Allergic rhinitis: How to identify the primary sensitisation

This illustrative case study explores an example of a young man's, David, journey, demonstrating how cutting-edge allergy diagnostics helped manage his persistent allergic rhinitis symptoms. His story highlights the pivotal role of Thermo Fisher Scientific’s ImmunoCAP^TM specific IgE test results in helping general practitioners identify and manage allergies with precision. Dive into the details and see the difference accurate allergy diagnostics can make in primary care.

Examination, investigations and results

Examination

Whilst talking to David, his GP noticed that he had nasal speech and was frequently sniffing and rubbing his nose. Allergic shiners, discolored circles under the eyes, were observed upon close inspection of his face and internal examination of his nose revealed turbinate hypertrophy. 

Examination and auscultation of David’s chest revealed no obvious abnormalities or stigmata of asthma. 

Which of David’s symptoms are particularly suggestive of allergic rhinitis, as opposed to non-allergic rhinitis?

Manifestations of rhinitis, which are particularly suggestive of allergy, are:¹

• Itchy nose and/or palate
• Sneezing
• Eye-related symptoms 

Investigations

David’s GP decided to request a specific IgE blood test; Allergy blood tests are not affected by antihistamines and can be performed in patients who have recently taken them, such as David.² The panel of allergens was selected based on David’s symptoms, age and local sensitisation patterns. As his symptoms usually begin in May and are at their worst in July, a range of allergens that typically present in spring/summer (including pollens and a fungus), were selected for testing. 

How could these specific IgE blood test results guide the GP’s management of David?

Specific IgE blood test results could guide the GP’s management of David in various ways, including:^3,4

• Confirmation of his previous seasonal allergic rhinitis diagnosis
• Determination of appropriate pharmacotherapy and timing of therapy
• Guidance on local allergen avoidance strategies
• Consideration of allergen immunotherapy^†

^†Refer to specialists/allergists for allergen immunotherapy, if required. 

Differential diagnosis

The results showed a significant IgE response to Timothy grass, confirming the previous diagnosis of seasonal allergic rhinitis. No other sensitisations were found, so allergies to birch pollen, ragweed, mugwort and Alternaria alternata can be ruled out. 

Management

As Timothy grass is an outdoor allergen, it cannot be completely avoided.⁵ However, David could use the following techniques to help limit his exposure:⁵

• Check local pollen counts to anticipate grass pollen season and monitor pollen levels.
• Keep windows closed during pollen season. 
• Take a shower, wash hair, and change clothing after working or playing outdoors. 

Information gained from specific IgE blood tests can be an important factor in better pharmacotherapy management. For example, commencing therapy just before the start of the local grass pollen season could maximise treatment effectiveness for David.³

Allergen immunotherapy (AIT) is the only potentially disease-modifying option for the treatment of allergies⁷ and is usually initiated by allergy specialists.⁸ Appropriate AIT can prevent the development of asthma⁹ and, in patients with comorbid asthma, improve symptom control.¹⁰  David’s GP decided to refer him to an allergy specialist for selection of AIT. 

*The following products are included in the ImmunoCAP™ blood test portfolio:

• ImmunoCAP Allergen g6, Timothy
• ImmunoCAP Allergen t3, Common silver birch
• ImmunoCAP Allergen w1, Common ragweed
• ImmunoCAP Allergen w6, Mugwort
• ImmunoCAP Allergen m6, Alternaria alternata 

IgE: immunoglobulin E; kUA/L: allergen-specific kilo units per litre 

Conclusion

David's steps from suffering to relief highlight the essential role of precise allergy diagnostics and customized treatment plans. With Thermo Fisher Scientific’s ImmunoCAP specific IgE test solutions, his general practitioner was provided with accurate results to guide personalized care that significantly enhanced David’s quality of life.