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Rhinitis

Aproximately 65% of patients diagnosed as having allergic rhinitis and prescribed a non-sedating antihistamine are not allergic.1,2 As allergic rhinitis and non-allergic rhinitis have such similar symptoms, but different management, it is imperative to correctly diagnose the cause.3

Guidelines provide a foundation for the process of diagnosing allergic rhinitis, which starts with a physical examination and an allergy-focused patient history.3

Guided by the allergy-focused patient history, the most appropriate next step should be testing for allergen triggers. Specific IgE tests and skin prick tests (SPT) can be leveraged as tools to identify sensitizing allergens and increase diagnostic certainty.4,5

  

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 diseases such as type 2 diabetes and dyslipidemia, specific IgE serological tests aid in the diagnosis of allergic disease. As such, anyone presenting with allergic rhinitis or other allergy symptoms is a candidate for specific IgE testing.

Common Allergens to test for:6

Asthma Symptoms

Pollens

Asthma Symptoms

Foods

Asthma Symptoms

Pets

Asthma Symptoms

Molds

Asthma Symptoms

Dust Mites

Asthma Symptoms

Other Animals

Who Should Be Tested

It is important to consider allergic rhinitis in patients with asthma, eczema, conjunctivitis, sinusitis, polyposis, upper respiratory tract infections, otitis media, sleeping disorders, and in children with learning and attention impairments.

More than 80% of people with asthma also suffer from rhinitis,3 suggesting the concept of ’one airway one disease.7,8 The presence of allergic rhinitis commonly exacerbates asthma, increasing the risk of asthma attacks, emergency visits and hospitalizations for asthma.8-11 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.8-11

Symptom Threshold

Up to 80% of patients with allergies are sensitized to more than one allergen.17

The effect is cumulative: An individual patient may have a number of triggers, which combined may lead to symptoms.18 The allergen symptom threshold is the point at which the cumulative allergen load leads to symptoms. 18

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.18 By reducing exposure to certain triggers, symptoms can be avoided.20-22

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

Before exposure reduction15,16

After exposure reduction18-20

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 IgE antibodies and the sensitization to a specific whole allergen. Specific IgE antibodies can appear as a result of exposure and following sensitization 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 and allergen components. Over 550 different allergens are available for determinations.23


 

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 given 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 ImmunoCAP Allergen Components are available for determinations.23

  

Clear results are easy to interpret and explain to patients

The higher the concentration if slgE antibodies, the higher the risk for symptomatic allergy24

Chart reference 21

Guided by the IgE-mediated test result, 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; patients should be provided with a personalized allergy action plan, including exposure reduction advice for all their confirmed triggers.

Why Test for Allergies

Rhinitis significantly reduces quality of life and results in substantial healthcare costs.26,27 As such, there are several valid reasons why a specific IgE serological test should be considered if your patient is experiencing any symptoms:

  • Avoid unnecessary or inefficient medication
  • Identify all relevant allergy triggers
  • Allergies may change over time
Conditions information

Conditions & Diseases

Understand allergic and autoimmune diseases.
 

References
  1. Szeinbach SL, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004;10(3):234-238.  
  2. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: allergic and non-allergic. Allergy Asthma Immunol Res. 2011;3(3):148-156.  
  3. Pawankar R, 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.  
  4. 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.  
  5. 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.
  6. Smith P. Global Atlas of Allergic Rhinitis and Chronic Rhinosinusitis. 2015. http://www.eaaci.org/globalatlas/ENT_Atlas_web.pdf. Accessed December 2017.  
  7. Grossman J. One Airway, One Disease. CHEST. 1997:111:2:11S - 16S  
  8. Bousquet J, et al. Allergic Rhinitis and Its Impact on Asthma. J Allergy Clin Immunol. 2001;108(suppl 5):S147–S334. 
  9. Thomas M, et al. Asthma-Related Health Care Resource Use Among Asthmatic Children With and Without Concomitant Allergic Rhinitis. Pediatrics. 2005;15:129-134.  
  10. 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.    
  11. Valovirta E. Managing Co-Morbid Asthma With Allergic Rhinitis: Targeting the One Airway With Leukotriene Receptor Antagonists. WAO Journal. 2012;5:S210-S211.    
  12. Wallace DV, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(suppl 2):S1-S84.
  13. Wheeler PW, et al. Vasomotor rhinitis. Am Fam Physician. 2005;72(6):1057-1062.  
  14. Welsh N, et al. The pharmacoeconomic impact of ImmunoCAP testing on the usage of second-generation antihistamines and a leukotriene receptor antagonist at Wilford Hall Medical Center. J Am Pharm Assoc. 2006;46(5):624-640.  
  15. Papadopoulos, et al. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy. 2015; 70; 474–494  
  16. Molderings et al. Mast cell activation disease: a concise practical guide for diagnostic workup and therapeutic options. J Hema & Onc. 2011; 4:10  
  17. 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.  
  18. Wickman M. When allergies complicate allergies. Allergy. 2005;60 (suppl 79):14-18.
  19. Eggleston PA. Control of environmental allergens as a therapeutic approach. lmmunol Allergy Clin North Am. 2003;23(3):533-547. 
  20. Baxi SN and Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. 2010;21(1):57-71.  
  21. Wu F and Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115:971-975.    
  22. Morgan WJ, et al. Results of a Home-Based Environmental Intervention among Urban Children with Asthma. N Engl J Med. 2004;351:1068-80.    
  23. Phadia™ ImmunoCAP™ Specific IgE Directions for Use for the Phadia 250 Laboratory System. Issued September 2017.
  24. Yunginger JW, et al. Quantitative IgE antibody assays in allergic diseases. J Allergy Clin Immunol. 2000;105(6pt1):1077-1084.  
  25. Zethraeus N, et al. Health-care cost reduction resulting from primary-care allergy testing in children in Italy. Ital J Pediatr. 2010;36:61.  
  26. Scadding GK. Optimal management of allergic rhinitis. Arch Dis Child. 2015 Jun; 100(6): 576-582.  
  27. Bousquet, J., et al. Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper. Allergy. 2008;63: 842–853.