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Symptoms may occur in connection with allergen exposure, exercise, cold air, dry air, and airway infections. Other irritants, such as strong scents or cigarette smoke, can also trigger an exacerbation. To manage your patient's asthma, it is important to identify and minimize his or her exposure to triggers.
During an allergy-focused patient history and physical exam, you will likely find several variable and recurring symptoms that are the characteristics of asthma. You may detect airflow obstruction, bronchial hyperresponsiveness, and underlying inflammation.
Following a diagnosis of asthma, guidelines recommend that factors that trigger or exacerbate asthma must be elicited routinely and documented in the medical records and action plans of all patients with asthma.17 Diagnosing underlying allergy in asthma starts with a physical examination and an allergy-focused patient history. A few key questions will provide you with a detailed history and help you create an effective management plan for your patient. With allergic asthma, history is often not enough to make an accurate diagnosis. For example, a patient can present with a history indicative of house dust mite or cat allergy but actually not be sensitized.18
Guided by the allergy-focused patient history, the most appropriate next step may be specific IgE tests. Specific IgE blood tests, skin-prick tests (SPT), or both, are important diagnostic tools. When added to an allergy-focused patient history, SPT and specific IgE measurements can help you rule in or rule out allergen sensitization, which may give you the ability to correctly diagnose and improve clinical management.19,20
Up to 90 percent of children and 60 percent of adults with asthma suffer from allergies,23,24 and guidelines recommend factors that trigger or exacerbate asthma be identified routinely and documented in the medical records and personal asthma action plans of all patients with asthma.25 Reducing exposure to one or more allergic triggers can help reduce symptoms and the need for medication.22
Adapted from the National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 200722 and Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report.26
Most patients with asthma have multiple allergic sensitizations (e.g., perennial and seasonal aeroallergens) contributing to their allergen load.4,21 These allergen sensitizations can add to the patient’s trigger load, eventually resulting in asthma exacerbations—even from other, non-allergic, triggers.4,5 In patients with asthma and aeroallergy, in addition to pharmaceutical strategies, reducing exposure to sensitized allergens can alleviate or reduce symptoms.23, 24, 27-29
Specific IgE Testing Improves
Accuracy of Results vs. Patient History Alone18
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Asthma is a major chronic respiratory disease due to its prevalence and its impact on quality of life.30 Asthma has been shown to negatively impact patients’ physical health (e.g., obesity, physical limitations), psychological health (e.g., anxiety, depression, self-esteem), and social health (e.g., social interaction, peer acceptance) and adversely affect their health-related quality of life (HRQoL).31,32
Patients with asthma can have both short-term treatment for asthma exacerbations and long-term treatment to obtain and maintain asthma control. Emergency treatment of asthma exacerbations is frequently, and sometimes almost exclusively, used by many asthma patients.30
In addition, atopic sensitization and comorbidities are present in a large percentage of asthmatics. Indoor and seasonal allergies are very common, and many asthmatics have more than one type of allergic sensitization.30 Allergens are the trigger of asthma symptoms for the majority of patients.33 These may include perennial allergens, such as pets and dust mites, and seasonal allergens, such as pollen.30,33
Practice parameters have been developed to classify and manage treatment of asthma and guideline-directed management has been shown to improve disease control.34