Allergologia a l’atenció primària / Allergology in primary care

Fonament. Actualment, els especialistes en al·lergologiaduen a terme l’assistència en l’àmbit hospitalari. Entrediferents models d’assistència proposats, la incorporacióparcial de l’al·lergòleg a primària és l’aplicada en aquestestudi.Objectiu. Reduir el temps d’espera per a la primeravisita al servei d’al·lèrgia. Quantificar el nombre i tipus depatologia derivada per estudi. Avaluar el grau de resoluciódel pla i de satisfacció dels usuaris.Mètode. L’estudi s’ha dut a terme des del setembre del2004 fins al juliol del 2005. L’al·lergòleg s’ha desplaçat auna àrea bàsica de Manresa (ABS-M3) per fer la primeravisita, les exploracions complementàries (proves cutànies,funcionalisme pulmonar) i una enquesta sobre el grau desatisfacció dels usuaris atesos. Es van incloure infants de0-14 anys remesos per a estudi al·lergològic.Resultats. Es van fer 46 primeres visites ambulatòries.La patologia respiratòria fou el motiu de consulta més freqüent(31/46; 67.4%) seguit d’al·lèrgia alimentària (14/46;30.4%), urticària i angioedema (12/46; 26.1%) i estudi defàrmacs (3/46; 6.5%). El 39.1% (18/46) dels pacients forendonats d’alta des de primària sense que calgués desplaçarsea l’hospital, mentre que el 60.9% (28/46) es derivaren al’hospital per completar l’estudi o fer seguiment clínic. Elgrau d’absentisme fou inferior a l’hospitalari (2.2%).Conclusions. El desplaçament de l’al·lergòleg a primàriaredueix el temps d’espera dels infants remesos a la consultaespecialitzada. La patologia més freqüentment derivadafou la respiratòria. L’absentisme fou inferior a l’hospitalarii el grau de satisfacció dels pacients elevat. Probablement,un model mixt que inclogui l’assistència hospitalària i ambulatòriaseria l’adequat per millorar l’assistència

Background. Currently, allergy specialists are hospitalbased.Among the different future models of primary care,some proposals include the presence of an allergy specialistin primary care centers. This is the approach that wasevaluated in this pilot study.Objective. To reduce the delay to the first visit by theallergologist. To determine the number of patients andthe type of clinical problems referred for evaluation. Toevaluate the satisfaction level of the patients.Method. This study was performed between September2004 and July 2005. An allergologist moved to one ofManresa's primary health care centers (ABS-M3) to performthe first visits, prick tests, pulmonary function tests,and a survey about the patients' satisfaction.Results. Forty-six new patients were evaluated. Themost common reason for referral was respiratory symptomatology(67.4%), followed by food allergy (30.4%),urticaria/angioedema (26.15), and drug allergy (6.5%).Twenty-eight patients (60.9%) were subsequently referredto the hospital in order to complete the evaluation. Theno-show rate decreased significantly to 2.2% when comparedto hospital visits. Conclusions. The transfer of an allergologist to primaryhealth care centers reduces the time to the first visit.Respiratory symptoms were the most common reason forreferral. No-show rates were lower, and the level of satisfactionwas high. A hybrid model including hospital andprimary health care centers would improve access to specializedcare in allergology

Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract.

BACKGROUND: Food allergy may be life-threatening, and patients affected need to receive accurate diagnoses and treatment. Hazelnut has often been implicated as responsible for allergic reactions, and trace quantities can induce systemic reactions. OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerance of sublingual immunotherapy with a standardized hazelnut extract in patients allergic to hazelnut. METHODS: This was a randomized, double-blind, placebo-controlled study. Inclusion criteria were a history of hazelnut allergy and positive skin prick test and double-blind placebo-controlled food challenge results. Patients were then randomly assigned into 2 treatment groups (hazelnut immunotherapy or placebo). Efficacy was assessed by double-blind, placebo-controlled food challenge after 8 to 12 weeks of treatment. Blood samples were drawn for measurement of specific IgE, IgG(4), and serum cytokines before and after treatment. RESULTS: Twenty-three patients were enrolled and divided into 2 treatment groups. Twenty-two patients reached the planned maximum dose at 4 days. Systemic reactions were observed in only 0.2% of the total doses administered. Mean hazelnut quantity provoking objective symptoms increased from 2.29 g to 11.56 g (P = .02; active group) versus 3.49 g to 4.14 g (placebo; NS). Moreover, almost 50% of patients who underwent active treatment reached the highest dose (20 g), but only 9% in the placebo. Laboratory data showed an increase in IgG(4) and IL-10 levels after immunotherapy in only the active group. CONCLUSION: Our data confirm significant increases in tolerance to hazelnut after sublingual immunotherapy as assessed by double-blind, placebo-controlled food challenge, and good tolerance to this treatment.