Jill is about to have asthma symptoms and she won t know why. Timothy grass ASTHMA Dog dander House dust mites Underlying allergies affect asthma Discover the connection Specific IgE blood testing helps you identify allergic triggers, allowing you to develop a management plan.
Discover the connection between asthma and allergy Recognize that asthma rates and its costs are increasing. 1 ~25 million people in the United States have asthma 2 Asthma exacts a major clinical and economic toll 1,3-5 1.8 million ER visits 497,000 hospitalizations Common triggers that may induce or worsen asthma: 86% of patients taking controller medications experience daily symptoms 7 Up to 31% of costs spent on medications $37.2 billion (annual direct costs of asthma care) Cost per symptom day ranges from $79.43 to $126.71 SEASONAL ALLERGENS IRRITANTS PERENNIAL ALLERGENS Per patient annual direct costs of asthma care range from $2,646 to $12,813 6 INFECTIONS COMORBIDITIES 2 3
Discover the connection between asthma and allergy The majority of asthma patients suffer from allergies. 8-10 Combination of allergy and viral infections increases the risk for severe asthma exacerbation. 11 Odds ratio/risk of hospitalization 100 90 80 70 up to 90% 60% of children 8 of adults 10 Allergen exposure, sensitization, and viral infection Sensitization and viral infection Synergistic effect 60 50 Viral infection only 40 30 20 10 0 5 10 15 20 25 Multivariate analysis of odds ratios (95% CI) for risk factors of hospital admission for acute asthma exacerbation in children ages 3 to 17 years. 11 A nearly 20-fold increased risk for hospitalization for patients with asthma, allergen exposure, and viral infection compared to patients with asthma alone. 11 Identifying triggers early is the key to improved patient management. 4 5
Uncover the benefits of allergen exposure reduction Identify the allergic triggers that can lead to asthma symptoms Reducing allergen exposure improves asthma control 13 MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB ASTHMA SYMPTOM THRESHOLD Symptoms appear when asthma patients reach their symptom threshold 12,13 Grasses Irritants (e.g. cigarette smoke) Mold Viral infections Viral infections SYMPTOM OF ASTHMA DAYS/YEAR 120 CONTROL INTERVENTION 110 100 90 80 70 60 Intervention year Follow-up year 34 fewer days of wheezing over 2 years 13 House dust mite 90% of people suffering with allergies are sensitized to multiple allergens 14 4.4 2.1 21.3 Fewer missed school days per year Fewer emergency room/ clinic visits per year Fewer symptom days per year Identifying allergic triggers will help you manage patients. Inner-City Asthma Study (ICAS). Controlled trial of environmental interventions (education and remediation) for exposure to allergens and environmental tobacco smoke. Symptom results per patient for intervention year and follow-up year. 13 6 7
Specific IgE blood testing results plus case history improves confidence in diagnosis Case history alone may not be enough... Confidence in diagosis has been shown to increase when specific IgE results are added to clinical history 15,16 % of patients 100 75 50 25 50 % 90 % Specific IgE blood testing can easily be performed irrespective of: Patient age Skin condition Medication Disease activity Pregnancy status No precaution for severe reactions as with skin-prick test (SPT) Test results Diagnosis 0 Case history only Addition of Specific IgE (n=1101) Case history Adapted from: Duran-Tauleria E. Allergy 2004; 59 (suppl 78): 35-41. Niggemann B. Pediatr Allergy Immunol. 2008; 19:325-331. Study among patients with symptoms of eczema, wheezing and/or asthma, and rhinitis in primary care. 15,16 NIH guidelines recommend specific IgE testing in addition to clinical history and physical exam for patients with asthma 17 8 9
Specific IgE blood test results play a key role in making the correct diagnosis NIH guideline based asthma care 17 Clear results are easy to interpret and explain to patients 17,18 Persistent Asthma: Daily Medication Common symptoms: nighttime awakenings, cough, wheeze, shortnesss of breath, tightness in the chest Etiological Evaluation Order Respiratory Inhalant Allergens Positive Specific IgE Results Proportion of individuals with symptomatic allergy (probability %) Symptom Relation Uncommon Low Common 0.10.3 13 10 30 100 IgE antibody concentration (ku A /l) High Very High Educate patient on environmental control Tailor Pharmacotherapy * Factors to consider for a final diagnosis: Age, degree of atopy, allergen load, type of sensitizing allergens, previous symptoms, other triggering factors. Any reading of 0.10 ku A /l indicates sensitization. Assess patient asthma symptom control and individualize management plan As in all diagnostic testing, any diagnosis or treatment plan must be made by the physician based on test results, individual patient history, the physician s knowledge of the patient, and the physician s clinical judgement. Adapted from the NIH Guidelines for the Diagnosis and Management of Asthma and NIH Guidelines for the Diagnosis and Management of Food Allergy. 10 11
You ve discovered the connection Now consider the benefits of specific IgE blood testing Specific IgE blood testing helps you to: Identify allergic triggers and develop a diagnosis Develop and implement a personalized plan to manage allergic and non-allergic symptoms Comply with guidelines-based asthma care References: 1. Kwong KYC, et al. Am J Manag Care. 2011;17:S447-S459. 2. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/nchs/fastats/ asthma.htm. Accessed February 22, 2012. 3. Kamble S, et al. J Asthma. 2009;46:73-80. 4. National Center for Health Statistics. http://www.cdc.gov/ nchs/data/hestat/asthma03-05/asthma03-05.htm. Accessed April 10, 2012. 5. Bollinger ME, et al. Ann Allergy Asthma Immunol. 2010;105:274-281. 6. Cisternas MG, et al. J Allergy Clin Immunol. 2003;111:1212-1218. 7. Colice GL, et al. Ann Allergy Asthma Immunol. 2012;108(3):157-162. 8. Host A, et al. Allergy. 2000;55:600-608. 9. Milgrom H. AAAAI news release. Milwaukee, WI: American Academy of Allergy Asthma & Immunology; June 18, 2003. 10. Allen-Ramey F, et al. J Am Board Fam Pract. 2005;18(5):434-439. 11. Murray CS, et al. Thorax. 2006;61:376-82. 12. Halken S, Host A, Niklassen U, et al. Effect of mattress and pillow encasings on children with asthma and house dust mite allergy. J Allergy Clin lmmunol. 2003;111(11):169-176. 13. Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. N Eng/ J Med. 2004;351 (11 ):1 068-1080. 14. Ciprandi G, Alesina R, Ariano R, et al. Characteristics of patients with allergic polysensitization; the polismail study. Eur Ann Allergy Clin Immunol. 40(3); 2008: 77-83. 15. Adapted from Duran-Tauleria E, et al. Allergy. 2004;59 Suppl 78:35-41. 16. Adapted from Niggemann B, et al. Pediatr Allergy Immunol. 2008;19:325-31. 17. NIH. Guidelines for the Diagnosis and Management of Asthma, 2007. NIH publication 08-4051. 18. Yunginger JW, et al. J Allergy Clin Immunol. 2000;105(6pt1):1077-1084. 2015 Thermo Fisher Scientific Inc. All rights reserved. All trademarks are the property of Thermo Fisher Scientific Inc., and its subsidiaries. Thermo Fisher Scientific 4169 Commercial Avenue, Portage, MI 49002, 800.346.4364 www.thermoscientific.com 587793.03