When spring allergy symptoms persist

Persistent respiratory symptoms during pollen season: Why primary care clinicians should consider specific IgE blood testing

Spring is a busy time in primary care. Patients present with nasal congestion, rhinorrhea, sneezing, cough and sometimes wheeze. It can be easy for clinicians to assume symptoms are allergy-related — and suggest antihistamines or a nasal spray as treatment options, which are commonly recommended in clinical practice guidelines.¹  But symptoms alone do not confirm allergic disease.

Without testing, it can be difficult to distinguish allergic rhinitis from non-allergic rhinitis, particularly when viral triggers or asthma overlap may be contributing.²  Specific IgE blood testing can help determine whether IgE-mediated sensitization is present and support more targeted management from the start.

When allergy is confirmed, clinicians can discuss practical avoidance strategies, such as keeping windows closed during high pollen counts, showering after outdoor exposure or reducing indoor allergen exposure. Allergen avoidance has been associated with improvements in symptom control and quality of life.³  Testing provides a clearer foundation for these conversations.

Why symptomatic treatment alone often fails in pollen-related respiratory disease

Medication plays an important role in managing rhinitis. However, real-world data suggest that treatment is not always optimized. In one study, nearly 90% of patients reported using symptomatic medication, yet only 14.4% were using the guideline-recommended combination of an intranasal corticosteroid and an antihistamine.⁴

Effective management may include more than medication alone. Comprehensive care can involve allergen avoidance, patient education and consideration of allergen immunotherapy (AIT).²

Without getting to the bottom of symptoms, these additional management options may never be discussed. As a result, care may remain focused on repeated pharmacologic symptom relief rather than addressing the underlying cause. Confirming whether symptoms are allergy-driven can help shift the approach from reactive treatment to targeted management.

When persistent respiratory symptoms require diagnostic clarification

Seasonal allergic rhinitis is often intermittent. However, symptoms may persist when pollen seasons overlap or when asthma or non-allergic rhinitis is also present.

Although diagnosis is sometimes based on history alone, phenotyping can be challenging in routine practice. A medical history, physical examination and objective testing such as a specific IgE blood test may be needed to guide diagnosis.

Because the symptoms of allergic rhinitis are often nonspecific, distinguishing it from other causes of persistent respiratory symptoms can be clinically challenging.⁵  Early objective testing can therefore play an important role in clarifying the diagnosis and guiding appropriate management.

How overlapping pollen exposures can prolong respiratory symptoms

Many patients are sensitized to more than one allergen. When exposures overlap, symptoms may last longer than expected for a single pollen season. Specific IgE blood tests are recognized tools to help differentiate allergic from non-allergic rhinitis.²

Why identifying allergic triggers matters in primary care

Identifying the trigger changes the management conversation.

When sensitization to a specific allergen is identified, clinicians can offer targeted advice rather than general recommendations. Allergen avoidance has been shown to reduce disease burden. In one study, inner-city children with atopic asthma were provided with individualized environmental intervention assistance that helped reduce asthma-associated morbidity.³

In a review of randomized controlled trials and observational studies, it was found that 15 out of 18 studies reported improvements in symptom scores, quality of life or medication use following avoidance strategies.⁷

How early identification of allergic sensitization supports long-term outcomes

Allergic rhinitis is often perceived as mild and seasonal. However, symptoms can persist and may be associated with future asthma risk.

Children with pollen-related allergic rhinitis are more likely to continue experiencing symptoms into young adulthood and have an increased risk of developing asthma compared to non-allergic individuals.⁴

AIT is effective for allergic rhinitis and should be considered for patients with specific IgE antibodies to clinically relevant allergens.¹

Real-world evidence suggests that sublingual immunotherapy is associated with a reduction in the risk of asthma onset or worsening.⁸

Identifying clinically relevant sensitization supports informed discussions about long-term management and referral when appropriate.

The role of specific IgE blood testing in primary care

When an allergy is suspected, objective confirmation matters.

ImmunoCAP™ Specific IgE blood test is a clinically proven method for identifying allergen sensitization and supporting personalized allergy care. Backed by more than 50 years of leadership in in vitro allergy diagnostics, ImmunoCAP tests deliver accurate, reproducible results that align with international guidelines and support confident diagnosis and management decisions.

Testing can be performed during the pollen season and does not require patients to stop antihistamines, making it practical in everyday primary care.

Key features include:

• Suitable for children and adults
• Ability to test multiple clinically relevant allergens
• Objective results that support clinical decision-making
• No interference from antihistamines

Guidelines recommend confirming the diagnosis of allergic rhinitis with objective testing, such as specific IgE testing, when the clinical history is consistent with allergy.¹  In primary care, testing can help answer a simple but important question: Is this truly allergy?

Explore four key reasons respiratory allergy diagnostics are essential in primary care.

Key takeaways for primary care practice

When spring symptoms persist, continuing empiric treatment alone may leave important questions unanswered.

Confirming allergic sensitization can help:

• Clarify diagnosis
• Identify relevant triggers
• Support targeted avoidance strategies
• Inform referral and long-term management decisions

Persistent seasonal symptoms warrant diagnostic clarity.

When symptoms continue beyond the expected pattern, consider confirming allergic sensitization before continuing or escalating symptomatic therapy.

Learn how ImmunoCAP specific IgE blood testing can support allergy diagnosis in primary care.