Asthma Management Handbook

Allergy tests for diagnosis in adults

Recommendations

Consider allergy testing as part of diagnostic investigations if you suspect allergic triggers, or to guide management.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

To investigate allergies in a person with severe or unstable asthma, or a history of anaphylaxis, refer to a specialist allergist for investigation to minimise risk.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australasian Society of Clinical Immunology and Allergy, 20131

If allergy testing is needed, refer to an appropriate provider for skin prick testing for common aeroallergens.

Notes

If staff are trained in the skin prick test procedure and its interpretation, skin prick testing can be performed in primary care. If not, refer to an appropriate provider.

When performing skin prick testing, follow Australasian Society of Clinical Immunology and Allergy (ASCIA) guidance: Skin prick testing for the diagnosis of allergic disease. A manual for practitioners

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australasian Society of Clinical Immunology and Allergy, 20131

Blood test (immunoassay for allergen-specific immunoglobulin E) can be used if skin prick testing is (any of):

  • unavailable
  • impractical (e.g. a patient who is unable to cooperate with test procedure, a patient taking antihistamines when these cannot be withdrawn, or a patient taking tricyclic antidepressants or pizotifen)
  • contraindicated (e.g. patients with severe dermatographism, extensive skin rash, or those at risk of anaphylaxis including patients with occupational asthma due to latex sensitivity).
How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australasian Society of Clinical Immunology and Allergy, 20131

More information

Allergy tests in diagnostic investigation in adults and adolescents

Not all asthma is allergic, so negative allergy tests cannot exclude asthma. The probability that respiratory symptoms are due to allergic asthma is increased if a person has a history of allergy, or a family history of allergic rhinitis or atopic dermatitis.

The Australasian Society of Clinical Immunology (ASCIA) recommends skin prick testing as the first-choice method for investigating allergies in a person with asthma.1 ASCIA cautions that non-specialist practices should not perform skin prick testing in patients with persistent severe or unstable asthma due to potential adverse effects.1

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References

  1. Australasian Society of Clinical Immunology and Allergy (ASCIA), Skin Prick Testing Working Party. Skin prick testing for the diagnosis of allergic disease: A manual for practitioners. ASCIA, Sydney, 2013. Available from: http://www.allergy.org.au/health-professionals/papers/skin-prick-testing