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Atopic Dermatitis

Guidelines advise that diagnosis of atopic dermatitis starts with a physical examination and an allergy-focused patient history.1,2 Guided by the allergy-focused patient history, the most appropriate next step should be allergy 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 on 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 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.

When clinically assessing patients with atopic eczema, healthcare professionals should seek to identify potential trigger factors including:2

  • Irritants, i.e. soaps, detergents, toiletries, and wool
  • Contact allergens
  • Food allergens
  • Aeroallergens

Common Allergens to Test For: 2

Egg

Egg

Milk

Milk

fish

Fish

Shellfish

Shellfish

wheat

Wheat

Peanut

Peanut

soy bean

Soy Bean

Asthma Symptoms

Tree Nuts

mite

House Dust Mites

animal dander

Animal Dander

pollen

Pollen

Who Should Be Tested

With up to 70% of infants and young children with eczema having an underlying allergy that contributes to disease severity,6,7 healthcare professionals can utilize specific IgE testing to enhance the diagnostic process and pinpoint those allergens. The specific information gleaned from test results can also be used to develop a personalized treatment plan.

Eczema algorithm2

Patient presents with skin manifestations consistent with AD

If Yes
Evaluation based on history and exam diagnostic for AD dermatitis
If No
 
If No
Consideration of other conditions
If Yes
 

Symptom Threshold

 Up to 80% of patients with allergies are sensitized to more than one allergen.The effect is cumulative: An individual patient may have a number of triggers, which, combined, may lead to symptoms.8 The allergen symptom threshold is the point at which the cumulative allergen load leads to symptoms.8

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 may not show symptoms. However, when these allergens add up, they have a cumulative effect, pushing the patient over his or her symptom threshold.8 By reducing exposure to relevant triggers, symptoms can be avoided.8

Identifying all relevant sensitizing allergens will help you outline a comprehensive exposure reduction plan to keep your patient below his or her symptom threshold.

Before exposure reduction8,9

After exposure reduction10-12

Allergen Testing

ImmunoCAPTM Whole Allergen

ImmunoCAP Whole Allergen provides an objective measurement of the circulating IgE antibodies and the sensitization to a specific allergen. Specific IgE antibodies appear as a result of exposure and following sensitization to an allergen. ImmunoCAP Whole Allergen measures IgE antibodies to specific allergens in human serum or plasma and allows quantitative measurements of a wide range of individual allergens and allergen components. Over 550 whole allergens and mixes are available for determinations.


 

ImmunoCAPTM Allergen Components

ImmunoCAP Allergen Components measure specific IgE antibodies to individual molecular allergens in serum or plasma. These allergens, which are purified 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 given substance or by a cross-reaction with another allergen. Component testing also helps the clinician weigh a patient’s risk of a systemic reaction versus a more mild or localized response. Over 100 different components are available for determinations.

Clear results are easy to interpret and explain to patients15

The higher the concentration of slgE antibodies, the higher the risk for symptomatic allergy

Reference 15

 

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;16 patients should be provided with a personalized allergy action plan including exposure reduction advice for all their confirmed triggers.

Why Test For Allergies

Allergic dermatitis has been shown to have significant impact on daily functioning, social health, and emotional health for children and their families:1,16

  • Eczema may result in fatigue and loss of concentration and can provoke behavioral difficulties during childhood.1
  • Children with AD have a worse quality of life than children with asthma, diabetes, or epilepsy17
  • Children suffering from eczema, and their parents, can lose up to 2 hours of sleep per night18

AD usually starts in early childhood as skin barrier dysfunction that may lead to both food and aeroallergens entering through the impaired barrier, initiating immunological reactions and inflammation.1 About half of the children with early-onset eczema develop allergen sensitization by the age of two when eggs and milk are first introduced.19

Allergy Testing

Conditions & Diseases

Understand allergic and autoimmune diseases.

 

References
  1. 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.  
  2. Schneider L, Bernstein D, et al. Atopic dermatitis: A practice parameter update 2012. J Allergy Clin Immunol. 2012;131: 2 295-299.e27.  
  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. Spergel JM. Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements. Am J Clin Dermatol. 2008;9:233-44.    
  6. Eigenmann PA, et al. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998;101:E8.  
  7. 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.  
  8. Wickman M. When allergies complicate allergies. Allergy. 2005;60 (suppl 79):14-18.  
  9. Eggleston PA. Control of environmental allergens as a therapeutic approach. lmmunol Allergy Clin North Am. 2003;23(3):533-547.    
  10. Baxi SN and Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. 2010;21(1):57-71.    
  11. Wu F and Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115:971-975.    
  12. Morgan WJ, et al. Results of a Home-Based Environmental Intervention among Urban Children with Asthma. N Engl J Med. 2004;351:1068-80. 
  13. PhadiaTM ImmunoCAPTM Specific IgE Directions for Use for the Phadia 250 Laboratory System. Issued September 2017. 
  14. Yunginger JW, et al. Quantitative IgE antibody assays in allergic diseases. J Allergy Clin Immunol. 2000;105(6pt1):1077-1084.    
  15. Zethraeus N, et al. Health-care cost reduction resulting from primary-care allergy testing in children in Italy. Ital J Pediatr. 2010;36:61.  
  16. Chamlin SL, et al. Effects of atopic dermatitis on young American children and their families. Pediatrics. 2004;114:607-611.    
  17. Beattie PE, et al. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155:145-51.    
  18. Reid P, et al. Sleep difficulties and their management in preschoolers with atopic eczema. Clin Exp Dermatol.1995;20:38-41.    
  19. Illi S, et al. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol. 2004;113:925-31.