Estudio del paciente

alérgico

¿En quién se debe hacer un estudio de alergia?

Las personas que tienen síntomas de asma (o
bronquitis o broncoespasmo), rinitis, conjuntivitis,
dermatitis atópica, urticaria, edema o inflamación,
dermatitis de contacto, síntomas digestivos de dolor,
vómitos o diarrea más o menos intensa, reacciones
con alimentos, medicamentos o con picaduras pueden
tener alergia. No todas las personas con esos
síntomas tienen alergia, pues puede haber otras
causas.
Hay más sospecha si los síntomas son prolongados, o
si se van repitiendo con frecuencia, aunque entre
medias se recupere totalmente.
También se sospecha si se nota relación clara entre
tocar, respirar o comer alguna sustancia sospechosa y
la aparición de los síntomas.
Aunque no haya ninguna sospecha, si los síntomas
son intensos, o frecuentes, o duraderos, o se presenta
alguna complicación, o si los síntomas limitan las
actividades y disminuyen la calidad de vida, también
debe hacerse un estudio de alergia.

¿Qué sustancias (alergenos) se estudian
habitualmente?
Las sustancias que pueden causar alergia se llaman
alergenos. Cuando se realiza un estudio de alergia se
comprueba si se está sensibilizado frente a los
alergenos más frecuentes, que varían según la
enfermedad que se padezca, según la edad, según la
zona de residencia.
Además de los alergenos frecuentes, también se
estudian otros menos frecuentes, según los lugares y
ambientes a los que el paciente acuda con más
frecuencia, aunque parezca que no causan síntomas,
y otros alergenos si el paciente o su familia han
observado en algún momento alguna reacción
sospechosa.
¿Cómo se estudia una posible alergia?
Se utilizan las pruebas en piel, se realizan análisis de
sangre de IgE total o IgE específica, se ponen parches
en la piel, se realizan pruebas de función respiratoria,
o se hacen pruebas de exposición, de provocación o
tolerancia. Según los datos de cada paciente se hacen
unas pruebas u otras, y el especialista las interpreta
para decidir el diagnóstico y el tratamiento más
adecuado.
¿Cuándo se repiten las pruebas y análisis?
Depende de cada paciente, de si los resultados son
normales, anormales o dudosos, fuertes o débiles, de
los síntomas que tenga, etc. En algunas personas se

repiten cada año, en otras cada dos o tres años o más,
y en algunas personas se hacen una sola vez en la
vida.

Pruebas en piel

¿Para qué se usan?
Las pruebas cutáneas se usan para averiguar si el
paciente tiene IgE específica frente al alergeno
probado; las personas sin alergia no tienen IgE frente
a ese alergeno. Si el paciente tiene IgE se dice que la
prueba es positiva y que el paciente está sensibilizado.
Si no da reacción, se dice que la prueba es negativa,
que el paciente no le tiene alergia a ese alergeno.
¿En qué consisten?
Las pruebas en piel se realizan habitualmente en el
brazo. Las más utilizadas se llaman “prick tests”. Se
pone una gota de líquido con el alergeno sospechoso,
y se punciona la piel a través de la gota con una
lanceta cuya punta mide un milímetro. El alergeno
penetra en la piel, y si se tiene alergia, al cabo de unos
15-20 minutos se forma una pápula, un abultamiento
de la piel con enrojecimiento. Para ser considerada
alergia, la pápula ha de alcanzar un tamaño

determinado, que habitualmente es de unos 3
milímetros de ancho.
¿Qué son el suero y la histamina?
Se ponen siempre dos pruebas de control o testigos.
Estas pruebas son con suero salino y con histamina.
La prueba del suero no tiene que dar reacción (prueba
negativa), y la de histamina sí que tiene que dar una
pápula (prueba positiva). Si no es así, las pruebas no
son válidas.
Si el suero da reacción puede deberse a que el
paciente tiene una piel excesivamente sensible (esto
se llama dermografismo), frente a estímulos como el
propio pinchazo, y si las sustancia probadas dan
reacción no puede determinarse que realmente sea
por alergia sino por esa sensibilidad. Este resultado se
llama falso positivo.
La histamina da reacción en la piel de todas las
personas, tengan o no alergia. Si la histamina no da
reacción es que la piel no está respondiendo bien, y
puede que tampoco responda frente a las sustancias
que le causen alergia. Este resultado se llama falso
negativo. Esto suele deberse principalmente a que el
paciente esté tomando alguna medicación.
¿Los medicamentos influyen en las pruebas?
Algunos medicamentos pueden alterar las pruebas y
hacer que no sean fiables. Los principales
medicamentos que las alteran son los antihistamínicos,
que se usan para la alergia, catarros, picores,

síntomas gripales, el mareo, para dormir, etc. Hay que
intentar evitarlos desde siete días antes. En otro
documento de esta web se muestran medicamentos
que alteran las pruebas.
Cuando vayan a hacerle pruebas dígale al especialista
todos los medicamentos que está tomando.
¿Son dolorosas las pruebas?
Estas pruebas pueden doler algo, aunque los niños
suelen llorar más por el miedo que por el propio dolor.
Hay niños muy pequeños que no se quejan nada en
absoluto.
Hace años se hacían las pruebas por
intradermoreacción. En esta manera se inyectaba el
alergeno en la piel con jeringuillas, como se hace
actualmente con la prueba de la tuberculina, y eran
bastante más dolorosas. Hoy en día también se usa la
intradermoreacción, aunque con menos frecuencia.
¿A qué edad pueden hacerse?
A cualquier edad, incluso en niños de un mes de edad.
Hay una falsa creencia de que no pueden hacerse
hasta los tres años o más. Esto no es cierto, se
pueden hacer a cualquier edad, y se deben hacer
cuando haya alguna sospecha justificada.
¿Cuántas pruebas se hacen?
El número de pruebas se decide individualmente para
cada paciente según el motivo de consulta y las

sospechas que se tengan. Pueden variar desde tres
hasta varias docenas.
¿Qué sustancias se estudian en las pruebas?
Las pruebas no son “automáticas”, sino individuales.
Es decir, no se hacen pruebas y automáticamente dan
el resultado de todas las cosas a las que se tiene
alergia. Se estudia cada alergeno de forma individual:
si se quiere saber si se tiene alergia a una cosa, se
hace una prueba; si se quiere saber si se tiene alergia
a dos cosas, se hacen dos pruebas, etc. Si se quiere
saber si se tiene alergia a mil cosas, habría que hacer
mil pruebas.
Como esto no es posible, se estudian los alergenos
habituales, y otros fuera de lo habitual si hay alguna
sospecha concreta; esas sospechas concretas deben
comunicárselas al especialista antes de realizar las
pruebas. Si no las comunica, lo más probable es que
no se le prueben.
Como ejemplo, después de hacerle pruebas no le
pregunte al especialista si le ha salido alergia a la
berenjena o al calabacín, porque no se lo habrán
estudiado si previamente no ha dicho sus sospechas.
¿Cómo se valoran las pruebas de piel?
Se valora el tamaño de la pápula, del abultamiento. Se
valora tanto la anchura por sí misma como
comparándola con la histamina. Se suele exigir una
anchura mínima de tres milímetros. El tamaño varía

desde apenas perceptible a 2 ó 3 centímetros, con
formas muy irregulares.
¿Las pruebas fuertes coinciden con síntomas
intensos?
No siempre coinciden. Puede haber variaciones y
desacuerdo entre los resultados de la piel y los
síntomas, de manera que algunas personas con
pruebas grandes tienen pocos síntomas o incluso
ninguno y, viceversa, personas con pruebas poco
importantes pueden padecer síntomas intensos y
frecuentes.

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