Coronavirus in many areas has permanently changed the medical market, as evidenced by the boom in telemedicine. Today, innovative solutions are sought that ensure quality improvement and increase the efficiency of the system. The bottom-up model is a diagnostic strategy in allergy that meets the new expectations.
The problem of millions of Poles
Runny nose, watery eyes, rash, shortness of breath? Relax, it’s not COVID-19, it’s “just” an allergy. But is it really “easy”? Is allergy itself a serious threat that must not be underestimated?
It is not without reason that allergic diseases are called “the epidemic of the 50st century”. We are talking about a common and growing problem – it is estimated that the percentage of Polish residents with various allergies reaches XNUMX%! This group includes seniors, adults, adolescents and small children.
The increase in morbidity observed over the last hundred years is mainly explained by the progress of civilization: we moved from “green enclaves” to “concrete jungles”, we more and more observe the rules of personal hygiene, we breathe polluted air, and our plates are dominated by products full of hormones, preservatives and fillers.
Experts emphasize that allergy is not a disease limited only to troublesome symptoms. It is an ailment that reduces the quality of life and has serious consequences. Allergic urticaria, atopic or contact dermatitis have an impact on such fundamental aspects of life as relationships, intimate relationships and professional life. Some patients experience symptoms of depression and anxiety attacks.
Untreated or poorly treated allergic rhinitis can over time lead to the development of bronchial asthma, a chronic and incurable inflammatory disease of the airways that is life-threatening in severe or uncontrolled form. Statistics show that in the European Union one person dies of asthma every hour, mostly young.
Some allergic reactions can be life-threatening as soon as they occur, as is the case with an allergy to the venom of stinging Hymenoptera (bees, bumblebees, wasps, hornets). Also, drug allergy or food allergy can lead to anaphylactic shock – with a sharp drop in blood pressure, respiratory and circulatory arrest, loss of consciousness and, as a result, death.
The COVID-19 pandemic, which has been the number one topic worldwide since the beginning of 2020, has pushed other diseases to the background but not disappear. Unfortunately, the fear of potential contagion means that even when returning to medical services, patients do not report to doctors or come to them too late.
I hear information that patients are still afraid to go to the clinic or laboratory, which, despite the strict standards of hygiene and disinfection, perceive them as a potential source of infection. Instead of diagnosing the causes of allergies, they choose emergency measures in the form of antiallergic pills. Given that the COVID-19 pandemic is not going out, and we can expect the coronavirus to come back in a second wave in the fall, the diagnostic delays and treatment delays become dangerously long.
Failure to recognize the cause of allergy and, consequently, the lack of its treatment may result in a more severe course of allergy, e.g. in patients allergic to house dust mites, already in the fall of this year. Symptoms of aggravation of allergies, as well as autumn colds, can reduce immunity and deprive our body of the strength to fight a potentially more dangerous virus. In order not to expose yourself to such a risk, it is worth thinking about allergy diagnostics right now – emphasizes Dr. Emilia Majsiak, MD.
Inverted Pyramid?
Experts agree that the coronavirus has changed health protection, as evidenced by the growing popularity of telemedicine services. Innovative solutions are sought that ensure quality improvement and increase the efficiency of the system. A diagnostic strategy in allergy that meets the new expectations is the Bottom-up algorithm, pointed out by Prof. Bolesław Samoliński in the article “Strategy for diagnosing Bottom-up allergies in the period of epidemic threat with SARS-CoV-2 virus causing COVID-19 disease”.
The “turning the diagnostic pyramid upside down” model has a number of benefits. First of all: it allows to limit the number of patient-doctor-laboratory contacts, and thus reduces the risk of coronavirus infection. Second, the multiplex diagnostic tool allows the characterization of the entire IgE repertoire for all potential allergens to which the patient is allergic, which greatly speeds up diagnosis and treatment initiation. What’s more, as the expert emphasizes, the Bottom-up diagnostic model can contribute to faster unloading of queues after the end of the epidemic threat and faster return to the normal mode of admitting patients.
The classic Top-down diagnostic model includes a clinical interview, skin tests (not recommended by the Polish Society of Allergology during the SARS-CoV-2 pandemic) and blood tests to determine the level of specific IgE antibodies. After an interview and examination, it is the doctor who decides what scope of research should be performed. The diagnostic path is therefore long – we have a waiting time for the first consultation, testing in the laboratory, waiting for the second consultation and starting treatment. Bottom-up strategy turns everything upside down – in its case the first step is to perform a wide test, the result of which reflects the individual allergy profile of the patient. Only then do we see a doctor who, based on the test results and the patient’s clinical symptoms, proposes treatment – explains Dr. Emilia Majsiak, MD.
Until recently, the only test that was used in the Bottom-up method was the ISAC test. Two other tests are now available: the FABER test and the ALEX test, based on nanotechnology, allowing the simultaneous testing of nearly 300 molecules and extracts.
As Emilia Majsiak, MD, PhD emphasizes, multiplex tests not only significantly shorten the time of diagnosing patients, but also allow for obtaining accurate results at the beginning of the road.
For example, I will use a real-life story. The patient was a 2,5-year-old child diagnosed with atopic dermatitis. At the first medical visit, the pediatrician prescribed steroids, which did not help. On the next, two months later, he suggested an ointment, which also did not bring any improvement. At the third visit, the doctor issued a referral to an allergist who offered to perform inhalation tests. Unfortunately, all of them turned out to be negative, as did the food tests that were ordered at the next consultation.
As you can see, the diagnostic path in the classic model is very long and does not guarantee therapeutic success at all. Ultimately, the parents decided to perform an extensive test containing over 300 allergens. It turned out that the allergen that sensitized it was flax – a component of most emollients recommended for atopic dermatitis. Parents unknowingly applied moisturizing and lubricating preparations to the child’s skin, containing an allergen sensitizing the child. In this context, the implementation of the bottom-up strategy avoids the trial and error method.