Page 1 INTRODUCTION
1. The
History and Physical Examination
2.
Evaluation of the Patient’s Environment
a) House dust Mite Analysis
b) Detection of Pollen and Mould Allergens
i.) Regional Pollen and Mould Counts
ii.) Home Air Sampling
iii.) Mould Plate Cultures
3.
Identification of the Atopic Patient
a.)
Cord Blood IgE
b.)
Total IgE
c.) The
Phadiatop Test
Page 2
4.
Identification of the Causative Allergen by measurement of Allergen Specific IgE
a.) In
Vivo TestsSkin Prick Tests
b.) In
Vitro Tests
i.) The Radio-Allergo-Sorbent Technique (RAST)
ii.) RAST Mixed-Allergen Tests
iii.) RAST Tests for Individual Allergens
Pollen allergy
Mould allergy
Food allergy
Diagnosis of
Venom Allergy
Diagnosis of
Drug Allergy
Page 3
5.
Monitoring Allergic Inflammation
1. The
Total Eosinophil Count
2.
Nasal Eosinophils
3.
Eosinophil Cationic Protein
4. Mast Cell
Tryptase
5.
Histamine Assays
6.
CAST Assays
7. Allergy
Cytokine Assays
8.
Immunoglobulin Levels
9.
Antibodies to the IgE Receptor
10.
Blocking Antibodies
References
4. Identification of the Causative Allergen by measurement of Allergen Specific IgE
Specific allergy testing should be guided by the history, clinical examination, environmental assessment of the patient and an assessment of atopy. Specific allergy tests are classified into in vivo and in vitro tests.
a.) In Vivo Tests
Skin Prick Tests
b.) In Vitro Tests
i.) The Radio-Allergo-Sorbent Technique (RAST)
ii.) RAST Mixed-Allergen Tests
Asthma, Hayfever, Eczema and Food Allergy – Investigating the Allergic Patient – Page 3
[ Handbook ]
Investigating the Allergic Patient
Page 2
Page 1 INTRODUCTION
1. The
History and Physical Examination
2.
Evaluation of the Patient’s Environment
a) House dust Mite Analysis
b) Detection of Pollen and Mould Allergens
i.) Regional Pollen and Mould Counts
ii.) Home Air Sampling
iii.) Mould Plate Cultures
3.
Identification of the Atopic Patient
a.)
Cord Blood IgE
b.)
Total IgE
c.) The
Phadiatop Test
Page 2
4.
Identification of the Causative Allergen by measurement of Allergen Specific IgE
a.) In
Vivo TestsSkin Prick Tests
b.) In
Vitro Tests
i.) The Radio-Allergo-Sorbent Technique (RAST)
ii.) RAST Mixed-Allergen Tests
iii.) RAST Tests for Individual Allergens
Pollen allergy
Mould allergy
Food allergy
Diagnosis of
Venom Allergy
Diagnosis of
Drug Allergy
Page 3
5.
Monitoring Allergic Inflammation
1. The
Total Eosinophil Count
2.
Nasal Eosinophils
3.
Eosinophil Cationic Protein
4. Mast Cell
Tryptase
5.
Histamine Assays
6.
CAST Assays
7. Allergy
Cytokine Assays
8.
Immunoglobulin Levels
9.
Antibodies to the IgE Receptor
10.
Blocking Antibodies
References
4. Identification of the Causative Allergen by measurement of Allergen Specific IgE
a.) In Vivo Tests
Skin Prick Tests
b.) In Vitro Tests
i.) The Radio-Allergo-Sorbent Technique (RAST)
ii.) RAST Mixed-Allergen Tests
iii.) RAST Tests for Individual Allergens
- grass pollens
- weed pollens
- tree pollens
- animal danders, epithelia, feathers & body fluids
- house dust mites & other mixes
- mould spores
- drugs & chemicals
- occupational allergens
- food allergens, such as vegetables, fruits, nuts, meats, fish, crustacea, spices, dairy products, etc.
- insects and insect venoms
- parasites
- house dusts
- other miscellaneous allergens
Plate 3 on pages 124 and 125 shows a “generic” Laboratory Test Request Form for the various IgE-based assays that can be utilised by laboratories and clinicians.
Pollen
allergy
may be due to grass pollen or weed pollen and only rarely to tree pollen. Allergy to grasses is the most important, particularly for highveld patients. The very long grass season in South Africa often results in prolonged symptoms both at the coast and inland. Local studies have shown that common allergenic grasses in South Africa are Bermuda allergenic. In screening for grass allergy, the most appropriate grass mix is the RAST Grass Mix gx2, since this includes Bermuda grass. The Panicoidiae grass family appears to be important in Southern Africa. However, in view of cross-reactivity among grasses, testing individually for both Bermuda grass and Rye grass or Timothy grass specific IgE will detect most grass allergic subjects. There is a high level of cross-reactivity among grasses, with the exception of Bermuda grass that must be individually identified, and if immunotherapy is to be given then Bermuda grass should be included.
In South Africa, unlike the USA where Ragweed is common, allergy to weed pollens is fairly uncommon.
Allergy to tree pollen is common in Sweden (birch) and in Mediterranean countries (cedar), but uncommon in South Africa. The trees to which patients may react include oak, plane, willow, poplar, acacia species and prosopis tree (particularly in Namibia). There is a clear seasonality with tree pollen, with various trees pollinating during limited periods of the early spring in different regions of the country. At the University of Cape Town, we have recently confirmed that Port Jackson pollen also induces IgE antibodies.
Mould
allergy
is an important cause of symptoms, and mould allergens include Aspergillus fumigatus, Cladosporium herbarium, Alternaria alternata and Epicoccum. Unlike grass allergy, mould allergens do not, i
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