Allergology in Germany
One of the main areas of work for the allergy clinics recommended by msp group germany, – the diagnosis, prevention and treatment of allergy. These clinics are able to carry out a full work-up to the very latest standards within an extremely short time and to offer innovative therapeutic methods that meet the highest quality requirements. The number of people suffering from allergies is rising steadily. Tracking down the allergen is hard work — much like that of a detective who gathers information using a variety of diagnostic methods. Because the list of known allergens is so long, patients often have to undergo a great many tests before the trigger responsible for the body's allergic reaction is found.
Causes of allergy
An allergy is a heightened sensitivity of the immune system to various environmental factors, such as plant pollen, house dust mites, animal hair and dander, foods, medicines, cosmetics and cleaning products, and even to physical phenomena such as cold and sunlight, to certain infectious agents and to stress.
The best-known allergic conditions are atopic and contact dermatitis, eczema, urticaria – including solar and drug-induced urticaria, angio-oedema (Quincke's oedema), hay fever, bronchial asthma and anaphylactic shock.
Once the allergen has been identified, the specialist has to select a suitable therapy. Where there is an allergy to one or several substances, hyposensitisation, which takes from 3 to 5 years, can lead to success.
If there are signs of an allergic disease, treatment is given with a range of medicines, both topical and systemic.
Symptoms of allergy
Allergy can show itself in very different ways: various skin reactions, itching, breathing problems (allergic asthma), coughing, a runny nose, nasal congestion, sneezing, conjunctivitis, watery eyes, red eyes, shortness of breath, a feeling of tightness behind the breastbone, and swelling.
To avoid complications of allergy, once its causes have been established the doctor will suggest the methods of dealing with them that are most effective in each individual case.
Complications of allergy
If an allergy is left untreated, the symptoms may build up, leading to more severe forms of disease: chronic urticaria, bronchial asthma and polyposis of the nasal sinuses.
Innovative methods of treating and preventing allergy (including in children) make it possible to reduce or completely remove the impact of allergens on people's lives.
In skin diseases that occur with signs of immune deficiency, allergy specialists first assess the immune status, including its quantitative and functional parameters, and then prescribe tailored immunocorrective therapy.
Diagnosis and treatment of allergic diseases in Germany
German allergy clinics attract international patients thanks to the extremely broad range of services their specialists provide. The names of these institutions usually refer not only to the treatment of allergic diseases, but also of dermatological and at times immunological ones, since the body's immune mechanisms are involved in the development of allergic conditions.
Some people assume that treating an allergy abroad is pointless, supposedly because the allergens present in the patient's home environment are absent in another country. This is a profoundly mistaken view.
In recent years European medicine has made enormous progress in the treatment of allergic diseases (allergic rhinitis, bronchial asthma, atopic eczema, food and drug allergy, allergy to insect stings). This concerns above all the refinement of diagnostic methods (including detailed testing for hundreds of substances potentially capable of causing an allergic reaction), the prevention of acute allergic reactions and the relief of chronic allergies.
In the past, treating an allergy consisted mainly of identifying the allergen and advising the patient to avoid contact with it or reduce it to a minimum. With allergies to pollen or other airborne substances, however, this is a practically hopeless task. Modern medical technologies make it possible to reduce excessive secretion of immunoglobulin E and to regulate the release of histamine.
Drug therapy for allergy in Germany
Modern German allergology has at its disposal a whole range of medicines that can substantially reduce the clinical manifestations of allergy and improve the patient's condition: antihistamines, mast cell stabilisers, β2-agonists, leukotriene receptor antagonists, immunomodulators, immunosuppressive drugs and monoclonal antibodies.
Nevertheless, none of the drugs listed above cures the allergy itself; they only improve patients' quality of life by relieving or completely removing the symptoms of the disease.
Hyposensitisation (allergen immunotherapy) in Germany
Hyposensitisation — is a fundamentally different approach to treating allergy, in which the patient receives gradually increasing doses of the allergen over a certain period of time, leading either to a substantial weakening of the body's reaction to the allergen or to its complete disappearance. In a sense, in the course of hyposensitisation the patient develops tolerance to ever larger doses of the allergen. Studies have demonstrated a long-term therapeutic effect, as well as the possibility of using hyposensitisation as a way of preventing the development of new allergies. A meta-analysis has confirmed the efficacy of hyposensitisation in the treatment of allergic rhinitis (including in children), allergic bronchial asthma and allergic conjunctivitis.
Another method of immunotherapy for allergy is intravenous administration of monoclonal antibodies against immunoglobulin E (IgE). This treatment has been shown to be effective in certain forms of atopic conditions, but this type of immunotherapy is not used for food allergies.
A further form of immunotherapy for allergic diseases is sublingual immunotherapy. The method is based on the phenomenon of oral (in the mouth) tolerance of immune reactions to non-pathogenic antigens such as foods and resident bacteria. Sublingual immunotherapy has become quite widespread in Germany.
The advantages of allergy diagnosis and treatment in Germany lie in the availability of specialised clinics that have the equipment needed for comprehensive laboratory and instrumental diagnostics and for the treatment of all types of allergy — including clinics located in regions where naturopathic factors can be used in therapy: a favourable climate or salt springs.
Psoriasis treatment in German clinics
Treating psoriasis is a very difficult problem; nevertheless, with a systematic approach doctors in German clinics manage to achieve good results (stable remission).
In specialised dermatology clinics in Germany, any treatment is always preceded by comprehensive diagnostics aimed at identifying the «triggers» of the disease, that is, the factors that set the pathological processes in motion.
German clinics use combinations of different methods to treat psoriasis, including:
Topical treatment:
- salicylic acid preparations;
- baths with exfoliating additives;
- salt baths;
- vitamin D analogues;
- glucocorticosteroids;
- tar-containing preparations;
- dithranol-containing preparations, topical retinoids
Ultraviolet therapy:
- narrowband UVB-311 phototherapy;
- broadband UVB phototherapy;
- SUP (selective UV phototherapy);
- systemic PUVA therapy;
- PUVA creams.
Laser treatment:
treatment of the affected areas with the 308 nm excimer laser (compared with ultraviolet therapy, fewer sessions are needed for the same effect).
Systemic therapy:
- retinoids;
- methotrexate;
- ciclosporin A;
- fumaric acid derivatives;
- "biologics" (for example, alefacept).
A case from our practice
Patient (a boy), 9 years old. In Russia the child had suffered for several years running from a severe allergic reaction that showed itself in marked redness of the eyes, burning and watering. The condition peaked between June and August. Over-the-counter anti-allergy products sold in pharmacies improved the symptoms only slightly. While the boy was being prepared for eye surgery in 2017 for uveitis of unclear origin, German doctors suspected a serious allergic reaction to unknown substances, postponed the operation and recommended seeing an allergist immediately. At a private dermatology clinic in Aachen the doctors reviewed his medical history, examined the child's living conditions in detail (pets, region of residence, seasonality of the flare-ups and so on) and carried out a comprehensive work-up, which revealed hypersensitivity to the flowering and pollen of mugwort and plantain, as well as to the hair and dander of the cats that the boy's mother is so fond of. Hyposensitisation was prescribed, using individually made-to-order preparations in the form of sublingual drops. The therapy is planned to run for 3 to 5 years; it has freed the child from the unpleasant symptoms and will prevent serious complications of the allergy. And of course the mother had to make a choice — her child or her cats.
