EVALUATION OF ALLERGY IN ASTHMA

EVALUATION OF ALLERGY IN ASTHMA Gülfem E. Çelik, MD Ankara University Department of ChestDisease Division of Allergy

Questions 1.Association of asthmawithallergy • What is allergy? • Areeveryasthmaticsallergic? 2. Allergytests: aretheynecessary? Whyarewedoing? • Anyeffect on treatment? 3. Howcouldallergy be evalauted in asthma? Whichtests, when? 4. General issuesrelatedtotests? • Inourcountry • What can be done?

Hypersensitivityreactions: re-occurence of thereactionsafter re-exposuretostimuli in sensitizedsubjects but in normals Allergy: Hypersensitivityreactionsmediatedbyimmunemechanisms (Type 1,2,3,4) Atopy:TendencytosyntheseIgEtocommonenvironmentalallergens

Asthma Nonallergic Asthma AllergicAsthma ~50% of asthmaticsareallergic!

Asthmaandallergy

Allergenspecificprovocation Specific IgE

Evaluatıon of allergy 1. History Demographic features: Age, sex, occupation, living area History: Symtoms(particularly presence of rhinitis and conjunctiivitis) When ? Any seasonality in symptoms? Factor aggrevating the symptoms Exposure to cat/dog Expoure to pollens Exposure to dust History of allergic disease in childhood (atopic dermatitis, food allergy) History of atopy in family Hobbies, environmental conditions

Whom do wesuspectfromallergybased on hıstory?

Perennialsymptoms Persistantsymptoms Increase in symptomsindoorenvironment Symptomwithexposuretodust Symptomspredominated at nights Living in humidarea Housedustmites Symptomsupontoexposureto pet Cat/Dog Symtomsparticularly in mayandJune Co-occurence of rhinitis Morefrequent in youngadults Grasspollens Perennialsymptoms Persistantsymptoms Increase in symptomsindoor Problem at home! (moldyarea) Moulds

Question: What is thevalue of history in diagnosis of allergy?

Question Answer: No

Which test should be selected? Specific IgE

Skin Prick/Puncture Tests Thefirstoptionunless a contraindicationexists.

Intradermaltests Could be performed in caseswithconvincing history but negativepricktests

Measurement of SpeCIfICIgE Should be preferredif skin pricktests couldn’t be performed >0.35 KU/l (+); >0.7KU/l; had clinical importance

Availableequıpmentformeasurement of specıfıcıge

Allergydiagnosisshould be based on positive test resultscompatible withsymptoms.

35 yearsold, malesubject • Diagnosis: Asthma • Clinical presentation: • Perennial symptoms • No seasonality • Sepcific IgE: Positivity in grass pollens • 45 yearsoldfemalesubject • Diagnosis: asthma • Clinical presentation: • Symptoms predominated at nights • Increase in symptoms when exposed to dust and while cleaning • Skin tests: Positivity in house dust mites Test result is not compatiblewithclinicalpresentation Test result is compatiblewithclinicalpresentation

summary: Allergytests • Prick tests should be performed first unless a contraindication exits • Intradermal tests could be performed in cases with positive (convincing) history but negative skin prick tests • Evaluation of specific IgE should be done if prick tests couldn’t be performed. • Allergy diagnosis should be based on positive test results compatible with symptoms.

General ısSuesrelatedtoalergytests“skıntests” • The validity and quality of extracts used in tests • Evaluation of test technique, requirement of trainned personnel • Selection of aeroallergen panel • Reporting of test results

Thestudieswhıchınvestıgatetheeffecacy of allergensusedıntestsarecontınuıng

New development: use of recombınantallergensınskıntests

Testsshould be performedbyspecıallytraınnedpersonnel

Number of allergensare not standart History Geographiclocalizationandplantation (crossreactivity of allergens) Hobbies, habits Occupation Travelling

Standardızatıon of skın test panel ıneurope • Cat • Dog • Der.p • Der.f • Blatella • Tree mix • Olive tree • Cypress • Plane • Grass mix • Artemisia • Ambrosia • Parietaria • Cladosporium • Aspergillus Heinzerling L et al. Allergy 2005; 60:1287-1300

Test reportsare not standardızed • Name of the center • Name of physician and thecnician • Contact adress and phone/fax numbers of the physician • Date and time • Current medications of the patient • Which test(intradermal, prick) • Allergen panel and company • Device (lancet, multi-dip etc) • Test area (arm, back) • Exact measurement should be given Test report

Summaryfor general ıssues relatedtotests • There is an attempt to improve the quality and validity of allergen extracts • A standardized test panel seems to be reasonable although some regional allergens could be added to the panel • More common use of standardized test reports

General ıssuesrelatedtoallergy test ınourcountry

Report of Allergy Skin Test Name of center: Name of physician: Name of thecnician: Date: Time: Contactaddress: Medications Co-morbidedisorders Test appled: □Prick □ Intradermal Allergenkits: Test area: □ arm □Back Vehicle: □ Lancet □ Multidip TEST PANEL Pozitive control: Negative control: • Mixture of Grasspollens • Treepollens • acer • Poplar • Cyress • Plane • Weed • Chenopodium • Plantago • Artemisia • Housedustmites • Mould • Alternaria • Cladosporium • Aspergillus • Cockroaches • Cat • Dog Comment:

summary • Evaluation of allergy has significant effect on asthma management • This approach should be started from history taking. • Tests should be planned according to need of the patient • Allergy tests should be performed by trainned personnel • Why am I doing this test?

EVALUATION OF ALLERGY IN ASTHMA