Asthma persists as one of the most frequent chronic conditions which impacts millions throughout the world. In the United States alone, asthma affects approximately 25 million individuals, and its prevalence continues to rise. This is especially true for women, who are disproportionately affected by asthma as 11% of women aged 18 and older suffer from asthma but for adult males this percentage is 6.8%.

Asthma management is primarily handled by Nurse Practitioners (NPs), who are responsible for treating most asthma-related visits as part of their role as primary care providers (PCPs). Approximately 60% of asthma-related visits take place in primary care settings, where many NPs directly provide care.

Since primary care NPs typically see their patients annually, they have the opportunity to build strong, ongoing relationships and gain a comprehensive understanding of their patients’ needs. This long-term rapport allows NPs to utilize historical data to enhance asthma care, implementing full-scale management strategies such as allergy testing and personalized treatment plans.

The Importance of Allergy Testing in Asthma Management

Asthma exacerbations most often occur because of environmental allergens including pollen, dust mites, pet dander and mold in the environment. The majority of asthma symptoms become more severe and can occur frequently because of environmental factors that are not properly addressed during basic asthma treatment. Research demonstrates that allergic triggers can cause symptoms to worsen in 60%-90% of children with asthma and 50% of adults. The presence of allergic triggers makes asthma harder to control and results in increased hospitalizations and emergency room visits.

Despite the profound role that allergens play in asthma exacerbations, they are often underdiagnosed or inadequately managed in many asthma treatment plans. Many asthma care plans depend only on pharmacological treatments such as inhaled corticosteroids and beta agonists without adequate consideration of allergen-specific interventions. The implementation of allergy testing within asthma treatment protocols is necessary to help healthcare providers identify which specific allergens may trigger patient symptoms so more personalized, preventative interventions may be implemented as a part of the individualized treatment plan.

NPs who identify environmental triggers can proactively develop strategies which extend past symptom management. Allergy testing helps medical professionals determine if patients have allergic or non-allergic asthma which determines the most suitable treatment approach. When allergic asthma becomes the diagnosis, the treatment plan should include methods for avoiding allergens and considering additional medications like antihistamines or referral for allergen immunotherapy that can address the allergic component of the disease.

Blood tests are a crucial tool in identifying allergic triggers. These invitro blood tests use laboratory procedures to measure the amount of specific IgE antibodies which develop as an immune response to allergens. Blood tests deliver comparable results to skin prick testing and are easily accessible to both specialty and primary care clinicians alike. The blood test works together with a region-specific respiratory allergen profile which contains common indoor allergens such as dust mites, cockroaches, mice and pets, alongside local grass, tree and weed pollen allergens to determine the environmental factors that affect patients living in their geographical area. Serological testing for specific IgE is convenient for patients and only requires a relatively small amount of sera to assess a comprehensive profile of suspected allergens. Additionally, unlike skin prick testing, there is no need for patients to stop any medications prior to testing. The availability of these clinical laboratory profiles across national and regional locations makes allergy testing an affordable tool which NPs can integrate into their routine asthma management

Identifying allergic triggers through specific IgE testing enables the development of customized treatment plans that combine exposure reduction strategies with appropriate medications. NPs should educate patients on how to minimize exposure to identified allergens.

For instance:

• House Dust Mites: Advise patients to encase mattresses, pillows, and box springs in allergen-proof coverings, wash bedding weekly in hot water (130°F), and use a dehumidifier to reduce indoor humidity.
• Animal Dander: Recommend keeping pets out of bedrooms, using HEPA filters in the home, and bathing pets regularly to decrease dander levels.
• Pollen: Suggest checking daily pollen counts, keeping windows closed during high pollen seasons, and showering after outdoor activities to remove pollen from skin and hair.

By providing tailored education on these exposure reduction techniques, NPs empower patients to effectively manage their symptoms, leading to fewer asthma exacerbations and improved overall control of their condition.

The Role of Nurse Practitioners in Allergy Testing

The training of NPs prepares them to deliver patient-centered holistic care through a complete assessment of both the medical history and environmental factors that influence asthma symptoms. Clinicians have the capability to evaluate asthma patients beyond their symptoms because they can also take into account environmental allergens that might worsen their condition.

Asthma management from a multidisciplinary perspective is within the capabilities of PCPs since they understand that treatment goes beyond prescribing inhalers and exacerbation management. The evaluation process requires an examination of environmental factors alongside co-existing health conditions and development of personalized treatment strategies. NPs can advance asthma diagnosis through allergy testing because this method helps identify environmental allergens which may trigger asthma exacerbations.

Through their established relationship with patients NPs can conduct extensive discussions about symptom details along with lifestyle factors and potential allergens. The open communication between NPs and patients enables better allergy testing because patients feel comfortable sharing information about their allergen exposure along with their symptom patterns. Patient history along with diagnostic testing are essential tools because they help NPs detect triggers which would normally remain invisible.

In addition to identifying potential allergens, allergy testing enables primary care NPs to collaborate more effectively with specialists when necessary. When allergy tests demonstrate substantial sensitizations to multiple allergens and the patient’s symptoms are not well controlled, primary care NPs can develop proper referral recommendations for allergists, pulmonologists, and other specialist practitioners who can provide additional therapeutic interventions such as biologics and allergen immunotherapy. The medical team works together to deliver the most suitable treatment plan that patients require between primary care facilities and specialized centers.

Best Practices for Integrating Allergy Testing

To successfully integrate allergy testing into routine asthma care, NPs should adopt best practices that ensure the testing process is thorough, efficient, and impactful. The following steps can help NPs incorporate allergy testing into their asthma management protocols.

While all patients with persistent asthma should have their allergic triggers identified, clinicians should especially focus on those patients with asthma that is difficult to control and those experiencing frequent exacerbations.

The CDC along with NIH suggests testing every persistent asthmatic for allergic triggers, especially those with uncontrolled symptoms. NPs should use validated tools like the Asthma Control Test (ACT) to perform regular asthma assessments which will help them find patients who would especially benefit from allergy testing.

Interpreting and Acting on Test Results

Upon receiving results for specific IgE allergen sensitizations, NPs can first determine whether a patient is atopic. If atopy is confirmed, the results should be interpreted in the context of the patient’s clinical symptoms. This will allow personalized guidance on targeted allergen exposure reduction techniques and appropriate medication selection and usage. For patients with difficulty controlling symptoms the testing will help inform appropriate specialist referrals for advanced treatments such as biologics and/or allergen immunotherapy. Understanding their specific allergy triggers empowers patients to address key contributors to their symptoms, take targeted steps to reduce exposure, and potentially improve symptom control and medication effectiveness.

Overcoming Common Challenges in Allergy Testing

Non-provider clinical office staff can be utilized to facilitate both identification of patients who would benefit from assessment of allergic triggers and to facilitate patient education regarding exposure reduction methods for specific identified allergens. Reinforcing this along with other asthma education (e.g. proper inhaler use and review of asthma action plans) will provide a more patient-centric experience.

Conclusion: Enhancing Asthma Care through Allergy Testing

Integrating allergy testing into routine asthma management offers a valuable opportunity for PCPs to provide more personalized, preventative care for their patients. By identifying specific allergic triggers, clinicians can tailor treatment plans that not only improve asthma control but also reduce exacerbations and enhance overall patient quality of life. With their patient-centered approach and ability to collaborate with specialists, when necessary, primary care NPs are uniquely positioned to play a key role in advancing asthma care through the strategic use of allergy testing. Adopting this practice as part of routine asthma management can lead to more comprehensive, proactive care, ultimately improving long-term outcomes for patients.

Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FAANP, FNAP, FAAN, is
former President of the American Association of Nurse Practitioners and Nurse Practitioner at DePaul Community Health Centers

References:

• Centers for Disease Control and Prevention. (2024). The status of asthma in the United States. Preventing Chronic Disease, 21, E50. https://www.cdc.gov/pcd/issues/2024/24_0005.htm.
• Asthma and Allergy Foundation of America. (2024). Asthma facts. https://aafa.org/asthma/asthma-facts/
• Akinbami, L. J., Santo, L., Williams, S., Rechtsteiner, E. A., & Strashny, A. (2019). Characteristics of asthma visits to physician offices in the United States: 2012–2015 (National Health Statistics Reports No. 128). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhsr/nhsr128-508.pdf
• Oppenheimer, J. J. (2019, October 7). Allergic and environmental asthma: Overview, patient history, differential diagnosis. Medscape. https://emedicine.medscape.com/article/137501-overview?form=fpf