Overview of allergic disease diagnosis and treatment Overview An allergic reaction, also known as allergy, is a special state caused by abnormal immunity. What we call allergic disease is a disease in which the body can tolerate normal antigens (protein-based), but people with allergic constitution or in an allergic state react with abnormal resistance to them (renamed as allergens). Common allergic diseases include: allergic rhinitis (perennial allergic rhinitis, seasonal allergic rhinitis commonly known as hay fever), allergic asthma, hereditary allergic dermatitis (atopic dermatitis), allergic contact dermatitis, allergic urticaria, anaphylaxis, food allergy, drug allergy, etc. Other diseases associated with allergy include allergic purpura, allergic pulmonary fungal disease, chronic eczema, and other clinically refractory or rare conditions. Etiology The occurrence of allergic diseases is mainly related to genetic predisposition (or acquired allergic susceptibility), environmental factors and growth status. Once a patient develops an allergic reaction, clinical symptoms are produced in response to one or more allergens. Currently, we are familiar with allergens including airborne allergens (indoor: mites, cockroaches, animal hair, natural clothing products, outdoor: pollen, fungal spores, airborne particulate proteins), food allergens (all foods and food additives can be potential allergens), contact allergens (covering most of the airborne and food allergens that can come into direct contact with the human body, but also characteristically include compounds allergens: e.g. cosmetics, dyes, alloy products) and specific allergens (e.g. pharmaceutical products, medical devices, anesthetics and contrast agents). Triggers However, many clinical patients often report to us: Am I allergic to cold air? Am I allergic to smoke? Am I allergic to perfume? Am I allergic to emotions? Am I allergic to peppers? And so on. In fact, these are not all the underlying causes of allergic diseases, because patients with allergic diseases are usually stimulated by certain allergens, resulting in a long-term allergic inflammatory state in which their sensitivity is abnormally high compared to normal people. At this time, a small amount of stimulation of the corresponding allergenic site can produce clinical allergy symptoms. For example, we often encounter allergy patients who report that rhinitis and asthma may be mildly aggravated when the climate changes (alternating hot and cold), when they have a cold and fever; when they exercise or are emotionally unstable, allergic purpura recurs; when eating special foods leads to the recurrence of controlled urticaria; or when they go out to play or even to newly renovated houses, allergic diseases may be induced. These are episodes of disease caused by people exposed to triggering factors when the underlying allergen is not routinely avoided or controlled (also known as the lowest allergic inflammatory state). The main common clinical triggering factors are: infectious agents, pollutants, climatic factors, exercise states, emotional states, and food factors. Diagnosis If you are aware of or suspect the possibility of allergic disease, you need to actively go to an allergy specialist for allergen testing. The World Health Organization has long called for early identification of the type of allergen for allergic diseases so that early defense can be carried out to avoid irreversible damage to the body. The current allergen testing market is mixed, but the root cause of the test is nothing more than allergen skin testing (to find the type of allergen), allergen serum specific immunoglobulin testing (to screen the type of allergen, determine the severity of the allergen and investigate the allergic body state) and special allergen testing (suspected or no commercial allergen can be point-to-point test and safety excitation test, etc.). Other auxiliary tests are not directly related to the allergen itself, but only reflect the severity of the disease or the current state of each organ (e.g., blood tests, immune panel, rhinoscopy, pulmonary function tests, etc.), although they are of great value for clinical diagnosis and treatment. After confirmation of the allergen type by allergen testing, the patient also needs confirmation of the disease by the physician through a review of the disease and other quantitative scoring instruments. Because the results of many allergen tests only indicate that the patient is sensitive to the allergen, it is not necessarily the allergen that is causing the current episode. Moreover, in many patients treated with specific immunotherapy, the stronger allergen becomes a lifelong marker and remains positive on skin tests and serum tests for a long time, but in fact these patients already have a strong allergic disease tolerance and do not need further treatment. Therefore, the examination of allergens and confirmation of the condition cannot rely solely on laboratory results for conclusions. Treatment However, once a patient is first confirmed to have an allergic disease, and allergy is confirmed by allergen testing, and a significantly higher level of allergy is reached by serum analysis, standardized treatment is required. The standardized treatment of allergic diseases, as called for by the World Health Organization, consists of four areas, which are: specific immunotherapy; medication-assisted treatment; environmental control; and standardized patient education. Specific immunotherapy, also known as desensitization therapy, has been in clinical use for more than 100 years. It involves making a vaccine from low to high concentrations of allergens in small to large doses and repeatedly injecting it subcutaneously into patients to gradually increase their tolerance to the allergens. After treatment, the patient no longer has allergic symptoms or the allergic symptoms are reduced when exposed to the allergen again as an etiological treatment. The treatment includes two phases, the regular treatment period and the maintenance treatment period, and the general course of treatment is 3~5 years. The World Health Organization recommends that allergic diseases, once diagnosed, should be treated with specific immunotherapy as soon as possible to avoid serious damage to the body. Specific immunotherapy is currently recognized by the World Health Organization as a treatment method that can effectively intervene in the natural course of allergic diseases, with both therapeutic and preventive effects. Targeting immunotherapy to the cause of the disease can effectively improve the clinical symptoms of patients, reduce the use of allopathic drugs, and significantly reduce the chances of patients with allergic diseases developing from a single allergic disease to other allergic diseases and from a single allergen to multiple allergens, and its efficacy can continue for many years after the course of treatment. With the exception of atopic immunotherapy, many patients consider other treatment modalities to be non-essential. In fact, the World Health Organization has clearly stated the error of this view, which can be illustrated by the Chinese medicine theory “fighting poison with poison”. The medication we use for this treatment is a vaccine, but it is also an allergen, only in very low concentrations, and generally does not induce overall symptoms. However, due to individual differences in the human body, many patients may still experience various adverse reactions (mild allergy aggravation or local redness and itching at high concentrations or doses). This is the possible side effects of this allergen vaccine (toxin) in the human body, so other medication adjuncts can effectively reduce the occurrence of side effects, and at the same time, standard standardized treatment requires little to no attack of overall patient symptoms to ensure maximum tolerance of the human body to the allergen, otherwise the allergy vaccine may fail to be injected. In addition to the effect of medication on symptom control and adjunct to immunotherapy, environmental control and patient health education are now flourishing in the field. In clinical practice, teaching patients how to avoid triggers and minimize allergen exposure can be effective in relieving symptoms and reducing the type and dosage of adjuvant medications. At the same time, adjunctive surveys of patients’ exposure to individual microenvironmental allergens and pollutants, informing them of the results and providing control measures will further help patients reduce their exposure to allergenic etiologies and triggers. In conclusion, the treatment of allergic diseases should be integrated and individualized in order to ensure a good natural prognosis of disease regression.