On the morning of June 19, Xiao Mei, an Anhui girl wearing a large mask, sat wearily in the waiting area of a Beijing hospital’s allergic reaction department, surrounded by a crowd of patients with southern accents. Xiao Mei is not the only one wearing a mask. They are not afraid of the current influenza A, but to block the allergic substances that keep them sneezing and crying. What are those “demons” floating in the air? In Xiao Mei’s bag, she carried the test results of several hospitals. These various tests had given Mei hope, but they also brought more confusion. Xiao Mei is only one of the increasing number of patients with allergic rhinitis. Allergies, with their different manifestations, lead patients to turn to dermatology, respiratory medicine, pediatrics, allergic reactions and other departments. There are no population prevalence statistics in China yet, but the growing number of patients has overwhelmed doctors. According to the introduction, allergy has become a global affluenza. 20-40% of people have suffered from allergic diseases in their lifetime, including allergic rhinitis, bronchial asthma, acute urticaria, infant eczema, contact dermatitis, food/drug allergy, anaphylaxis, etc., among which anaphylaxis is the most fatal. Professor Yin Jia, director of the Department of Allergic Reactions at Peking Union Medical College Hospital, provided a set of data from abroad: the incidence of anaphylaxis in North America, Europe and Australia is about -2%; anaphylaxis has affected the lives of Americans, with 11 million people having experienced life-threatening anaphylaxis; the incidence of anaphylaxis in hospitalized patients in the UK from 1990 to 2004 The incidence of inpatient anaphylaxis in the United Kingdom increased sevenfold from 1990 to 2004, with a fivefold increase in anaphylaxis induced by food allergies, not including emergency patients, and the number of prescriptions for anaphylaxis medications has increased 12-fold since 1991. There are many misconceptions about allergies Allergy, also called allergic reaction, is an abnormal immune response of the body, triggered by substances that are otherwise harmless to people. Associate Professor Wang Lianglu, deputy director of the Department of Allergic Reactions at Peking Union Medical College Hospital, told reporters that the substances that cause allergies, or allergens, are large molecules of protein, and that “without protein there is no allergy.” Wang Lianglu said that there are few people who are confused about the concept of allergy. Some people get pimples on their faces when they eat chili peppers, thinking that this is an allergy, which is obviously not true, this is a poor diet caused by acne. After drinking milk, the stomach is bloated, that is lactose intolerance. Some people claim to be allergic to alcohol, but that is actually called intolerance. Compared with internal, external, gynecological and pediatric disciplines, allergology is a very young discipline. The history of allergic reactions in China is only 50 years old. Nowadays, most medical schools still do not have a special course on allergic reactions, but only occupy a section in clinical immunology. As a result, many physicians are unaware of it, and patient awareness is even worse. Allergen testing, it is recognized that there are only two major categories Many people can usually only wear pure gold and silver jewelry, as soon as they wear an alloy necklace, a circle of red rash will appear on the neck. Professor Zhu Xuejun, director of the Department of Dermatology at Peking University First Hospital, said this is typical of contact dermatitis, which is an allergy to nickel in alloys. If you want to confirm the diagnosis, do the skin patch test can be. The specific method is to put a small aluminum box with a diameter of 5 mm (inside is the allergen preparation) on the back of the patient, remove it after 48 hours, and then look at the results for 72 hours to judge according to the reaction of the skin. This method is also applicable to contact dermatitis caused by hair dyes, rubber, cosmetics, etc. In addition to skin patch test, skin test also includes intradermal test and prick test. The intradermal test involves making a liquid form of the antigen and injecting milliliters into the patient’s skin to see how it reacts. The prick test, on the other hand, involves placing several drops of the antigen preparation on the forearm, 0.1 ml per drop, 1.5 cm apart, and then lightly pricking the liquid-infiltrated skin with a special needle, which must not bleed. Inhalation allergies and food allergies can be tested in this way. Another major type of test is the blood test, which looks for allergens by checking the patient’s body for specific antibodies to IgE. The reasoning is that if the body is allergic to a certain antigen, the body will produce an antibody that is specific to that substance only, so it is the most accurate. Wang Lianglu said, “Skin tests are cheap, so in principle, skin tests are done first as a screening process, combined with the medical history, and then further check for antibodies in the blood. For adult patients with allergic rhinitis, the inhalation group allergen skin test is usually prescribed first, and adults have to check a full set, about 20 or so, and then combine it with the medical history to narrow the circle and pick several kinds of blood tests.” Children with allergic rhinitis younger than 5 years old, because of poor tolerance for skin tests, can pick mites, molds, pets and several other most common checks, or directly draw blood for laboratory tests. In addition, Wang Lianglu emphasized that it is sometimes dangerous to give skin tests directly to patients without asking for medical history, especially for patients allergic to milk, nuts, buckwheat, extremely small amounts of allergens into the body, it may lead to anaphylaxis. Therefore, people who are suspected of being allergic to these three types of foods should have their blood drawn directly for laboratory testing. ”It should be noted that drugs can affect the results of the skin test, such as anti-allergic drugs will weaken the skin reaction. Therefore, antihistamines need to be stopped for 3-5 days before the skin test, and systemic hormones should be stopped for 1 week. In addition to drugs, skin condition, whether the operation is standardized, etc., will affect the results.” Wang Lianglu said. Medical history is the cornerstone of diagnosis To treat allergic diseases, Professor Ye Shitai, founder of the discipline of allergic reactions in China, has summarized four words: avoid, that is, avoid contact with substances that cause allergies; avoid, do not contact or eat substances that cause allergies; substitute, if you are allergic to a certain item, find other substances instead; move, leave the environment that causes allergies. As you can see, finding the allergen is a prerequisite. Wang Lianglu said that there is a crossover phenomenon between allergens: there is a crossover between food, such as people who are allergic to pistachios, may be allergic to kumquats and peppers; there is a crossover between food and pollen, such as people who are allergic to artemisia, are allergic to pears, peaches, lychees, longan and other fruits; there is a crossover between pollen and different molds. Therefore identifying allergens enables patients to develop the necessary awareness of precautions. In addition, over time, some patients will have more allergens, while others have allergies that can heal themselves. For example, children who are allergic to milk and eggs have the potential to heal themselves as their gastrointestinal immunity and shielding functions improve. Therefore, allergen testing should be reviewed regularly according to the condition. At present, there are many hospitals in China that carry out allergen testing programs, but there are many irregularities, the most prominent of which is the lack of attention to medical history. Wang Lianglu pointed out that the diagnosis of allergens, the need to combine medical history and skin tests, blood test results to determine the comprehensive, which plays a decisive role is the medical history. Patients should try to give clues to the doctor, just like ranking suspects, recalling the symptoms, duration, seasonality, occasion and weather of the attack, and if it is related to food, how long after eating the attack, whether it is exercising, etc., based on which laboratory tests will be conducted. Peking Union Medical College Hospital once received a northeastern patient who had a skin test at the local hospital, which resulted in more than 20 red bags each much larger than 3 x 3 mm and all with a red halo. So, the doctor told him that chicken, duck, fish and meat can not be eaten, rice, white flour, corn and other grains can not be eaten. As a result, this patient for several years can only take potatoes as the main food, the side dish is boiled cabbage in salt water, even dare not put soy sauce. When he came, his whole face was yellow and thin, and he was already malnourished. In fact, this patient was not allergic to any of these things, but the skin was just too reactive, creating the illusion. “So, when explaining the skin test results to patients, we usually don’t say ‘positive’ or ‘negative’, but rather say that there is a reaction, no reaction, and how strong the reaction is, so as not to mislead patients.” Wang Lianglu said. In addition, blood sampling should also be screened first, check the inhalation group of allergens or food allergens two categories, to see the results and then a detailed investigation. Blood tests are also available in various combinations, such as dust mite group, tree pollen, weed pollen, pasture pollen, etc. “Asking for more than one medical history can save a lot of money for the patient, never spread a big net like testing.” Is the bioresonance instrument really that god When it comes to the standard of blood testing allergens, Wang Lianglu described the current situation in China as a “universal fair” – there are no less than 10 kinds of machines and supporting reagents, including both the international professional field recognized Among them, there is the Swedish CAP system, which is the gold standard recognized by the international professional field, and the “paper method” with less accurate results. The latter is to put a drop of blood on a piece of test paper, which is only a rough qualitative method with poor accuracy. Because of the different machine systems, the results are not comparable from one hospital to another. Patients are often disowned at one hospital and have to be checked again at another, causing great distress to patients. Professor Lin Jiangtao, general director of the Chinese Asthma Alliance and director of the Department of Respiratory Medicine at the China-Japan Friendship Hospital of the Ministry of Health, emphasized that inhalation allergies can be desensitized, such as bronchial asthma and allergic rhinitis patients who are allergic to dust mites and pollen, of which the most internationally recognized is the desensitization of dust mites. “And for skin testing to be accurate, it requires that the antigen preparation must be purified, that internationally certified and nationally approved standardized systems should be used, and that doctors and nurses should all receive professional training.” In the puncture test, after a drop of reagent, the needle should be replaced every time it is tied, and the following one should not be tied as soon as the cotton ball is wiped to avoid contamination. In addition, the puncture reagents and puncture needles require the same manufacturer’s complementary products, otherwise the accuracy is affected. When it comes to allergen testing, the most controversial field is the German-made “Bioconductor bioresonance detector” that floods the Chinese market, which does not draw blood or lance needles and claims to detect 400 to thousands of allergens, including bacteria, food, inhalants, and even inorganic substances, and says it can also desensitize. At present, many hospitals across the country carry out such programs, including some tertiary hospitals. In the consultation room of a professor at Peking Union Medical College Hospital, a girl took out a laboratory test from a people’s hospital in Qingdao, which is the result of this kind of Baikang detector, and there was an allergy to gasoline in it. Wang Lianglu said that if a test tells you that you are “allergic to pesticides and gasoline”, this test is not scientific. The reporter saw in one of the first hospitals in Beijing to use this instrument, the machine is a rectangular box, less than half a meter wide, less than 1 meter long, and about 20 centimeters thick. The doctor picked up a wire connected to the machine, the other end is a metal tip with a grip, the tip on the reporter’s finger, “the operation is so simple”, she said, about 2 out of 10 patients use the instrument to detect allergens. The cost of doing a test using bioresonance is 430 yuan, and the cost of a treatment is 120 yuan. In a hospital that claims to use a new generation of the instrument, the doctor said that if the electrodes are held in the hand, the testing process is painless; if the machine is dipped in the potion and then in contact with more than 30 parts of the arm, it will be a little painful, and the latter costs more than 300 yuan each time and can detect hundreds of allergens. “Generally speaking, doctors will use bioresonance instrument detection only when they cannot be measured using traditional detection methods.” Wang Lianglu believes that the principle of this instrument is equivalent to a multimeter, the measurement is actually the body’s electrical conductivity, “you hold a little tighter, looser, sweaty hands without sweat, or wash your hands, shower and then measured, the results will be different.” For this reason, our reporter interviewed the relevant departments in Germany. Ms. Lan Mo, spokesperson for the German Federation of Allergy and Asthma Diseases, said in an interview with reporters on June 16 that at present, the main way to check what kind of substances patients are allergic to in Germany is through allergy tests on the skin and blood. The treatment method is mainly desensitization therapy, which means that the body’s immune system becomes tired of the allergen by allowing the patient to ingest a small amount of the allergenic substance under the supervision of a doctor, thus gradually adapting to it and increasing its tolerance. However, this method is currently mainly applied to rhinitis and asthma patients who are allergic to dust mites, pollen, etc. The efficiency is up to 80%, and there is no special treatment for patients with other allergies such as food. In response to the “bioresonance allergy detection and treatment instrument” launched by some German manufacturers, Lammer stressed that the German medical community has never recognized this instrument, and there has never been a scientific report proving that this instrument can detect and treat allergic diseases; on the contrary, there are a large number of reports that it does not have its claimed functions. The device has been available for 20 to 30 years, but no regular hospital in Germany uses it, no health insurance agency includes the examination and treatment of this device in its insurance coverage, and no professional doctor recommends its use. This instrument is currently only used in individual privately owned non-medical units, and the cost is entirely borne by the individual.