Do asthma patients in general practice profit from a structured allergy evaluation and skin testing? A pilot study.
BACKGROUND
Although allergy is central to the pathophysiology of asthma, little is known about the benefits of a structured approach to allergen diagnosis and management in primary care asthma patients.


OBJECTIVE
We studied effects of a structured allergen evaluation and allergen avoidance advice combined with or without additional allergy skin testing on health status, illness perception, and lung function of asthma patients treated in general practice.


METHODS
Fifty-four asthma patients were randomly assigned to three groups: (i) Standard asthma care with information on the stepwise treatment approach, a written action plan, and inhaler technique training; (ii) Additional structured allergen evaluation and avoidance advice; (iii) Additional structured allergen evaluation and avoidance advice based on skin prick test results. Patients were seen for one initial appointment at a primary care asthma clinic and a follow-up examination 3 months later. On both occasions, questionnaire measures of symptoms, illness perception, and the perceived control of asthma were administered. Lung function was measured by spirometry (PEF, FEV1). Perceived allergic asthma triggers, the trigger impact, and the trigger control were assessed in both intervention groups.


RESULTS
Following intervention, a decrease in beta-adrenergic inhaler use, an increase in the perceived control of asthma, and a decrease in the bothering from asthma symptoms were observed for all three groups. Intervention groups showed a higher awareness of animal-allergic triggers, and the perceived control of asthma triggers was increased in the group receiving no skin tests. FEV1 showed an improvement in both intervention groups.


CONCLUSIONS
Structured allergy evaluation and avoidance advice can improve lung function and the control of asthma in primary care. Further research is needed on the additional benefits of allergy skin testing.
Bobb
Carol
C
South Lewisham Group Practice, Catford, London, UK.
Ritz
Thomas
T
D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001294:Attitude to Health; D003376:Counseling; D005194:Family Practice; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006266:Health Education; D006304:Health Status; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D010865:Pilot Projects; D012882:Skin Tests / Q000379:methods
D000485:Allergens