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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.
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
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
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.
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
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
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.
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.
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: