). It is often associated with pollen allergy.
- Atopic dermatitis: Inflammation and redness of the skin that may be related to food allergies, especially in children where it is moderate or severe.
- Allergic contact dermatitis: Delayed reaction located in the area of contact with a food, usually in the form of eczema, redness and irritation.
- Urticaria of contact.
- Delayed gastrointestinal symptoms: They include vomiting, diarrhoea that may have blood or fat, abdominal pain or anemia, among others.
Diagnosis
When a food allergy is suspected, an interview is held with the patient to know their eating habits in depth and a physical examination is carried out. Then, they are carried out:
Laboratory tests with a blood sample to determine Immunoglobulin E antibodies. Skin tests.
Provocation tests, which consist of generating contact with the food that is suspected to cause the allergy.
Treatment
Once the responsible food has been identified, the allergist recommends strict food avoidance and tells the patient what regimen to follow to eliminate it. Also, he explains how to recognize the allergic symptoms he may have after eating the food without knowing it or accidentally, and what medication he must take if it is the case. The patient must always go with this medication on top.
ITO (Oral Immunotherapy)
Oral tolerance induction treatments, which aim to reach total tolerance of the food, or at least to increase the tolerance threshold in patients with resistant allergies, so that they can follow a diet with minimal restrictions. These treatments, which studies indicate that they have success rates of around 90%, are not risk-free and must be carried out in specialized centers and with prepared personnel. At Germans Trias it is done in a care way to do in children with serious persistent food allergies to egg and cow milk proteins.
New treatments
In addition, in recent times, and still very restricted, oral tolerance induction treatments are beginning to be used, which aim to reach total tolerance of the food, or at least to increase the tolerance threshold in patients with resistant allergies, so that they can follow a diet with minimal restrictions. These treatments, which studies indicate that they have success rates of around 90%, are not risk-free and must be carried out in specialized centers and with prepared personnel. In Germans Trias it begins to be done in selected cases of children with severe persistent food allergies to egg and cow milk proteins.
Allergy to drugs
The suspicion of allergy to drugs is one of the most frequent consultations in the Specialty of Allergology.
Drugs are capable of causing adverse reactions of all kinds, not just allergies. In addition, the drug is often associated with the cause of very diverse symptoms, which can be confused with a secondary reaction rather than a mediated IgE reaction.
Allergic reactions to drugs are unpredictable reactions and may not be exentes of life risk. Any medication can cause allergic reactions.
Among the drugs that most often cause allergic reactions are antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), iodine contrasts for radiology, anticonvulsants, certain antihypertensives, etc.
The clinical manifestations they produce are varied but 80% affect the skin level, being the most frequent lesions urticaria (faves) and angioedema (swelling of soft parts) in immediate reactions, or exantema (rash) in delayed reactions. Other organs such as the respiratory system (asthma and/or rhinoconjunctivitis), the digestive system (abdominal pain, nausea, etc.) may also be involved, etc. until life is compromised (anaphylaxis).
In case of mediated IgE reactions, the clinic usually appears in the first hours after taking the drug.
The allergy tests to a given drug are those carried out on patients who have, in their clinical history, evidence of having suffered a process caused by a reaction of hypersensitivity to this drug or any of its components.
Currently, the most suitable tests to achieve a correct diagnosis of allergy to drugs can be in vitro (specific IgE, mastocyte activation test or lymphocyte transformation test), skin tests (prick test and intradermoreaction) and tolerance test to that drug or alternative, or in cases where the diagnosis of allergy has been confirmed but the drug is essential desensitization test to it.
What are drug tolerance tests?
They are a set of tests with which the doctor confirms or discards the patient's allergy to a certain drug or group of drugs of the same drug family. To carry out the study, it is necessary to administer increasing doses of the drug involved under strict medical control, since there is the possibility that some of the symptoms attributed to the drug may reproduce. This procedure is carried out in the Multipurpose Day or Pediatric Hospital or in the hospital plants.
All these tests are always carried out under strict medical supervision, with permanent medical control.
The section regularly participates in clinical trials both in relation to the introduction of new drugs in respiratory allergies and new therapies and guidelines in specific respiratory immunotherapy. The results are presented in national and international communications and the most relevant are published in medical journals.
We carry out this task in the Hospital’s Multipurpose Clinical Research Unit (UPIC), which provides facilities and personnel dedicated to carrying out clinical trials of phases I, II, III and IV as well as observational studies, independent promotion or industry. Thanks to these facilities we managed to lead in many trials the recruitment of patients . This fact has allowed to carry out research contracts in members of the Service once the residence is over.
We participate in several multidisciplinary projects:
- Asthma Grave Unit where allergologists, pneumologists, pediatricians, ORL and immunologists collaborate to offer the best multidisciplinary care for those patients with more complex and less controlled asthma. The SEAIC (Spanish Society of Alergology and Clinical Immunology) has accredited this unit as a unit of excellence and as a teaching unit to provide face-to-face practical training in severe asthma. The Unit is coordinated by Dr. Maria Basaga.a. Each year an Asthma course is held aimed at both Primary and Specialists
- Multidisciplinary Chronic Urticaria Unit where allergologists, dermatologists and immunologists collaborate. Protocols for the management of this pathology are created in accordance with the Network of Urticaria of Catalonia and the Balearic Islands. The Unit is coordinated by Dr. Nathalie Depreux.
- Atopic Dermatitis Unit where allergologists and dermatologists collaborate. A protocol for the management of this disease has been created and has facilitated the introduction of Dupilumab as a biological treatment for the disease. Dr. Yanina Jurgens participates.
- Toxicothermy Unit where allergologists, dermatologists and pharmacologists collaborate. A circuit has been created for the study of this pathology. Dr. Yanina Jurgens participates.
The current research projects of the Section are:
- The Doctoral Thesis called “Factors of Prognostic Eosinophilic Fat in Eosinophilic Severe Asthma” within the Grey Asthma Unit.
- Together with the Cutaneous Allergy Committee of the Catalan Society of Allergology and the Department of Nutrition of the UB, work is being done on the project in scientific progress on the aetiology, diagnostic parameters and dietary management of food histamine intolerance. Winning project of the 2020 Call “R&D&i Projects” modality oriented to the challenges of society.
- Grant from the Health Research Fund in Allergy to Beta-Lactams together with Pharmacy and Vall d'Hebrón Hospital.
In addition, we have been awarded on several occasions by the Germans Trias Talents Grants, which has allowed us to introduce the induction of oral tolerance in pediatric patients with persistent allergies and poor prognosis in cow's milk or egg as a care activity and carry out a thorough study on eosinophilic asthma.
Postgraded teaching
According to the National Specialty Commission, Allergology is a medical specialty that is based on the knowledge, diagnosis and treatment of the pathology produced by immunological mechanisms, with the techniques that are its own.
It is a transversal specialty that evaluates and treats the patient as a “systemic disease” since allergology can affect an organ or be manifested in a multiorganic way. Therefore, knowledge of different specialties such as Dermatology, Pneumology, Immunology or ORL among others is essential during the rotation of residents.
Official designation of the Specialty: Allergology and Clinical Immunology
Duration: 4 years
Previous degree: Medicine and Surgery
The Specialty Training Programme is in line with the Specialty Training Programme for Allergology published in the B.O.E (order SCO/3081/2006 of 20 September).
The Allergology Section of Germans Trias is one of the few that teaches the specialty in Catalonia and of the first that was accredited (2006), so it enjoys great experience in this field. It does so by integrating theoretical and practical clinical teaching, as well as laboratory, for the diagnosis of allergic diseases. It is a tutored learning based on scientific evidence, with an equitable distribution of training and care tasks and a total integration of Resident Internal Doctors (MIR) into scientific tasks.
It currently has capacity for one resident per year.
As it is a multidisciplinary specialty, the training period includes the following rotations (table content in catalan):
Continuing education
An annual training program is carried out to update allergology accredited by the Catalan Council for Continuous Training of Health Professions.
Information for residents
- See the Teaching guide.
- Find out what our residents think about the Allergology service of the Germans Trias.
Contacte: alergia.germanstrias@gencat.cat