01-05-2018
Both the diagnosis and the treatment of contact allergy pose quite a challenge for physicians. To date, therapeutic options have mainly involved extensive prophylaxis. Difficulties in the treatment of contact allergy arise not only from the complexity of its pathomechanism, but also from the lack of standardised treatment regimens. The complexity of the mechanism of allergy involves many components of the immune system, so the selection of appropriate pharmacotherapy becomes a challenging task.
Prevention - the' gold standard'?
Until now, the 'therapeutic gold standard' has been to avoid exposure to symptom-causing haptens. Based on the results of patch tests, it is relatively easy to identify the sensitising allergen and lead to its elimination. A large role is therefore played by the doctor, who must be characterised by an extensive knowledge of materials science, so as to properly advise the patient on what he or she should avoid and eliminate from his or her immediate environment. For some, this can be a difficult choice, which sometimes just means giving up their favourite jewellery, while for others it means having to change the nature of their work. A detailed education of the patient plays an important role, which consists of a thorough explanation of the problem of allergy and convincing the patient that the condition he or she suffers from is chronic and requires full commitment to the therapeutic process. It is important for the patient to understand that, even when fully cured - that is, the "normal appearance of the skin" - for a long time (even several months), skin hypersensitivity persists in the area where the allergy was present. Thorough patient education appears to play a key role in the therapeutic process.
Medication - what is available?
The choice of pharmacotherapy depends on the phase of allergy. In the acute phase, glucocorticosteroids (ICS) are used in various forms. Most commonly these are ointments, creams or emulsions. It is important to bear in mind that GCS therapy must not last too long because it can lead to skin atrophy or folliculitis. In the exudative phase, bacterial superinfection may occur, so preparations with antibiotics, antiseptics and antimicrobials may be helpful. In the chronic phase, skin lubrication plays an important role, which protects against water escape and provides a natural protective barrier. In cases of resistance to steroid therapy, phototherapy can be used, the mechanism of which is based on inhibiting the migration of Langerhans cells and thus suppressing the immune response. Calcineurin inhibitors, which act by inhibiting the inflammatory response, are also used in treatment. In contact allergy with increased pruritus, antihistamines can also be used.
