1-Good allergy practice:

  • Allergy specialty has multiple interactions with other organ specialties.
  • Teamwork by:
    • A specialist with approved higher medical training in a field related to allergy/immunology
    • Nurses and qualified dietitians are essential.
  • The investigation of allergic diseases includes:
    *Skin tests.
    * Tests for food allergy.
    *Specialized laboratory for investigations such as measurements of specific IgE antibodies and other immunological tests as appropriate.
    * Spirometry (including peak flow measurements).

2-Areas covered by Allergy & immunology specialists:

    • Seasonal rhinitis (seasonal)
    • Perennial rhinitis (all year around)
    • Allergic conjunctivitis (seasonal; all year around)
    • Allergic asthma (including occupational asthma), Spirometry (including peak flow measurements).
    • Allergy to stinging insects (especially Wasps & Bees)
    • Allergy to medications
    • Allergy related skin disorders namely, urticaria, angio-oedema, atopic eczema, and contact dermatitis.
    • Food allergy and intolerance.
    • Anaphylaxis.
    • Hereditary and acquired angio-edema.
    • Diseases of the immune system (primary and secondary immune deficiencies, humoral and cellular).
    • Primary and congenital immunodeficiency.
    • Hypereosinophilia and related syndromes.
    • Allergic bronchopulmonary aspergillosis.
    • Hypersensitivity pneumonitis.
    • Mastocytosis

3-When to refer patients for specialist allergy advice:

*For investigation and management of allergic rhinitis, conjuctivitis and asthma.

*For investigation and management of anaphylaxis.

*If the diagnosis of allergy is in doubt (for example, discordance between clinical history and the results of skin prick testing or the radioallergosorbent test.)

*If food allergy is suspected (for assessment and expert dietic input).

*If occupational allergy is suspected.

*In case of urticarial, especially if chronic (>6 weeks)

*For consideration of immunotherapy (in cases of severe rhinitis, allergic asthma, allergy to venom from stinging insects).

*To exclude allergy as a cause of non-specific illness.

*Recurrent respiratory, skin or other infections.

4- Diagnosis approaches by allergist/immunologist:

  • Performing skin test. (The gold standard of allergy diagnosis)

Practice points:

*Always check that the patient is not taking antihistamines.

*Always include positive (histamine) and negative (allergen diluents) control test.

*Oral corticosteroids do not significantly inhibit allergen skin prick tests.

*Dermographism may confound results (although it is evident as a positive response at the negative control site).

*Skin prick tests should not be performed if the patient has severe eczema.

*Measurement of allergen specific IgE concentrations (radio-allergosorbent test (RAST) is an alternative if skin prick tests cannot performed.

  • Indications for Bronchial provocation testing to a diagnosis of occupational asthma:

                *Diagnosis uncertainty despite adequate prior investigation.

                *Impracticability of serial peak flow.

                *Uncertainly about which of several potential agents may be implicated.

(Note: provocation testing is not indicated solely for medico legal purposes).

  •  Measuring Total IgE
  • Specific serum IgE dosage, indicated by allergist/immunologist and its interpretation.
  • Epicutaneous Patch test to diagnose a contact & atopic eczema.
  • Food allergy: – Skin prick testing (with extracts or fresh fruits…)

                                  -Confirmation with oral or nasal food challenge.

5-Summary of guidelines on specific allergen injection immunotherapy:

*Use only high quality standardized allergen extracts.

*Administer in specialized clinics only.

*Doctors should have appropriate experience and training in immunotherapy.

*Adrenaline should always be immediately available.

*Ready access to resuscitative facilities; attendant staff should be trained in resuscitative techniques.

*Patients should be kept under close observation for the first 15 minutes after each injection.

6-Sublingual immunotherapy constitutes another way for treatment that can be administered at home