300 million people 300 MILLION PEOPLE

Asthma affects approximately 300 million people in the world,3 nearly 1 in 10 people in Ireland.4 More than 80% of people with asthma also suffer from rhinitis3

300 million people INCREASED RISK OF FATAL ANAPHYLAXIS

Patients with asthma, plus allergy to peanuts or tree nuts, are at an increased risk of fatal anaphylaxis5,6. It has been demonstrated that early diagnosis followed by active management can reduce asthma costs by more than half3

300 million people 3 PEOPLE STILL DIE EVERY DAY FROM ASTHMA

The NHS spends around £1 billion a year treating and caring for people with asthma. Despite this asthma exacerbations hospitalise someone every 8 minutes, hospitalise a child every 20 minutes and on average 3 people die a day from asthma6

The benefits of allergy testing

Allergies trigger asthma exacerbations in 60-90% of children and 50% of adults with asthma.1,2

The UK National Review of Asthma Deaths recommends that factors that trigger or exacerbate asthma must be elicited routinely and documented in the medical records and personal asthma action plans of all patients with asthma.7

Most patients with allergies have multiple allergic sensitivities (perennial and seasonal aeroallergens etc.) contributing to their allergen load;8 these allergen sensitisations add to the patient’s allergen/trigger load eventually resulting in asthma exacerbations – even from other, non-allergic, triggers.9,10

Reducing exposure to sensitised allergens can improve control9-15

Symptoms occur when patients reach their symptom threshold

  • Allergen exposure reduction can lead to 61% medication reduction in patients with asthma9
  • Improving indoor environments can result in up to a 30% reduction in asthma symptoms10
  • A study in approximately 900 children with asthma, published in the New England Journal of Medicine, showed that implementing comprehensive avoidance plans (including education and advice on cleaning and physical barriers) which are targeted at all positive allergens can lead to:11

Allergy testing can lead to savings of £210 per patient by year 212

*Initial sIgE testing decreased the average number of medication episodes over 2 years by 11% for antihistamines, 70% for bronchodilators, and 51% for corticosteroids. 

Go beyond symptoms
and identify the cause

  • Avoid unnecessary prescriptions
  • Avoid unnecessary consultations/referrals
  • Reduce the prescription burden and save costs
  • Reduce time off school, college or work and reduce waiting lists
  • Save time, costs and help patients live a less encumbered life

- Early diagnosis of allergy
- Determine the right treatment plan

  • Reduce emergency admissions
  • Reduce unnecessary prescriptions, consultations and referrals
  • Improve controls
  • Enable patients to take part in normal daily activities
  • Save time, costs and help patients live a less encumbered life

Active
management

  • Improve quality of life

Common allergens

Asthma history

Asthma usually presents as one or more of wheezing, coughing, shortness of breath and chest tightness. Other symptoms of asthma can include gastric reflux and vomiting (often as a result of coughing). When managing asthma it is important to identify and minimise exposure to the manageable triggers.5,9-15

Diagnosing allergy in asthma starts with a physical examination and an allergy-focused patient history

History alone is not enough;16 don’t guess – test

With aeroallergens, history is often not enough. Patients can present with a history indicative of house dust mite or cat allergy but actually not be sensitised,16 likewise they can present with no indicative history and the cat may be the primary trigger – hence it is important to test for the most common triggers in patients with asthma.

Download an expert-endorsed asthma review template

Download

Testing & recommendations

Consider conducting a blood test (allergen-specific IgE), or by trained, competent clinical staff, in a clinical environment with sufficient clinical support and facilities to manage anaphylaxis, a skin prick test17 to test for the common allergens triggering asthma. Specific IgE testing can be performed on any patient irrespective of age, allergic symptoms (i.e. eczema) and medication.

When taking blood for a test a 1 ml sample of whole blood is sufficient to test for up to 10 different allergens.

Interpretation of test results

Results should be read in conjunction with the clinical history; patients should be provided with a personalised asthma action plan including exposure reduction advice for all their confirmed triggers.

Download an asthma action plan

Download

Confirm the likely triggers

Interpret the test results alongside the allergy-focused clinical history.12 A specific IgE result of ≥0.1 kUA/L indicates sensitisation

Patient with...**

Asthma and confirmed food allergy

  • Refer to secondary care
  • Ensure the patient's asthma is well controlled and consider prescribing an adrenaline autoinjector

Asthma and confirmed pollen/mould allergy

  • Provide exposure reduction advice to the specific mould or pollen 
    Visit Allergy UK
  • Consider seasonal daily antihistamines and nasal steroids targeted to the peak pollen/mould season
    View the pollen calendar
  • For patients with sensitisation to mould, especially Alternaria Sp. provide advice around minimising exposure before and after thunder storms18
  • Consider adapting asthma medication

Asthma and confirmed pet allergy

  • Provide exposure reduction advice to the specific pets 
    Visit Allergy UK
  • Optimise treatment and consider regular antihistamines

Asthma and confirmed house dust mite allergy

  • Provide exposure reduction advice19
  • Consider regular antihistamines and nasal steroids if symptoms persist

*Skin prick tests should be undertaken where there are facilities to deal with anaphylactic reaction17

**Adapted from expert-endorsed asthma history template. Click here to download

When to refer

The NICE guideline on food allergy offers specific advice on which patients should be referred to secondary care.17

Managing anaphylaxis

Managing allergy is painless

Dr Susan Leech discusses patient management and when to issue patients with an adrenaline autoinjector.

Printable action plans

To ensure your patient follows your management advice, it is important to provide them with an action plan.

Download these useful action plans to guide your management of allergy patients:

Management & referral

Prof Somnath Mukhopadhyay discusses the management of children and young adults with asthma.

The benefits of reducing allergen exposure

Avoidance or reduction in exposure to allergens can alleviate or reduce symptoms.

In patients with asthma and aeroallergy, in addition to pharmaceutical strategies, it has been shown that exposure reduction advice tailored to the patients confirmed triggers can have a significant impact on control.9-15 

Learn more..

In patients with asthma and confirmed food allergy, NICE recommends referring the patient to secondary care. Patients with asthma and food allergy are at increased risk of fatal anaphylaxis. Food should be removed from the diet in consultation with a dietitian.17

References
  1. Allen-Ramey F, et al. J Am Board Fam Pract 2005;18(5):434-439.
  2. Host A, Halken S. Allergy 2000;55:600-608.
  3. Pawankar R (Ed), et al. White book on allergy, 2011; World Allergy Organisation UK.
  4. Asthma Society of Ireland. Available from https://www.asthma.ie/get-help/resources/facts-figures-asthma; last accessed August 2016.
  5. Punekar YS and Sheikh A. Clin Exp Allergy 2009; 39:1889-1895.
  6. Asthma UK. Available from https://www.asthma.org.uk/about/media/facts-andstatistics/;last accessed April 2017.
  7. Why asthma still kills – the National review of Asthma Deaths (NRAD), Confidential Enquiry report – May 2014. Available from: https://www.rcplondon.ac.uk/sites/default/files/whyy-asthma-still-kills-full-report.pdf last accessed April 2017.
  8. Ciprandi G, et al. Eur Ann Allergy Clin Immunol 40(3); 2008: 77-83.
  9. Eggleston PA. lmmunol Allergy Clin North Am 2003;23(3):533-547.
  10. Wickman M. Allergy 2005;60 (suppl 79):14-18.
  11. Morgan WJ, et al. N Engl J Med. 2004;351(11):1068-1080.
  12. Zethraeus N, et al. Italian Journal of Pediatrics 2010;36:61.
  13. Liao, et al. Journal of School Health. 2006; 76(6):313-319.
  14. Janson, et al. J Allergy Clin Immunol 2009;123:840-6.
  15. Griffin R, et al. Clin Exp Allergy 2014;45:492-540(O.6).
  16. Smith HE, et al. J Allergy Clin Immunol 2009;123:646-50.
  17. National Institute for Health and Clinical Excellence. Food allergy in children and young people (CG116). 2011. London: National Institute for Helth and Clinical Excellence.
  18. D'’Amato G, et al. Clin Exp Allergy 2016;46:390-396.
  19. Murray CS, et al. Am J Respir Crit care Med 2017; doi: 10.1164/rccm.201609-1966OC [Epub ahead of print].