+
For Healthcare Professionals
For Lab Professionals
+
For Patients & Caregivers
For Lab Professionals
+
For Patients & Caregivers
For Healthcare Professionals

Welcome! Click here for Healthcare or Laboratory Professional content

Welcome! Click here for Patient or Laboratory Professional content

Welcome! Click here for Patient or Healthcare Professional content

Are you a healthcare professional?

The information in this website is intended only for healthcare professionals. By entering this site, you are confirming that you are a healthcare professional.

Are you a laboratory professional?

The information in this website is intended only for laboratory professionals. By entering this site, you are confirming that you are a laboratory professional.

Allergic 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.1,2 A few key questions, followed by confirmatory testing, will provide you with a detailed history and help you create an effective management plan for your patient.

History alone is often not enough to accurately identify all of the patient’s allergic triggers. For example, a patient can present with a history suggestive of house dust mite or cat allergy but actually not be sensitized.2 Likewise, a patient can present with a few non-specific symptoms, but the cat may be the primary trigger.

Allergen sensitization testing improves accuracy of results vs. patient history alone2


 

Guided by the allergy-focused patient history, the next step should be testing. When added to an allergy-focused patient history, the use of skin prick tests (SPT), serological tests, or both increases your confidence in diagnosis and clinical management by ruling in or ruling out allergies.3,4

KEY ALLERGY TEST DIFFERENCES
Specific IgE blood testing
Skin prick testing
Typically ordered and reviewed by a clinician
YES
YES
Patients do not need to discontinue allergy medications
YES
NO
Requires only one needle stick (a single blood sample)
YES
NO
Carries no risk of severe allergic reaction
YES
NO
Can be used when extensive skin rash is present
YES
NO
Component testing is available
YES
NO
Same day results in the office
NO
YES

 

Just as diagnostic testing is routine for diagnosis of chronic diseases such as type 2 diabetes and dyslipidemia, specific IgE tests can be routine to aid in the diagnosis of allergic disease.

Common Allergens to test for:5

Asthma Symptoms

Pollens

Asthma Symptoms

Foods

Asthma Symptoms

Pets

Asthma Symptoms

Molds

Asthma Symptoms

Dust mites

Asthma Symptoms

Other Animals

Who Should Be Tested?

As allergies trigger asthma exacerbations in up to 60-90% of children and about 50% of adults with asthma,6,7guidelines recommend factors that trigger or exacerbate asthma must be identified routinely and documented in the medical records and personal asthma action plans of all patients with asthma.1 Reducing exposure to one or more allergic triggers can help reduce symptoms and the need for medication.5

Persistent Asthma: Daily Medication

Common Symptoms: nighttime awakenings, cough, wheeze, shortness of breath, tightness in the chest

Etiologic Evaluation

     

Order Respiratory
Profile







Risk of Severe Asthma Exacerbations and/or
History Suggestive of Food Allergy
 

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 2007 5 and Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report8

Symptom Threshold

Up to 80% of patients with allergies are sensitized to more than one allergen.9 The effect is cumulative: An individual patient may have a number of triggers, which, combined, may lead to symptoms.10 The allergen symptom threshold is the point at which the cumulative allergen load leads to symptoms.10

Each patient has a different level of IgE antibodies at which he or she will show symptoms. Until the symptom threshold is reached, the patient will not show symptoms. However, when these allergens add up, they have a cumulative effect, pushing the patient over his or her symptom threshold.10 By reducing exposure to certain triggers, symptoms can be avoided.10

Identifying and reducing exposure to sensitized allergens, particularly house dust mite, can reduce the risk of virally-induced asthma exacerbations.15 In patients with asthma, allergies and respiratory viral infections act synergistically – pushing the patient over their symptom threshold – to increase the risk of a severe exacerbation.15 Patients with asthma and allergy, who subsequently develop a respiratory viral infection, are at increased risk of hospital admission.15

Before exposure reduction10,11

More than 80% of people with asthma also suffer from rhinitis,16 suggesting the concept of ‘one airway one disease.17,18 The presence of allergic rhinitis commonly exacerbates asthma, increasing the risk of asthma attacks, emergency visits and hospitalizations for asthma.18-22 It is not clear whether allergic rhinitis represents an earlier clinical manifestation of allergic disease in atopic patients who will later develop asthma or whether rhinitis itself is causative for asthma.17-21

One study has demonstrated that allergen exposure reduction can lead to 61% medication reduction in patients with asthma.11

Identifying all the relevant sensitizing allergens will help you outline a comprehensive exposure reduction plan to keep your patient below his or her symptom threshold. Help your patients assess their environments with these tips for reducing exposure to allergic triggers > 

 


 


After exposure reduction
12-14

A study in approximately 900 children with asthma, published in the New England Journal of Medicine, showed that implementing comprehensive avoidance plans (including education and advice on cleaning and physical barriers) which are targeted at all positive allergens can lead to:14

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%)

Allergen testing

When taking blood for a test a 1 ml sample of whole blood is usually sufficient to test for up to 10 different allergens, although up to 3.5ml of serum is required for some respiratory profiles.
 

ImmunoCAPTM Whole Allergen

ImmunoCAP Whole Allergen testing provides an objective measurement of the circulating specific IgE antibodies and the sensitization to a specific whole allergen. Specific IgE antibodies can appear as a result of exposure to an allergen in atopic individuals. ImmunoCAP Whole Allergen measure IgE antibodies to specific allergens in human serum or plasma and allows quantitative measurements of a wide range of individual allergens. Over 550 different allergens are available for determinations.22


 

ImmunoCAPTM Allergen Components

ImmunoCAP Allergen Components measure specific IgE antibodies to individual molecular allergens, in either serum or plasma. These allergens, which are purified, native or recombinant proteins, offer the unique opportunity to assess a person’s allergic sensitization pattern at the molecular level. Different component groups often elicit different types of reactions, so testing them can indicate if a patient’s prior symptoms or positive test results were caused by allergy to a species-specific substance or by a cross-reaction with another allergen. Component testing can also help identify patients who may be good candidates for supervised oral food challenges. Over 100 different allergen components are available for determinations.22

  

Clear results are easy to interpret and explain to patients

The higher the concentration of slgE antibodies, the higher the risk for symptomatic allergy23,24,25

 

Guided by IgE-mediated test results, an individual plan to manage and treat the allergy can be tailored, in order to achieve improved quality of life and overall well-being.

Interpretation of test results

Results should be read in conjunction with the clinical history.24 Patients should be provided with a personalized asthma action plan, including exposure reduction advice for all their confirmed triggers.1

Why Test For Allergen Sensitizations

Most patients with asthma have multiple allergic sensitizations (perennial and seasonal aeroallergens etc.) contributing to their allergen load;9,10 these allergen sensitizations can add to the patient’s trigger load eventually resulting in asthma exacerbations – even from other, non-allergic, triggers.10,11 In patients with asthma and aeroallergy, in addition to pharmaceutical strategies, reducing exposure to sensitized allergens can alleviate or reduce symptoms.7,8, 14,24,25

Allergy Testing
References
  1. National Review of Asthma Deaths (NRAD). Why Asthma Still Kills: Confidential Enquiry Report. London: RCP; 2014.  
  2. Smith HE, Hogger C, Lallemant C, et al. Is structured allergy history sufficient when assessing patients with asthma and rhinitis in general practice? J Allergy Clin Immunol. 2009;123:646-650.  
  3. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl 78):35-41.    
  4. Niggemann B, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by invitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331.    
  5. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007.    
  6. Allen-Ramey F, et al. Sensitization to Common Allergens in Adults with Asthma. J Am Board Fam Pract.  2005;18(5):434-439.    
  7. Host A, Halken S. The role of allergy in childhood asthma. Allergy. 2000;55:600-608.    
  8. Boyce JA, et al.  NIH Guidelines for the Diagnosis and Management of Food Allergy.  J Allergy Clin Immunol. 2010 Dec; 126(6 0): S1–58.  
  9. 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.  
  10. Wickman M. When allergies complicate allergies. Allergy. 2005;60 (suppl 79):14-18.  
  11. Eggleston PA. Control of environmental allergens as a therapeutic approach. lmmunol Allergy Clin North Am. 2003;23(3):533-547.  
  12. Baxi SN and Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. 2010;21(1):57-71.    
  13. Wu F and Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115:971-975.    
  14. Morgan WJ, et al. Results of a Home-Based Environmental Intervention among Urban Children with Asthma. N Engl J Med. 2004;351:1068-80.    
  15. Murray CS, et al. Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax. 2006;61:376–382.  
  16. Pawankar R, Holgate S, Canonica G, at el. World Allergy Organization. White Book on Allergy (WAO). 2011. http://www.worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf. Accessed December 2017.  
  17. Grossman J. One Airway, One Disease. CHEST. 1997:111:2:11S - 16S  
  18. Bousquet J, et al. Allergic Rhinitis and Its Impact on Asthma. J Allergy Clin Immunol. 2001;108(suppl 5):S147–S334  
  19. Thomas M, et al. Asthma-Related Health Care Resource Use Among Asthmatic Children With and Without Concomitant Allergic Rhinitis. Pediatrics. 2005;15:129-134.    
  20. Crystal-Peters J, et al. Treating allergic rhinitis in patients with comorbid asthma: The risk of asthma related hospitalizations and emergency department visits. J Allergy Clin Immunol. 2002;109(1):57-62.    
  21. Valovirta E. Managing Co-Morbid Asthma With Allergic Rhinitis: Targeting the One Airway With Leukotriene Receptor Antagonists. WAO Journal. 2012;5:S210-S211.    
  22. Phadia™ ImmunoCAP™ Specific IgE Directions for Use for the Phadia 250 Laboratory System. Issued September 2017. 
  23. Yunginger JW, et al. Quantitative IgE antibody assays in allergic diseases. J Allergy Clin Immunol. 2000;105(6pt1):1077-1084.  
  24. Zethraeus N, et al. Health-care cost reduction resulting from primary-care allergy testing in children in Italy. Ital J Peds. 2010;36:61.    
  25. Janson, et al. Individualized asthma self-management improves medication adherence and markers of asthma control. J Allergy Clin Immunol. 2009;123:840-6.