Allergy Assessments

Quantifies patient-assessed symptoms of rhinorrhoea, nasal congestion and nasal itching or sneezing on a 3-point scale. A normal score is ≤ 2.8 (with a maximum score of 9) (Downie et al. 2004) For access and permissions click here

Can be useful for monitoring allergy symptom severity (Bousquet et al. 2015). This is also currently freely available in a mobile phone app which can be found here.

A quality of life questionnaire to developed to measure functional problems in adults with rhinoconjunctivitis (Juniper 1997). For access and permissions click here

A validated score for sino-nasal disease with 4 domains: rhinological, psychological, sleep, ear/facial. A normal is 9.3 ± 1.8, a score >40 indicates likely sinonasal disease (Hopkins et al. 2009)

An adequate SPT battery will contain:

• a positive (histamine) control
• a negative (glycerol saline) control
• house dust mite (Dermatophagoides pteronyssinus +/-D farinae))
• animal danders – usually dog and cat but may include horse and others if relevant
• a variety of pollen allergens that vary according to geographical region but may include any or all of the following: perennial rye grass, Bermuda grass, Bahia grass, parietaria, plantain, olive tree, plane tree, cupressus tree;
• common fungi e.g. Alternaria, Aspergillus, Cladosporium
• other allergens can be included according to patient history.

Relative contraindications to SPT include active skin rashes, significant dermographism and an inability to withhold drugs that interfere with the assay (oral and topical anti-histamines, antidepressant medications including doxepin and any tricyclic antidepressant)

For information on SPT methods click here

Total serum IgE measurements are not usually helpful for severe asthma, except for access to omalizumab monoclonal therapy (which requires a serum IgE > 30 IU/mL) and for the monitoring of allergic bronchopulmonary aspergillosis (ABPA). For more information see Medication – Monoclonal Antibodies

Assessment of serum-specific IgE may be useful when skin testing is not available or there are relative contra-indications to SPT. Medicare will rebate 4 allergens at one time, which can be repeated x 4 per annum. Further information on performing assessment and interpretation are available here

Can identify chronic rhinosinusitis with / without polyps and help determine whether surgery may be of assistance

Can be useful to identify signs consistent with allergic rhinitis, to identify nasal polyps and to examine the posterior nasopharynx, oropharynx, laryngopharynx (which can indicate candidiasis, vocal cord dysfunction, or upper airway collapse consistent with obstructive sleep apnoea) For more information see Comorbidities – Rhinitis, Vocal Cord Dysfunction & Obstructive Sleep Apnoea

May be appropriate in the following circumstances and should only be conducted by those with expertise in the relevant techniques (Allergists/Clinical Immunologists) under safe circumstances with ability to treat anaphylaxis or severe acute asthma:

• Diagnosis of occupational asthma (Vandenplas et al. 2014)
• Elimination diet and challenges for diagnosis of food chemical sensitivity. This includes: salicylates, aspirin, MSG, amines, preservatives such as sulphites, food colourings (Further information about food intolerance is available here)
• Diagnosis of aspirin exacerbated respiratory disease (AERD), by means of aspirin or lysine aspirin challenge. For more information click here or (Stevenson et al. 2015)
• Topical (ocular, intranasal) challenge with suspected allergen when skin and serum testing is negative, to demonstrate a local allergic response.

Avoidance of a particular allergen where appropriate and feasible or avoidance of implicated food chemical or drug(s) may be useful to minimise symptoms

Treatment of the relevant allergic co-morbidity (e.g. allergic rhinitis, chronic rhinosinusitis), may improve asthma symptoms or response to asthma medications

May be considered for treatment of allergic rhinitis, or both allergic rhinitis and asthma. Immunotherapy is safe provided asthma is stable and FEV₁ > 70% of predicted.

Resources for subcutaneous immunotherapy (SCIT) are available here

Online e-training for allergen immunotherapy is available here