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testing provides physicians and patients a more comprehensive list of allergy triggers — Thermo Scientific's catalogue of allergens contains as many as 600 allergens. For convenience, major reference laboratories have created profiles reflecting 20 unique regions in the United States and identified common allergens in each to provide resources to physicians who may not have a working knowledge of allergens affecting their local population. Effectively identifying allergen sensitivities, Dr. Reinhardt says, establishes the basis for a comprehensive asthma management plan. Once testing reveals the allergy triggers, Dr. Reinhardt encourages physicians to be prepared to synthesize the results to establish a plan to prevent symptomatic asthma. "After testing patients for allergen sensitivities and finding multiple triggers, physicians must be able to counsel patients on how to manage their triggers," Dr. Hicks says, adding it's not beneficial to test for allergies if it changes nothing. "Physicians should be able to tell patients what to do to avoid those triggers." Pinpointing allergens allows patients to modif y their lifestyles in ways that will help avoid close contact with the underlying causes of their allergy or asthma symptoms. However, Dr. Reinhardt notes that inaccurate testing may impact patients in ways other than allowing persistent allergy triggers to exacerbate asthma. "Exposure reduction measures aren't easy to do from a lifestyle or economic standpoint," says Dr. Reinhardt. "Some of these measures are costly, so it's important for patients or parents to know that what you're telling them to do is going to address the symptoms and not just be guesswork." Controlling Asthma Is Possible Without Increased Medication Reducing exposure to triggers has demonstrated efficacy in elevating quality of life. Authors of a 2004 study GUIDELINES FOR OPTIMAL ASTHMA MANAGEMENT ONCE PRIMARY CARE physicians have identified allergic triggers for asthmatic patients, an asthma management plan should be implemented. The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends medicines such as inhaled corticosteroids, for long-term asthma relief, in addition to allergen avoidance measures. Physicians should establish a schedule for follow-up visits with patients to ensure these measures effectively manage asthma. According to the National Heart, Lung, and Blood Institute (NHLBI), check-up schedules may vary depending on the clinician's judgment; however, it recommends the following schedule: • For patients initiating or increasing therapy to control asthma, follow-up appointments should be scheduled at two- to six-week intervals. • After preventing chronic symptoms (such as coughing and shortness of breath), reducing the need for inhalers and other quick-relief medications, achieving good lung function, restoring normal activity levels and restful sleep patterns, and preventing asthma attacks, asthma is said to be controlled. Once controlled, the NHLBI recommends check-ups at one- to six-month intervals. If physicians suspect medicinal therapy may need to be reduced, then follow-ups should be scheduled at three-month intervals. William Hicks, M.D., head allergist, partner at HealthEast Care System, urges physicians whose patients are unable to achieve persistently good asthma control to refer them to asthma specialists for further management. published in The New England Journal of Medicine reached out to inner-city children suffering with asthma across the United States. The often suboptimal condition of inner-city housing makes for high allergen prevalence and poor asthma control. By reaching out to the community and providing education on how to avoid potential asthma triggers and how to maximize medical control plans, researchers found reductions in emergency department visits by 66%, hospitalization by 84% and the number of missed school days by five. Dr. Reinhardt notes that studies such as this demonstrate that asthma may be controlled without increases in medication if physicians and patients know which allergens to avoid. ImmunoCAP proves a useful tool to help primary care physicians identify allergen sensitivities, and for physicians who find themselves in unfamiliar territory — such as in ra re insta nces when patients' ImmunoCAP tests ret ur n w it h r e s u lt s w h ic h a r e d i f f ic u lt to i nterpret — Dr. Reinhardt recommends referral to an allergist. I MDNEWS.COM I MD NEWS Twin Cities | 15

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