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.

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.

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 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.

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.