Managing Allergies and Asthma: What Primary Care Physicians Need to Know

With more than 50 million Americans suffering from allergies each year, it’s critical for primary care physicians to play a pivotal role in appropriately managing asthma and allergic diseases.

About 7.8% of Americans age 18 and older suffer from hay fever (also known as allergic rhinitis) and more than 24 million Americans, including 5.5 million children under 18, suffer from asthma. Both allergic rhinitis and asthma affect quality of life and productivity at work or school.

The financial implications are staggering. Allergic rhinitis costs the U.S. economy approximately $3.4 billion annually in medical expenses and days missed from work or school while asthma costs exceed $81 billion each year. Equipping primary care physicians to better diagnose and treat allergies and asthma can help improve patient outcomes and mitigate these costs.

Diagnosis and diagnostic advances
Allergies occur when the immune system responds to a foreign substance, such as pet dander or pollen, that is usually harmless. When the body comes into contact with the allergen, the immune system goes on the attack and starts producing IgE antibodies. Obtaining a good clinical history and identifying the source of the specific allergen is essential so patients can begin to minimize their exposure to their allergens and develop an effective treatment plan.

Since some allergy symptoms can overlap with other conditions such as nonallergic rhinitis or viral illnesses, it’s important for patients to know their triggers and symptoms. Common environmental allergens include dust mite, pollen, mold, pet dander and mouse. Clinical guidelines recommend specific IgE allergy testing for patients who do not respond to over-the-counter medications; have moderate to severe symptoms; or simply want to know what they are allergic to so they can appropriately intervene.

Common environmental allergens can also trigger asthma exacerbations: 60% percent of those with asthma have allergic asthma, making it important for asthma patients to understand their allergic trigger(s) to prevent a flare. NIH guidelines recommend specific IgE allergy testing (blood or skin prick) to common environmental allergens for patients with persistent asthma.

Additionally, clinical studies suggest that advanced molecular diagnostics specifically pet allergen component testing (which identifies 11 different molecular allergen component proteins found in dogs, cats or horses) can be used as a marker of asthma risk and asthma severity. A study of 696 cat allergic children in Sweden found cat-induced asthma symptoms were significantly associated with serum specific IgE to cat allergens Fel d 1 and Fel d 4.

Among dog-sensitized children, the majority were sensitized to more than one dog component, and co-sensitization to Can f 5, Can f 1, and Can f 2 were associated with higher risk for asthma. The study further confirmed that asthma was associated with higher levels of component sensitization. Progression of allergic sensitization over time has been shown to involve IgE recognition of an increasing number of components from the sensitizing allergen source, which suggests molecular spreading, and correlates with disease severity.

Chronic disease management model
With the rise in allergies, it is important to incorporate it into the chronic disease management model. The goal is to eliminate or minimize exposure to allergens to improve health outcomes in sensitized individuals. The treatment and management of allergic diseases requires a multifaceted approach.

In addition to the selection of the appropriate medications, allergic triggers need to be assessed and an environmental mitigation strategy needs to be implemented; which can include low cost interventions in sensitized individuals. The role of allergies in asthma is well established.

According to updated NIH asthma guidelines published in 2020 in the Journal of Allergy and Clinical Immunology, individuals with asthma who are sensitized to indoor allergens should use multiple strategies to reduce exposures to their allergens. For e.g. in dust mite sensitized individuals hypoallergenic pillow and mattress covers and high efficiency particulate air (HEPA) filtration vacuum cleaners can be used to help reduce exposures.

Primary care physicians often serve as a first line of defense for allergy and asthma sufferers, helping diagnose and treat their symptoms. Specific IgE testing can help primary care providers tailor treatments to patients’ needs and make more appropriate referrals to allergists, who remain key members of the treatment team. It also aligns with value-based care delivery by ensuring the right care is delivered to the right patient in the right setting. This can lead to greater continuity of care and has the potential to lower costs as patients receive treatment that aligns with their needs.