Treatment Summary Perspectives CAP RAST CHDsURDs LRDs Allergy and Asthma: Improving Outcomes in...

Treatment SummaryPerspectivesCAP RASTCHDs URDs

LRDs

Allergy and Asthma: Improving Outcomes in Primary Care

El PasoNovember, 2007

Len Fromer, M.D., FAAFP

CHDs URDs

LRDsTreatment CAP RAST SummaryPerspectives

The Etiology Challenge

• Common symptoms and diseaseshave many possible etiologies

• IgE-mediated allergies triggersymptoms from infancy into adulthood

• Identification of true underlying cause is essential for effective management

CHDs URDs


The Allergic Inflammatory Response

CHDs URDs


Common Childhood Diseases

• The illnesses of the Allergy March

– Atopic dermatitis (eczema)

– GI distress

– Recurrent otitis media

– Allergic rhinitis

– Allergic asthma

• The symptoms

– Inflammatory in nature

– Multiple etiologies

– Treated empirically

CHDs

CHDs

CHDs URDs


The Allergy March: A Progression of Seemingly Unrelated Diseases CHDs

CHDs

AtopicDermatitis

GI Distress

RecurrentOtitisMedia

AllergicAsthma

AllergicRhinitis

Food Sensitivity

InhalantSensitivity

Time (~years)

Genetic Predisposition

CHDs URDs


0

10

20

30

40

50

Age (years)

Prevalence of Atopic Disease

1 3 5 10 17

Symptoms

Gastrointestinal Respiratory Skin

Pre

vale

nce

(%

)

Saarinen UM, Kajosaari M. Lancet. 1995;346:1065-1069.

Allergy March CHDs

CHDs

CHDs URDs


Age (years)

0

1

2

3IgE Antibody Level

4 - 90 - 3 10 - 15

n= 12 29 12

Mea

n s

co

re(P

ha

de

ba

s R

AS

T C

las

s)

Sigurs N, et al. J Allergy Clin Immunol. 1994;94:757-763.

Allergy March CHDs

CHDs

Birch pollen

Peanut

Egg white

CHDs URDs



• Atopic dermatitis (AD)1

– 17%-20% prevalence in US, other western countries

– Not necessarily severe reaction (anaphylaxis)

– Driven by early exposure and sensitization

– 40% of AD caused by food sensitivity

– Empirical treatment: trials of topicals

CHDs

1. Leung DYM. In: Pediatric Allergy: Principles and Practice. Mosby-Year Book, Inc; 2003:561-573.

CHDs

CHDs URDs



• GI distress1

– Colic, diarrhea, vomiting, constipation, reflux

– Multiple etiologies:

• atopy, infection, intolerance, malabsorption, inflammatory bowel, anatomic defect

– 10%-42% of symptomatic patients are atopic2,3

– 50%-60% of infants with food sensitivities show GI symptoms(not necessarily full-blown food allergy)

– Empirical treatment: trials of formulas

1. Høst A, Halken S. In: Pediatric Allergy: Principles and Practice. Mosby-Year Book, Inc; 2003:488-494. 2. Australasian Society of Clinical Immunology and Allergy. Adverse reactions to food. Available at:

http://www.allergy.org.au/aer/infobulletins/adverse_reactions.htm.3. Sicherer SH. Pediatrics. 2003;111:1609-1616.

CHDs

CHDs

CHDs URDs



• Recurrent otitis media (OM)

– 26% prevalence in US1

– Key risk factors include attendance in daycare,cigarette smoke exposure2

– 40%-50% involve atopy3,4

– Common underlying cause = eustachian tube dysfunction

• Caused by inflammation related to allergy or infection

• Recurrence = not treating the underlying cause

– Empirical treatment: antibiotics, surgery

1. Lanphear BP, et al. Pediatrics. 1997;99:1-7.

2. AAAAI. The Allergy Report. 2000;2:155-161.

3. Data on file, Pharmacia Diagnostics.

4. Fireman P. J Allergy Clin Immunol. 1997;99:S787-S797

CHDs

CHDs

CHDs URDs


Atopy’s Long-Term Consequences

• Nearly 80% of children with AD go on to develop allergic rhinitis and/or asthma1

• Children with early and long-lasting food sensitization:

– 3x more likely to develop allergic rhinitis (AR) than those transiently sensitized2

– 5x more likely to develop asthma than those transiently sensitized2

• Young wheezers with confirmed atopy are more likely to develop asthma3

1. Leung DYM. In: Pediatric Allergy: Principles and Practice. Mosby-Year Book, Inc; 2003:561-573.

2. Kulig M, et al. Pediatr Allergy Immunol. 1998;9:61-67.

3. Martinez FD, et al. J Allergy Clin Immunol 1999;104:S169-S174.

CHDs

CHDs

CHDs URDs


Knowledge of Etiology Guides Treatment for Today and Tomorrow

• Specific IgE testing in children can help the clinician:

– Identify allergen sensitivities

– Counsel for avoidance

– Eliminate or reduce symptoms

– Reduce medication use (including antibiotics)

• Targeting atopy can eliminate symptoms and interrupt the Allergy March1-5

– ETAC: Cetirizine and avoidance halved asthma risk in children with AD1

– PAT: Immunotherapy significantly reduced asthma risk in children with AR2

– CCAPPS: Multifaceted avoidance intervention reduced asthma prevalence 56% in high-risk children5

1. ETAC® Study Group. Pediatr Allergy Immunol. 1998;9:116-124.2. Möller C, et al. J Allergy Clin Immunol. 2002;109:251-256.3. Platts-Mills TAE. N Engl J Med. 2003;349:207-208.4. Sampson H. Ann Allergy Asthma Immunol. 2004;93:307-308.5. Chan-Yeung M, et al. J Allergy Clin Immunol. 2005;116:49-55.

CHDs

CHDs

CHDs URDs


Etiology Is Elusive URDs

URDs


LRDs

Overlapping Symptoms

Allergic Rhinitis

– Nasal congestion

– Rhinorrhea

– Increased secretions

– Sneezing

– Itchy, watery eyes

Non-allergic Rhinitis


– Rhinorrhea

– Increasedsecretions

– Postnasal drainage

Chronic Sinusitis


– Rhinorrhea

– Increased secretions

– Postnasal drainage

– Headache

– Facial pain

URDs

URDs

CHDs URDs


Upper Respiratory Diseases

• Allergic rhinitis, non-allergic rhinitis, sinusitis

• Symptoms caused by inflammation

– Multiple etiologies, including:

• Allergic • Hormonal

• Anatomic • Vasomotor

• Infectious

• Usually treated empirically/symptomatically

• Depending upon etiology, treatment can/should be different

URDs

URDs

CHDs URDs


Productivity Loss $ per 1000 Employees

$1,436,292

$880,152

$520,884

$275,808$187,200 $148,512

$0

$500,000

$1,000,000

$1,500,000

Allergies Depression Hypertension

Respiratory Diabetes CV Disease

CHDs URDs


Comparison of Quality-of-Life in Asthmatic & Chronic Rhinitis Patients

Mean Quality-of-Life Score (Scale 1-100)*

Health ConceptAsthma(n=252)

Chronic Rhinitis(n=111)

Social functioning 84 73

Physical functioning 80 89

Role limitations (emotional) 70 64

Role limitations (physical) 66 61

Energy/fatigue 59 55

Pain 74 77

Change in health (1 year) 55 50

CHDs URDs


Distribution of URD in US1-3

• 39% of total population (115M of 295M) have URD

1. AHRQ. Management of allergic and nonallergic rhinitis. May 2002: AHRQ Pub. No. 02-E023. 2. Spector SL, ed. Dialogues in Redefining Rhinitis. 1996;1(1,4):1-16. 3. Allergy Statistics.AAAAI Web site. Available at: http://www.aaaai.org/media/resources/media_kit/allergy_statistics.stm.

URDs

40M

35M

40M

Sinusitis30%

Non-allergicRhinitis

35%

Allergic Rhinitis35%

URDs

CHDs URDs


Actual Atopy and Antihistamine Use

1. Szeinbach SL, et al. J Manag Care Pharm. 2004;10(3):234-238.

URDs

URDs

Identification of allergic disease among users of antihistamines1

• Allergic rhinitis, non-allergic rhinitis, sinusitis

• Study of managed-care patients repeatedly prescribed oral antihistamines

• Convenience sample of 246 evaluated with in vitro allergy testing

• Results revealed non-atopicsymptom etiology in 2/3 of patients

35%Atopic

Etiology 65%Non-atopic

Etiology

CHDs URDs


Non-allergic Rhinitis

• Wide array of types and etiologies1,2

– Includes: infectious, vasomotor, hormonal, anatomic, occupational, drug-induced

• Not caused by IgE-mediated allergic inflammation

– Non-sedating antihistamines and other allergy-targeted therapies will not treat underlying cause

1. AAAAI. The Allergy Report. 2000;2:1-31. 2. Dykewicz MS, et al. Ann Allergy Asthma Immunol. 1998;81:478-518.

URDs

URDs

CHDs URDs


Allergic Rhinitis

• Triggered by seasonal or perennial allergen(s)

• Symptoms may include:

– nasal congestion, rhinorrhea, increased secretions, sneezing, itchy nose/eyes, watery eyes, coughing, postnasal drip1,2

• Cumulative threshold disease3,4:

– Patients are rarely monosensitized

– Symptoms emerge after “allergic threshold” has been exceeded

1. AAAAI. The Allergy Report. 2000;2:1-31.

2. Dykewicz MS, et al. Ann Allergy Asthma Immunol. 1998;81:478-518.

3. Pharmacia & Upjohn Diagnostics. The Value of Allergen Identification.1998. Publication 98006.01.

4. Wickman M. Allergy. 2005;60 (Suppl 79):14-18.

URDs

URDs

CHDs URDs


Cumulative Threshold Disease1

1. Pharmacia & Upjohn Diagnostics. The Value of Allergen Identification. 1998. Publication 98006.01.2. Ciprandi G, et al. J Allergy Clin Immunol. 1995;96:971-979.3. Boner AL, et al. Clin Exp Allergy. 1993;23:1021-1026.

URDs

Symptoms

Situation A2

No avoidancemeasures

Situation B3

No avoidancemeasuresThird allergen

Situation C3

Avoidance measuresemployedThird allergen

Cat dander

Dust mites

Ragweed

URDs

CHDs URDs


Support for Avoidance in the Management of Allergies and Asthma

• …It has become clear that early intervention may modulate the natural course of atopic disease…the reduction in exposure of high-risk infants to food and house-dust mite allergens substantially lowers the frequency of allergic manifestations in infancy.”1 – Halmerbauer, et al.

• “Extensive experience suggests that both drug treatment and immunotherapy are more effective if patients also decrease exposure. The approach is to identify the allergen source (or sources) to which the patient is allergic and to educate patients extensively.”2 – Platts-Mills, et al.

• The NIH, AAAAI, and AAFP urge trigger avoidance as a cornerstone of asthma management3-5

1. Halmerbauer G, et al Pediatr Allergy Immunol. 2003;14:10-17.2. Platts-Mills TAE, et al. J Allergy Clin Immunol. 2000;106(5)787-804 .3. NIH. Guidelines for the Diagnosis and Management of Asthma.1997. NIH publication 97-4051.4. AAAAI. The Allergy Report. 2000;2:33-109. 5. AAFP. Asthma & Allergy Resource Guide. 2004:11-13

Return to >> Cumulative Threshold

URDsURDs

CHDs URDs


Sinusitis

• Multiple etiologies

– Caused by inflammation from infection, allergy, structural abnormalities,other causes1

– ENT experts use term “rhinosinusitis” due to epithelial continuum of sinus/nasal passages1,2

• Common comorbidity–often with atopy

– Rarely occurs without concurrent rhinitis2

– >50% of moderate to severe asthmatics have chronic rhinosinusitis3

1. Brook I, et al. Ann Otol Rhinol Laryngol. 2000;109:2-20.

2. AAO-HNS. Fact sheet. ENT Link Web site. Available at: http://www.entnet.org/healthinfo/sinus/allergic_rhinitis.cfm.

3. AAAAI. The Allergy Report. 2000;2:7,137-153.

URDs

URDs

CHDs URDs


Why Should You Test?

• History and physical alone yield a correct diagnosis only 50% of the time1

• Different etiologies demand different treatment approaches

• Testing for specific IgE levels can rule in/out atopy

• If atopic:

– NSAs probably drug of choice

– Testing can help clinician pinpoint offending allergens

• If non-atopic:

– Results will allow you to focus on other etiologies

– Drugs of choice may include decongestants/steroids

– Patient can avoid unnecessary/ineffective treatment

URDs

1. Homburger HA. Arch Pathol Lab Med. 2004;128:1028-1031.

CHDs URDs


URD Management Options

Specific IgE-Positive/Abnormal Atopic Etiology

Specific Allergen Avoidance

AdequateResponse

Allergy-TargetedPharmacotherapy(eg, NSAs, LTRAs)

Stop

Inadequate Response

Referral?

Inadequate Response

URDs

Specific IgE-Negative/Normal Non-Atopic Etiology

AdequateResponse

Pharmacotherapy(allergy-targeted

Rx not helpful)

Stop

Inadequate Response

Referral?

CHDs URDs


The Experts on Differential Diagnosis of Rhinitis

“A positive diagnosis (or diagnoses) should be made before formulating management.”1

1. Middleton E, et al, eds. Allergy: Principles & Practice. Vol II, 5th ed. St. Louis, Mo: Mosley-Year Book, Inc; 1998:1007.

URDs

URDs

CHDs URDs



• An expert panel in the area of allergy diagnosis recommended selective use of in vitro allergy testing by primary care physicians.

• According to these experts, in vitro tests1:

– Offer a well standardized alternative to skin testing

– Are easily used by generalist physicians

– Are effective in the diagnosis of allergy

URDs

1. Selner JC, et al. Ann Allergy Asthma Immunol. 1999;82:407-412.

CHDs URDs



“Allergy [IgE] testing should be considered in all patientswith a suspected diagnosis of allergic rhinitis.”1

1. Bierman CW, et al, eds. Allergy, Asthma, and Immunology From Infancy to Adulthood. 3rd ed. Philadelphia, Pa: WB Sanders Company; 1995:403-404.

URDs

URDs


LRDs

Etiology Linked to Triggers LRDs

LRDs


LRDs

Overlapping Symptoms

“All that wheezes is not asthma.” – Chevalier Jackson [1865-1958]

LRDs

Allergic Asthma

– Wheezing

– Cough

– Dyspnea

– Chest tightness

– Rhinitis

– Conjunctivitis

Non-allergic Asthma

– Wheezing

– Cough

– Dyspnea

– Chest tightness

“Bronchitis”

– Wheezing

– Cough

– Dyspnea

LRDs

CHDs URDs


Lower Respiratory Diseases

• Course and severity affected by inflammation (often caused by allergy)

• Underlying atopy shown to increase symptoms and precipitate exacerbations

• A wide range of possible triggers include:

– Allergy

– Occupational exposures

– Infection

– GERD

– Tobacco smoke

– Emotional stress

– Exercise

– Cold weather

LRDs

LRDs

CHDs URDs


Asthma

• Widespread

– 7% prevalence (>20 million1) and rising

– 73% managed by PCPs2

• Allergic vs. non-allergic asthma

– 60% of asthmatics have allergic asthma3

– 90% of children with asthma also have allergies4

LRDs

1. NCHS. Asthma prevalence, health care use and mortality 2002. Available at: http://www.cdc.gov/nchs/Default.htm.2. NCHS. Ambulatory care visits 1999–2000. Available at: http://www.cdc.gov/nchs/Default.htm.3. Milgrom H. Understanding allergic asthma [AAAAI News Release]. June 18, 2003. 4. HØst A, Halken S. Allergy. 2000;55:600-608.

LRDs

CHDs URDs


The “One Airway” Concept

• Common inflammatory process links upper and lower airways1

– Asthma and allergic rhinitis commonly co-exist2,3

– In concomitant disease, experts recommend evaluation and treatment of one condition to aid management of the other4

– Asthma management guidelines from ARIA,4 the NIH,5 AAFP,6 and AAAAI7 encourage treatment of AR (and other URDs) to help control asthma

1. Bachert C, et al. Immunol Allergy Clin N Am. 2004;24:19-43.2. Nayak AS. Allergy Asthma Proc. 2003;24:395-402. 3. Halpern MT, et al. J Asthma. 2004;41:117-126.4. Bousquet J, et al. Allergic Rhinitis and its Impact on Asthma (ARIA). Allergy. 2002;57:841-855.5. NIH. Guidelines for the Diagnosis and Management of Asthma.1997. NIH publication 97-4051.6. AAFP. Asthma & Allergy Resource Guide. 2004:18.7. AAAAI. The Allergy Report. 2000;2:33,54.

LRDs

CHDs URDs


NIH Asthma Guidelines1

Trigger identification/control is primary management step

• “For at least those patients with persistent asthma on daily medications,the clinician should:

– Identify allergen exposures

– Use the patient’s history to assess sensitivity to seasonal allergens

– Use skin testing or in vitro [blood] testing to assess sensitivity to perennial indoor allergens

– Assess the significance of positive tests in contextof the patient’s medical history”

LRDs

1. NIH. Guidelines for the Diagnosis and Management of Asthma.1997. NIH publication 97-4051.

LRDs

CHDs URDs


NIH Asthma Guidelines1 (cont’d)

• “Use skin testing or in vitro testing to determine the presence of specific IgE antibodies to the indoor allergens to which the patient is exposed year round.”

• Allergy testing is the only reliable way to determine sensitivity to perennial indoor allergens.”

• For selected patients with asthma at any level of severity, detection of specific IgE sensitivity to seasonal or perennial allergens may be indicated as a basis for avoidance, or immunotherapy, or to characterize the patient’s atopic status.”

LRDs

1. NIH. Guidelines for the Diagnosis and Management of Asthma. 1997. NIH publication 97-4051.

LRDs

Return to >> Third-party Perspectives

CHDs URDs


Knowledge of Symptom Triggers Guides Management

• Allergy testing may be conducted along with pulmonary function testsand other diagnostic evaluations1

• In allergic asthma:

– Confirm atopy and identify specific allergic triggers for avoidance counseling, symptom reduction, and control of severity and comorbid AR

• In non-allergic asthma:

– Rule out atopy to focus on possible non-allergic triggers

– Prevent needless control measures

1. NIH. Practical Guide for the Diagnosis and Management of Asthma. 1997. NIH publication 97-4053.

LRDs

LRDs

CHDs URDs


Asthma Management Options LRDs

Specific IgE-Negative/NormalNon-Atopic Etiology

Referral?

InadequateResponse

AdequateResponse

Pharmacotherapy• Allergy Rx not helpful • Controller(s)• Rescue Rx

Stop

Focus on Non-allergic Triggers

Specific IgE-Positive/Abnormal Atopic Etiology

Specific Allergen Avoidance

AdequateResponse

Pharmacotherapy • Treat AR (eg, NSAs)• LTRAs• Controller(s)• Rescue Rx

Stop

Inadequate Response

Referral?

Inadequate Response

CHDs URDs


What Is Happening to Treatment?

• Mechanism of disease is better understood

– Means that treatments are nearer the root cause

• Therapeutic specificity is increasing

– Diseases are different and differentiation is key

– The mechanism of action of drugs is more specific than ever

– Diagnostic precision by PCP is necessary

• New diagnostic technology must be employed

Treatment

Treatment

CHDs URDs

LRDsTreatment CAP RAST SummaryPerspectivesTreatment

Market Review: The Role of Diagnostics in Pharmacotherapy

Medications for Respiratory Allergy

$$$$$$

Highly specifictreatment

Highly specific resolution of symptoms

due to IgE response only — necessitates

perfect diagnosis

Binds to IgE;Suppression of IgE

response

Anti-IgE Vaccine(2003)

$$$

Very specific to atopy — necessitates even more accurate diagnosis (Doctors

report marginal response for AR with

Singulair — could be 65% are not allergic)

Specific resolution of symptoms of atopy by blocking another mediator pathway

Leukotriene antagonist

Montelukast(2002)

$$

Introduction of “D” formula creates less

specific treatment

More specific resolution of symptoms primarily due to atopic

etiology — necessitates more specific diagnosis

Antihistamine effect with very little

anticholinergic effect

Non-sedatingAntihistamines

(1990s)

$

Broad (shotgun)

Non-specific resolution of symptoms regardless

of etiology

Antihistamine effect +

Anticholinergic effect

1st GenerationAntihistamines

(1970s)

Cost

Therapeutic Approach

Treatment Results

Mode(s) of Action

TreatmentProgression

Treatment

Treatment

CHDs URDs


Disease Paradigms

Treatment

Treatment

Hx & PE lab tests diet & exercise pharmacotherapy

Diabetes Mellitus Type 2

Hx & PE lipid profile diet & exercise pharmacotherapy

Hypercholesterolemia

Hx & PE pharmacotherapy

CHDs, URDs, LRDs

?IgE profile avoidance

CHDs URDs


CAP RAST: Gain Knowledge to Guide Treatment

• FDA-cleared quantitative measure of specific IgE

• Only a single blood draw required

• Covered under most insurance plans

• Accuracy superior to RASTTM*1

– Next-generation assay offers consistently improved sensitivity ,2

– De facto standard, documented in >2,700 peer-reviewed publications3

• In vitro blood testing and skin prick testing (SPT) viewed as interchangeable4

• CAP RAST is available throughout the nation from all major reference and clinical laboratories, including Quest Diagnostics, NS-LIJ & BioReference

* RAST is a trademark of Pharmacia Diagnostics.

1. Williams PB, et al. J Allergy Clin Immunol. 2000;105:1221-1230.

2. Szeinbach SL, et al. Ann Allergy Asthma Immunol. 2001;86:373-381.

3. Johansson SGO. Expert Rev Mol Diagn. 2004;4:273-279.

4. Hamilton RG. In: Pediatric Allergy: Principles and Practice. Mosby-Year Book, Inc; 2003:233-242.

CAP RAST®

CAP RAST®

CHDs URDs


H. Drevin, 1989A. Kober, 2004

Solid-phase Protein Binding Capacity Comparison

Solid Phase

•CAP RAST cellulose polymer binds almost 150 times more protein than a passively coated tube, well or bead, and about 250 percent more protein than a paper disc.

CHDs URDs


Accuracy of Immunoassays for Specific IgE

*The authors noted that regression values below 0.80 reflect poor performance in the ability to correctly detect levels of specific IgE antibodies. ONLY CAP RAST had consistently acceptable regression values.**Alastat was recently replaced by 3gAllergy. Studies show 93% agreement between both methods.

Williams PB, et al. J Allergy Clin Immunol. 2000;105:1221-1230.

CAP RAST®

CAP RAST®

Line represents minimum acceptable R2

performance values

Alastat/3gAllergyTM**

RAST/Modified

RAST

Newest generation:CAP RAST

Ideal Test (Correlation Coefficient)

.65

.82

.96 - .981.0

CHDs URDs


Predictive Value vs. Skin Prick Testing (SPT)*

Performance parameters In vitro† SPT

Sensitivity (%) 87.2 93.8

Specificity (%) 90.5 80.1

PPV (%) 91.1 90.1

NPV (%) 86.4 87.1

Clinical Efficiency (%) 88.8 89.2

*Adapted from Reference 1.†CAP RAST Specific IgE blood test was used in this study.1. Wood RA, et al. J Allergy Clin Immunol. 1999;103:733-779.

CAP RAST

• Authors concluded that CAP RAST Specific IgE blood test and SPT values both exhibited excellent efficiency1

CAP RAST®

Return to previous slide

CHDs URDs


Profiles Carefully Designed

• Profiles engineered to detect >95% of patients with allergy1-3

• Regional respiratory profiles include key indoor/outdoor allergens selected according to:

– Geographic pollen patterns

– Regional disease prevalence

– Cross reactivity to other allergens in each inhalant class

• Allergy March profiles include key food/inhalant allergens

– Six foods account for 90% of food allergy reactions in children4

– Inhalants include common/cross-reactive indoor and outdoor allergens

– Generally recommended for children ≤6 years of age, based on symptoms

CAP RAST

1. Sampson HA, Ho DG. J Allergy Clin Immunol. 1997;100:444-451.2. Yunginger JW, et al. J Allergy Clin Immunol. 2000;105:1077-1084. 3. Poon AW, et al. Am J Man Care. 1998;4:969-985. 4. AAAAI. The Allergy Report. 2000;3:69.

CAP RAST®

CHDs URDs


Understanding Total IgE1

• Total IgE often of little practical value when considered alone

• Levels rarely high when specific IgE titers are not

• Lacks sensitivity as a rule-out screen: Specific IgE levels may be significantly high when total IgE is low/normal

• Extremely high total IgE may be seen in some very rare non-atopic conditions2:

– Certain immunodeficiency diseases (including HIV)

– IgE myeloma

– Drug-induced interstitial nephritis

– Graft-versus-host disease

– Parasitic diseases

– Skin diseases in addition to eczema

– Hyper-IgE syndrome (dermatitis, recurrent pyogenic infection)

CAP RAST

1. Fromer LM. J Fam Pract. 2004;suppl:S4-S14.

2. AAAAI. The Allergy Report. 2000;1:35.

CAP RAST®

CHDs URDs


Understanding Total IgE CAP RAST

Return to previous slide

*Includes URDs (Upper Respiratory Diseases), CHDs (Childhood Diseases), and LRDs (Lower Respiratory Diseases)

1. AAAAI. The Allergy Report. 2000;1:35.

CAP RAST®

Interpretation of Total IgE* Results

Negative(Normal)

Positive(Abnormal, Elevated)

Negative(Normal)

Positive(Abnormal,Elevated)

Non-allergic Patient

Scenario A

Rare1

Scenario B

Allergic Patient

Scenario C

Allergic Patient

Scenario D

Sp

eci

fic I

gE

Re

ad

ing

Total IgE Reading

CHDs URDs


Summary

• Diagnostic precision leads to evidence-based medical care

– Improves patient care

– Creates better patient satisfaction

– Provides more appropriate referrals

• CAP RAST Specific IgE blood test is an accurate test to differentiate atopic from non-atopic patients

• Experts, specialty organizations, and government agencies support allergy testing in primary care

Summary

Summary

CHDs URDs


URD Inhalant

Panel

Interpretation

Of

Results

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