Allergic diseases represent a true modern scourge in Western societies, recording the greatest increase in prevalence over the last two decades compared to any other human condition. The Allergy Clinic of the "St. Luke's" Clinic aims at the comprehensive treatment of patients with allergic diseases. 

Services of the Clinic

Indicatively, the following services are provided at the Allergology Clinic:

Aetiology investigation of allergic asthma and rhinitis in children and adults 

The allergy investigation, through clinical examination, skin tests and special laboratory tests reveals the guilty allergens of the environment, such as dust mites, fungi, pollen or pet epithelium, providing the main means for subsequent treatment.

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Desensitization with special immunotherapy 

In the case of allergic rhinitis and asthma, immunotherapy is the only etiological treatment, that is, the only treatment that treats the cause. The cause is the allergen that causes the disease. The result of this method is achieved by long-term administration of the incriminated allergen itself that causes desensitization in the patient. Administration is done either subcutaneously, or in the form of sublingual drops. In this way, we can: 

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• To intervene in the natural course of the problem
• Greatly improve allergic symptoms 
• Reduce the number of conventional drugs, such as cortisone or antihistamines
   

It should be particularly emphasized that the immunotherapy procedure is most valuable in the early years of the allergic disease, as it gives the opportunity to halt the typical progression of rhinitis or asthma to more severe forms.

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Integrated control of atopic eczema (atopic dermatitis)

The Clinic performs a comprehensive atopic eczema testing, as well as the investigation of skin rashes where allergic participation is possible. Especially the handling of atopic eczema is of fundamental importance, as this is the condition that, when uncontrolled, gives birth to the rest of the atopic diseases, such as food allergy, allergic rhinitis and asthma. Thus, prevention is put in the foreground.

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Other services provided: 

• Special venom immunotherapy (bee, wasp). In this case, immunotherapy is a one-way street, since this particular allergy is often life threatening.
  
• Diagnosis and managing of pharmaceutical allergy.
• Diagnosis and individualised management of food allergies.

Modern treatment of food allergy

Food allergy is the most recent of the modern allergy "epidemic". The frequency of food allergy is reported to have increased tenfold within the last 10-15 years, following the rise of other atopic diseases, reaching up to 10% of the child population. 

How food allergy affects the quality of life

The long-term persistence of allergy to one or more foods degrades the quality of life of the child and the family, mainly due to dietary restrictions, justified or not, but also the constantly floating risk of systemic anaphylactic reaction to some accidental exposure of the child to the allergenic food.

Characteristically, the example of allergy to peanut or dry fruit is mentioned, which may be associated with a decrease in the level of quality of life greater than that in children with insulin-dependent diabetes mellitus. 

Dealing with the problem is therefore imperative and requires: 

• Individualised diagnostics
  
• Allergy counselling
   
• Active desensitization, where possible

To which patients is the specific allergy testing for food allergy addressed?

All children who avoid regular administration of a particular food for the possibility of food allergy are entitled to allergy assessment. The primary purpose here is the overall assessment of the risk and the introduction of all safe foods into the diet. Specifically, the special allergy assessment for food allergy is addressed to:

Patients to whom the administration of this food has caused symptoms in the past

The most typical symptoms are blisters (red rashes similar to a mosquito bite), itching in the mouth, vomiting and/or respiratory symptoms (cough, hissing, dyspnoea), while more rarely the consumption of food may be associated with various chronic symptoms from the gastrointestinal system and developmental delay.

Patients who have undergone an allergy examination (usually a RAST blood test) in the past and have positive results for a food, but have not been given special allergy counselling

This is of particular importance, as in more than half of the cases of positive RAST tests, these do not correspond to a clinical disease, making the guided reintroduction of the food safe.

Children (and less often adults) with an instruction to avoid a food, without this being based on a history of compatible symptoms

Here, too, it is necessary to clarify the necessity or not to limit the diet, since it is often the case that entire food groups are excluded from the diet, based on non-proven knowledge.

Benefits of the specific allergy approach

The specific allergy approach can ensure the correct diagnosis. This is based on: 

• In the clinical assessment
• The individualised control with sting skin tests (painless skin tests with the various allergenic proteins) and epidermal tests (special stickers containing the food to be examined) 
• The appropriate laboratory testing, using both classical serology methods and modern molecular techniques

This multi-faceted approach can clarify the likelihood of food allergy, but also assess qualitatively and quantitatively the severity of a possible allergic reaction. 

• If clinical tolerance is strongly suspected, the food is introduced into the patient's diet with controlled provocation in a properly equipped area of the Clinic, so that it can then be administered without fear at home. 
• On the contrary, in cases where the clinical allergy is evaluated as quite possible, special advice is provided on the ways to avoid the food, the proper management of a possible reaction and the required diet. 

Knowing which foods to avoid

It is necessary for the patient and his family to know which foods, relevant or seemingly irrelevant, may contain related allergenic substances and what kind of reaction we would expect. For instance: 

• When a child with a milk allergy should avoid beef or not
• When a patient with an allergy to a fish could consume alternative species of fish or other seafood
• If hypersensitivity to shrimp could conceal allergic asthma from dust mites
• If the apparent allergy to fruits could reflect for example hypersensitivity to proteins of the rubber band

In this way, such 'paradoxical' reactivity can be predicted and interpreted, while unnecessary food exclusions based on unproven oral knowledge, which often lead to a significant increase in daily costs for the family due to the need to consume substitute foods, as in the case of cereals or cow's milk, are reduced.

Active treatment of food allergy

Allergy Desensitization

In a large number of allergic children, it is possible to actively treat food allergy, which expresses the most modern trend of the scientific literature. This is applied using special protocols in diagnosed allergic patients, in whom we want to increase daily safety and improve the prognosis, accelerating the withdrawal of the allergy. Nowadays, active treatment with the administration of modified or crossed food protein is possible in the case of allergy to cow's milk, egg, fish and some plant products (nuts and fruits), while specialised tolerance induction protocols are applicable to selected children with persistent, strong cow's milk allergy, in order to improve overall the safety and quality of life of the whole family.

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Molecular diagnostics

With the use of molecular diagnostic methods, it is now possible to distribute the characteristics of the allergy more accurately, since we are able to know not only against which food the body has made "allergic" antibodies, but also in which specific molecules of the food. The example of nuts, which contain dozens of separate allergens each, is the most characteristic one. Traditionally, a patient with a positive allergy test could not know exactly what his positive results mean: 

• Do they mean that the patient can consume a few fruits at a time without symptoms beyond a mild itching in the mouth?
• Do they mean that the patient is at risk of a severe anaphylactic reaction in contact even with traces of the specific nut? 
• Is it an allergy that will pass or is it a long-term and persistent disease? 

This information is now given thanks to the responsible allergen molecule in food, which may be 'harder' or 'milder' and, therefore, the allergy follows the corresponding characteristics.

Indicatively, the benefits of molecular diagnostics are the following:

• It helps to determine the 'guilty' protein in the case of allergic asthma and allergic rhinitis. 

• It helps to select patients for immunotherapy to environmental allergens.

• It contributes to the choice of the most appropriate immunotherapy regimen, based on the content of various formulations in the various molecular allergens. 

• It clarifies the responsible molecular allergen in the case of allergy to Hymenoptera (bee, wasp). 

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Scientific coordinator of the Allergy Clinic

Savvas Savvatianos

Allergist for Children & Adults

Research Fellow of the Allergy Unit B' of the Paediatric Clinic of the University of Athens

E-mail: ss@allergy.gr

URL: www.allergiologos-thessaloniki.gr