When diagnosing allergic diseases in children and adults, doctors pay special attention to collecting the patient's history. Sometimes knowledge of family diseases, allergy predispositions, and food intolerances greatly facilitate the diagnosis. The article considers the concept of anamnesis about allergies, the features of its collection and significance.
Description
An allergic history is the collection of data on allergic reactions of a test organism. It is formed simultaneously with the clinical history of the patient's life.
Every year the number of complaints of allergies is growing. That is why it is important for every doctor who consults a person to know the reactions of his body in the past to food, medicines, smells or substances. Compiling a complete picture of life helps the doctor quickly establish the cause of the disease.
This tendency to increase allergic reactions is due to the following factors:
- inattention of a person to his health;
- medication not controlled by doctors (self-medication);
- insufficient qualification of doctors of the periphery (distant from the center of settlements);
- frequent epidemics.
Allergies appear differently in each person: from mild forms of rhinitis to edema and anaphylactic shock. She also has a polysystemic nature, that is, the manifestation of deviations in the work of several organs.
The Russian Association of Allergologists and Clinical Immunologists is developing recommendations for the diagnosis and treatment of various types of allergic reactions.
Medical history goal
An allergic history should be collected for each person. These are its main goals:
- determination of a genetic predisposition to allergies;
- determination of the relationship between an allergic reaction and the environment in which a person lives;
- search and identification of specific allergens that could provoke pathology.
The doctor interviews the patient in order to identify the following aspects:
- allergic pathologies in the past, their causes and consequences;
- signs that allergy manifested itself;
- medicines that were prescribed earlier, and the speed of their impact on the body;
- the relationship with seasonal phenomena, living conditions, other diseases;
- relapse information.
History of Tasks
When collecting an allergological history, the following tasks are solved:
- Establishing the nature and form of the disease - identifying the relationship between the course of the disease and a specific factor.
- Determination of concomitant factors that contributed to the development of pathology.
- Identification of the degree of influence of household factors on the course of the disease (dust, dampness, animals, carpets).
- Determination of the relationship of the disease with other pathologies of the body (digestive organs, endocrine system, nervous disorders and others).
- Identification of harmful factors in professional activities (the presence of allergens in the workplace, working conditions).
- Identification of atypical reactions of the patient's body to medicines, food, vaccines, blood transfusion procedure.
- Assessing the clinical effect of previous antihistamine therapy.
Upon receipt of complaints from the patient, the doctor conducts a series of studies, a survey and examination, after which he establishes a diagnosis and prescribes treatment. With the help of tests, the doctor determines:
- Clinical and laboratory studies (general blood tests, urine tests, radiography, respiratory and heart rate indicators), which allow to identify where the process is localized. It can be the respiratory tract, skin, eyes and other organs.
- Nosology of the disease - whether the symptoms are dermatitis, hay fever, or other forms of pathology.
- The phase of the disease is acute or chronic.
Data collection
The collection of an allergological history involves a survey that takes some time and requires attention, patience from the doctor and patient. Questionnaires have been developed for this; they help simplify the communication process.
The history collection scheme is as follows:
- Determination of allergic diseases in relatives: parents, grandparents, brothers and sisters of the patient.
- Making a list of allergies in the past.
- When and how allergies appeared.
- When and how did reactions to medication occur.
- Determination of the relationship with seasonal phenomena.
- Identification of the impact of climate on the course of the disease.
- Identification of physical factors for the course of the disease (hypothermia or overheating).
- Influence on the course of the disease of physical activity and mood swings of the patient.
- Identification of links with colds.
- Identification of a relationship with the menstrual cycle in women, hormonal changes during pregnancy, lactation or childbirth.
- Determining the degree of manifestation of allergies when changing places (at home, at work, in transport, at night and day, in the forest or in the city).
- Determination of the relationship with food, drinks, alcohol, cosmetics, household chemicals, contact with animals, their impact on the course of the disease.
- Determination of living conditions (presence of mold, material for making walls, type of heating, number of carpets, sofas, toys, books, pets).
- Conditions of professional activity (harmful factors of production, change of job).
Usually, pharmacological and allergological history are collected simultaneously. The first shows which drugs the patient took before seeking medical help. Allergy information can help identify pathological conditions caused by medications.
Medical history collection - a universal method for detecting a disease
The collection of an allergological history is carried out, first of all, for the timely detection of a pathological reaction of the body. It can also help determine which key allergens the patient responds to.
Using the collection of information, the doctor determines the risk factors, related circumstances and the process of developing an allergic reaction. Based on this, a treatment and prevention strategy is determined.
The doctor is obliged to collect an anamnesis for each patient. Incorrect conduct of it can not only not help in the appointment of treatment, but also aggravate the situation of the patient. Only after receiving the correct test data, questioning and examination, the doctor can decide on the appointment of therapy.
The only drawback of this diagnostic method is the length of the survey, which requires perseverance, patience and attention from the patient and the doctor.
Anamnesis is burdened / not burdened - what does it mean?
First of all, when examining a patient, the doctor asks about allergic reactions from his relatives. If there are none, then it is concluded that the allergic history is not burdened. This means a lack of genetic predisposition.
In such patients, allergies can occur against the background of:
- change of living or working conditions;
- colds;
- eating new foods.
All physician concerns about allergens should be studied and determined using provocative skin testing.
Often in patients, a family history is aggravated by allergic reactions. This means that his relatives experienced an allergy problem and were undergoing treatment. In this situation, the doctor draws attention to the seasonality of the manifestation of the disease:
- May-June - pollinosis;
- autumn - allergy to mushrooms;
- winter is a reaction to dust and other symptoms.
The doctor also finds out whether the reactions were aggravated when visiting public places: a zoo, a library, exhibitions, a circus.
Data collection in the treatment of children
An allergic history in a child’s medical history is of particular importance, because a child’s body is less adapted to environmental risks.
When collecting information about diseases, the doctor draws attention to how the pregnancy proceeded, what the woman ate during this period and when breastfeeding. The doctor should exclude the ingestion of allergens with mother's milk and find out the true cause of the pathology.
An example of a child’s allergic history:
- Ivanov Vladislav Vladimirovich, born on 01.01.2017, a child from the first pregnancy proceeding against the background of anemia, delivery for a period of 39 weeks, without complications, Apgar score 9/9. In the first year of life, the child developed in accordance with age, vaccinations are given on the calendar.
- Family history is not burdened.
- Previously, allergic reactions were not observed.
- Parents of the patient complain of rashes on the skin of the hands and abdomen, which appeared after eating an orange.
- No reaction to medication was previously observed.
The collection of specific detailed data on the life of the child and his condition will help the doctor quickly diagnose and select the best treatment. We can say that with an increase in the number of allergic reactions in the population, information about this pathology becomes more significant when collecting a history of life.