Diagnosing Allergic Asthma and Determining Treatment

Once a patient has been diagnosed with asthma, you can confirm if the patient has allergic sensitivity by either:

  • Skin test
  • Blood test for specific IgE

Specific and Total IgE Tests Can Guide Diagnosis and Treatment

Allergy testing is the only reliable way to determine sensitivity to perennial aeroallergens. 15

Specific IgE Test Results
  • Measure sensitivity to specific allergens (eg, dust mites, pet dander, cockroach debris) 13,15
  • Can confirm an Allergic Asthma diagnosis 13
  • Are considered positive for allergic sensitization when specific IgE levels are >0.35 kUA/L 13,*
  • Are measured using a skin test (eg, prick, scratch, intradermal) or blood test (eg, RAST, FEIA, or ELISA) 13
In order to qualify an appropriate patient for XOLAIR treatment, 1 sensitivity to only one perennial aeroallergen is needed to confirm the patient’s asthma is allergic and in determining XOLAIR eligibility.
Total IgE Test Results
  • Measure total serum concentration of IgE
  • Cannot be used alone to confirm an Allergic Asthma diagnosis nor rule out sensitization to specific aeroallergens 16,17 
  • May still indicate allergic disease if total IgE levels are <100 kU/L§ and the specific IgE test is positive 16
  • Are measured using a blood test
To determine XOLAIR dosing, 1 the following is used: pretreatment serum total IgE level 30 to 1300 IU/mL in patients aged 6 to <12 years, and pretreatment serum total IgE level 30 to 700 IU/mL in patients aged ≥12 years.
Please see the XOLAIR dosing tables for more information.

ELISA, enzyme-linked immunosorbent assay; FEIA, fluorescent enzyme immunoassay; RAST, radioallergosorbent test.

*The clinical significance of the results must be assessed in the context of the patient’s medical history and clinical symptoms. 
Skin testing is not appropriate in patients taking medications that suppress the immediate skin test or in patients who have eczema or dermatographism. 
A total IgE test can be included as part of a specific IgE panel or ordered as a separate test.
§kU/L and IU/mL are equivalent units of measure. XOLAIR dosing is typically shown in IU/mL.

When to Consider XOLAIR According to NHLBI Guidelines

XOLAIR is approved for appropriate Allergic Asthma patients aged 6 years and older who are uncontrolled on inhaled corticosteroids (ICS) Learn more about who is right for XOLAIR

XOLAIR is the only biologic for asthma management recommended by the National Heart, Lung, and Blood Institute (NHLBI) Guidelines. NHLBI Guidelines recommend testing for allergies as early as Step 2 and considering XOLAIR as early as Step 5 in patients aged 12 and older.15  Below is a stepwise approach for determining treatment options.

Stepwise Approach for Asthma Management in Patients ≥12 Years

Important Notes for the NHLBI Guidelines

  • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.
  • If alternative treatment is used and response is inadequate, discontinue it and use the preferred treatment before stepping up.
  • Zileuton is a less desirable alternative due to limited studies as adjunctive therapy and the need to monitor liver function. Theophylline requires monitoring of serum concentration levels.
  • In Step 6, before oral systemic corticosteroids are introduced, a trial of high-dose ICS + LABA + either LTRA, theophylline, or zileuton may be considered, although this approach has not been studied in clinical trials.
  • Steps 1, 2, and 3 preferred therapies are based on Evidence A; Step 3 alternative therapy is based on Evidence A for LTRA, Evidence B for theophylline, and Evidence D for zileuton. Step 4 preferred therapy is based on Evidence B, and alternative therapy is based on Evidence B for LTRA and theophylline and Evidence D for zileuton. Step 5 preferred therapy is based on Evidence B. Step 6 preferred therapy is based on EPR-2 1997 and Evidence B for omalizumab.
  • Immunotherapy for Steps 2-4 is based on Evidence B for house dust mites, animal dander, and pollens; evidence is weak or lacking for molds and cockroaches. Evidence is strongest for immunotherapy with single allergens. The role of allergy in asthma is greater in children than in adults.
  • Clinicians who administer immunotherapy or omalizumab should be prepared and equipped to identify and treat anaphylaxis that may occur.

Key: Alphabetical order is used when more than one treatment option is listed within either preferred or alternative therapy.

EIB, exercise-induced bronchospasm; LABA, long-acting beta2-agonist; LTRA, leukotriene receptor antagonist.

Please see full report of NHLBI EPR-3 Asthma Guidelines at http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf for an explanation of Evidence A to D.

For Your Asthma Patients Uncontrolled on ICS, When It’s Allergic Asthma, Think XOLAIR