Effective allergy management may be one of the best-kept secrets in modern medicine. Allergic rhinitis alone is one of the five costliest chronic conditions in the US, and many allergy-related conditions, such as asthma and anaphylaxis, can be even more serious and costly.
Despite wide availability of allergy testing, from traditional skin-prick testing to more advanced, reliable immunoglobulin E (IgE) blood testing, too few patients are tested for allergy triggers. How can we manage allergies without knowing triggers?
A study in the Journal of Managed Care Pharmacy found that 65 percent of patients who used an oral antihistamine prescribed for allergic rhinitis were not actually sensitized to allergens for which medication had been prescribed. Prescribing antihistamines to these patients was not only wasteful, but it also precluded treatments that might actually have helped their symptoms.
Despite the prevalence of patients with symptoms, allergic and non-allergic rhinitis are commonly misdiagnosed. Nasal irritation incorrectly attributed to an allergen (pollen, for example) can actually be caused by a physical response to irritants in the nostril. In other cases, the wrong trigger is suspected of causing the symptoms. In either case, an antihistamine may have no effect on symptoms. The only way to effectively manage symptoms is to know the underlying cause.
Why do so many patients seek relief without sufficient knowledge of underlying causes? It certainly isn’t for lack of options. IgE testing, which accurately and precisely measures the blood level of IgE antibodies produced in response to exposure to specific allergens, requires only a simple blood draw to reveal a patient’s allergy triggers. Even skin-prick tests, an older method that cannot be administered as readily and easily as blood-based tests, are a better alternative than no testing at all. Knowledge is the most important remedy: By combining patient history and known triggers, a physician is much closer to developing a plan to manage allergic sensitivity.
Every patient is different, and the avoidance of triggers is the key to symptom relief. Allergen sensitivity is cumulative, and avoiding one trigger (household dust, for example) may be enough to decrease or alleviate symptoms, even if a patient is still exposed to another known trigger (ragweed pollen, for example). It is very important to know your allergic sensitization profile.
For treating and managing allergies, as with any medical condition, more information yields better results. It’s time to shed more light on allergy testing – especially widely available, accurate and easy to administer IgE blood testing. Instead of looking to the bottle to find the best-kept secret to allergy relief, it’s time that physicians and their patients look instead at a better diagnosis – through better testing.
Dr. Robert Reinhardt MD is an associate professor of family medicine at the Michigan State University College of Human Medicine. Dr. Reinhardt has served on medical school faculties at the University of Michigan and at Brown University, where he also completed his residency.
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