Discover the connection
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1 Jill is about to have an asthma exacerbation, and she won t know why Timothy grass ASTHMA Dog dander House dust mites Underlying allergens affect asthma Discover the connection ImmunoCAP blood testing helps you identify allergy triggers and develop an exposure reduction plan for improved patient well-being
2 Discover the connection between asthma and allergy It may be time to go beyond asthma controller therapy Up to 2/3 of patients report that their asthma symptoms are uncontrolled1,2 Common triggers that may induce or worsen asthma: FOOD ALLERGENS INFECTIONS IRRITANTS INHALANT ALLERGENS COMORBIDITIES
3 Discover the connection between asthma and allergy The majority of asthma patients suffer from allergies % of children 60% of adults Case history alone may overlook relevant inhalant and food allergies
4 Recognize the risk of allergy in your asthma patients Allergy increases the risk for severe asthma Odds ratio/life-threatening asthma Any food allergens Any inhalant allergens SENSITIZATION Children with asthma and concomitant food allergy have a 7x higher risk for life-threatening asthma exacerbations9,10 Independent risk factors for lifethreatening asthma, from a casecontrolled analysis of children ventilated for asthma exacerbation.9
5 Recognize the risk of allergy in your asthma patients Combination of allergy and viral infections increases the risk for severe asthma11 Odds ratio/risk of hospitalization Allergen exposure, sensitization, and viral infection Sensitization and viral infection Synergistic effect Viral infection only A nearly 20-fold increased risk for hospitalization in patients with asthma, allergen exposure, and viral infection compared to patients with asthma alone11 Identifying triggers early is the key to improved patient management and overall well-being Multivariate analysis of odds ratios (95% CI) for risk factors of hospital admission for acute asthma exacerbation in children ages 3 to 17 years.11
6 Uncover the underlying triggers Identify the allergy triggers that can lead to asthma symptoms Inhalant allergens may have additive effects on symptoms12,13 Symptoms appear when asthma patients reach their symptom threshold MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB ASTHMA SYMPTOM THRESHOLD Birch pollen Viral infections Viral infections Irritants (e.g. cigarette smoke) Mold House dust mite Up to 80% of allergic patients are sensitized to several allergen extracts, on average 3 allergens14,15 Identifying the sensitizing allergens will help you outline an exposure reduction plan to keep patients below symptom threshold
7 Uncover the benefits of allergen exposure reduction Reducing allergen exposure improves asthma control Shown to be as effective as ICS* therapy in reducing symptoms16,17 SYMPTOM OF ASTHMA DAYS/YEAR 120 CONTROL INTERVENTION 34 fewer days of wheezing over 2 years16, Fewer missed school days/year 16 Intervention year Follow-up year 13% > 50% Fewer emergency room/ clinic visits per year 16 Reduction in ICS* usage in majority of patients 18 * Inhaled corticosteroid therapy. Education and remediation decreased exposure to indoor allergens, including cockroach and dustmite allergens, resulting in reduced asthmaassociated morbidity. Effect was achieved without worsening symptoms, lung function or increased need for rescue medication. Reduction was reached in 73% (active treatment group) vs. 24% (control group) at 12 months ( p>0,01) using bedding encasements in dust mite allergic patients.
8 ImmunoCAP plus case history improves diagnostic certainty Case history alone is not enough to identify allergy triggers Diagnostic certainty in ruling in or ruling out allergy has been shown to increase when ImmunoCAP Complete Allergen results are added to clinical history19,20 % of patients % (n=1101) Adapted from: Duran-Tauleria E. Allergy 2004; 59 (suppl 78): Niggemann B. Pediatr Allergy Immunol. 2008; 19: % Case history only Addition of ImmunoCAP Study among patients with symptoms of eczema, wheezing and/or asthma, and rhinitis in primary care.19,20 ImmunoCAP Complete Allergens help rule in or rule out allergy and identify allergy triggers19-21 Guidelines recommend IgE testing, such as ImmunoCAP, in addition to clinical history and physical exam for patients with asthma21-23
9 ImmunoCAP plus case history improves diagnostic certainty ImmunoCAP testing can easily be performed irrespective of 24-27: Patient age Skin condition Medication Disease activity Pregnancy status TEST RESULTS CASE HISTORY No precaution for severe reactions as with skinprick test (SPT)23,24 COMPLETE DIAGNOSIS
10 ImmunoCAP Complete Allergens Common inhalant and food allergens in wheezing and/or asthma patients Wheezing/Child Asthma/Adult g6 t3 t25 w6 e1 e5 d1 f1 f2 f13 g6 t3 t25 w1 w6 e1 e5 d1 m6 i6 Timothy Birch Ash Mugwort Cat Dog House dust mite Egg white Cow s milk Peanut Timothy Birch Ash Ragweed Mugwort Cat Dog House dust mite Alternaria Cockroach A 1-mL sample of whole blood is sufficient to test for up to 10 different allergens
11 ImmunoCAP Complete Allergens ImmunoCAP provides true quantitative results for accurate decisions12,28,29 The higher the concentration of sige antibodies, the higher the risk for symptomatic allergy* 100 Proportion of individuals with symptomatic allergy (probability %) Very high 80 High 60 Common 40 Symptom relation 20 Low Uncommon sige antibody concentration (kua/l) ImmunoCAP is the most extensively studied and widely used IgE blood test available * Factors to consider for a final diagnosis: Age, degree of atopy, allergen load, type of sensitizing allergens, previous symptoms, other triggering factors. Any reading of 0.10 kua/ l indicates sensitization.
12 The connection: ImmunoCAP Allergen Component testing ImmunoCAP Allergen Components offer a second step for improved diagnosis30 1 Complete Allergens 2 Allergen Components
13 The connection: ImmunoCAP Allergen Component testing Up to 70% of pollen allergic patients suffer from pollen-related food allergies31 ImmunoCAP Allergen Components help you distinguish between cross-reactive and specific food sensitization30 Allows you to assess the risk of systemic reactions in patients with allergies to peanuts, tree nuts, and other plant-derived foods 30, Helps you decrease the need for provocation testing and improve recommendations for allergen avoidance30 1 Complete Allergens 2 Allergen Components
14 The connection: Clinical history plus ImmunoCAP Jill, 12 years old case history: Eczema as an infant and toddler Egg allergy diagnosed as a young child Outgrew both conditions, developed rhinitis at age four Diagnosed with asthma at six Frequent asthma exacerbations when having a cold On inhaled steroids during spring and summer Uses bronchodilators during asthma exacerbations Current situation: Jill eats a chocolate bar containing peanuts and suddenly experiences urticaria and coughing Jill s doctor orders ImmunoCAP Complete Allergen tests to get a better understanding of her allergy triggers
15 The connection: Clinical history plus ImmunoCAP ImmunoCAP test results: Timothy grass 20.5 kua/l Birch Cat dander Dog dander 7.5 kua/l <0.1 kua/l 7.4 kua/l House dust mite 5.2 kua/l Alternaria Peanut <0.1 kua/l 4.1 kua/l Interpretation and management: Jill should avoid peanuts, as they may elicit asthma and other symptoms She may need to carry an adrenaline auto-injector She should avoid triggers, especially when she has a cold She should avoid visiting friends who have a dog Pollen exposure can be reduced by drying clothes and bed sheets indoors and minimizing time outdoors during pollen season House dust mite exposure can be reduced by controlling indoor climate and using hypoallergenic bedspreads and pillowcases Outlook: With these precautions, Jill s asthma should be kept in better control Doctor decides to order ImmunoCAP Allergen Component tests to evaluate if Jill is at risk for a systemic reaction to peanuts
16 You ve discovered the connection Now consider the benefits of ImmunoCAP Asthma is a serious condition affected by underlying inhalant and food allergies Up to 7x higher risk for life-threatening asthma than in children with asthma alone6-10 Inhalant allergens add up and may push the patient over the symptom threshold12-15 Reducing allergen exposure improves asthma control Fewer symptoms, fewer hospital visits, and improved quality of life16-18 ImmunoCAP helps you identify the allergic triggers The most extensively studied and widely used sige blood test available Increases certainty in diagnosis from 50% to 90% when added to clinical history19,20 Can easily be performed irrespective of patient s age, skin condition, medication, disease activity, and/or pregnancy status24-27
17 See if it is allergy or not Phadiatop correctly classifies more than 9 out of 10 patients as allergic or non-allergic Phadiatop indicates whether or not your patients symptoms are due to atopy Case history alone vs case history + Phadiatop 90% Efficiency 50 <50%15,19, %36, Case history alone (No tests) Case history + Total sige (Blood test) Case history + Phadiatop/ Phadiatop Infant (Blood test)
18 See if it is allergy or not Rule in or rule out allergy early with Phadiatop Phadiatop measures sige antibodies to a list of common inhalant allergens, like grasses, trees, weeds, household pets, dust mites, and molds Phadiatop Infant is optimized for children under 5 years of age and includes common inhalant and food allergens Phadiatop: Differentiates sige-mediated atopic allergy from other allergy-like symptoms41-46 Identifies patients who need further specific IgE testing for allergen identification and continued management41-46 Positive case history Positive Phadiatop Complete Allergens For allergen identification Patient management and well-being
19 References: Rabe KF, et al. J Allergy Clin Immunol. 2004;114:40-7. Cazzoletti L, et al. J Allergy Clin Immunol. 2007;120: Arbes SJ, Jr., et al. J Allergy Clin Immunol. 2007;120: Allen-Ramey F, et al. J Am Board Fam Pract. 2005;18: Host A, et al. Allergy. 2000;55: Simpson AB, et al. Pediatr Pulmonol. 2007;42: Schroeder A, et al. Clin Exp Allergy. 2009;39: Malmberg LP, et al. Clin Exp Allergy. 2010;40: Roberts G, et al. J Allergy Clin Immunol. 2003;112: Liu AH, et al. J Allergy Clin Immunol. 2010;126: e Murray CS, et al. Thorax. 2006;61: Simpson A, et al. J Allergy Clin Immunol. 2005;116: Stoltz DJ, et al. Clin Exp Allergy. 2013;43: Ciprandi G, et al. Eur Ann Allergy Clin Immunol. 2008;40: Petersson CJ, et al. Sensitization profile in undiagnosed children with skin and respiratory allergy-like symptoms in primary care. Abstract presented at WAO, Buenos Aires, Argentina 6 10 December Morgan WJ, et al. N Engl J Med. 2004;351: Szefler S, et al. New Engl J Med. 2000;343: Halken S, et al. J Allergy Clin Immunol. 2003;111: Adapted from Duran-Tauleria E, et al. Allergy. 2004;59 Suppl 78: Adapted from Niggemann B, et al. Pediatr Allergy Immunol. 2008;19: Eigenmann PA, et al. Pediatr Allergy Immunol. 2013;24: Expert Panel Report 3 (EPR-3) J Allergy Clin Immunol. 2007;120:S Walsh J, et al. Br J Gen Pract. 2011;61: Siles RI, et al. Cleve Clin J Med. 2011;78: Bonnelykke K, et al. J Allergy Clin Immunol. 2008;121: Belhocine W, et al. Pediatr Allergy Immunol. 2011;22: Bacharier LB, et al. Allergy. 2008;63: Soderstrom L, et al. Allergy. 2003;58: Sampson HA. J Allergy Clin Immunol. 2001;107: Canonica GW, et al. World Allergy Organ J. 2013;6: Vieths S, et al. Ann N Y Acad Sci. 2002;964: Fernandez-Rivas M, et al. J Allergy Clin Immunol. 2006;118: Asarnoj A, et al. Allergy. 2010;65: Masthoff LJ, et al. J Allergy Clin Immunol. 2013;132: Williams PB, et al. Ann Allergy Asthma Immunol. 2003;91: Kaliner MA, et al. Module 9, Global Resources in Allergy (GLORIA), World Allergy Organization (updated 2011). 37. Carosso A, et al. Int Arch Allergy Immunol. 2007;142: Halvorsen R, et al. Int J Pediatr. 2009;2009: Paganelli R, et al. Allergy. 1998;53: Fiocchi A, et al. Ann Allergy Asthma Immunol. 2004;93: Eriksson NE. Allergy. 1990;45: Wever-Hess J, et al. Acta Paediatr. 1999;88: Ballardini N, et al. Allergy. 2006;61: Nilsson C, et al. Pediatr Allergy Immunol. 2012;23: Lau S, et al. Pediatr Allergy Immunol. 2008;19: Williams PB, et al. Ann Allergy Asthma Immunol. 2001;86:
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