Allergists. Victims of excessive hygiene? Episode 14

Monika Rachtan
Good afternoon, I would like to welcome you to another episode of the programme "Patient First". My guest, and above all your guest, is Professor Maciej Kupczyk. A very warm welcome, Professor.

Maciej Kupczyk
Welcome to the editor, and welcome to you too.

Monika Rachtan
Professor, you are an allergologist and a specialist in lung diseases. Today we are going to talk about both allergies and bronchial asthma. I would also like to ask you a few questions about this subject.

Maciej Kupczyk
Of course, with pleasure. I am at your disposal, Madam Editor, as well as at your disposal.

Monika Rachtan
Before we get into the topic, however, I would like to take questions from our viewers. This is a programme where I try to speak the language of the patients and ask those questions that they themselves are afraid to ask the doctors, don't have time, or are on a long waiting list. It is not about specific diagnoses, but rather about counselling. So I have two questions from patients. The first is about allergies to insect venom. If I don't have a venom allergy now, is there a risk that I might develop one next year? Is it worth it to have children tested for insect venom?

Maciej Kupczyk
This is a difficult question. If someone is prone to allergies, called atopy, allergies can develop over time. Without being born with specific allergies, we can acquire them. Often one allergy may disappear, perhaps as a result of therapy, and another may reappear. In terms of insect venom, we diagnose sensitisation mainly on the basis of clinical symptoms. In practice, this means that a venom allergy can develop at any age. There are several risk groups and we know people who are more likely to develop an allergy. Exposure to the allergen is key here. Beekeepers, for example, are more likely to develop an allergy to bee venom, but their families are also at risk.

Monika Rachtan
Why?

Maciej Kupczyk
Because they live near beehives and come into contact with bees, which do not usually fly very far. They are less often stung, but the risk is there. People who work in confectioneries or grocery shops are most at risk. There are no tests to predict whether an allergy will develop.

Monika Rachtan
I understand.

Maciej Kupczyk
Tests can only show whether someone has a genetic predisposition to develop various allergies, but they cannot predict if and when a specific allergy will develop in someone.

Monika Rachtan
That is, it is worth noting that even if we perform the tests and the result is negative, we are not completely safe.

Maciej Kupczyk
Exactly, this is a very valid observation. If someone has a predisposition to develop allergies, they may develop them in the future. A negative test result in a given year does not guarantee that one will not develop allergies in the future.


Monika Rachtan
Another question comes from my favourite mum's group, but this time I found it on the Wrocław mums' group. This mum's daughter is 3 months old and is breastfed. She has developed skin lesions: redness and dry patches. The doctor suggested that it could be an intolerance to dairy. If I want to continue breastfeeding her, I need to wean her off it. Isn't it better to have the baby tested to be sure what she is allergic to?

Maciej Kupczyk
This is a very good and practical question. In the first months of an infant's life, especially in children with a predisposition to allergies, the first symptoms of allergies usually appear. These are most often food allergies, and in most cases allergies to cow's milk protein. The symptoms most often manifest themselves on the skin. For example, such frosted lesions appear on the cheeks. But later on, they can be more extensive and involve other areas of the body.

Maciej Kupczyk
It is worth remembering that the immune system is developing at this age. At three months of age, it may still be too early to get specific results from blood tests. Of course, they can be done, but the results may be incomplete. Over time, the child's immune system matures, which in turn affects its susceptibility to viral infections.

Monika Rachtan
Yes, up to 9-10 infections a year is the norm for a preschooler.

Maciej Kupczyk
Exactly. These are mainly viral infections, which are indicators of a still immature immune system. But back to the question, it is best to rely on the clinical picture and what we already know. The suggestion that the problem may be related to cow's milk and that the mother should eliminate it from her diet is the most likely one. Of course, tests can be done but, as I mentioned, these may not be complete.

Monika Rachtan
And after how long, if mum weans off dairy, should these skin lesions calm down?

Maciej Kupczyk
It depends on the individual situation of the child. If we are dealing with a food allergy, we usually see an improvement within a few days or weeks. An elimination diet is not the only treatment. You can also use emollients to moisturise the skin, appropriate baths and therapeutic ointments, depending on the age and severity of the symptoms. However, if we are talking about more advanced skin inflammation, treatment may take longer.


Monika Rachtan
Thank you very much for agreeing to answer questions from patients. I would now like to move on to the actual conversation. I thought we would start with the youngest patients and then move on to the slightly older ones.

Maciej Kupczyk
We will go through all age groups, paying attention to the so-called "allergy march".

Monika Rachtan
Exactly.

Maciej Kupczyk
In the context of allergology, we speak of the allergic march. In other words, allergy symptoms vary in the same person at different stages of life: in childhood, youth, as a young adult and in adulthood.

Monika Rachtan
I would also like to ask about mature age in a moment. But I'll start with the youngest ones, specifically those who are yet to be born. Can a young woman who plans to become a mother in the future already do something now? I am mainly thinking of a lifestyle, so that her child does not develop allergies.

Maciej Kupczyk
This is a good question, and one that many mothers are probably wondering about. We know that genetic conditions, inherited from both parents, are important in the development of allergies in humans. If the mother is allergic, the risk that the child will also have allergic tendencies is higher. It is not just one gene, these are very complex mechanisms involving dozens of different genes. On top of all this, there are also environmental factors that contribute to a greater likelihood of developing allergies.

Monika Rachtan
That is, both mum and dad.

Maciej Kupczyk
If both parents are allergic and, for example, have asthma, the risk of the child developing asthma is even around 80%. There is not much we can do here. Unless the woman finds a partner without allergies, in which case the risk will be lower.

Monika Rachtan
That is, I will now be looking for an allergy-free partner on Tinder.

Maciej Kupczyk
Ultimately, there is not much we can do about genetic conditions. In terms of environmental factors, we know that the risk of developing allergies is lower in children who grow up in more natural conditions, such as in the countryside or in farming families. But what we can really change is the period of pregnancy and breastfeeding. Smoking during pregnancy has been proven to significantly increase the risk of a child developing allergies and asthma.

Monika Rachtan
And many other diseases.

Maciej Kupczyk
Yes, many other diseases. But we are focusing on this particular disease entity that the editor asked about. So if the mother smokes cigarettes during pregnancy, the risk of the child developing asthma and allergies increases significantly. Natural childbirth also reduces the risk of these diseases in the future. Breastfeeding is another element that can reduce the risk. To answer a frequent question from patients: the presence of animals in a young child's environment or a good diet can also have an impact, but this is very individual.

Maciej Kupczyk
Nowadays we have too clean, we live in sterile conditions. Our immune system is not exposed to positive stimuli, which leads to its improper maturation. As a result, it reacts to stimuli that are not harmful to us at all, such as insect venom. This is a distorted reaction of the immune system, and it is a problem in allergology.

Maciej Kupczyk
In summary, there are some things we can influence: avoid smoking during pregnancy, choose natural childbirth if there are no medical contraindications, and follow an appropriate diet. We do not recommend an elimination diet. These are general recommendations for the population, not for a specific sick patient.

Maciej Kupczyk
When it comes to babies born by caesarean section, their immune system is less exposed to 'good' bacteria, which can be a problem. There is interesting research on this issue. At the moment, however, we do not have certain and simple solutions. We can only observe and wait for further research results.

Monika Rachtan
Do we already know if this is the right thing to do, or is research on the issue still ongoing?

Maciej Kupczyk
Research is still ongoing and it is difficult to conclude clearly. We have evidence that good bacteria can reduce some gastrointestinal complications in children. But we lack clear recommendations on how to do this so that the effect is significant for everyone. It is possible that we need to look at it in a more complicated way. As for animals, the hygiene hypothesis is that the presence of animals in a child's environment stimulates the child's immune system from an early age. But it also depends on the lifestyle of the family, not only on whether we get the child a dog or a cat.

Monika Rachtan
My understanding. What about a pregnant woman who already had allergies before pregnancy? Does she have to stop the medication?

Maciej Kupczyk
Absolutely not. All asthma and allergy treatment standards say that it is important for the mother-to-be to feel as well as possible. We do not recommend stopping medication abruptly. Every pregnant woman should consult her doctor as soon as possible. Treatment can be modified by choosing the medicines that are safest during pregnancy. For example, one can switch from oral to topical medication. As far as asthma is concerned, current standards do not even recommend modifying existing treatment. It is therefore important to consult your allergist. All pregnant women are admitted without a queue if there is an urgent need for consultation.

Monika Rachtan
So I think it's worth talking to your doctor about the illnesses you have and the medications you are taking. It's important to let him know.

Maciej Kupczyk
Sure, of course.

Monika Rachtan
Let me come back to the topic of babies. Apart from the food allergies you have already mentioned, which allergies are most common in young children?

Maciej Kupczyk
In summary, we have talked about the so-called allergy march. There are different allergies at different stages of life. In infants, it usually starts with atopic dermatitis. Later on, inhalant allergies, allergic rhinitis and asthma appear. In older age groups, asthma predominates. Problems such as allergies to venoms or medication can occur at any age. When it comes to infants and young children, the most common allergens are food allergens, such as cow's milk proteins, egg yolk and egg white, and nuts.

Maciej Kupczyk
In our climate zone, we may encounter allergies to wheat flour or soya. In older children and young adults, these proportions change. Allergies to seafood, raw fruit and vegetables are added.

Monika Rachtan
I would like to know more about the term 'cross allergy'.

Maciej Kupczyk
Cross allergy is an important term, especially when talking about food allergies in children. In infants, atopic dermatitis predominates, most often caused by cow's milk proteins. In adults, on the other hand, oral allergy syndrome predominates, i.e. reactions to raw fruit and vegetables.

Maciej Kupczyk
These symptoms are specific and appear within seconds after contact with the allergen. They are usually mild and are secondary to another allergy, usually to trees like birch. This is because of the similarity in the structure of the proteins in different plants, which we call pan-allergens. Therefore, the immune system reacts to both birch pollen and these foods.

Monika Rachtan
When you talk about it, I think it is a complex problem. A patient who is facing these symptoms really needs a complex approach. The doctor needs to sit down and look at the whole situation.

Maciej Kupczyk
Yes, exactly.

Monika Rachtan
Are there any such doctors?

Maciej Kupczyk
If you suspect allergic problems in yourself, it is worth talking to your doctor. As we discussed before our meeting, I am an old-school doctor. I believe that you should first talk to the patient, take a history and see the clinical picture of the disease. Only later can tests be done. We don't treat the test results, we treat the patient and their problems. The tests are additional and should direct us to what is really relevant. We rely on our knowledge, experience and on what the patient tells us.

Monika Rachtan
I have noticed that parents very often request examinations for their children. When the first health problems appear, parents are concerned and do not know what to do. What can be done if these problems have already subsided? Is it worth revisiting the problem when the child is already 3, 4, 5 years old?

Maciej Kupczyk
Yes, as we have discussed, if there are clinical problems, for example food allergy or atopic dermatitis, usually these symptoms ease over time. In this case, doing tests for a 3-, 4- or 5-year-old for future problems will not add much to the management. On the other hand, if allergy symptoms from the respiratory tract start to appear at this age, it is worth paying attention to this right away and thinking about allergies.

Maciej Kupczyk
At this age, children often develop sensitisation to inhalant allergens. If someone has had problems in childhood, the genetic basis remains. Not everyone develops symptoms at the same time of life. It is worth being vigilant. As soon as symptoms appear, it is necessary to go for diagnostics.

Monika Rachtan
If a six-year-old has untreated allergy-related illnesses, or the treatment is inadequate - the parents are not conscientious or do not take the doctor's advice - does this increase the risk of developing other illnesses in their teenage years or adulthood?

Maciej Kupczyk
This is a very good question. Firstly, we have really effective medicines and methods to effectively control allergy symptoms. The main thing we aim for is that the patient, in this case our child, feels well and has a good quality of life. This is a broad term that encompasses various aspects of life, from daily needs to whether a child can learn effectively and be productive at school. Scientific evidence, mainly from studies conducted in the United States, shows that allergy sufferers have worse exam results during the peak pollen season than during the off-season.

Monika Rachtan
This is very interesting research, but I think ...

Maciej Kupczyk
Exactly, and this highlights just how important it is to treat allergies properly. Allergy is a disease that most often starts in childhood and can continue throughout life in various forms. It is therefore worth controlling it well. If at the beginning there is only allergic rhinitis, which seems to be a seasonal and harmless disease, over the years it can progress. New allergies may appear and symptoms may become increasingly troublesome.

Maciej Kupczyk
It usually starts as a seasonal allergy, for example from early to late April, when the patient is allergic to birch trees. After a few years, however, he or she may notice that symptoms start in March and end in September. This indicates that the patient is starting to become sensitised to other allergens, such as early trees or grasses. And this is the typical evolution of an uncontrolled allergy.

Maciej Kupczyk
There is also another, more worrying scenario. A patient who initially only had a runny nose may start complaining of shortness of breath in subsequent years. This means the appearance of another allergic manifestation, namely bronchial asthma, which is already a serious disease. This is why it is so important to recognise an allergy and treat it effectively.


Monika Rachtan
What are the options for allergy sufferers? When you struggle with a runny nose for four weeks, it can seem like a trivial problem, as the professor said. Is it possible to get this rhinitis under control quickly?

Maciej Kupczyk
Generally speaking, exposure to an allergen can be avoided. For example, if one is allergic to animals, it is advisable to avoid cats, mice, rats and other rodents. If one is allergic, there is unfortunately a risk of developing an allergy that is difficult to treat. The simplest way is to avoid the allergen. In the case of food allergies, avoiding exposure is also fundamental. Of course, this is not always possible, so then we use medicines that are widely available, even without a prescription. However, I recommend consulting a doctor, because it is worthwhile to diagnose the problem and know what the appropriate medication is.

Maciej Kupczyk
There are a number of different treatments, which are selected individually, depending on the patient's needs. Pharmacotherapy does not reduce the risk of allergy progression. To do so, it is worth considering immunotherapy, or desensitisation.

Monika Rachtan
Is it a complicated and lengthy process? How does it burden the patient and how much does it cost?

Maciej Kupczyk
We have access to several different methods. The most common in Poland is oral or injectable immunotherapy. Both of these methods are long-lasting and last between 3 and 5 years. In terms of the burden on the patient, there are different treatment regimens. The frequency of injections depends on the specific preparation, but generally it is up to 12 injections per year, so it is not a heavy burden. As for cost, many preparations are reimbursed.

Maciej Kupczyk
An alternative for people who do not want to come for injections or are afraid of needles is oral immunotherapy. It is just as effective if we follow the doctor's instructions.

Monika Rachtan
So the burden falls on the patient?

Maciej Kupczyk
Exactly, the burden falls on the patient and, when it comes to children, on their parents. In practice, it is sometimes difficult to motivate adolescents to take their medication regularly, so it requires some work. It is worth doing because we have scientific evidence that such therapy significantly reduces the risk of allergy progression. Not only do we improve the symptoms of the disease and reduce the need for medication, but we also reduce the risk of developing new allergies and asthma by 50%. This is a very big advance in medicine.

Monika Rachtan
A risk reduction of 50% is really significant. However, I would like to ask about bronchial asthma. It seems to me that there is a lack of understanding in the minds of Poles of the connection between a rash or a runny nose and a severe form of bronchial asthma. At what age do the first symptoms of asthma usually appear?

Maciej Kupczyk
The first symptoms usually occur in children. It is not as easy to diagnose immediately as with many other diseases. However, looking at it retrospectively, it is most common for symptoms to start in childhood. Frequent recurrent viral infections associated with dyspnoea, or bronchospasm, are characteristic. In practice, this means that our children have infections, colds and wheezing. This is very characteristic and audible even without the use of a stethoscope. But it is worth noting that this is not yet typical asthma, because the structure of the airways in children is different - they are shorter and smaller in diameter. Therefore, swelling and wheezing easily occur. However, if you have a child with a positive family history, symptoms of atopic dermatitis and positive test results for food allergens, it is worth bearing this in mind.

Maciej Kupczyk
Frequent recurrent viral infections in such a child form the picture of an evolving pathway, which we call the allergic march, towards the development of asthma. This is the most typical pathway and paediatricians know this. We do not overlook it and implement appropriate treatment.

Monika Rachtan
And as an adult, for example in my thirties, can I suddenly develop asthma?

Maciej Kupczyk
Yes, you can. We were talking here mainly about asthma with early onset, which is most often allergic and occurs in children. But asthma can also develop in adults. Not all forms of it are allergic. In adulthood, we often deal with so-called late-onset asthma. Here, recurrent viral infections and prolonged coughing after infection are also characteristic. Often patients complain about the ineffectiveness of antibiotic therapy. These are usually the first symptoms of asthma and not, as sometimes misdiagnosed, chronic bronchitis or pneumonia.

Maciej Kupczyk
Therefore, it is worth paying attention to this, especially when infections occur seasonally, during autumn and spring. We do not have to have allergies to have asthma. In adulthood, asthma is more likely to co-occur with other conditions, such as chronic sinusitis or allergy to aspirin and other non-steroidal anti-inflammatory drugs. These are forms of severe asthma that require specialised care.

Monika Rachtan
I was thinking about what the professor said about antibiotics. This is a very important topic that is certainly worth taking up in the next conversation. I think it is worth reminding patients that in Poland we often tend to force antibiotics on doctors. This distorts the picture of asthma in older age, especially when it comes to its first symptoms.

Maciej Kupczyk
Of course, I admit that we doctors also misuse antibiotics. In Poland, we have an antibiotic protection programme, which we should take care of. Antibiotics are our precious resource and if we are not careful, we will have no way to treat bacterial infections in the future. The WHO World Health Organisation predicts that bacterial infections will become society's biggest problem in the coming decades. We will not be dying from oncological or cardiovascular diseases, but from infections that cannot be treated. We use antibiotics too widely, especially in viral infections and especially in children. It is therefore worth thinking twice before giving an antibiotic unnecessarily.

Maciej Kupczyk
If in doubt, it is worth waiting and seeing how the disease develops. Antibiotics are not antiviral drugs, they are not cough or sore throat drugs. We should only use them for specific clinical problems resulting from a bacterial infection. We must have evidence of this infection and implement the appropriate antibiotics. We should not use antibiotics prophylactically unless there is a strict medical indication to do so. Although I am going outside my speciality here, from the point of view of an allergologist I have to say that the inappropriate diagnosis and treatment of viral infections, especially in adults, and the prophylactic use of antibiotics in children in viral infections, is a huge mistake.

Monika Rachtan
It seems to me that we have a huge problem with creating awareness. The professor spoke about abuse by doctors, but on the other hand I hear from patients: "The doctor didn't want to give me an antibiotic, he has to give me an antibiotic because my child is coughing for the third day". This pressure on doctors from patients is a big problem. There is also a lack of understanding of what the professor said about antibiotic protection.

Maciej Kupczyk
I am glad that the editor is raising this issue. I meet young doctors who cannot cope with pressure from patients. At the beginning of the day you can still explain that we will see in a few days how the situation will develop. But when you have 50 patients a day, it's hard to resist that pressure. This is a huge problem. As a society, we are poorly educated about hygiene and health. We don't know basic health-promoting principles, let alone addictions.

Maciej Kupczyk
There is no pill that can replace exercise or miraculously slim us down. You can't expect miracles from your doctor; you also have to approach him as a patient in a partnership way.

Monika Rachtan
I notice that especially older people don't bring documentation because they want to see if the new doctor will say the same thing as the previous one, or see the same tumour on examination. They don't realise that the doctor wants to compare the results, to see if the tumour has grown.

Maciej Kupczyk
True, many patients simply do not know that they should be prepared for a consultation. This is the basis of social cooperation and health-seeking behaviour. Of course, it is worth comparing test results, as this guides us in further treatment. There is no point in starting all over again if the previous approach did not work.

Monika Rachtan
I'll be the one to ask. Oh, a very trending issue on the web: allergies. Is there an allergy to gluten or to lactose?

Maciej Kupczyk
Oh, it's a really broad topic.

Monika Rachtan
It is good that we have raised it. Do such allergies really exist? Can a symptom of a gluten allergy be abdominal pain? And if I have such a symptom, who should I see? To an allergologist, a gastroenterologist, a surgeon, or perhaps a nutritionist?

Maciej Kupczyk
These are very important questions, and we are indeed entering a slippery slope here. We need to understand that people often confuse allergies with intolerances to various substances, not just foods. This also applies to medicines, which can have side effects. These are not allergies, but side effects. But going back to foods, in fact the allergist often encounters two problems: gluten allergy and lactose allergy. Most cases, however, are intolerances, not allergies. Intolerances can be different: enzymatic, or due to immune reactions.

Maciej Kupczyk
In the case of cow's milk, we often speak of a food allergy that manifests itself as atopic dermatitis in infants, children and even young adults. Lactose intolerance is an enzymatic problem. This means that the digestive tract lacks the enzyme lactase, which is necessary for the digestion of the milk sugar lactose. A deficiency of this enzyme leads to symptoms such as abdominal pain, bloating and diarrhoea.

Monika Rachtan
That is, it is not an allergy.

Maciej Kupczyk
Exactly, it is not usually an allergy. Of course, food allergies can also cause abdominal pain or intestinal inflammation, but if we are talking about the most common cases, lactose and gluten sensitisation are usually intolerances, not allergies.

Maciej Kupczyk
As far as diagnosis is concerned, it is worth consulting an allergologist. There are various lactose-free milk products. If we tolerate lactose-free milk well, but react badly to standard milk, it is clear that we are dealing with lactose intolerance. People with a deficiency of this enzyme usually tolerate fermented yoghurts better, as they contain lactic acid bacteria that help digest lactose. Smaller amounts of this sugar are usually better tolerated than large amounts.


Monika Rachtan
Milk, right?

Maciej Kupczyk
Yes, and we still have the option of supplementation. If we are anxious to have milk soup for breakfast, we can take a tablet containing the right enzyme to help us do this. This is possible. Speaking of lactose intolerance, there is no doubt that allergy to cow's milk proteins is the predominant food allergy in infants and young children. It is much less common in adults. Symptoms such as abdominal pain, a feeling of fullness, gas and diarrhoea after consuming particularly large quantities of milk are more a feature of a deficiency of the enzyme lactase, which digests milk sugar. The second issue is an allergy to gluten.

Maciej Kupczyk
This is already a more specialised issue. Gluten allergy is a problem for the allergist. Most situations in daily practice are neither related to an allergy to wheat proteins nor to coeliac disease. Coeliac disease is a completely different disease, associated with damage to the small intestine resulting from inflammation caused by gluten. Ladies and gentlemen, if we have a suspicion of celiac disease, it is worth doing the appropriate tests rather than immediately starting a gluten-free diet.

Monika Rachtan
Because after that it's probably more difficult.

Maciej Kupczyk
Not only is it more difficult, tests can be false negatives if someone is already on a gluten-free diet. In my practice, there are times when a patient comes in and says: "I have been on a gluten-free diet for 6 months and I feel better. Now check if I have celiac disease'.

Monika Rachtan
It is then impossible to check. Research is unfortunately unreliable.

Maciej Kupczyk
Exactly, the basis of the diagnosis is a biopsy of a section of the small intestine. If someone is already on a gluten-free diet, the typical damage may not be visible. There are still methods like genetic testing or enzymes specific to celiac disease, but their levels may be reduced on a gluten-free diet. This is a big mistake. First diagnosis, then diet.

Maciej Kupczyk
Why does the patient feel better on a gluten-free diet? Because we eat a lot of wheat flour products in our diet. We just need to modify our diet: less flour products, more other grains and vegetables. A gluten-free diet is varied and includes other products, so we can actually feel better on it.

Monika Rachtan
It is simply healthier.

Maciej Kupczyk
It's just healthier, so it's no surprise. But this is not proof that we had celiac disease to begin with. Celiac disease is a certain medical problem. In the past, it was more often diagnosed mainly in children, but of course it can happen at any period of life. In adults, the clinical manifestations are a little different and it is not easily recognised. If we have doubts, let's start with the diagnosis, and more specifically with the gastroenterological diagnosis, because it is not an allergy. We can go to an allergologist who will do tests and show that we do not have an allergy to proteins such as gluten, but this does not rule out celiac disease. These are two completely different disease entities. It would be good to understand that not every intolerance to different products or substances is an allergy.

Maciej Kupczyk
So, I know it's a bit of an oversimplification, but it's nice if we were open about it. If we have an allergologist who explains where it comes from, we can usually understand it, because it can be checked quite easily. If we follow the right diet, for example for lactose intolerance, we can see the improvement in practice. I recently had a patient who came to my practice and claimed that he definitely had a problem. This was a man in his mid-50s, so for him to have come to see the doctor, he must have had serious symptoms.

Monika Rachtan
This is true.

Maciej Kupczyk
Men of this age rarely choose to seek treatment, but he came around. And he was indeed very worried. He had quite severe symptoms, but after another visit he no longer had them because it turned out to be lactose intolerance.

Monika Rachtan
Professor, in conclusion, I would like to ask for a one-minute answer to my question. Three important things that the listener should remember from our conversation today.

Maciej Kupczyk
Three key points, yes. If you suspect allergic problems or sensitisation in yourself, seek the help of an allergologist. There are around 1,500 allergologists in Poland, so everyone will find a specialist who can make a diagnosis at an early stage and implement appropriate medication. If this is sufficient, you can then continue treatment on your own. Firstly, let's reach out for a diagnosis. Let's talk to someone who knows what this looks like in practice and can advise us. When it comes to intolerances, remember that not everything you are intolerant to is an allergy. It is therefore worth consulting a specialist before we decide to take certain measures, such as restrictive diets. In general, we do not recommend them. Apropos milk allergy, we try to introduce a varied diet as early as possible so that our immune system matures.

Monika Rachtan
And one last question, because a partner, as I probably mentioned at some stage in our discussions, of our programme is the Institute for Patients' Rights and Health Education, which talks about the humanisation of medicine. Professor, in three sentences, what is the humanisation of medicine for you?

Maciej Kupczyk
Unfortunately, it seems to me that we are living in an era of the dehumanisation of medicine, where additional tests and an instrumental approach to a medical problem dominate. I am a bit of an old-school doctor and I believe that we talk to the patient first, look at the clinical picture and try to understand what the patient's biggest problem is. All other activities and investigations are additional. Medicine is about understanding the patient and their problem, not just doing tests.

Monika Rachtan
His situation.

Maciej Kupczyk
His situation and help to resolve it. We do not treat test results, but look at the patient holistically.

Monika Rachtan
Professor, thank you very much for our conversation today. We wish our viewers such doctors who will look at their problems holistically. We thank you for your attention. Once again, thank you very much.

Maciej Kupczyk
Thank you very much, Madam Editor. Thank you.