Allergic diseases
More than a quarter of the population of industrialised countries suffers from allergic diseases. Watery eyes, runny nose and sneezing attacks are the most common symptoms of hay fever, allergic rhinoconjunctivitis. In addition to seasonal allergies to e.g. trees, grasses or herbs, year-round allergic symptoms, predominantly with nasal obstruction, can be triggered by mites in the home, animal epithelia and moulds.
Over the course of the disease, the sensitisation spectrum can expand, often accompanied by reactions to other allergens and an intensification of the symptoms. Cross-reactions to certain foods (carrots, nuts, apples, etc.) can occur due to allergen relatedness. A change of stage with the development of bronchial asthma is described in 30% of patients with allergic rhinitis.
In our consultation hours, it is possible to diagnose allergies of the upper respiratory tract and cross-allergies with skin tests, blood tests (detection of specific antibodies, molecular allergy diagnostics) and allergen provocation (nasal, conjuctival).
The patient and their symptoms take centre stage. Accordingly, therapy planning is individually tailored to the patient ("personalised therapy approach"). Therapeutic options include allergen avoidance measures (avoidance of the causative allergens), medication to reduce symptoms and causal allergen immunotherapy (AIT; hyposensitisation). AIT is intended to lead to tolerance of the allergens administered, can be carried out with injections under the skin (subcutaneous) or in the form of drops or tablets under the tongue (sublingual) and usually lasts three years. In co-operation with colleagues in private practice, the initiation of therapy, the entire AIT or bridging, e.g. in the event of problems, can be carried out in our clinic.
This is a pseudo-allergy (intolerance) to ASA (acetylsalicylic acid) and other painkillers (NSAIDs), which usually only becomes apparent from the third decade of life. Most patients initially develop chronic inflammation of the upper airways with the formation of polyps in the nose and paranasal sinuses (chronic rhinosinusitis with polyposis; CRSwNP), followed by bronchial asthma. The development of asthma is not obligatory. Some patients also suffer from gastrointestinal problems or skin symptoms (urticaria) after ingesting food containing salicylic acid(http://samter-trias.de/tag/salicylsaeuregehalt-von-lebensmitteln/). Typical symptoms of nasal polyps are olfactory disorders and nasal obstruction. There is a very high risk of recurrence after surgical repair and removal of all polyps in the nose/sinuses (NNH), so that a revision of the NNH is often necessary despite drug therapy (e.g. nasal spray containing cortisone, cortisone tablets, antibiotics). The cause is a metabolic defect, as a result of which increased cysteinyl leukotrienes (inflammatory mediators) are formed, which lead to the development of polyps, asthma and allergy-like symptoms. The pseudo-allergy is intensified by ASA, NSAIDs and salicylates.
The ENT University Hospital Ulm offers testing for ASA intolerance and so-called "adaptive ASA deactivation" (specific therapy). Both are carried out under inpatient conditions. Adaptive deactivation is intended to lead to a normalisation of the metabolism and the development of tolerance to the triggering substances. Patients are usually put on 300 mg ASA and must continue to take this dose daily. The majority of patients experience a significant reduction in symptoms, their asthma improves and recurrent polyps occur less frequently.