Schweiz Med Wochenschr. 1999 Jun; 129(24): 905-14.

[Allergology: quo vadis?]

Wüthrich B.

Dermatologische Klinik und Poliklinik, UniversitätsSpital Zürich. wuethric@derm.unizh.ch

The discovery of the immunoglobulin E 30 years ago, and the subsequent availability of serological techniques for in vitro allergy tests, have given fresh impetus to allergy diagnosis in clinical practice. Independently of the more refined allergy diagnosis, there has been a continuous increase in allergic diseases in recent decades. Various factors, summed by the term "Western lifestyle", have produced this increase. As well as individual measures (primary, secondary and tertiary allergy prevention), intensive interdisciplinary cooperation is necessary to arrive at a broad and successful prevention concept. Governments and the political community should accord higher priority than hitherto to fighting allergies, which are now the primary environmental diseases. Parallel to progress in fundamental immunology and the introduction of effective drugs for symptomatic treatment of the various atopic manifestations, a problem facing us today is the growing popularity among the public of "alternative medicine" for the treatment of allergies, even though many of these unconventional diagnostic and therapeutic methods are judged pseudoscientific and their efficacy is unproven. The allergy patient is increasingly caught in the tug-of-war between allopathic and "alternative" medicine, pharmacists, so-called "natural healers", patient and consumer organisations and the mass media. Expectations of successful results from "natural", "soft", "Chinese" or "Tibetan" medicine are high, along with the corresponding marked placebo effect and scepticism about allopathic medicine. This "nocebo" effect thrives on psychosocial territory and is fostered by public opinion. Evidence of this is the rise of new environment-related forms of disease for which there is no proof of a toxic or immunologic origin ("idiopathic environment-related intolerances", according to the new WHO terminology). Allopathic and complementary medicine are often consumed together, thus increasing treatment costs. At the same time, fewer and fewer allergy patients are treated by allergen immunotherapy, the only treatment which can affect the natural course of allergic disease and which may also prevent the development of asthma in patients which allergic rhinitis.