to better manage your patients' asthma and allergies ... · to better manage your patients’...

Before you treat it, ImmunoCAP it.

The more you know about all of their allergic sensitivities, the better you can optimize their management.

To better manage your patients’ asthma and allergies,

start by DECODing them.

ImmunoCAP offers you the most comprehensive allergy testing available—including tests for aeroallergens and food allergies to:

• Identify specific allergy triggers to help control allergic asthma and viral symptoms

• Reduce costs associated with absenteeism and lost productivity at work and school

• Prevent unnecessary medications and unscheduled doctor visits

Thermo Fisher Scientific4169 Commercial Avenue, Portage, MI 49002, 800.346.4364,www.thermoscientific.com/phadia 558585.02

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References:1. World Allergy Organization, Allergic Diseases Resource Center Website. September 2007. Available at http://www.worldallergy.org/professional/allergic_diseases_center/allergic_march/. Accessed May 2, 2013. 2. Colice GL, Ostrom NK, Geller DE, et al. The CHOICE survey: high rates of persistent and uncontrolled asthma in the United States. Ann Allergy Asthma Immunol. 2012;108(3):157-162. 3. Allen-Ramey F, Schoenwetter WF, Weiss TW, et al. Sensitization to common allergens in adults with asthma. J Am Board Fam Pract. 2005;18(5):434-439. 4. Høst A, Halken S. The role of allergy in childhood asthma. Allergy. 2000;55:600-608. 5. National Heart Lung and Blood Institute. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Full Report 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed May 3, 2013. 6. Eggleston PA. Control of environmental allergens as a therapeutic approach. lmmunol Allergy Clin North Am. 2003;23(3):533-547. 7. Wickman M. When allergies complicate allergies. Allergy. 2005;60(suppl 79):14-18. 8. Wu F, Takaro TK. Childhood asthma and environmental interventions. Environ Health Perspect. 2007;115(6):971-975. 9. Murray CS, Poletti G, Kebadze T, et al. Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax. 2006;61(5):376-382. 10. Olenec JP, Kim WK, Lee WM, et al. Weekly monitoring of children with asthma for infections and illness during common cold seasons. J Allergy Clin Immunol. 2010;125(5):1001-1006.e1.11. Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351(11):1068-1080. 12. Sullivan SD, Rasouliyan L, Russo PA, Kamath T, Chipps BE; for the TENOR Study Group. Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma. Allergy. 2007:62(2):126-133. 13. Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol. 2010;105(4):274-281. 14. Caubet JC, Kondo Y, Urisu A, Nowak-Wegrzyn A. Molecular diagnosis of egg allergy. Curr Opin Allergy Clin Immunol. 2011;11(3):210-215. 15. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107(5):891-896. 16. Roberts G, Patel N, Levi-Schaffer F, Habibi P, Lack G. Food allergy as a risk factor for life-threatening asthma in childhood: a case-controlled study. J Allergy Clin Immunol. 2003;112(1):168-174. 17. Boyce JA, Assa’ad A, Burks WA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 suppl):S1-S58. 18. Movérare R, Ahlstedt S, Bengtsson U, et al. Evaluation of IgE antibodies to recombinant peanut allergens in patients with reported reactions to peanut. Int Arch Allergy Immunol. 2011;156(3):282-290. 19. Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008;122(3):583-588. 20. Fiocchi A, Schunemann HJ, Brozek J, et al. Diagnosis and rationale for action against cow’s milk allergy (DRACMA): a summary report. J Allergy Clin Immunol. 2010;126(6):1119-1128. 21. Asarnoj A, Movérare R, Östblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65(9):1189-1195. 22. Eigenmann PA. Anaphylactic reactions to raw eggs after negative challenges with cooked eggs. J Allergy Clin Immunol. 2000;105(3):587-588. 23. Docena GH, Fernandez R, Chirdo FG, Fossati CA. Identification of casein as the major allergenic and antigenic protein of cow’s milk. Allergy. 1996:51(6):412-416. 24. Lemon-Mulé H, Sampson HA, Sicherer SH, et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122(5):977-983.

DECODE allergies to

manage important health risks.


As in all diagnostic testing, a diagnosis should be made by the physician based on both test results and patient history.

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70% of children with egg allergy can tolerate cooked egg.24

step 2: ImmunoCAP allergen component test.ImmunoCAP Component testing reveals sensitization to unique proteins for specific food allergens to help diagnose and optimize management.

some proteins may:

· Cause no reactions or mild localized reactions18

· Be tolerated only when cooked or baked19,20

· Cause systemic reactions (i.e., anaphylaxis)21-23

Component tests can help determine what a patient can or cannot eat.*

For example, as with other common food protein sensitivities (milk, peanut), the specific egg protein(s) will indicate the risk for a systemic reaction.

egg protein sensitivities

ovAlbumIn (f 76)

mAy ToleRATe Cooked egg14

ovomuCoId (f 233)

AvoId All foRms of egg19

egg Ige, PosITIve

step 1: ImmunoCAP whole allergen test.IgE testing can determine allergen sensitization to help identify which patients are appropriate for further food component testing.

studies show that food allergies are over-reported by patients. this highlights the need for objective measurements to establish a true food allergy diagnosis.

Approximately 75% of children with self-reported food allergy are not actually allergic.17

This highlights the need for objective measurements to establish a true food allergy diagnosis.

*ImmunoCAP helps identify which patients are appropriate for a cooked/baked oral food challenge with a specialist.15

2

decode every step of the allergic march.

Allergies tend to progress and change over time.Because allergic triggers can exacerbate atopic conditions in patients as they age, it may help to identify IgE sensitization early.

A combination of clinical history and possible allergic symptoms suggests that it is time for ImmunoCAP.

A history of atopic dermatitis

Sleep problems due to congestion

Persistent cough

Abdominal pain

A history of otitis media

Persistent wheeze

Reactions to milk, eggs, peanuts, or other foods

Rhinitis symptoms

Diarrhea

Nausea or vomiting

AToPIC deRmATITIs AsThmA(gI) food AlleRgIes RhInITIs

0 1 3 7 into adulthoodAge (yeARs)

RelATIve PRevAlenCe of symPToms ACCoRdIng To Age1 (MANY CHILDREN ExHIBIT SYMPTOMS SIMULTANEOUSLY)

GLUE STRIP

3

ImmunoCAP offers the most comprehensive aeroallergen and food allergy testing available in just 2 simple steps with one blood sample.

SteP 2: Decode specific allergy risks.

SteP 1: Decode the whole spectrum of allergic triggers.

Sample Whole Allergen Results

SPECIMEN INFORMATION

SPECIMEN: REQUISITION: COLLECTED: 10/30/12 REPORTED: 10/30/12 AMENDED: REPRINTED:

<0.35

<0.35

<<0.35

<0.35

Egg white IgE

Oak IgE

Elm IgE

White ash IgE

Birch pollen IgE

Mold (aspergillus fumigatus) IgE

1.79

1.22

ImmunoCAP can reveal IgE sensitivity for over 650 available allergens.

Profiles are customized to specific regions and the most common food allergens

Regional inhalant profiles contain up to 25 allergens based on geography

Test can be performed irrespective of age, symptoms, medication, and disease activity and/or severity

ImmunoCAP identifies and quantifies sensitivity to specific allergen proteins.

A growing variety of allergen component tests are available—including peanuts, eggs, and milk

Helps distinguish between cross-reactivity and clinical allergy

Determines the risk of reaction to heat stable vs. heat labile proteins

Sample Egg Component Results

SPECIMEN INFORMATION

SPECIMEN: REQUISITION: COLLECTED: 12/15/12 REPORTED: 12/15/12 AMENDED: REPRINTED:

ORDERING PHYSICIAN JONES, S.CLIENT INFORMATION 7200

NEW YORK LABS. 123 MAIN ST. Suite 1100 NEW YORK, NY 12345

OvomucoidOvalbumin

ORDERING PHYSICIAN JONES, S.CLIENT INFORMATION 7200

NEW YORK LABS. 123 MAIN ST. Suite 1100 NEW YORK, NY 12345

<0.35 2.36

decode asthma because the causes are cumulative.

4

Up to 90% of children and 60% of adults with asthma have allergic triggers.3,4

MAx 32 years old

Allergic rhinitis/asthma

Birch pollen, mold, dust mite, smoke

Max still uses inhaled corticosteroids (ICS) to control his moderate, persistent asthma. After ImmunoCAP, he was able to lower his dose.

Implemented an allergen exposure reduction plan tailored to his specific needs Takes an antihistamine only when his seasonal allergies hit

Current nIH guIdelInes reCommend in vitro IgE testing, as well as clinical historyand physical exam for all patients with persistent asthma.5

PerCentAge of ASthMA PAtIentS on MedICAtIon Who ContInue to exPerIenCe SyMPtoMS2

0% 50% 100%

86%

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5

Identify the triggers that lead to allergy and asthma symptoms.Symptoms occur when asthma patients reach the symptom threshold.

reducing cumulative allergen load reduces the need for medication.6

A customized trigger avoidance plan helped Max stay under his asthma symptom threshold.7

Improving indoor environments can result in as much as a 30% reduction in asthma symptoms.8

After trIgger exPoSure reduCtIon

Before trIgger exPoSure reduCtIon

MAR APr MAy Jun JUL AUG SEP OCT NOV deC JAn FEB

dust mite

Irritants (cigarette smoke)

Viral infections

Viral infections

MAR APr MAy Jun JUL AUG SEP OCT NOV deC JAn FEB

ASthMA SyMPtoM threShold

dust mite

Irritants (cigarette smoke)

Birch pollen

Mold

Viral infections

Viral infections

ASthMA SyMPtoM threShold

Birch pollen

Mold

trig

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uctio

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decode because allergies trigger asthma emergencies.

6

Alice has mild, persistent asthma. After ImmunoCAP, her asthma symptoms are better controlled.

AlICe 9 years old

Allergic rhinitis/asthma

Ragweed, cat dander, cockroach

Children with allergies and asthma have a

3x greater risk for hospitalization when exposed to allergens compared to children with asthma only.9

Implemented an allergen exposure reduction plan tailored to her specific needs After exposure reduction, she was able to avoid adding a second medication

ASth

MA

/SeVe

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y

Compared to non-sensitized children, children with underlying allergies have:

Up to an average of 2.1 fewer unscheduled office visits per year.11

47%greater chance of symptomatic viral illnesses10

overall increase in frequency, duration, and severity of asthma and

virus-related symptoms10

025

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510

1520

rISk of ASthMA-relAted hoSPItAlIzAtIon9

SenSItIzAtIon, Allergen

exPoSure, & VIrAl InfeCtIon

SenSItIzAtIon & VIrAl InfeCtIon

VIrAl InfeCtIononly

Exposure reduction results in an almost

50% cut in severe asthma exacerbations

reduce the risk of asthma exacerbations by reducing allergen exposure.9

Almost 50%greater likelihood of moderate to severe

asthma symptoms when they have a virus10

7

decode to improve quality of life.

8

Better ASthMA Control MeAnS:

7 fewer missed work days per year12

and 21.3 fewer symptom days per year11

The cost of symptom days can be up to $126.71.13

4.4 fewer missed school days per year11

and up to 17 fewer days wheezing per year11

Didn’t miss this year’s field trip

Enjoyed more games of kickball during recess

Able to travel to finish a major project

Working out at the gym again

reC

oM

Me

nd

AtIon

S

9

Allergen exposure reduction can be as effective as pharmacotherapy in reducing asthma symptoms.6

Allergen exposure reduction led to 61% medication reduction.6

exPoSure reduCtIon VS. PhArMACotherAPy6

0

-20

-40

-60

-80

exPoSure reduCtIon

MontelukASt flutICASone

% C

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Ige testing leads to allergen exposure reduction.

reCoMMendAtIonS for Allergen SyMPtoM reduCtIon6

InterVentIontyPe

• Install mattress and pillow covers

•Wash bedding weekly

•Vacuum carpets more frequently

•Remove stuffed animals and extra pillows from bed

•Dehumidify

•Remove carpeting

•Replace draperies

•Replace fabric furniture

fIrSt lIne

SeCond lIne

· Exposure reduction cut rescue inhaler usage by 72%6

decode food allergies on a deeper level.

10

Jeremy has a history of atopic dermatitis and sensitivity to egg. After ImmunoCAP, he was able to enjoy birthday cake.

Sensitized only to ovalbumin (egg protein) and is likely to outgrow14

Ovalbumin is heat labile, so it can be tolerated in baked products. Eggs not fully cooked should be avoided14

Patients with asthma and food allergy are at greater risk for severe respiratory symptoms when exposed to food allergen triggers.16

JereMy3 years old

Prone to rashes

Experienced vomiting after eating scrambled eggs

ImmunoCAP helps identify which patients are appropriate for a cooked/baked oral food challenge with a specialist—which can save time and money.15






•Identify specific allergy triggers to help control allergic asthma and viral symptoms

•Reduce costs associated with absenteeism and lost productivity at work and school

•Prevent unnecessary medications and unscheduled doctor visits




DECODE allergies to




foo

d A

lleR

gIe

s

11



some proteins may:· Cause no reactions or mild localized reactions18






ovAlbumIn (f 76)


ovomuCoId (f 233)


egg Ige, PosITIve











• Identify specific allergy triggers to help control allergic asthma and viral symptoms

• Reduce costs associated with absenteeism and lost productivity at work and school

• Prevent unnecessary medications and unscheduled doctor visits




DECODE allergies to




foo

d A

lle

Rg

Ies

11



some proteins may:

· Cause no reactions or mild localized reactions18






ovAlbumIn (f 76)


ovomuCoId (f 233)


egg Ige, PosITIve






to better manage your patients' asthma and allergies ... · to better manage your patients’...

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