AIM

The aim of ALLERGY CENTRE will be to treat with the most recent advance in diagnosis, management & treatment of allergic & Asthma patients. The stress will be on clinical as well as research in Allergic disorders.

WHAT WE DO

In India, there is 10% of the population suffering from allergic diseases. To find out the incidence of allergy suffer in the capital, the Indian council of medical research(ICMR) carried out a study, which revealed that nearly 1% of the population of Delhi suffers from Allergic Bronchial Asthma alone. As a result of awakening about allergic diseases, a lot of work has been done on atmosphere pollen spectra, Fungi, House dust mite etc, by Shivpuri & Co-workers (1980-90).

Allergic Asthma is the consequences of their basic disorder-dysregulation of Lymphocytes, IgE synthesis increased level of chemical mediators & the enhanced response of bronchi to different stimuli (non-specific broncho-hyper responsiveness):

  • Allergy skin testing is a primary diagnostic toll to differentiate allergic & non-allergic asthma. Allergy is a multi organ systemic disease. Why some children develop asthma, others rhinitis & food Allergy? Genes hold the key too many atopy-phenotypes. Genetic influences & the Environment factors have been on inflammatory disorder, because bronchial remodelling has been observed in children before the onset of asthmatic symptoms. In order to detect the causative allergens in. Environment-POLLENS, FUNGI, DUSTS, MITES, INSECTS, DANDER, FURS and FOODS & CHEMICALS etc. are tested. IMMUNOTHERAPY is as method, which re-establishes normal immunity. It increase level of IgG4 immunoglobulin’s & IL-10 producing cells & diminishes IL-4 & IL-5 levels, Immunotherapy is the only potential curative treatment for ALLERGIOASTHAMA & RIHINITIS DISEASES.

    “The more money its costs to control a patient’s disease by symptomatic treatment the more reasonable it is to consider Immunotherapy as an alternative”.

    Cochrane review, Considered Meta-Analysis of 54 trials & has confirmed the efficacy of IT (Immunotherapy) in significant reduction of Asthma Symptoms need of medications & non specific bronchial hyper reactivity. IT (immunotherapy) prevents incidence new sensitization & prevents further progression of disease.

  • Broncho provocation has proved to be a practical tool for evaluating the response of air ways to inhaled substances. Inhalation challenge with methacholine, histamine & antigen allows the physician to characterize the bronchial hyperactivity of the airways to non-specific broncho constructive stimuli (methacholine, histamine) as well as to specific antigen (Pollen Extract of Dust mite, occupation allergens.

  • IgE level is predicator of atopic disease and level more than 417 u/ml (1000ng/ml) is one of the diagnostic criteria for allergic broncho pulmonary aspergillosis (ABPA). Allergic specific IgE indicated in anaphylactic sensitivity to hymenoptera venoms, food, drugs, & in doubtful interpretation on allergy skin tests.

PATIENT SELECTION

Select patients for specific allergen-immunotherapy & To monitors its efficacy at regular intervals:-

  • Allergic Rhinitis & Allergic BR Asthma.
  • Atopic steroid-dependant BR Asthma.
  • Insect Hypersensitivity.
  • Non-compliance & Intolerance with Pharmacotherapy in allergic disease.

Select Patients for Preventive Allergen Immunotherapy

  • Allergic rhinitis and chronic sinusitis.
  • Rhinoconjuctivitis and chronic urticaria.
  • Atopic dermatitis and recurrent Wheeze.
  • Bronchial hyper­reactivity and chronic cough.

Diagnostic Skin Testing

  • Contact dermatitis.
  • Re-current Angioedema & skin rashes.
  • Food & Drug Hypersensitivity.
  • Anaphylaxis(Food associated exercised induced)
  • Re­current Cough, wheeze & dyspnoea Syndrome.
  • Occupational Asthma.
  • Allergic Respiratory Mycosis e.g. A.B.P.A

DIAGNOSIS OF SPECIFIC SENSITIVITY

  • Exposure to allergen, related to appearance of symptoms
  • Presence of specific IgE antibody
    • Skin test
      • Prick test
      • Inradermal
    • In vitro assays(RAST)
    • Provocative Challenge
      • Conjuctival challenge
      • Nasal Challenge
      • Bronchial Challenge
      • Oral Challenge
  • Pharmacologic bronchoconstrictive stimuli
    • Methacholine
    • Histamine
  • Specific antigen
    • Pollen, Fungi
    • Dander’s
    • Dust mites, other dusts
    • Foods
  • Occupational exposure
    • Toluene dissocyanate
    • Phthalic anhydride

INDICATION FOR OUANTITATION OF ALLERGEN SPECIFIC IgE

  • Allergosorbent tests (RASïI7) in which skin tests in not possible.
  • Allergosorbent tests (RAST) for anaphylactic sensitivities.
  • Screning for Allergen with Allergosorbant test (RAST)
  • lmmunotherapy based on Skin Allergy Test & RAST test results.

CLINICAL INDICATIONS FOR INHALATION CHALLENGE

  • Clarification of the role of specific allergen in asthma, especially when other diagnostic criteria are inadequate.
  • To define, when appropriate the natural history of antigen sensitivity where there is no immunologic intervention or conversely, for evaluation of the therapeutic effect of immunotherapy.
  • For the evaluation of new or unrecognized allergens or provocative agents in pulmonary disease such as for the assessment of occupational inhalants in susceptible patients.