Severe Asthma ToolkitSevere Asthma Toolkit
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  • What is Severe Asthma?
    • Overview
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  • Diagnosis & Assessment
    • Overview
    • Diagnosis Overview
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    • Allergy Assessments
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    • Bronchoscopy
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      • About Severe Asthma
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    • Monoclonal Antibodies
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  • Co-Morbidities
    • Overview
    • Pulmonary & Upper Airways
      • Allergic & Non-Allergic Rhinitis
      • Chronic Rhinosinusitis
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      • Vocal Cord Dysfunction
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      • Bronchiectasis
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      • Obesity
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  • Living with Severe Asthma
    • Overview
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    • Experience of Asthma Attacks
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  • Paediatrics
    • Overview
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Allergy Assessments

Home Diagnosis & Assessment Allergy Assessments
Allergy Assessment

Allergy Assessments

Allergy assessment can be useful to:

  • Determine the allergy profile of the patient with severe asthma
  • Determine the presence and severity of co-morbidities (e.g. rhinitis, chronic rhinosinusitis (CRS), anaphylaxis, eczema or atopic dermatitis, food and drug related reactions). For more information on comorbidities, click here

Specific allergic triggers that may be assessed include:

  • Inhalant and food (if appropriate) allergy
  • Food chemical intolerance
  • Drug reactions

Allergy Assessment

A systematic assessment for allergy may include the following elements:

  • Specific clinical history
  • Questionnaires to assess symptom severity and impact on quality of life:

    These are useful for documenting asthma severity and changes. NOTE: Questionnaires may aid clinical decision making, but should not be the sole determinant on which a clinical decision is made.

Total Nasal Symptom Scores (TNSS)
Visual Analogue Scale (VAS) Assessments of Disease Severity
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)
Sino-Nasal Outcome Test (SNOT22)
Total Nasal Symptom Scores (TNSS)

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

Visual Analogue Scale (VAS) Assessments of Disease Severity

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.

Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)

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

Sino-Nasal Outcome Test (SNOT22)

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)

  • Specific tests

    The following assessments may be useful for the identification of specific allergic mechanisms and triggers.
Skin prick tests (SPTs)
Total serum IgE
Serum-specific IgE testing
CT Scan Paranasal Sinuses
Rhinoscopy
Allergen Challenge Testing
Skin prick tests (SPTs)

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

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

Serum-specific IgE testing

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

CT Scan Paranasal Sinuses

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

Rhinoscopy

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

Allergen Challenge Testing

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.

  • Treatment options:

    A number of treatment options can be considered if allergies are identified.
Avoidance
Treatment of a Relevant Co-morbidity
Immunotherapy
Avoidance

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 a Relevant Co-morbidity

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

Immunotherapy

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

Additional Resources:

  • ASCIA Allergic Rhinitis Clinical Update
  • ASCIA Health Professionals e-Training
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Last Updated on September 30, 2022

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  • Overview
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