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    Fast Facts: Respiratory Allergies: Understand aeroallergens, improve treatment response
    Fast Facts: Respiratory Allergies: Understand aeroallergens, improve treatment response
    Fast Facts: Respiratory Allergies: Understand aeroallergens, improve treatment response
    Ebook122 pages51 minutes

    Fast Facts: Respiratory Allergies: Understand aeroallergens, improve treatment response

    By J. Rimmer and F. Thien

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    About this ebook

    Allergic rhinitis, rhinoconjunctivitis and asthma are some of the most common presenting problems in clinical practice. While standard pharmacotherapy can control the symptoms of these respiratory allergies in most cases, accurate and specific diagnosis enables the implementation of allergen avoidance and allergen-specific immunotherapy. 'Fast Facts: Respiratory Allergies' provides: • the basic principles of allergy and its role in these common respiratory conditions • a better understanding of the distribution and seasonality of aeroallergens • the tools to obtain a comprehensive respiratory allergy history • an overview of diagnostic tests and the latest treatment options. This handy, fast-reference resource is ideal for all primary care providers, general internal medicine doctors and allied health professionals looking to reduce their patients’ medication requirements and treatment side effects and ultimately improve their quality of life. Table of Contents: • Epidemiology, etiology and pathophysiology • Aeroallergens • Diagnosis • Management • Delivery of medication • Future directions
    LanguageEnglish
    PublisherS. Karger
    Release dateMar 5, 2021
    ISBN9783318068016
    Fast Facts: Respiratory Allergies: Understand aeroallergens, improve treatment response

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      Book preview

      Fast Facts - J. Rimmer

      Introduction

      Respiratory allergies, in particular allergic rhinitis and allergic asthma, are among the most common presenting problems in clinical medicine. Careful clinical assessment of allergy triggers, together with appropriate diagnostic tests, are important for accurate diagnosis and to institute optimal management. While standard pharmacotherapy can control rhinitis and asthma symptoms in general, accurate allergy diagnosis enables the implementation of appropriate allergen avoidance and allergen-specific immunotherapy (AIT). These options can improve symptoms while reducing medication requirements. Furthermore, AIT is the closest thing we have to a ‘cure’ for allergy, inducing medium- to long-term disease remission.

      Knowing the basic principles of allergy and its role in these common chronic respiratory conditions is important for clinicians. Respiratory allergies are often under-recognized and poorly managed, and an allergy diagnosis can provide patients with an opportunity to manage their ongoing disease burdens and risks in more targeted and effective ways. This resource covers the fundamental information that allied health professionals, general practitioners and general internal medicine specialists who encounter patients with these conditions need, in a handy fast-reference format.

      Definitions

      Respiratory allergies are defined as any symptoms arising from the respiratory tract (upper and/or lower airways) caused by contact with allergens and involving an immunoglobulin E (IgE)-related mechanism. Usually, the allergen is encountered by inhalation, but food allergens can cause respiratory symptoms when applied topically or ingested.

      The main diseases involved are asthma, allergic bronchopulmonary aspergillosis (ABPA), allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC), chronic rhinosinusitis, allergic fungal sinus disease, oral allergy syndrome, food allergies/anaphylaxis, urticaria and angioedema, as well as allergies to some drugs. This book focuses on the two most common diseases: ARC/AR and allergic asthma, which are closely related and frequently coexisting conditions that affect the respiratory system.

      Atopy is a genetic predisposition to produce IgE antibody in response to environmental allergens. An individual’s atopic status is identified by the presence of IgE antibodies against specific allergens, which are detected by skin or serum testing. Atopy increases the risk of developing asthma and ARC as well as eczema or allergic dermatitis (AD), but it does not have to manifest in a clinical disorder. In other words, an atopic individual may not have clinical symptoms of allergy. In developed countries, the prevalence of atopy is often 30–45%, whereas asthma is 5–10% and rhinitis 10–20%.

      Highly allergic individuals usually present with symptoms early in life, often eczema and food allergies with subsequent development of asthma and rhinitis. This process is often labeled the atopic march (Figure 1.1).

      Figure 1.1 The atopic march: symptom progression and severity according to age. Eczema is more severe in early childhood, while asthma severity has a biphasic peak, with severity increasing in childhood and later life, and the severity of rhinitis (AR/ARC) peaks at around 12 years of age. Adapted from Durham and Church 2006¹

      Allergic respiratory disease. The symptoms of ARC/AR are:

      • red, itchy, watery eyes

      • sneezing

      • nasal congestion or blockage

      • runny nose

      • itchy or sore throat

      • postnasal drip

      • cough

      • itchy ears

      • blocked ears.

      ARC is the preferred term to AR, as 75% of people with the condition have ocular symptoms, as described above. ARC used to be described as perennial and seasonal, referring to the seasonality of the inciting allergens; however, this has been largely replaced by the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, which encompasses symptom pattern, severity and impacts (Table 1.1).² ARC is classified as moderate to severe in most people with the condition.

      Asthma symptoms include:

      • wheeze

      • shortness of breath

      • chest tightness

      • cough.

      These symptoms vary over time in their occurrence, frequency and intensity. They are associated with variable airflow limitation and inflammation of differing phenotypes.³

      Variable airflow limitation over time or in response to a stimulus is often referred to as airway hyperresponsiveness (Table 1.2). Extreme hyperresponsiveness is associated with more severe asthma (Figure 1.2).⁴,⁵

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