Modern approaches to the treatment of allergies

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Modern approaches to the treatment of allergies

Chapter 1: Understanding Allergies: Fundamentals and Mechanisms

Allergies are an excessive reaction of the immune system to usually harmless substances known as allergens. This reaction can manifest itself in various forms, from light skin rashes to life -threatening anaphylactic reactions. Understanding the allergy mechanisms is crucial for the development of effective treatment strategies.

  • Immunological foundations:

    • Ige and allergic reaction: The central role in allergic reactions is played by immunoglobulin E (Ige). In the first contact with the allergen in predisposed people, the immune system is produced by IgE antibodies specific to this allergen. These antibodies are associated with fat cells and basophils, which are widespread in the tissues of the body, especially in the skin, respiratory tract and gastrointestinal tract.
    • Sensitization: The process of production of IgE antibodies is called sensitization. During sensitization, dendritic cells capture the allergen and represent it to T-Hellers (Th2). Th2 cells are distinguished by cytokines, such as Interleukin-4 (IL-4) and Interleukin-13 (IL-13), which stimulate B cells to switch to IGE production.
    • Degranulation of mast cells and basophils: With repeated contact with the allergen, the allergen is associated with IgE antibodies, already located on the surface of fat cells and basophils. This binding causes cross-sewing IgE receptors, which leads to activation of cells and the release of mediators, such as histamine, tripatase, leukotrienes and prostaglandins.
    • Allergy mediators: The released mediators are responsible for the clinical manifestations of allergies.
      • Histamin: It causes vasodilation (expansion of blood vessels), an increase in vascular permeability (which leads to edema), a reduction in smooth muscles (for example, in bronchi) and stimulation of nerve endings (which causes itching).
      • Leukotrines: More powerful bronchodhonstructors than histamine, and also contribute to inflammation and increased secretion of mucus.
      • Prostaglandin: Participate in inflammation, pain and fever.
      • Triptase: The marker of activation of mast cells and can contribute to tissue damage.
      • Cytokines: They attract and activate other immune cells, strengthening and supporting the inflammatory process.

  • Types of allergens:

    • Food allergens: The most common food allergens include milk, eggs, peanuts, wood nuts, soils, wheat, fish and mollusks.
    • Aeroallergen: Allergens transferred through the air include pollen of plants (trees, herbs, weeds), spores of mold, animal hair (cats, dogs), dust mites and the products of the vital functions of cockroaches.
    • Medicinal allergens: Medicines such as penicillin and other antibiotics, non -steroidal anti -inflammatory drugs (NSAIDs) and some anticonvulsants can cause allergic reactions.
    • Insect poison: Boots of bees, OS, hornets and ants can cause serious allergic reactions.
    • Latex: Natural latex contained in gloves, condoms and other medical devices can cause allergic reactions in predisposed people.
    • Contact allergens: Substances that cause allergic contact dermatitis include nickel, cosmetics, detergents and some plants (for example, ivy).

  • Risk factors for the development of allergies:

    • Genetic predisposition: Allergies are often inherited. If one or both parents have an allergy, the child increases the risk of its development. Heredity, predisposing to the development of allergies, is called atopia.
    • Environmental factors: The effects of allergens at an early age can increase the risk of sensitization. Air pollution, tobacco smoke and other environmental factors can also contribute to the development of allergies.
    • Hygienic hypothesis: This hypothesis suggests that a decrease in the effects of infections at an early age can lead to impaired development of the immune system and increase the risk of developing allergic diseases. A cleaner environment in childhood can reduce the stimulation of the immune system, which leads to a skew towards the Th2-answer, which contributes to the development of allergies.
    • Diet: Mother’s diet during pregnancy and breastfeeding, as well as a child’s diet at an early age can affect the risk of allergies.
    • Intestinal microbia: The composition of the intestinal microbioma plays an important role in the modulation of the immune system. Dysbiosis (microbiotic balance) can contribute to the development of allergies.

Chapter 2: Allergy Diagnostics: Identification of causal factors

Accurate diagnosis is crucial for the effective treatment of allergies. It includes the collection of an anamnesis, physical examination and allergological tests.

  • A history of anamnesis:

    • Detailed medical history: The doctor in detail question the patient about his symptoms, the time of their occurrence, frequency, severity and factors that exacerbate or facilitate them.
    • Family history: The presence of allergic diseases in family members is clarified.
    • Anamnesis of exposure: Information about possible allergens that the patient was subjected to work, at home and in other places is collected.
    • Dietal history: The patient’s diet is evaluated to identify possible food allergens.
    • Anamnesis of medication: It turns out what medicines the patient takes to exclude medicinal allergies.

  • Physical examination:

    • Skin rating: Inspection of the skin for rashes, urticaria, eczema and other signs of an allergic reaction.
    • Assessment of the respiratory system: Listening to the lungs for the presence of wheezing, whistling breathing and other signs of bronchospasm.
    • Assessment of the mucous membranes: Inspection of the nose, eye and throat for redness, edema and discharge.

  • Allergological tests:

    • Skin tests:

      • SKO-test: A small amount of allergen is applied to the skin, and then the skin is slightly pierced with a needle. If the patient has an allergy to this allergen, redness and swelling (blister) are formed at the site of the puncture. Sk-tests are fast, relatively painless and economical.
      • Intercidy testing: A small amount of allergen is inserted under the skin. This method is more sensitive than a hut test, but also more likely causes false positive results.
      • Application tests (Patch tests): Allergens are applied to special patchings, which are glued to the skin for 48 hours. After 48 and 72 hours, the patchmakers are removed, and the skin is estimated at the presence of signs of allergic contact dermatitis.

    • Blood test for specific IgE antibodies:

      • RAST (Radioallergosorbent test) и ELISA (Enzyme-linked immunosorbent assay): These tests measure the level of IgE antibodies to specific allergens in the blood. They are a useful alternative to skin samples, especially in patients with severe eczema, dermographism (the appearance of blisters on the skin after a scratch) or taking antihistamines. CAP-Rast is a more modern and exact method for determining specific IgE.

    • Provocative tests:

      • Food provocative tests: The patient is given a small amount of suspects of food allergen under the supervision of a doctor. The test is carried out in conditions that allow you to quickly provide assistance in the case of an allergic reaction. Food provocative tests are the “gold standard” of food allergy diagnostics.
      • Nasal provocative tests: The allergen is inserted into the nose, and the reaction of the mucous membrane is evaluated.
      • Bronchial provocative tests: The allergen is inhaled, and the function of the lungs is evaluated. It is carried out only in specialized centers.

  • Differential diagnosis:

    • It is important to exclude other diseases that can cause symptoms similar to allergies, such as respiratory tract infections, skin diseases (for example, psoriasis), idiopathic urticaria and others.

Chapter 3: Methods for treating allergies: Modern approaches

Modern treatment of allergies includes several strategies aimed at alleviating symptoms, preventing exacerbations and changing the reaction of the immune system to allergens.

  • Avoidance of allergens:

    • Food allergies: The strict exclusion of allergen from the diet is a cornerstone of food allergy treatment. It is important to carefully read the labels of products and avoid cross -pollution when cooking. Patients with food allergies should always have an epinephrine autoinfrine (adrenaline) for emergency care with anaphylactic reaction.
    • Pollen allergies: During the flowering period, it is recommended to limit stay on the street, especially in windy weather. The use of air purifiers with HEPA filters, closing windows and doors, washing clothes after staying on the street and regular wet cleaning of the house can help reduce the effects of pollen.
    • Allergies to dust ticks: The use of special covers for mattresses and pillows that do not pass dust ticks, regular laundry washing in hot water (at least 60 ° C), maintaining low humidity in the house (less than 50%) and removal of carpets and upholstered furniture can help reduce the amount of dust mites.
    • Animal wool allergies: Avoiding contact with animals is the most effective way to prevent symptoms. If it is impossible to avoid contact, it is recommended to regularly bathe the animal, use air purifiers with HEPA filters and limit the stay of the animal in the bedroom.
    • Allergy to mold: The elimination of mold sources, such as leaking taps, wet basements and bathrooms, and maintaining good ventilation can help reduce the amount of mold in the air. The use of air drainages can also be useful.

  • Medication:

    • Antihistamines:

      • First -generation antihistamines: (for example, diphenhydramine, chloropenamine) are effective for alleviating itching, cold and sneezing, but can cause drowsiness, dry mouth and other side effects. The use of these drugs is limited due to side effects.
      • Second generation antihistamines: (for example, cetirizine, Loratadine, Fexofenadin) have a less sedative effect than first -generation antihistamines, and are drugs of choice for the treatment of allergic diseases. They block the effect of histamine, relief of the symptoms of allergies.
      • Third generation antihistamines: (for example, desloratadine, levocetirizine) are metabolites of the second -generation antihistamines and have even higher selectivity and fewer side effects.

    • Corticosteroids:

      • Local corticosteroids: (for example, creams, ointments, nasal sprays) are used to treat skin rashes, allergic rhinitis and other localized allergic reactions. They reduce inflammation and itching. With prolonged use, side effects, such as thinning of the skin and telangiectasia, can be caused.
      • Systemic corticosteroids: (for example, prednisone) are used to treat severe allergic reactions, such as anaphylaxia and a severe asthmatic attack. They have a powerful anti -inflammatory effect, but with prolonged use they can cause serious side effects, such as weight gain, increase in blood pressure, osteoporosis and cataracts. Systemic corticosteroids should be used only in extreme cases and for a short period of time.

    • Decongestants:

      • Vasocusing drops and sprays for the nose: (for example, oxymetazolin, xylometazoline) facilitate the congestion of the nose, narrowing the blood vessels in the nasal mucosa. It is not recommended to use more than 3-5 days in a row, as this can lead to the development of ricocher edema of the nasal mucosa (drug rhinitis).
      • Perforal decongestants: (for example, pseudo -ephedrin, phenylefrin) also facilitate the congestion of the nose, but can cause an increase in blood pressure, insomnia and other side effects.

    • Material cell stabilizers:

      • Sodium cromlycat and undercrace sodium: Prevent the release of mediators from mast cells. Used to treat allergic rhinitis, conjunctivitis and asthma. They are less effective than antihistamines and corticosteroids, but have less side effects.

    • Antileycotrine drugs:

      • Montellukast: Blocks the action of leukotrienes that are involved in the development of allergic inflammation. Used to treat asthma and allergic rhinitis.

    • Epinephrine (adrenaline): First aid drug for anaphylactic reaction. It is introduced intramuscularly using an autoin object. Patients at the risk of anaphylaxia should always have an epinephrine autoinfrine autoinfine and know how to use it.

  • Allergen-specific immunotherapy (AIS):

    • Principle Actions: AIT (also known as allergovaccination) is aimed at changing the reaction of the immune system to allergens. The patient is administered gradually increasing doses of allergen, which leads to a decrease in sensitivity to this allergen.
    • Types of AIS:
      • Subcutaneous immunotherapy (PKIT): The allergen is administered under the skin in the form of injections. PKIT is an effective method of treating allergic rhinitis, conjunctivitis, asthma and allergies to insects.
      • Sublingval immunotherapy (merged): The allergen is introduced under the tongue in the form of tablets or drops. The merging is a convenient alternative to PKIT and can be carried out by the patient at home. Sharp is effective for the treatment of allergic rhinitis and allergies to pollen.
    • Indications for AIT: AIT is shown to patients with allergic rhinitis, conjunctivitis, asthma and allergies to the poison of insects, in which symptoms are not controlled by the aviation of allergens and drug treatment.
    • Contraindications to AIS: Severe asthma, autoimmune diseases, malignant neoplasms and pregnancy are contraindications to AIT.
    • Side effects of AIS: Local reactions (redness, edema, itching in the injection site or under the tongue) are the most common side effects of AIS. Systemic reactions (urticaria, angioedema, bronchospasm) are less common, but can be life -threatening. AIT should be carried out under the supervision of a doctor, and patients should be under surveillance for 30 minutes after injection or taking the drug under the tongue.

  • Biological therapy:

    • Moralizomab: Monoclonal antibody to Ige. It is associated with IgE in the blood, preventing its binding with fat cells and basophils. It is used to treat severe allergic asthma, not controlled by inhalation corticosteroids and long-acting beta, as well as for the treatment of chronic spontaneous urticaria.
    • Dupilumab: Monoclonal antibody to the IL-4 receptor. Blocks the action of IL-4 and IL-13, cytokines, which play a key role in the development of allergic inflammation. Used to treat atopic dermatitis (eczema).
    • Mepolizumab, Reslizumab, Benralizumab: Monoclonal antibodies that block the action of IL-5 or its receptor. IL-5 plays an important role in the development of eosinophilic inflammation. Used to treat severe eosinophilic asthma.

  • Other treatment methods:

    • Phototherapy: Ultraviolet (UV) skin irradiation is used to treat atopic dermatitis and other skin diseases.
    • Psychotherapy: Helps patients cope with stress and anxiety associated with allergic diseases.
    • Alternative treatment methods: Some patients use alternative treatment methods such as acupuncture, herbal medicine and homeopathy. However, the effectiveness of these methods has not been proven, and they should not replace traditional medical treatment.

Chapter 4: New directions in the treatment of allergies:

Studies in the field of allergology are constantly developing, and new methods of treatment appear that promise to be more effective and safe.

  • Octol immunotherapy (sores): Supplies consists in taking small doses of allergen orally. Sitting showed its effectiveness in the treatment of food allergies, especially allergies to peanuts. Currently, protocols are being developed for the treatment of other food allergies, such as allergies to milk and eggs.
  • Epicated immunotherapy (epithet): The epithet consists in applying an allergen to the skin using a special patch. The epithet has shown its effectiveness in the treatment of allergies to peanuts.
  • DNA -based vaccines: DNA -based vaccines contain genes encoding allergens. After introducing into the body, these genes are expressed by cells, which leads to the production of allergen and stimulation of the immune response. DNA -based vaccines are at the stage of clinical tests for the treatment of allergies to pollen and dust mites.
  • Monoclonal antibodies to other cytokines: Monoclonal antibodies are developed that block the action of other cytokines involved in the development of allergic inflammation, such as IL-17 and TNF-α.
  • Target therapy: Targeted therapy is aimed at influencing specific molecules or cells involved in the development of allergies. For example, preparations are developed that block the interaction between IgE and its receptor on mast cells and basophiles.
  • Modulation Microbioma Kidnika: Studies show that the modulation of the intestinal microbioma can affect the development of allergies. Probiotics and prebiotics can be used to change the composition of the microbioma and reduce the risk of allergies.
  • Cell therapy: Cell therapy includes the use of immune system cells to treat allergies. For example, methods are developed aimed at suppressing the activity of the Th2 cells and increasing the activity of regulatory T cells (Treg), which play a role in suppressing the immune response.
  • CRISPR-CAS9 Genes editing: CRISPR-CAS9 technology allows you to edit the genes of the immune system, which can lead to a complete cure for allergies. This method is at an early stage of development, but promises to be revolutionary in the treatment of allergic diseases.

Chapter 5: Allergies in childhood: Features and approaches to treatment

An allergy is a common disease in childhood, and its manifestations may differ from manifestations in adults. Particular attention should be paid to the diagnosis and treatment of allergies in children in order to prevent the development of chronic diseases and improve the quality of their life.

  • Prevalence: Allergies occur in 20-30% of children. Food allergies, atopic dermatitis and allergic rhinitis are the most common allergic diseases in children.
  • Features of the immune system in children: The immune system of children is in the process of development, and they are more susceptible to the development of allergies.
  • Risk factors for the development of allergies in children: Genetic predisposition, early effects of allergens, intestinal dysbiosis and environmental factors increase the risk of allergies in children.
  • Allergies in children:
    • Food allergies: Symptoms of food allergies in children can vary from light skin rashes and gastrointestinal disorders to a severe anaphylactic reaction.
    • Atopic dermatitis (eczema): Chronic inflammatory skin disease characterized by itching, dryness and rashes. In children, atopic dermatitis often begins at an early age and can affect the quality of their life.
    • Allergic rhinitis (hay fever): Inflammation of the nasal mucosa caused by allergens carried through the air. Symptoms of allergic rhinitis include a runny nose, nasal congestion, sneezing and itching in the nose.
    • Asthma: Chronic respiratory disease, characterized by inflammation and narrowing of the bronchi. Symptoms of asthma include coughing, whistling breathing, shortness of breath and constraint in the chest.
  • Allergies diagnostics in children: The diagnosis of allergies in children includes the collection of an anamnesis, physical examination and conducting allergological tests. Skin tests and blood test for specific IgE antibodies are the most common methods for diagnosing allergies in children. Food provocative tests are the “gold standard” of food allergy diagnostics.
  • Allergy treatment in children:
    • Avoidance of allergens: The strict exclusion of allergen from the diet is a cornerstone of food allergies in children. It is important to carefully read the labels of products and avoid cross -pollution when cooking. Patients with food allergies should always have an epinephrine autoinfrine (adrenaline) for emergency care with anaphylactic reaction. A decrease in the effects of allergens transferred by air is also important for the treatment of allergic rhinitis and asthma.
    • Medication: Antihistamines, corticosteroids (local and systemic ones), decongestants, fat cell stabilizers and anti -aicotrienic drugs are used to treat allergies in children. The choice of medicine depends on the severity of the symptoms and age of the child.
    • Allergen-specific immunotherapy (AIS): AIT is an effective method of treating allergic rhinitis, conjunctivitis and asthma in children. PKIT and merging are available options for AST for children.
    • Teaching parents and children: It is important to teach parents and children about allergies, its causes, symptoms, treatment methods and ways to prevent exacerbations. Children should know how to use an epinephrine autoin -subject and how to act in the case of an allergic reaction.

Chapter 6: Life with allergies: tips and recommendations for patients

Life with allergies can be complicated, but compliance with certain rules and recommendations can help patients control their symptoms and improve the quality of their lives.

  • Compliance with the doctor’s recommendations: It is important to regularly visit the doctor and follow his recommendations for the treatment of allergies.
  • Maintaining a diary of symptoms: The diary of symptoms can help identify allergens that cause symptoms and evaluate the effectiveness of treatment.
  • Thorough reading of products: Patients with food allergies need to carefully read the labels of food and avoid products containing allergens.
  • Avoiding cross pollution: When cooking, it is necessary to avoid cross -contamination using individual cutting boards, knives and dishes for products containing allergens.
  • Information of others: It is important to inform relatives, friends, teachers and colleagues about their allergies and how to act in the case of an allergic reaction.
  • Wearing a medical bracelet or necklace: A medical bracelet or necklace with information about allergies can help medical personnel provide timely and adequate assistance in case of emergency.
  • Travel planning: Patients with allergies need to plan travel in advance, making sure that they have enough drugs and that they know where they can get medical care if necessary.
  • Psychological support: Allergies can cause stress and anxiety. An appeal to a psychologist or psychotherapist can help patients cope with these feelings.
  • Joining support groups: Joining support groups can help patients communicate with other people living with allergies and share their experience.
  • First aid training for anaphylaxia: Patients with the risk of anaphylaxia need to undergo first aid training in anaphylaxia so that they can help themselves and other people if necessary.

Chapter 7: Alternative and complementary methods for treating allergies: review and prospects

Many patients with allergies turn to alternative and complementary treatment methods such as phytotherapy, acupuncture and homeopathy. It is important to understand that the effectiveness of these methods is not always proven, and they should not replace traditional medical treatment.

  • Phytotherapy: The use of plant drugs for the treatment of allergies. Some plants, such as nettles and chamomile, have anti -inflammatory properties and can help alleviate the symptoms of allergies. However, it is necessary to be careful when using phytotherapy, as some plant drugs can cause allergic reactions.
  • Acupuncture: The treatment method based on the introduction of thin needles into certain points on the body. Acupuncture can help alleviate the symptoms of allergic rhinitis and asthma. However, additional studies are needed to confirm the effectiveness of acupuncture in the treatment of allergies.
  • Homeopathy: The treatment method based on the use of highly diluted substances that cause symptoms similar to the symptoms of the disease. The effectiveness of homeopathy in the treatment of allergies has not been proven.
  • Probiotics: Living microorganisms, which when used in adequate quantities have a beneficial effect on the health of the owner. Probiotics can help modulate intestinal microbia and reduce the risk of allergies.
  • Prebiotics: Interesting dietary fiber that serve as food for probiotics. Prebiotics can contribute to the growth of beneficial bacteria in the intestines and improve intestinal health.
  • Vitamins and minerals: Some vitamins and minerals, such as vitamin D and zinc, play an important role in the functioning of the immune system and can help reduce the risk of allergies.
  • Yoga and meditation: Yoga and meditation can help reduce stress and improve the quality of life of patients with allergies.

It is important to remember that alternative and complementary treatment methods should not replace traditional medical treatment. Patients with allergies need to consult your doctor before starting to use any alternative treatment methods.

Chapter 8: The role of diet and food in allergies management

Diet and food play an important role in allergies. Certain products can cause allergic reactions, while others can help strengthen the immune system and reduce the risk of allergies.

  • Excluding diet: The exclusion of suspects of food allergens from the diet can help identify allergens that cause symptoms. The excluding diet should be carried out under the supervision of a doctor or nutritionist.
  • Elimination diet: A more stringent form of excluding diet, in which all potential food allergens are excluded. The elimination diet should be carried out only for a short period of time and under the strict supervision of a doctor.
  • Rotation diet: A method in which products that are often used alternate with products that are used less often. The rotational diet can help prevent the development of food allergies.
  • Anti -inflammatory diet: Diet, rich in fruits, vegetables, whole grain products, omega-3 fatty acids and antioxidants. An anti -inflammatory diet can help reduce inflammation in the body and improve the health of the immune system.
  • Diet rich in vitamin D: Vitamin D plays an important role in the functioning of the immune system. Some studies show that vitamin D deficiency can increase the risk of allergies. Products rich in vitamin D include fatty fish, eggs and enriched products.
  • Diet rich in zinc: Zinc also plays an important role in the functioning of the immune system. Products rich in zinc include meat, poultry, nuts and seeds.
  • Breast-feeding: Breastfeeding is the best way for babies for babies, as it provides all the necessary nutrients and antibodies necessary for protection against infections and allergies. It is recommended to breastfeeding a baby exclusively during the first 6 months of life.

Chapter 9: Allergy Prevention: Precautions and Strategy

Allergy prevention is an important aspect of allergies. Taking precautions and following certain strategies can help reduce the risk of allergies and prevent exacerbations.

  • Breast-feeding: Breastfeeding is the best way to prevent allergies in infants.
  • Introduction of solid food: The introduction of solid food should begin at the age of about 6 months. New products should be introduced gradually, one after another, so that any allergic reactions can be detected.
  • Avoiding the effects of tobacco smoke: The effect of tobacco smoke can increase the risk of allergies in children. Do not smoke in the presence of children.
  • Air pollution control: Air pollution can aggravate the symptoms of allergies. Avoid staying on the street on days with a high level of air pollution.
  • Stress management: Stress can weaken the immune system and increase the risk of allergies. You should learn to manage stress using methods such as yoga, meditation and physical exercises.
  • Maintaining a healthy lifestyle: Maintaining a healthy lifestyle, including a balanced

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