Gentowa

A skin strap of a needed width is cut off closely above the red, the red is extended up on the place where the skin strap was cut off. Although the smoothest injection and stitches are used, the patient has to hope the scars will be invisible, or only less visible.

The marks of the intervention stay everytime, depends on individuality. Everyone has a visible white line etween the red and the lip which make the contrast. And after the intervention the contrast isn´t so visible anymore and a patient should know it.

A permanent make-up – the tattooed contour of lips by pigmented color – save the situation. It will last 3 – 5 years, according to the quality of skin. This is provided in tattoo saloons or in bigger comestic saloons. The price is 2 – 3 tousends crowns.

The allergic reaction is conditioned by the contact with the allergen. There are many impetuses, which can worsen the allergic reaction, in particular its clinical state. The well known factors, which worsen the eczema symptoms include:

● itching

● dry skin

● warm

● woollen, nylon and acryl fibres

● viral infections

● staphylococcus skin infections ( Staphylococcus aureaus bacteria infection)

● food non-toleration

● food irritants (spice, spicy vegetable, tomatoes, citrus fruits)

● rash/urticaria

● weather and climate changes

● contact with original or further allergens (mites, pets)

● other irritating matters (soup, chlorine water in the pool)

● it can be worsen by the stress, although eczema does not belong to the psychogenic diseases

Special regime is necessary in case of infants and children. Nursing mother should exclude all irritating food components – eggs, milk, dairy products, and nuts. Unless the clinical state of the child is not improved within a month, the former eating habits can be returned. It is necessary to nurse the child as long as possible, at least for six months.

While starting with the artificial food the food ingredients should be added gradually one by one! The allergy causing food (chapter on the allergens) is added to the food as late as possible. If the child reacts to new food ingredient by clinical state worsening, its elimination is needed at once.

The child’s skin is creamed regularly – the appropriate unguent is recommended by your physician.

The child should have the nails cut due to the limitations of the skin damages caused by itching. As for the sleeping suit the soft long sleeved cotton pyjamas with trousers are recommended since they protect the patients from irritating and itching.

The child should have made the surroundings harmonic and peaceful without any stress factors. The good, profound sleep should be supported.

House bee (Apis mellifera)

● the incidence and bites are common due to their spread extent considering the honey production and the plants fertilisation

● lives in bee hives, nests and tree hollows

● is generally not aggressive; it does not sting if it is not provoked

● always looses its sting

● appears more often at the beginning of the summer

African bee – cross breaded

● came to Brazil in 1956 for the sake of breeding improvements, but it gained aggressive features; it gradually spreads through the whole continent northwards

● is dangerous due to its extreme aggression, it attacks in hundreds

Bumblebee (Bombus terrestris)

● robust hairy insect with distinctive colours

● nests in the ground made out of wax and collected fibrous material

● nests look like grapes

● is usually not aggressive, it does not sing until being provoked

Wasp (Vespula vulgaris)

● almost without hairs with typical black and yellow stripes on the abdomen

● nests on the ground, or under wood

● makes the nests from chewed wood with more small holes layers situated one under another

● is attracted to food and sweet beverages – often flies around in garden restaurants and when people eat outside

● is very aggressive and attacks even without being provoked

● loose the sting only seldom

● usually appear in the late summer and autumn (vintage time)

The very important fact relates to the information about the previous bites and their clinical consequences (local reaction – global reaction, its therapy duration, way and effect). If it is possible, the identification of the insect (e.g. wasp, bee) will be suitable, as well. You can be allergic to one or more insect species.

The allergy reaction initiator determination is important for the therapy, but also for the prevention and avoidance of further episodes.

If you do not know the name of the insect, the identification can be helped by following facts:

● how did it look like? the colour, pattern

● where was it found? (trees, grass, ground)

● how did it behave? (was it provoked into biting; was it aggressive)

● did it leave the sting in the affected spot?

The professional diagnosis is made with the help of the skin tests with the toxin of the particular suspicious insect (commercially prepared). According to the severe reactions danger many various concentrations are gradually used.

If the skin tests are not persuasive, the laboratory examination, where all IgE type antibodies against the insect species toxins (as far as we are concerned it goes for bees and wasps) are determined, will be made.

The nose is an organ with two basic functions:

● olfactory

● respiratory

The main respiratory (breathing) function of the nose and the nasal cavity is to provide the transport of the air to the lungs. In addition to that, other important functions include:

● processes of the inhaled air (warming-cooling, humectation)

● enables the resistance against the strong air

● filters the inhaled air

● provides the immunology barrier

In order to provide these “services” the nasal cavity is fit out with the complex structure. The nasal mucosa is able to make itself thinner and rougher hence it has an important influence on the air rate of flow resistance. The nasal resistance can alter from the slight to complex obstruction. The changes of the nasal mucosa thickness are influenced by the vascular system, too. The nasal mucosa contains a large amount of the mucous glands, which humidify the inhaled air. The nose noticeably prevents the lungs from the flow of the inhaled parts. It is able to remove the pollen grains of 15-30μm almost complex and enables the reduction the mites allergens of approximately 5μm up to 50%. The soluble chemicals can be removed from the inhaled air by being dissolved in the mucous.

The nose plays its role in the defensive line of the immune mechanisms, as well. By the collecting and the phagocytic process it liquidates a part of the microorganisms. The mucosa consists of lyzozymes; there is also immunoglobulin, especially the phlegmy IgA together with the phagocytes, there. On the other hand it is full of mastocytes, which play a negative role in allergic people lives.

What is a common cold (runny nose)?

The common cold (rhinitis) is defined as the nasal mucosa inflammation, which is characterised by one or more symptoms:

● nasal obstruction

● secretion

● sneezing

● nasal itch

While taking the symptoms into consideration, it can be difficult to distinguish the infectious cold from the allergic one. No diagnosis can be usually made only from the clinical count without anamnestic data and a special allergist examination. Similar problems can be brought about by polyps, anatomic mechanic factors, swellings and tumours and in the case of small children by foreign bodies (beans, bullets, peas).

The nasal cavities, which enable the air circulation, relate anatomically to the nose. When somebody suffers an allergy, they are usually affected by the allergic inflammation, as well. Sinusitis itself, as this disease is called, is usually a symptom of an allergy.

The typical symptoms, i.e. the itchy papules appear fast. They develop themselves even after several hours since the allergy reaction start (after allergen food consummation, after insect sting, medication administration, etc.). They can persist on the same place for hours, disappear later on, but usually, reappear elsewhere.

If the state of health lasts for a long time, the symptoms might not be caused by the IgE antibody mediated allergy. We should take into account even the immunocomplex reaction (III.type) or other diseases, as well.

The urticaria can reappear after a shorter or longer period of time. It can be also the episode, from which the patients do not have to suffer for years.

The acute urticaria lasts several hours; hence the total time of the particular episodes should not overrun 6 weeks.

The chronic urticaria takes more than 6 weeks. It can last for months or years. In this case, the atopic process should be excluded.

What causes the urticaria?

The most frequent allergy reaction causes, which lead to the urticaria, include:

● medications: usually antibiotics, although the reaction can occur after any medication

● food: including small amounts of chocolate, fish, nuts, eggs, etc.

● bee or wasp sticks

The significant part of the urticaria symptoms do not belong to the allergic reaction. The mediators – the one, who are released during the allergic reaction, can be released even in other ways (we talk about the pseudo-allergic reaction). The urticaria can appear even after the first contact with the person having the irritating factors.

are used with the bacterial infections. These preparations are aimed at ceasing of the bacteria growth or their killing. Since there are so many types of the micro-organisms and their changing sensibility to the antibiotic treatment, new antibiotics are produced every year.

Nowadays there is a whole range of various antibiotics types, which vary from each other in their chemical structure. Some belong to the related groups, others are different. Within the related groups the cross-reactions often appear i.e. the patient replies to all antibiotics of a particular group with the allergy.

Since the antibiotic treatment is considered an often impact, the allergic patients have their drug allergens marked in their health documentation. In spite of that we should be aware of the particular allergy starting allergen and should inform about it our doctor every time we visit him.

It is possible that the doctor, who is standing in for our doctor, does not have our health documentation at his/her disposal or that we will fall ill during our vacation or business trip. One particular antibiotic can be named differently, which commonly happens especially while travelling abroad. Moreover the medication, which was prescribed recently and which name you do not know, can belong to the derived group of antibiotics with the cross reaction.

How the allergy is diagnosed by the doctor

The diagnosis procedure is not easy. The clinical symptoms of the different origin illness are often similar. For instance the symptoms of the allergic fever – red stuffy nose, sneezing, nose secretion are the same as while having the cold (it is usually caused by a simple viral inflammation). But the treatment approach is different. Therefore the diagnosis procedure requires besides the judgement of the current health conditions further information, too.

The basis of all allergic examination is the detailed anamnesis. It is actually the list of all factors, which relate (sometimes only seemingly for the patients) to the illnesses.

The family anamnesis is an information on the illnesses appeared in the patient family. Naturally, the blood relations, not he wife or the brother-in-law, are important. The allergic reaction, their ancestors – father, grandmother, siblings or children-suffered from, indicates the relation to the current illness of the patient. The allergy predisposition is inherited. While the child of the parents, who do not suffer any allergy, inclines to the allergy at the odds of approximately 20%, the odds of the allergy increases up to 50% concerning the child of at least one allergic parent. If the mother suffers any allergy, the odds will increase even more and in the case of both allergic parents, it is almost 100% certain, that their child will suffer the allergy (especially if both parents are allergic to the same allergens).

Personal anamnesis includes the facts, which precedes the particular current illness. In the anamnesis, all the previous illnesses, we have undergone, are listened. The eczemas in the childhood, serious allergic reaction suffered years ago, or the repeated infections – all these are information, which indicate the possible immune system disorder or direct the allergic “before-period”. Concerning the women the important information is the number of the deliveries and

the development of the pregnancy, concerning the children, the time until they were nursed,

when they started to eat the baby food, is of the greatest importance.

The working anamnesis is the information on the surroundings, where we spend the main part of our day. The important facts refer not only to conditions of the building (cleanness, humidity, thermo regime) but also all things we come into contact with – the production, administration, special operations and chemicals. The significant information are the protection regime against the potential harmful chemicals at the workplace and our approach to it. The information about how we spend our spare time – our hobbies, the sport, etc, places where we have the chance of the contact with the factors initiating or starting the allergy, should be a part of this analysis, too.

The current illness – its description is the most important part of the “testimony” and no basic information can be omitted in it.

● illness start and description

● your own symptoms descriptions

● seasonal presence of the clinical effects (per year, during the summer, etc)

● allergic (not allergic) initiating factor – if we know it or if it seems to be assumed

● lifestyle influence

* the symptoms occurrence frequency and the seriousness symptoms

* influence on the occupation ( study)

* extra working activities (sport, hobby)

* sleep

● environmental allergens – surroundings allergens – (at home, work)

● existing treatment – ( if already treated)

* effect (little, significant; stopped to be effective after a period of time)

* side-effects

* satisfaction and the willingness to undergo this type of treatment.

The information on the further potential illnesses we have, especially on medications we take, is important. Many can influence not only the diagnosis, but also the particular allergic reaction itself – and not only in the negative sense – worsen of the clinical condition or on the contrary- covering of the particular typical symptoms.

The physical examination is the basis in all cases. The doctor examines all systems. He or she examines the skin al over the body, where the symptoms – even not the most serious and hence hidden, which the patient himself does not have to notice – inflammation, reaction to any mechanic irritation, dryness or wetness of the skin, nails, hair, are looked for. The oral cavity reveals the potential inflammation- infectious, but allergic, as well.

The nasal mucosa swelling and congestion, nasal discharge, red skin around the nostrils caused by the mechanic irritation are the symptoms of the common cold. The patients with the nasal congestion breathe through the mouth, which are open all the time. The nasal congestion As far as the children are concerned, the nasal congestion is revealed by the line on the top, especially the so called allergic salute (greeting), it is started with. It is a “gesture” of pushing the top of the nose up with the palm, while the nasal cavity is being released.

The auscultatory examination – examination with the phonendoscope – enables to hear the breathing sound. Unlike the healthy lungs, the patients with the clinical asthma make crunching, bubbling or whistling sounds while breathing. They do not have to be loud so that only the experienced ear of the doctor can hear and identify them. The palpating and percussing of the rib cage and the abdomen provides further information.

The entire examination, especially the first visit to the specialised doctor is necessary. Therefore even while examining the patients, who are think that they have “only” a common cold, we should expect the complex examination.

The laboratory tests are the necessary part of the diagnosis procedure, in the case that the previous examinations were not sufficient for the unambiguous conclusion. The important restriction of these tests is the fact that the patient’s allergic reaction includes different cells in different tissues of the high degree of the variability. Even in the case of the same patient the ability to react can change in a short period of time. For the sake of the laboratory examination the blood is necessary. The blood collecting is usually made in the morning. If we undergo the blood collecting, we will have to take into consideration that it will contain the small amount of the elements, which are influences by the food we have eaten. Hence the blood collecting should be undertaken not only on an empty stomach, but even in during the last evening before the collecting, the patients do not have to eat a fair amount of the fatty meals.

The leukocyte differential calculus belongs to the basic laboratory examination. The medical finding of the eosinophilia is typical as for the allergic patients. To the standard examinations belongs the total IgE level examination. The values above 100 IU/ml state the allergic reaction (illness). A reliable source of information is provided in the newborn umbilical cord examination, where the higher level above 10IU/ml reflects the higher risk of the allergic illness during the life.

The specific examination, which proves the allergy and analyses the initialising allergen, is the specific IgE antibodies examination. Here, the antibodies, which react against the particular allergen, are looked for and determined.

All the IgE determining methods are demanding and require special devices, hence are made only in bigger centres. They are not made to all patients. They are needed in cases, when the previous examinations did not prove the clear diagnosis. Moreover, even more simple methods using the testing slips of paper similar to the litmus paper are used in order to diagnose the IgE antibodies quantitatively.

Before the allergist examination all allergic patients should have examined the basic biochemical parameters, which are necessary for the therapeutic preparations. When needed, if we suspect the nasal cavity inflammation or the asthma, sometimes the X-ray examination is made. The X-ray pictures of the head, eventually of the lungs, where inflammation changes can be observed, are judged. The lungs and nose function is judged through the spirometric examination.

Naso (the nose) manometry (blood pressure) is an examination, which measures the flow of rate of the nose. The measure principle is similar to the spirometry. Even the spirometer, to which a special attachment is added, is used.

A healthy nose is clear and a healthy person breathes usually through it (unless he exerts him/herself). If some illness process obstructs or restricts the flow of nasal rate, the patient breathes through the mouth even while resting, which brings many disadvantages (filtration restrictions and humidifying air, mucosa drying, etc.). Detailed information is provided in the chapter on common cold. The nasometry examination enables to objectify the seriousness of the measured numbers and the nasal obstruction. The patient himself does not have to know about the extent of the obstruction and the one, whose nose is obstructed for a longer period of time, usually does not know about it for sure, since he/she is used to it and thinks that everything is all right in the way it is.

While the nasal examination of both nostrils, two small devices with small hollows are inserted into the nostrils. The devices are connected to a tube, which the air flows in both ways, in and out, through. On the other hand, in comparison with the spirometry, the examined person has closed mouth and breathes only through the nose. One device (it looks like a small olive) is bunged up so that it does not allow breathing through the nostril the device is put in. The rate of flow of both nostrils is measured hence after the half time the devices are exchanged. In the same was as during the spirometry, the device records the air rate of flow of both nostrils and judges the congestion values. The examination is used not only for the common cold obstruction diagnosis, but also for the effect of the treatment evaluation. On more time, the patient himself often does not estimate the health improvement extent (“I can breathe through the nose easier”)

The medical finding of the total obstruction is not rare although the examined person does not know about it.

The first examination should be undergone without the medical treatment.