Is structured allergy history sufficient when assessing patients with asthma and rhinitis in general practice?
ABSTRACT Many United Kingdom patients with asthma and rhinitis are allergic, but in primary care few diagnostic and management decisions are made with formal allergy assessment. Arguably, knowing a patient's atopic status might be helpful in distinguishing the cause of disease and in selecting appropriate treatments.
Our objective was to estimate the extent to which a formal allergy assessment (a structured allergy history and skin prick tests to 5 common aeroallergens) would improve the precision of allergy diagnosis compared with a patient's self-report or the structured allergy history alone.
One hundred twenty-seven patients with asthma, rhinitis, or both were recruited from 4 general practices in Wessex, United Kingdom. Allergy status based on the patient's opinion and on structured allergy history alone was compared with formal allergy assessment. Assessments were validated by an independent allergy specialist reviewing the files. Patients were given written advice specific to their allergies and followed up 3 months later to assess satisfaction, recall, and effect on health and behavior.
Self-reporting misclassified allergic status in many patients. A structured allergy history alone was little better and resulted in false-positive rates for cat allergy of 32%, grass pollen of 48%, house dust mite of 75%, tree pollen of 54%, and dog of 27% compared with formal allergy assessment. Skin prick testing combined with a structured history was essential to reach a correct causative diagnosis. Three months later, 41% patients had made changes to lifestyle, medications, or both, and 18% reported clinical improvement.
Skin prick testing improves the accuracy of an assessment of allergic status based on patient opinion or a structured allergy history alone.
- SourceAvailable from: Lain Pontes-de-Carvalho
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- "The majority of the methods for detecting anti-allergen IgE antibodies is based on the use of natural allergenic extracts, a fact that may compromise the interpretation of their results. Natural allergen extracts are highly complex molecular mixtures, containing many proteins, of which only some have allergenic properties, and with their relative contents varying greatly from one extract to another [6,7]. Caraballo and collaborators  described at least 25 IgE-binding protein bands in B. tropicalis crude extract. "
ABSTRACT: Background Blomia tropicalis is a dust mite and an important source of allergens in tropical regions. Up to now, the assays to diagnose atopy to this mite use whole body extract as antigens. However, anti-B. tropicalis IgE antibodies cross-react with Ascaris lumbricoides antigens, hindering the diagnosis of allergy to this mite. In this study, B. tropicalis recombinant allergens were evaluated with the purpose of developing an immunodiagnostic assay for allergy to this mite with greater specificity than those commercially available. Methods Two B. tropicalis allergens (Blo t 5 and Blo t 21) were cloned into a plasmidial expression vector, expressed in Escherichia coli and purified by affinity chromatography. Sixty-three sera containing anti-B. tropicalis extract (BtE) IgE antibodies were used to investigate IgE reactivity to the recombinant Blot 5 and 21 allergens. Inhibition assays with 20 sera pre-adsorbed with A. lumbricoides extract were performed using rBlo t 5, rBlo t 21, and BtE as antigens. All the assays were carried using indirect ELISA. Results Eighty-two point nine percent and 80.0% of the sera with anti-BtE antibodies from 35 children reacted with rBlo t 5 and rBlo t 21, respectively, whereas 92.8% and 89.3% of the 28 sera with anti-BtE antibodies from adult asthma patients reacted with the same allergens, and 96.4% of these sera reacted with a mixture of rBlo t 5 and rBlo t 21. In an inhibition ELISA, the absorption of sera by A. lumbricoides extract affected less the reaction with rBlo t 5 and rBlo t 21 than with BtE. Conclusions The rBlo t 5 and rBlo t 21 allergens contain important epitopes recognized by IgE antibodies of individuals allergic to B. tropicalis antigens. Moreover, the assays using the recombinant allergens had lower IgE cross-reactivity with A. lumbricoides antigens, a fact which would confers higher specificity to serodiagnostic assays than the crude mite extract. However, additional recombinant allergens should be evaluated in order to reach the same sensitivity of the commercially available assays based on mite extract.BMC Immunology 02/2013; 14(1):11. DOI:10.1186/1471-2172-14-11 · 2.25 Impact Factor
Article: [Asthma and pregnancy].[Show abstract] [Hide abstract]
ABSTRACT: A 23-year-old nonsmoking woman (gravida 1, para 0) presents at 11 weeks' gestation with an 8-year history of asthma, which has worsened over the past year. She reports asthma symptoms requiring albuterol two or three times per day and interfering with sleep two or three nights per week. A corticosteroid inhaler was prescribed before pregnancy, but she has been afraid to use it. Cleaning her house triggers asthma, and she has had a cat at home for 1 year. Her forced expiratory volume in 1 second (FEV1) is 75% of the predicted value; it increases to 88% of the predicted value after adminis- tration of albuterol. How should her case be managed?Quaderni di clinica ostetrica e ginecologica 11/1966; 21(10):739-46.
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