Gentowa

The therapy of the asthma has gone through relatively long development. It can be stated, that until recent times the patients suffering from the severe illness, dyspnoea (breathlessness) and choking, have been regarded quite common. The modern medication arsenal enables the patients – if it is used, disciplined and diagnosed correctly, to live the life with minimal or no troubles. The therapy must start on time! Delayed or neglected therapy relates to the continuing inflammation, to the gradual change and rebuild of the airways structure. It is more difficult to treat the anatomically changed windpipes and the therapy effect will not result in the absolute normalisation of the clinical conditions.

The asthma clinical symptoms are basically caused by two factors – the windpipes obstruction and the inflammation. The therapy is concentrated against those two processes, as well:

● bronchus dilatative (windpipes are expanding)

● antiphlogistic

The bronchus dilatative (bronchus – windpipes, dilatation – expanding) is a process of expanding (opening, enlarging) of the windpipes, which enables a better breathing. The medications used for this purpose belong to the basic asthma medications, yet they are taken even while suffering other windpipes contraction diseases. The medications are dosed according to the patient’s seriousness of the health conditions. They can be taken perorally (pills, syrup), injected or inhaled. Clinically they suppress the cough, the breathlessness and the whistling sounds. If they are dosed correctly, they enable the patients with contracted windpipes to breathe normally, without feeling sick. The medications are divided into – according to the effects principle several groups:

The basic group is the so called beta2 mimetics, also called betaagonists, which stimulate (irritate) the part of the autonomous vegetative nerve system with the result of released windpipes fibre muscles i.e. the windpipes extension.

The following side effects can occur, as well, although as for the modern medications they are rare:

● heartbeat and faster action

● short ague (especially hands)

● headache

● nervousness

The side effects result from the total medication influence, which effect in addition to the airways even other, especially cardiovascular system. The development of this type of medications is concentrated on the fact that the preparation should affect the airways the most and the other systems only minimal.

The best way to take the betamimetics is the inhalation. Hence many devices used to transfer the effective chemical to the needed place – the airways have been developed. If the preparation is liquid, the “small device”, which makes the aerosol from the liquid with the help of the driving gas, will be used. In this way the small medication particles get into the windpipes and the ronchus after the inhalation.

The second form is the powdered. The effective chemical is adjusted into the bin in the form of the powder and with the help of the ingenious mechanism while inhaling it is transferred into the particular target place. Both mentioned systems have their pluses and minuses.

The modern therapy uses two types of the beta2mimetics – effective for a longer or shorter period of time.

The short-term effective mimetics with the fast start are called the releasers. Their task is the windpipes spasm (cramp releasing). They are used if the patients can not breathe or if the health conditions get worse, since they are effective after several minutes. These medications are taken by the patients suffering from the intermittent asthma, since if the symptoms occur only once in a time (less than once a week), it will be the only therapy needed. If the breathlessness attacks appear oftener, the therapy has to be combined. Naturally, if needed, the patients suffering the severe disease undergo it, as well. Our market offers many preparations: salbutamol (SALAMOL, ECOSAL, VENTOLIN, and VENTODISKS), terbutaline (BRICANYL), fenoterole (BEROTEC also combined with the DITEC).

The long lasting betamimetics release the effective chemical gradually; hence they permanently affect the windpipes, which are extended under their influence. It is sufficient to take them twice a day. Together with the corticoids they are taken by the patients suffering from medium or severe asthma. Their effect start varies. There are salmeterol (SEREVEBT) and formoterol OXIS, FORADIL) used on our marketplace. The peroral betamimetics – either the pills or the syrup (terbitalin, prokaterol, bambuterol, klenbuterol) are used according to their systems side effects only rarely.

The anti-inflammatory therapy is based on the glucose-corticoids (cortisonides) taking, which are the hormonal preparations produced by the adrenal gland cortex (nowadays they are produces synthetically). They influence many levels and factors, which take part in the inflammation process. The best solution offers their local use – in the form of inhalation. The same devices as in the case of the betamimetics are used. In general, either injected or as pills, they are taken only in the most serious states of health. The doses are adapted to the seriousness of the illness. The informed patient can control their therapy to certain extent alone i.e. increase or reduce the doses according to their health conditions. The patient has to follow the criteria stated by his/her doctor.

We use: beclometozone (BECLAZONE, BECLOMET, BECODISKS, BECOTIDE, ECOBEC), budesonide (INFLAMMIDE, MILFONID, PULMICORT) fluzolide (BRONILIDE), flutikazone (FLIXOTIDE, FLIXOTIDE DISKUS), triamcinolone (AZMACORT).

From the point of the comfortableness and the effectiveness (anti-inflammatory and bronchodilative function) the combined preparations belong to the newest preparations. They are usually taken twice in a day. The corticoid element doses are taken according to the seriousness of the clinical health conditions. The Slovak market has two anti inflammatory and bronchodilative preparations at disposal: SERETIDE DISKUS and SYMBICORT. The modern preparations are the so called antileucotriens – the medications, which influence the molecular structure of the allergic inflammation process. These include sappirelukast (ACCOLATE) and montelukast (SINGULAIR), which are applied orally. In additions to these, the rommoglycolates in the inhalation form are used while treating the asthma. As for their advantage, they hardly have any side effects; their disadvantage is the often application (4-6 times a day). Considering the children they are very effective, their influence is restricted concerning the adults. There can be CROMOBENE, CROMOLYN, INTALCROMOGEN and nedopfromol (TILADE) found in our pharmacies.

Additional therapy is provided with the parasympatoliticums – the ipratrophiumbromid (ATROVENT combined with the COMBIVENT). The antihistamines, especially if the asthma is combined with other allergic symptoms, will be used, as well. After the allergen is defined, the allergen vaccination follows (detailed information in next chapter).

The teopfyline preparations (Syntophiline and so on), can not be used in the modern therapy except for the preparations with slow releasing (UNI-DUR, THEO-DUR, TEOTARD)

Biting insects (for example mosquitoes) secretions cause the local reactions as swelling and itching, although severe reactions happen only from time to time.

The biting insects comprise one of the most common causes of large or even global reactions.

All biting insects belong to the Hymenoptera species. We include bees, wasps and ants to this group.

The majority of the people react with bigger or small swelling of the area, where the stringer goes through the skin. In case of the multiple stings i.e. children bitten up to 50 times, even the global toxic reaction can be initiated as a result of the toxin effect.

That can not be applied to the allergy sufferers. After the venom follicle content, which is situated near the stinger, releases the toxins, the allergic reaction starts. This reaction is as serious as often the patient was bitten and hence sensitised.

The toxin structure of the Hymenoptera species is well analysed. The allergen is formed by a complicated mixture. It is interesting that bees, wasps and ants have one part of the toxin similar in the structure and another different. It means that the patient, who suffers an allergy to bee toxin can, but does not have to be allergic to wasp toxin and vice versa

The decorative plants were grown in Asia even two thousand years before. This custom was established in Europe later. The majority of the foliage plants, which is grown nowadays, came from Asia, as well – the tulips from Persia, the chrysanthemums from Japan, the primroses from China.

The fact that the foliage plants can cause the allergic reactions is known for years. Affected are professional plants growers, but also people, who care for these plants in their gardens and households – as their hobby.

In addition to problems with breathing – common cold, asthma, the decorative plants cause the allergies appearing on the skin and eyes, as well. The so called irritating skin reactions, which are caused by skin irritation by different matters contained in the plants, are not considered rare.

A significant role is played by the photocontact dermatitis. It is a reaction, which appears after the skin contacts the plant and is exposed to the sunlight later on.

After the contact allergic reaction the typical skin inflammation can be observed on hands and face, but elsewhere, as well.

The most common reaction is caused by the asterid plant – gerberas, chrysanthemums and daisy. Any part of the plant can cause the allergy, since they consist of the chemical substances – lactones, which more than 250 kind have been defined. They are contained in the cultivated foliage plants, as well as in the wild-growing ones (arnica, daisy and yarrow).

The chrysanthemums are considered the most significant plant from the point of the inhalation plants allergies. There is a cross reaction between the aster type genus plants.

The tulips often cause especially the skin allergy reactions. The professional skin reaction called tulip finger is well known particularly in Holland and touches the tulips sellers and .

The well known flower, which causes the contact allergy, is the primrose. The allergy is caused by the plant component primin, which is regarded a strong allergen concerning both, people and animals.

The plants growing in the plant pots are considered to be a safe alternative for the people suffering plant allergy. The reverse is true. Spatiphilium – glossy common plant with white flowers – has got pollen, which often causes the inhalation allergy. The rubber plant (ficus) – other favourite house plant – usually causes the allergy, as well. Besides, both contain the toxic calciumoxalate, which causes digesting troubles and bleeding after being consumed.

Whether at home or work we need to respect certain hygienic rules while working with the plants. Washing of those parts of the body, which came into contact with the plants should be natural. It is recommended to protect you with clothes and gloves, as well. The important thing is also the protection from the scratching or injuring, which increase the allergy possibility after the contact with the plant.

The people, who are busy with the plants and flowers growing professionally – gardeners, growers, sellers, decorators put themselves at high risk of the allergy start or development. Many of them are therefore forced to change their occupation. If they start to suffer from the allergy, no choice except for the occupation change remains.

Plants which are not suitable for growing

Parietaria judaica

is a weed, which commonly grows in gardens. It is regarded a common allergen as for its pollen. Hence it should be removed.

Ivy

which grows on the walls and in pots, has got many various colour types. It comprises toxic saponins and initiates even the contact allergy. Although it is regarded a type of weed, it is left in the gardens because of its nice colour. If we are allergic to this plant, we need to remove carefully (better with the gloves).

Cactuses and succulents

belong to favourite plants, but because of their thorns they are considered to be dangerous, especially for the children.

Angel’s trumpets (brugmansia)

are beautiful, but poisonous foliage plants. Their flowers can cause hallucinations and consciousness disorders.

Oleander (Nerium oleander)

All plants are poison. Fortunately, their taste is disgusting. The manipulation requires gloves and proper hands washing. It consists of irritating saponins.

Amaryllis

has poisonous bulbs, which can be mistaken for onion bulbs by children.

Digitalis

contains cardiac stimulants. However their usage can break the heart rhythm.

Azalea

is poisonous. It is dangerous to farm animals (sheep, goats, cattle), which dies after eating it.

Many flowers and plants, which we grow at home or in our garden, are very risky to up – especially considering the children since during their early age they put almost everything, which they came into contact with, into their mouth. The colourful flowers of interesting shapes are luring them. We need to be aware of it and hence protect them from such a contact with the toxic plants.

Urticaria (nettle hives) is named after well known weed, which causes typical small itching papules with modifying form and ephemeral appearance. It is caused by the mastocytes, which release the mediators responsible for the widening of the skin arteries and hence the increased penetrability of the arteries.

The angiooedemy is basically the same disease unit with small difference -the widen and permeable arteries are situated mainly in the subcutaneous tissue. One third of the patients suffer from the urticaria and angiooedemy at the same time.

Urticaria is considered to be relatively common disease, which affects patients of all age groups. While sudden and quick reactions appear especially in the childhood, the chronic and often long lasting urticaria is typical for adults. The disease affects the middle aged women the most.

How does urticaria look like?

The basic and characteristic symptom relates to the urticarial papules. The papules look like narrow, or more likely wide flat bulge with the diameter of one centimetre or more. The colour of the papule is pink, however white or red types can occur, as well. The papules can vary in size (from one to even twenty centimetres). They also have different forms – oval, longwise – or can even form various patterns. Their amount can differ, as well, containing two, three or more papules affecting the whole body.

Urticaria can appear everywhere including the hair part of the head, food arch and palms.

Its peculiarity relates to the changing nature of the symptoms and their evanescence. The symptoms disappear after several hours and reappear elsewhere – as if they are wandering.

In addition to the cosmetic handicap the patients suffer from unbearable itching of the papules. Since the scratching can not be stopped deliberately the patients have scratched skin and often even blood welts on feet besides the typical symptoms.

The papules are often combined with angiooedemy, which is a swelling of larger area, coming from the subcutaneous tissue. It usually affects the area around the mouth or the eyes. It can appear even elsewhere – affecting the neck, ears, palms, foot arches and genitals. The mucosa can be affected, as well – in the case of the mouth cavity it comprises the tongue, pharynx and larynx. This case is considered to be very serious since the patients run the risk of choking on it. The intestinal mucosa swelling is combined with diarrhoea, from time to time with the constipation.

The synovial joint cover, bronchus and other tissues can be swollen. The angioneurotic oedema (also called the Quinck oedema) of larger size, especially the one, which affects the mucosa tissues, is serious clinical state, which should be treated by specialists immediately.

The skin tests are necessary supplements of all basic allergist examinations. The allergichypersensitiveness proof was discovered by Charlie Blackley already in 1865. The techniquewas later on improved by Grant Lewis, Pepyes and others, who introduced the prick test (stinger) usage. Nowadays the standardized method introduced by the European allergist andclinical immunology academy. The skin test in based on the fact, that sensitive allergic patient has specific antibodiesagainst the allergens not only in the particular organ, in which the clinical symptoms areactive, but also in the cell membrane – mastocyte which are in the skin.

While testing, the suspect allergen is injected into the patients´ skin near the forearm.

 The allergen choice is made according to the patients´ data on the clinical symptoms period.

The standard group of allergens, which includes the following, is used:

 ● trees pollen

● grass pollen

● rye

● worm wood

● ambrosia

● mould

● feather

● mites

● positive control (histamine)

●negative control (usually a solution with dissolved allergens)

According to the seasonality, others allergens are added. If the patient is in the contactwith the animals, the animal allergens (dog, cat, etc) are tested, as well. Before the testing thepatient should cease the anti allergic treatment (the antihistamines for at least one week), butothers, as well. For example many preparations used by the psychiatrists relieve even the skin reaction at the skin tests.

When possible, the patient should be tested even off pollen season. It is notappropriate to test somebody during or right after the infection since it can cover the reaction,as well.

For checking the skin test realisation correctness beside the allergens, the positive andthe negative control is injected. As the positive control histamine is used – a chemical, whichis released during the allergic reaction in general, i.e. test with this chemical can be positiveeven in the case of the health people. If this reaction after the testing is negative, the test is notvalid, since some of the processes or the medications relieved all reactions.The negative checking is, on the contrary, is injected in order to exclude the reaction,which is only mechanical – the injury or the injection itself, or the allergic reaction to thesolution, eventually to the conservative chemical in the allergen solution.

The skin tests allergens are made commercially. Their content and dilution are standardised.

The allergic reaction, which appears in the eyes, is relatively common. It usually occurs together with the allergic common cold; through it rarely appears in the exe area only. Not for all the symptoms, which are regarded as the “red eyes”, the term allergy is correct. In addition to the reaction to the external irritation – the contact with the essential matter or dust, the infections and autoimmune disease can be taken into consideration, as well. The most common eye allergic disease is the allergic conjunctivitis – i.e. the pinkeye, which cover 25% of the population.

The conjunctiva is a thin phlegmy membrane, which covers the eye (the front side), the eyelash from the inner side hence it forms the so called eye conjunctiva bag. Since it is “stuffed” by the lymphocytes, eosinofilms and mastocytes it is a tissue, which the allergic reaction can appear in.

What are the allergic pink eye symptoms?

Usually the symptoms appear in different intensity, yet not all the symptoms appear at the same time. The common allergic conjunctivitis symptoms include the following:

● eye itch

● red eyes (red blood vessels)

● sore eyes

● lachrymation, often very intensive

● light sensitivity

The most typical symptom is the eye itch. The photophobia relates to the tingling feelings in the eyes during the increased light intensity. As for the unpleasant pinkeye side effects, the patients describe the sore eyes as having their eyes sprinkled with the sand. However, the eye does not hurt and if it does it is not the allergy. The allergic conjunctivitis can be distinguished according to the duration and season, in which it appears, into seasonal and perennial.

The seasonal is initiated by the pollen allergens and in most cases it accompanies the allergic common cold. Often the eyes symptoms appear at first, followed by the developing common cold. The symptoms can be observed on both eyes. However, their seriousness can differ – one eye can itch more than the other, and so on. While having only one inflamed eye, the disease can not be regarded as the allergic conjunctivitis.

The perennial allergic conjunctivitis is caused by the year – long appearing allergen contact – the mites, animal epithelium, moulds, which often occur together with the atopic eczema or even the asthma and sometimes is combined with the common cold. In most cases the inflammation gets worse during the pollen season. The conjunctivitis can be combined with the cornea inflammation - in this case we talk about the keratoconjunctivitis, which is more serious.

The vernal conjunctivitis has its name delivered from the fact that it appears in the spring time. Its development is regarded more serious. In addition to the common symptoms –itching, burning and shedding tears, the eye reacts with the megascopic protuberance – the capillaries. This inflammation can have complications, which can lead to the lost ob the patient’s sight. It can spread on the eye cornea and hence reduce the eye defensiveness to such a degree that the infection can start, as well.

The vernal conjunctivitis affects usually the children and the young population. The adults are affected by it only rare. The conjunctivitis is directly caused by the contact lens material, probably “in cooperation with “the mechanic eye irritation, hence as the contact lens started to be worn, the conjunctivitis has been spread. The gigantic papillary conjunctivitis – as this disease is called – is developing gradually and is a result of the intolerance of the lens, which can not be bear anymore. If we suspect any kind of illness disease in the eye, the ophthalmologic examination will be necessary. Do not try to treat these symptoms alone without an eye specialist.The allergic conjunctivitis therapy is connected with the allergic side effect therapy. It is based on the antihistamines – local and general.

Our market offers following preparations: levokabasine – LIVOSTIN, aselastine – ALLERGODIL, lodoxamide – ALOMIDE. For a long lasting therapy, even local cromoglycates – CROMMOHEXAL are used. In the case of massive inflammation, the short or long lasting corticoids can be used after the ophthalmologist´ s decision.

How the allergy is diagnosed by the doctor

The diagnosis procedure is not easy. The clinical symptoms of the different originillness 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 asimple viral inflammation). But the treatment approach is different.

Therefore the diagnosisprocedure 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 patientfamily. Naturally, the blood relations, not he wife or the brother-in-law, are important. Theallergic reaction, their ancestors – father, grandmother, siblings or children-suffered from,indicates the relation to the current illness of the patient. The allergy predisposition isinherited. While the child of the parents, who do not suffer any allergy, inclines to the allergyat the odds of approximately 20%, the odds of the allergy increases up to 50% concerning thechild of at least one allergic parent. If the mother suffers any allergy, the odds will increaseeven 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 inthe childhood, serious allergic reaction suffered years ago, or the repeated infections – allthese are information, which indicate the possible immune system disorder or direct theallergic “before-period”.Concerning the women the important information is the number of the deliveries andthe 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 themain 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 – theproduction, administration, special operations and chemicals. The significant information arethe protection regime against the potential harmful chemicals at the workplace and ourapproach 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 extension of lips by using collagen.

A 29-year-old woman – cosmetician – was operated two years ago. She had been using a pencil to make the contours of her lips voluminous. The upper lip was too thin and the permanent make-up didn´t help. The decision was made from one day to another.

Although she is afraid of injections she let her lips beeing cut and increased. During the consultation she found out that it will be enough when a cubic centimeter of collagen will be injected into the upper lip.

At first the alergy test was necessary. You can´t never say how will be the reaction of body on a foreign substance. Whether it will accept it or refuse it. So the surgeon injected her a little bit of collagen into her arm and after some time she came on the control. There was not any unwanted reaction and so she made a term with a surgeon. The operation took less than one hour. After the anaesthesia the surgeon injected her a half of “cubic“ into the left part and a half of “cubic“ into the right part of upper lip and he massaged it softly. The woman came home as a duck. The lower lip was normal, the upper lip was filled by collagen and also swollen. By the morning it became blue.

After a week these changes disappeared and the result was visible.

“I should have done it long ago“, she said everytime, as she was chceking her new lips in a mirror. The first day she used a straw when she was drinking and she could eat only slurry meal and she felt small “balls“ in the lip – Artecoll. It was impossible for her to connect the lips so that they could tighten. The collagen in the form of small balls she felt for next several months.

The woman had a small space between her upper lip and nose so this way – collagen – was the best way how to increase the upper lip. Later she let the contour of her lips beeing tattooed by a pigment color and so she was sutisfied completely.

The amount of collagen may be used again and the lips may be increased step by step. It isn´t good to inject collagen or another substance in the bigger amount at once. The lip is sensitive and it is swollen during the operation. So the patient can´t say during the intervention whether it is enough or whether she wants more collagen. Because the picture in a mirror isn´t the real picture.