Springtime is associated with renewal, as nature emerges from its winter slumber, accompanied by the return of color, a chorus of birdsong, and the delicate fragrance of blossoming flowers that awaken the senses. However, spring also brings an influx of patients to the clinic seeking relief from the unpleasant symptoms of seasonal allergic rhinitis (hay fever).
Around 81 million people in the U.S. were diagnosed with seasonal allergic rhinitis in 2021 — around 26% of adults and 19% of children. These numbers are growing for many reasons, including climate change, which is causing longer frost-free growing seasons and higher pollen levels.
With symptoms including sneezing, a runny nose, or congestion, and itchy, red, and watery eyes, allergic rhinitis is often confused with non-allergic rhinitis. Effective treatment (and, ideally, the prevention of future allergic reactions) relies on accurate diagnosis and a comprehensive management plan. Fortunately, primary care providers (PCPs) can request a convenient blood test that makes this possible.
Not All Rhinitis Is Allergy-based
Many cases of rhinitis are automatically assumed to be allergic, especially in the spring allergy season. However, they could instead be non-allergic rhinitis potentially triggered by pollution, cigarette smoke, cleaning chemicals, perfumes, or viruses.
Often, people with rhinitis take over-the-counter (OTC) antihistamines or are prescribed antihistamines by their PCP without diagnostic testing. In fact, one study showed 65% of patients medicated with antihistamines have symptoms that are not allergy-based. For these patients, the use of antihistamines is both wasteful economically and not the most effective approach long-term.
Determining the cause of rhinitis is key to PCPs providing patients with an appropriate management plan.
Allergen Testing Provides a Clear Picture
Whole Allergen Testing
Combined with clinical assessment, specific IgE blood testing can help differentiate allergic from non-allergic rhinitis. This powerful blood test measures specific IgE antibody concentrations to identify sensitization from a selection of hundreds of potential allergic triggers such as pollen, mold, dust mites, and animal dander.
Allergen Component Testing
When using an Enhanced Respiratory Allergen Profile, if the results of the whole allergen test are positive, reflex testing for allergen components is performed. Identifying the specific allergen component involved can provide additional information that aids more precise management and offers insights into disease development and severity.
Enhanced Patient Management Following Allergen Testing
Once PCPs have accurately identified their patient’s sensitizations, they can develop an allergen avoidance plan to help patients reduce exposure and, hopefully, drop below their symptom threshold. Such thresholds may be reached from exposure to a single allergen or from the cumulative effect of exposure to multiple allergens, leading to the onset of symptoms.
In an allergen avoidance plan, the first priority is to reduce exposure to the specific allergens to which the patient is most sensitized (i.e., those with the highest IgE sensitization levels). Then, the next priority would be to reduce exposure to allergens that are more manageable, particularly indoor allergens.
Allergen component testing provides even more detailed information for successful allergen avoidance and symptom management. For pet lovers, such knowledge can be used to guide pet selection — for example, choosing a female dog if they are monosensitized to the Can f 5 dog-allergen component produced by male dogs. Or feeding their cat an allergen-reducing food if they are allergic to Fel d 1.
If the avoidance plan doesn’t eliminate symptoms, oral non-sedating antihistamines and/or inhaled nasal steroids are usually successful. For those patients whose symptoms are recalcitrant, referral to a specialist for consideration of allergen immunotherapy (AIT) is an option. AIT involves gradually increasing doses of the allergen to which the person is allergic, prompting the immune system to become less sensitive to the substance.
Making an Allergy Diagnosis in Primary Care
Each year, increasing numbers of patients present to their PCPs with rhinitis symptoms. Treatment without testing can lead to misdiagnosis and the misuse of antihistamines. For accurate patient care, PCPs can directly request specific IgE blood testing (without referral to an allergist). With these test results, allergen sensitization can be ruled in or out quickly, and effective management plans (including allergen avoidance and medication) can be appropriately recommended.
Adding diagnostic testing can increase confidence in diagnosis. It also benefits the clinical management of patients with allergy-related symptoms in primary care by informing clinician advice on specific allergen avoidance, improving the patient’s quality of life and reducing the costs associated with absenteeism. This approach also optimizes medication use, reduces medication costs, and decreases unscheduled healthcare visits, contributing to a more efficient healthcare delivery.
Gary Falcetano, PA-C, is a licensed physician assistant with more than 25 years of diverse experience in emergency and disaster medicine, primary care, and allergy and immunology. Falcetano is the U.S. Clinical Affairs Manager for Allergy in ImmunoDiagnostics at Thermo Fisher Scientific.
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