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An allergy-focused patient history6 can provide you with a more detailed history and allow you to effectively manage your patient.
Guided by the findings of your allergy-focused patient history, you may want to consider allergy testing as the most appropriate next step. Specific IgE blood tests, skin-prick tests (SPT), or both, are important diagnostic tools. Skin-prick testing and specific IgE blood measurements can help you rule in or rule out allergen sensitization, which may give you the ability to correctly diagnose and improve clinical management.7,8 The patient medical history should be supplemented by allergen sensitization testing for accurate results.9
There are several valid reasons why a specific IgE serological test should be considered if your patient is experiencing any symptoms. Allergic disease and eustachian tube dysfunction:10,11
Up to 80 percent of patients with allergies are sensitized to more than one allergen.12 The effect is cumulative: An individual patient may have a number of triggers, which, combined, may lead to symptoms.13,14 The allergen symptom threshold is the point at which the cumulative allergen load leads to symptoms.13,14
Persistent chronic serous otitis media or recurrent acute otitis media may result in destructive changes in the middle ear. It can cause hearing loss or impaired hearing, which can interfere with language and speech development if it happens at critical times during a child’s life.1
Specific IgE serological tests aid in the diagnosis of allergic disease. As such, anyone presenting with chronic otitis media or other allergy symptoms is a candidate for specific IgE blood testing. Here are common allergens that can add up to symptoms:10
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
Determine how to reduce the exposure to allergic triggers and identify which long-term therapies may be best for their patients with allergy-based chronic otitis media. Otitis media may not only cause severe pain, but also result in serious complication, including permanent hearing impairment, if it is not treated.15 The underlying cause of chronic otitis media will likely dictate long-term management plan for patients with persistent symptoms.15,16 If chronic otitis media is occurring alongside an allergy diagnosis, avoiding potential triggers can be, in and of itself, a promising management strategy.10
Practice parameters have been developed to help guide the management and treatment of patients with otitis media.
For patients with chronic otitis media and comorbid allergic disease, exposure to allergic triggers and identification of long-term therapies should be based on the assessment of risk factors, including age and previously diagnosed allergeis.9