Gentowa

How does the skin test reaction look like?

The applied allergens are bound on the antibodies molecules IgE - on the outside part of the mastocytes and through the transfer of the signal their degranulation and the allergic reaction mediators release occur. These initiate the reaction through the affect on the surrounding blood vessels, the symptoms of which are the flush, the itch and the swelling with the diameter of several millimetres in the place of the injection. On the reaction, which starts approximately after 5 minutes from the allergen application, takes part also the so called substance P, which is released from the sensitive nerve ending, after the histamine stimulation. The reaction culminates in the period of 15-20 minutes, when the doctor subtracts it, after this time the reaction decreases.

The skin test realisation is not painful for the patient. On the palm side of the forearm the drops of the examining allergens are applied. In every drop a gentle puncture with the plastic or metal tool with the small sharp top is made. The skin is punctured only on the top skin layer so that the place does not have to bleed at all. After 20 minutes the reaction is judged. Places, which are either red or swollen in the same way as after applying the histamine, indicate that the reaction is positive. The patient can react to one or ore allergens. Beside the reaction when the small papule with the diameter of several millimetres appear, which is the most common reaction, the more extensive local reaction – of several centimetres, in rare cases even the swelling of the hand come about. These reactions cease to occur spontaneously after several hours.

In addition to the immediate reaction the patient can react in the so called later phase, when the papules appear after several hours. The patient deducts and informs the doctor of the reaction by himself/herself. The skin tests represent the allergist diagnosis basis. Together with the detailed taken anamnesis they are sufficient for the majority of the patients sensitive to common inhalation allergens for the typical symptoms of the diagnosis. Their role in the diagnosis is hence important, which relates to the fact that their preparation and realisation should be paid attention to.

The skin tests can be characterised as indirect provoking tests. They are called indirect, since their positives and negatives prove the sensitization of the human body. The presence of the specific IgE antibodies to applied allergen is proved on the skin without giving the information on the reactivity of the particular target organ (unless the target organ is the skin itself). Standard prick tests are used. They are made by the pharmaceutical companies, which prepare them according to the strict formulas. The content of all solutions with the allergens is diluted exactly together with the known analysed components of the particular chemical. The food allergens to the prick tests are chosen similar according to the patients. In the basic scale the eggs, nuts, milk and hesperidium should not be omitted. As far as the patient has not only a food allergy, but also the inhalational allergy, we add the cross reacting foodstuffs (birch-apple, Artemisia-celery, mites-crabs, latex-banana, etc.).

The professional airways allergic illnesses have increasing tendency. The allergens are represented by the whole range of various factors of both, the vegetable and animal origin, but also by the chemical agents. Besides the pharmacotherapy, which does not differ from the common recommended procedures, the fundamental step is the immediate transfer of the patient from the exposition of the cause, which is necessary to be defined. To the testing process the chemicals, which are not tested with the traditional patients, are added, as well.

The contact allergy diagnosis skin tests are made by putting the analysed chemical on the skin. More information is provided in the chapter about the contact allergy.

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.

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 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.