Allergy Testing

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Allergy Testing

Allergy
Author Credentials 

Cecelia Damask, DO and Matthew Ryan, MD
Education Program Directors
American Academy of Otolaryngic Allergy

Module Learning Objectives 
  1. Explain the immunologic factors driving seasonal and perennial allergies.
  2. Discuss epidemiology and impact on otolarygngology patients.
  3. Summarize signs and symptoms.
  4. Cite key components of a history and physical exam to evaluate allergic symptoms.
  5. Recognize and understand key testing modalities and evaluation of the results.

Anatomy

Learning Objectives 

Understand how allergic disorders impact various organs and systems.

References 
  1. IFAR: Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis.
  2. King HC, Mabry RL, Mabry CS. Interaction with the patient. in: Allergy in ENT Practice:  A Basic Guide. Thieme Publishing Group, New York, NY; 1998:64-94.

Pathogenesis

Learning Objectives 

Understand the immunologic reactions involved in allergy, including type i: immediate and anaphylactic involving IgE.

References 
  1. IFAR: Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis.
  2. Fireman P. Immunology of allergic disorders. in: Atlas of Allergies. Times Mirror International Publishers Ltd, London, United Kingdom; 1966:1-26.

Incidence

Learning Objectives 

Understand the patient population impact of allergic disease; role of heredity and environmental factors.

References 
  1. IFAR: Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis.
  2. Nathan RA, Meltzer EO, Siener JC and Storms W. Prevalence of allergic rhinitis in the United States. J Allergy Clin Immunol. 1997 Jun; 99(6): S808-814.

Genetics

Learning Objectives 

Understand the role of heredity in allergic disease.

References 
  1. IFAR: Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis.

Patient Evaluation

Learning Objectives 
  1. Understand key factors in history and evaluation of the patient.
  2. Understand role of environmental control; pharmaceutical control, and allergy testing.
  3. Consideration of testing to determine causative antigens and determine therapeutic options.
References 
  1. IFAR: Allergy Primer: Current Concepts in the Diagnosis and Management of Allergic Rhinitis.
  2. King, HC. Recognizing the Allergic Patient. in: An Otolaryngologist’s Guide to Allergy. Thieme Publishing Group, New York, NY; 1990:53-74.

Measurement of Functional Status

Learning Objectives 

While not necessary for routine allergy evaluation, understand role and use of various functional status tests such as acoustic rhinometry and audiometric/vestibular testing.

References 
  1. Lenders H, Pirsig W. Diagnostic value of acoustic rhinometry: patients with allergic and vasomotor rhinitis compared with normal controls. Rhinology. 1990 Mar; 28(1): 5-16.

Pathology

Learning Objectives 

Understand role of tissue or peripheral eosinophilia in diagnosing allergy.

Case Studies

  • Uncomplicated seasonal allergic rhinitis: A young male with sneezing, itching membranes, nasal congestion and rhinorrhea each fall, from early October to mid-November. Symptoms are controlled with the use of a topical nasal steroid during this time, with occasional addition of a non-sedating antihistamine and decongestant.
    • Probable single-season (ragweed) allergic rhinitis
    • No requirement for testing, nor for immunotherapy, unless the problem becomes more severe and/or more prolonged, and is uncontrolled by simple therapy.
  • Moderately severe allergic rhinitis: A middle-aged female with chronic nasal congestion, postnasal drainage, and rhinorrhea. Symptoms are perennial, and worse with house-cleaning, gardening, or exposure to dust. No response to conservative medical management.
    • Probably perennial allergic rhinitis (dust mite, mold, possible animal dander)
    • Environmental control should be emphasized.  Testing will define the causative allergens, and could allow definitive immunotherapy.

Review

Review Questions 
  1. What is the Gel and Coombs reaction that triggers an allergic reacton? What immune globulin triggers it? What mediators are released?
  2. Give examples of how allergy affects the ears, nose, throat, and sinues.
  3. List characteristics of an allergic patient noted during observation of the patient’s general appearance.
  4. Discuss the various methods by which testing can be carried out and not advantages and disadvantages of the various methods.
Resources 

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  1. Annual Meeting Webcast (AMW):