Casale Thomas B, Martin Richard J
Allergy/Immunology, Creighton University, Omaha, Nebraska, USA.
Clin Cornerstone. 2009;9(3):20-9. doi: 10.1016/s1098-3597(09)80009-4.
The strong association between allergy and asthma is well documented; however, few practitioners-even asthma specialists-accurately estimate the percentage of patients with asthma who have clinically relevant allergies. Because allergen exposure can prompt airway inflammation, trigger asthma exacerbations, and possibly lead to negative health outcomes for patients with asthma, identifying allergies and immunoglobulin E (IgE)-mediated disease in patients with persistent asthma is crucial. Updated Expert Panel 3 asthma guidelines from the National Asthma Education and Prevention Program reinforce the need for clinicians to identify allergic sensitivities in patients with persistent asthma and determine their clinical relevance. Allergy testing can be useful in educating the patient with IgE-mediated asthma about the need for allergic trigger avoidance and can help determine optimal therapy for patients with concomitant asthma and allergy. Implementing this guideline recommendation, however, requires active clinical engagement. Data from a recent observational study indicate that there may be a substantial gap between guideline recommendations and actual clinical practice. These data also suggest that when clinicians participate in education about the role of IgE in asthma and begin testing their patients for allergy, the recognition of allergies among patients with asthma dramatically increases.
过敏与哮喘之间的紧密关联已有充分记录；然而，很少有从业者——甚至哮喘专科医生——能准确估计出患有临床相关过敏的哮喘患者的比例。由于接触过敏原可引发气道炎症、触发哮喘发作，并可能给哮喘患者带来负面健康后果，因此识别持续性哮喘患者的过敏情况和免疫球蛋白E（IgE）介导的疾病至关重要。美国国家哮喘教育与预防计划更新的专家小组3哮喘指南强调，临床医生有必要识别持续性哮喘患者的过敏敏感性，并确定其临床相关性。过敏检测有助于教育患有IgE介导性哮喘的患者认识到避免接触过敏触发因素的必要性，还能帮助确定合并哮喘和过敏患者的最佳治疗方案。然而，要落实该指南建议，需要临床医生积极参与。近期一项观察性研究的数据表明，指南建议与实际临床实践之间可能存在很大差距。这些数据还表明，当临床医生参与有关IgE在哮喘中作用的教育，并开始为患者进行过敏检测时，哮喘患者中过敏的诊断率会大幅提高。
