Gentowa

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 skin tests are necessary supplements of all basic allergist examinations. The allergic hypersensitiveness proof was discovered by Charlie Blackley already in 1865. The technique

was 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 and clinical immunology academy.

The skin test in based on the fact, that sensitive allergic patient has specific antibodies against the allergens not only in the particular organ, in which the clinical symptoms are active, 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 contact with the animals, the animal allergens (dog, cat, etc) are tested, as well. Before the testing the patient should cease the anti allergic treatment (the antihistamines for at least one week), but others, 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 not appropriate 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 and the negative control is injected. As the positive control histamine is used – a chemical, which is released during the allergic reaction in general, i.e. test with this chemical can be positive even in the case of the health people. If this reaction after the testing is negative, the test is not valid, 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 the solution, eventually to the conservative chemical in the allergen solution. The skin tests allergens are made commercially. Their content and dilution are standardised.

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.

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 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.

It´s description is the most important part of the “testimony” andno 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 onmedications we take, is important. Many can influence not only the diagnosis, but also theparticular 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 mostserious 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 nostrilscaused by the mechanic irritation are the symptoms of the common cold. The patients with thenasal congestion breathe through the mouth, which are open all the time. The nasal congestionAs 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 pushingthe top of the nose up with the palm, while the nasal cavity is being released.

The auscultatory examination – examination with the phonendoscope – enables to hearthe breathing sound. Unlike the healthy lungs, the patients with the clinical asthma makecrunching, bubbling or whistling sounds while breathing. They do not have to be loud so thatonly the experienced ear of the doctor can hear and identify them.The palpating and percussing of the rib cage and the abdomen provides furtherinformation.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 commoncold, we should expect the complex examination.

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.

During the last hundred years the people have changed their eating habits, especiallythe content and preparation of the foodstuffs to such a degree than the whole existence hasnever achieved before. Today we can not find any foodstuffs, which would not b prepared insome way. The chemical conservation, colouring and flavouring of the foodstuffs and drinks is common procedure of their preparation.

The food industry nowadays uses for this sake tens of chemical compounds. It isobvious that the doses contained in the foodstuffs can not be toxic for the human body. Thisprinciple is controlled strictly by the particular authorities of the hygienic services. Thecolouring flavours can not be added to the fresh vegetable, fruit, coffee, tea. The butter, breadand milk might not be coloured with the synthetic colouring flavours. The conservative chemicals should not be added to milk, flour, bread, baby foods.

From time to time an affair comes up, related to the mass intoxication (let us mentionthe Spanish oils), but in this case it is always the human factor which failed. The reliable foodproducers can not afford in no case to go beyond the norms, which are stated for the particularadditives – as these chemicals are called. While developing these chemicals, the allergicpeople had been forgotten. Therefore we are now in the situation, when the huge amount ofthe allergic reactions is caused not by the foodstuffs itself, but by the chemicals added to it – whether as a result of their taste, smell, colour, or because of the freshness.

Tartrazine (E 102) is an orange colouring additive used perhaps to the greatest extent. Itis added to the whole range of foodstuffs and drugs, too. That might be the reason why it isthe well known and often food allergen (0, 5% of the population reacts to it). It becomes thesuspicious factor for the patients, who are allergic to foodstuffs without any relations among themselves (for example, the canned meat, ice-cream, sauce, conserves, chew gum, juice).

Sulphides (E 223) are used because of their antibacterial and antioxidant effects. They arecontained in the dried meals (fishes, fruits) and added to drinks (beer, wine, fruit andvegetable juices). In addition to the allergic reactions related to the food allergic sufferers, they worsen the health condition of up to 10% of the people suffering the asthma.

Parabenes (E 127) are often used in the food industry, but also in the drugs and cosmeticsproduction because of their antibacterial and antifungal effects. Pay attention to the dentalwaters and teeth pastes. They cause the allergic reaction, which affect the skin the most (eczema, urticaria).

Erythrosine (E 127) is a red water-soluble colouring additive used in the food industryand the drugs production. We van find it almost in all commercially produced foodstuffs, which are red. It causes all possible clinical forms of allergic reactions.

Carotenoids (E 160) are red colouring additives used in many foodstuffs (pasta, bakeryproducts, candies, ice-creams, fried milk creams, dry pastry, candies, mayonnaise products,mayonnaises, drinks, vinegar, powdered drinks, fruit and vegetable products, oils and fats,soups, pre-cooked rice, milk products, food concentrates, mustard, fish and poultry products,soup preparation products, powdered meals preparation mixtures, sauces). They cause the allergic reaction especially when the patients are allergic to some kind of vegetable.

Benzoates (E 210-219) belong to the most commonly used conservative chemicals. The allergic reactions caused by them have different clinical development.

Monosodium glutamate (E 621) is added as a flavour to the soups, sauces, and meatpreparation products. It can cause so called Chinese restaurant syndrome. It is not good for the little babies.

Butylhydroxyanisole (E 320) added to the majority of the foodstuffs as an antioxidant –to oils, fats, emulsified fats, candy products, soup and sauce preparation products, ketchups,flavoured vegetable creams, mayonnaise, flavoured horseradish, garlic paste, mustard, nutkernels, chew gums, products on the basis of the boiled potatoes, fried semi finished potato products.

Summary of the additive coding

E100 - E199 Foodstuffs colouring additives

E200 – E299 Conservative agents

E300 – E321 Antioxidants

E322 – E495 Emulsifiers, stabilizers, jelly reagents

E 500 – 3619 Acids, alkalis ( E 260, 270, 330, 334, as well)

E620 – E637 Taste flavours

E900 – E925 Various

E1000 - Others

RememberAccording to the food law the producers must obligatory label and mark the foodstuffs.The consumers must be informed on the content and composition of the packedfoodstuffs. The list of the particular components should be listened in the downwardorder – according to the declining amount.

The additive can me marked by the name orthe number code. In the European countries the initial E letter, established already 30years ago within the European system, is used. The INS (International NumberingSystem) labelling, which is identical with the E system, has started to be used. It enablesthe orientation in the food industry additives within the whole world.

Red and white beans

are often food components used in sauces or soups. They are oftenadded to canned meat food products. The patients often cross-react to other kinds of legumes,as well.

Soya beans are the most frequently used legume worldwide. Soya is used in various forms– starting with the traditional legumes, continuing with prepared foodstuff – tofu, soya fibre,soya “meat”. The soya sauce is a part of mixed sauces and dressings. According to itsfrequent usage it belongs to the most common causes of the allergic reactions. Moreover, thedisoriented patients, especially the parents of children suffering some allergies think that soyamilk can substitute the cows´ milk. The reverse is true! Offering another allergen, althoughany cross-reaction is threatening, is unsuitable for children.

The cross-reaction occurs withpeas, peanuts and other legumes.Meals which can contain the soya protein:

● ready made baby food

● bakery products

● pudding

● bread

● hamburger

● butter adjunct

● chocolate

● meat products

● sausages

● soups

● crackers

● dressings

● deserts

● ice-cream

● canned meat

● caned fish

Peas and lentils

do not belong to often allergens in these latitudes (in India it is the fifthmost common allergen). Those allergic to these legumes should be careful. Peas are added tovarious meals, for example mayonnaise and sandwiches.

Peanuts (groundnuts)

belong to the most common food allergens at all. In the UnitedStates it is the number one in particular because of the fact, that the peanut butter iscommonly used in American cuisine. This vice has already appeared in Europe – just think ofall the Nutela peanut butters and other sweet spreads, waffle fillings, etc.The peanut as an allergen is dangerous since its oil is added to the whole range offoodstuffs, while, unfortunately, this information is not written on the cover of the foodstuff!This goes for various sauces, cakes, ice-creams and flavours. It is often used for thickeningthe meals – mostly various barbecue sauces. Traces of peanuts allergens are marked even infoodstuffs, which do not contain any peanuts at all – as a result of the previous productionprocess of the production devices. After eating such foodstuff, a serious allergic reaction wasprecipitated. In the United States several tens of people die as a result of the anaphylacticshock after eating the peanuts or their parts.The cross-reaction can occur with other legumes.

Nuts and seeds

Many seeds inside the shells are regarded as nuts, although from the botanic point ofview they do not belong to this group of fruit. As foodstuff they are used commonlywhether as food supplements because of their high level of proteins and oils, or becauseof their taste.

The seeds and nuts are often allergens and danger the allergic people perhaps the mostbecause they are contained in many food products. The various bakery products – breads,pastry, cakes, cereals, candies, sweets, ice-creams, drinks, chocolate products, desserts, milkproducts and hundreds other products contain some of the nuts or seeds. The great danger forthe allergic people lies in the fact that many products contain such a small amount of theseelements so that the producer does not declare it. The patients allergic to some of thefollowing seeds or nuts have to be very careful while choosing their foodstuffs.

Almonds

are stone fruit kernels of typical taste. According to the presence or absence of theglycoside, which is called amygdaline, they are divided into bitter and sweet types. Thekernels are eaten either alone – roasted and salted or added to various products – ice-creams,chocolates, cakes, puddings, chew gums. Be careful – the almond oil is often added tocosmetic products.

Brazil nuts

are actually seeds from huge trees, growing in the wildness of the SouthAmerica and in the rain forests of the Amazon region. The trees are not planted, but the cropand the export of the seeds forms an important part of their economy. Inside the big fruit-up totwo kilograms of weigh- with the wooden shell, 10-22 seeds are growing. The nuts with ahigh nutritional value and 60 or more percentage content of the oil and 17% of the proteins.