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Symptom Threshold

Most patients with allergies have multiple allergen sensitivities contributing to their allergen load. Since the majority of atopic individuals are poly-sensitized,1 case history does not always tell the whole story. Yet, the identification of all allergens is an integral part of an accurate diagnosis.


The allergen load is the sum of all potential sensitizers that may push a patient over the symptom threshold leading to symptoms.2 In this example, a patient is sensitized to dust mites and mold then faces an environmental irritant. All of these add up, however the patient does not experience symptoms until spring, when the addition of birch pollen causes the combined exposure to exceed the symptom threshold and the patient exhibits symptoms.


Before exposure reduction2,6

 


 

History alone is often not enough, due to symptom overlap between conditions that are not managed the same. Do not assume - test to gain insights. Patients can present with a history indicative of house dust mite or cat allergy but actually not be sensitized, likewise they can present with no indicative history and the cat may be the primary trigger, hence it is important to test for the most common triggers in patients with allergies.


After trigger reduction3-5

The Tip of the Iceberg

What may seem as the obvious trigger may just be the tip of the iceberg. Since most atopic individuals are allergic to more than one allergen, it is important to identify all the allergens that contribute to the symptoms to ensure optimal symptom relief.

If patient history suggests an IgE-mediated allergy, conducting a specific IgE blood test may help complete the picture. The benefit of specific IgE blood testing is that the quantitative values of the different triggers help you to prioritize which of the multiple sensitizations to target with exposure reduction. Exposure reduction avoidance plans should be comprehensive; including education, cleaning and physical barriers.3


This approach can lead to:4*

Results

2.1 fewer

unscheduled visits per year
(13.6%)

Results

21.3 fewer

days with symptoms per year
(19.5%)

Results

4.4 fewer

missed school days per year
(20.7%)


True quantitative test results may transform into improved quality of life for patients.

Specific IgE Testing >


*A 24-month open, block-randomized trial including 937 children with atopic asthma (5-11 years) in seven major U.S. cities. Intervention lasted one year and included education and remediation for exposure to both allergens and environmental tobacco smoke.4

References
  1. Ciprandi G, Alesina R, Ariano R, et al. Characteristics of patients with allergic polysensitization; the polismail study. Eur Ann Allergy Clin Immunol. 2008; 40(3):77-83.
  2. Wickman M. When allergies complicate allergies. Allergy. 2005;60(suppl 79):14-18.
  3. Baxi SN, Phipatanakul W. Adolesc Med State Art Rev. 2010;21(1):57-71.
  4. Morgan WJ, Crain EF, Gruchalla RS, et al. N Engl J Med. 2004;351:1068-80.
  5. Wu F and Takaro TK. Environ Health Perspect. 2007;115:971-975.
  6. Eggleston PA. lmmunol Allergy Clin North Am. 2003;23(3):533-547.