Introduction to Allergy Testing Online Training

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Continue Continue ‹#› Unrestricted © Siemens Healthineers, 2021 ‹#› Unrestricted © Siemens Healthineers, 2021 Content Master Template HILS2218 | Effective Date: 25-Mar-2022 ? Introduction to Allergy Testing Online Training This online training explains how to diagnose and manage allergic diseases through the use of testing in conjunction with a patient's history and physical symptoms. Recognize the importance of allergy testing 1 Identify allergy testing methods and treatment options 4 Identify causes and symptoms of allergies 3 Describe what happens during an allergic reaction 2 Welcome 1.1_welcome.mp3 Welcome to the Introduction to Allergy Testing course. This online training explains how to diagnose and manage allergic diseases through the use of testing in conjunction with a patient's history and physical symptoms. This course will cover the following four learning objectives. For navigation help, select the question mark button located in the lower right corner of each slide. Understand that allergies are a global concern ? Why do we need allergy testing? Why Do We Need Allergy Testing? ? Allergy: Increasing Prevalence Each year, approximately 50 million Americans report experiencing some form of allergy, and 30,000 of them seek help at an emergency room.2,3 Hospitalization for allergy related anaphylaxis hospitalization on the rise in the US, Australia, Europe and other regions.4 There were 9,500 hospital discharges related to food allergy among US children from 2004-2006.5 The WHO estimates that 20% of the global population suffers from IgE-mediated allergic diseases.1 1. WHO/WAO meeting, Geneva. 2002 Jan. 2. ACAAI. 2018. Accessed Jan 2022. 3. Foodsafety.gov. 2020. Accessed Jan 2022. 4. The Journal of Allergy and Clinical Immunology: In Practice, Volume 8, Issue 4, April 2020, Pages 1216-1218 5. Center for Diseases Control, NCHS Data Brief ¡ No. 10 ¡ October 2008 Allergy: Increasing Prevalence 1.3_increasingprevalence.mp3 Allergic disease is an important health issue, and it is much more than a seasonal inconvenience. According to the World Allergy Organization, depending on geography and lifestyle the prevalence of allergies can be as high as 40%. The World Health Organization estimates that 20% of the global population suffers from IgE-mediated allergic diseases, placing heavy financial strains on clinician and hospital resources, particularly in emergent situations. In the United States alone, allergy ranks as the sixth-leading cause of chronic illness. Each year, approximately 50 million Americans report experiencing some form of allergy, and 30,000 of them seek help at an emergency room. 19% of patients in the U.S. have self-diagnosed as having food allergies, despite only 10.8% of those who undergo testing having confirmatory results. This point proves that it is crucial for adults with suspected food allergies to receive appropriate confirmatory testing and counseling, to ensure food is not unnecessarily avoided and quality of life is not overly impaired. Timely identification of allergic causes may directly influence the course of treatment and proper management of the patient. This is particularly true in children, as interventions are instituted both to mitigate symptoms and to stop the progression of the allergy march. Ignoring adult-onset allergies is no trivial matter either, as chronic allergic inflammation can lead to acute tissue damage in critical organs, such as the lungs. ? Describe what happens during an allergic reaction Identify what causes allergies and their symptoms What is an allergy? What is an Allergy? ? Allergic Reaction Allergy is a hypersensitivity reaction initiated by the immune system. Antibodies Mast Cell Histamines Antigen Antibodies Mast Cell Antigen B Cell Plasma Cell Specific IgE Antibodies Granules with chemicals Allergen (Antigen) Specific IgE Antibody Granules release the following inflammatory chemicals: histamines, leukotrienes, and prostaglandins, which cause allergic reaction. Allergic Reaction 1.5_allergicreaction.mp3 Allergy is a hypersensitivity reaction initiated by the immune system. Progression to an allergic reaction can be illustrated in four distinct phases, as shown below. An allergen (antigen), let’s say dust in this case, enters the body and a B-cell recognizes it as a foreign substance. Just like when any foreign substance is recognized, the body now begins to produce antibodies. In the case of an allergic reaction, Plasma cells produce specific IgE antibodies in response to the allergen. The specific IgE antibodies attach themselves to mast cells and now the body is sensitized, ready to defend if dust enters the nose, on the skin, or comes in contact through rubbing an eye. Mast cells contain granules and are located throughout our bodies, in skin, eyes, airway, and gastrointestinal tracts. When dust is again detected, the dust allergen binds to the antibody which then activate the mast cells to release chemicals in the granules. Let’s look closer at the last phase. The dust allergen binds to the antibodies, which stimulate mast cells to release histamines, leukotrienes, and prostaglandins. The release of these inflammatory modulators results in a localized or systemic reaction called the allergic reaction. ? Triggers & Symptoms Studies indicate that earlier detection of allergies in children allows for prompt intervention, which may stop the progression of allergies to more-morbid conditions such as pulmonary obstructive disease.1 Select the tab arrows and the button below to learn more about common allergens and symptoms, the Allergy March, and additional physical signs. Common Allergens Common Symptoms The Allergy March Other Physical Signs 1. Klimek L, Schendzielorz P. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2008;7:Doc04. Triggers & Symptoms 1.6_baselayer.mp3 Studies indicate that earlier detection of allergies in children allows for prompt intervention, which may stop the progression of allergies to more-morbid conditions such as pulmonary obstructive disease. Select the tab arrows and the button below to learn more about common allergens and symptoms, the allergy march, and additional physical signs to be on the lookout for. 1.6_commonallergens.mp3 Allergy symptoms can be triggered by everyday things in our environment like: food, molds, trees, grasses, weeds, insects, dust, pets, and medications. Ninety percent of food allergies in children are caused by the following foods: cow’s milk, egg white, peanuts, wheat, soybean, and tree nuts. While in adults the most common food allergies include: peanuts, fish, tree nuts and shellfish. 1.6_commonsymptoms.mp3 Allergic reactions can range from mild to severe. Symptoms of allergies are similar to that of cold and flu, such as coughing and sneezing. Other symptoms include runny nose, irritated red eyes, colic and stomach upset or itchy rashes. In its most severe manifestation, the patient’s airway can constrict, making breathing difficult or impossible. This potentially life-threatening reaction can progress to death if not immediately treated. These manifestations may vary between adults and children. 1.6_allergymarch.mp3 IgE-mediated allergic disease often progresses in a predictable manner from mild conditions, such as atopic dermatitis and rhinitis, to morbid conditions such as allergic asthma. This progression has been termed the allergy march. Typically, food allergies evolve into inhalant allergies, and clinical symptoms usually correlate to age, with eczema being found in infancy, followed by gastrointestinal distress in infancy or childhood. Rhinitis is commonly seen in later childhood, and respiratory symptoms are manifested by allergic asthma in the preteen and teenage years. 1.6_physicalsigns.mp3 Children with allergies can manifest physical symptoms like the dark circles of Allergic Shiners or the distinctive wrinkling around the eyes known as Dennie’s lines. Allergy kids can also be seen pushing up on their nose. This is known as the Allergic Salute which can lead to an allergic crease, which appears as a transverse line across the bridge of the nose. Nasal congestion and mouth-breathing can lead to chapping around the nose and mouth. Allergic Shiners: Dark, bruise-like shadows under eyes Dennie's Lines: Wrinkling, lines on lids and under eyes Allergic Salute: Pushing up on nose to open airway Nasal Crease: Appears as line/indent, transverse across nose Chapping: Around the nose and mouth The Allergy March Atopic dermatitis Eczema (Rashes) Gastrointestinal (GI) disorders Allergic rhinitis Runny nose Respiratory Asthma The Allergy March demonstrates how allergy can progress to asthma in children. Common Symptoms Coughing A picture containing person, clothing, man, wearing Description automatically generated Runny nose A person in a blue shirt Description automatically generated Itchy eyes A picture containing person, car, appliance, dryer Description automatically generated Sneezing Ein Bild, das drinnen, Person, Mann, Frau enthält. Automatisch generierte Beschreibung Skin rashes Stomach cramps Common symptoms include sneezing, red eyes, abdominal discomfort, rashes, and respiratory issues, and can lead to asthma (via the Allergy March). Allergic reactions can range from mild to severe. Anaphylaxis is the most severe form of an allergic reaction - one that may even result in death. Note: Select the Glossary tab in the Menu to learn more about other symptoms. Allergy symptoms can be triggered by everyday things in our environment like: food, molds, trees, grasses, weeds, insects, dust, pets and medications. Common Allergens Most common food allergies in adults are: peanuts, fish, tree nuts (almond, cashew, etc.), shellfish.1 Most common food allergies in children are: cow’s milk, egg (white), peanuts, wheat, soybean, and tree nuts.2 1. American Academy of Allergy, Asthma & Immunology. Allergy diagnosis in clinical practice. 2006 Nov. 2. Robert G. Hamilton, Kim Mudd, Mirinda Anderson White, Robert A. Wood, MD. Extension of food allergen specific IgE ranges from the ImmunoCAP to the IMMULITE systems. Ann Allergy Asthma Immunol. 2011;107:139 -144. ? Understand how an allergy is diagnosed Compare skin prick and blood test methods How do we diagnose an allergy? How Do We Diagnose an Allergy? ? Allergy Diagnostic Process Checking patient’s medical history. Conduct a complete physical exam… … with emphasis on eyes, ears, nose, throat, chest and skin. Allergy testing using either blood or skin prick test. Allergy Diagnostic Process 1.8_diagnosticprocess.mp3 This following guideline for allergy diagnosis process is supported by both European and U.S.-based allergy organizations. First, the patient visits a physician’s office with symptoms, which need to be investigated. The physician will begin by looking at the patient’s medical history. Medical history is a critical link between the allergy test results and the disease. The physician will then perform a physical exam. A complete physical exam with emphasis on eyes, ears, nose, throat, chest, and skin is essential for accurate diagnosis. Finally, the physician will order allergy testing. There are two methods of allergy testing available, blood or skin prick test, to detect a patient’s sensitivity to common allergens. Timing and result quantification is dependent on test type. Blood Test ? Testing Methods Allergy testing can be performed by in vivo (skin prick test) or in vitro (blood test) methods. Antigen B Cell Antibodies Mast Cell Plasma Cell Specific IgE Antibodies Antigen Antibodies BLOOD TESTS Offer early detection of specific IgE, which causes allergic responses. SKIN PRICK TEST Detect allergic response after the fact. Select the images below to learn more about each testing method. Skin Prick Test Testing Methods 1.9_testingmethods.mp3 Allergy testing can be performed by in vivo or in vitro methods. There are benefits and limitations to both methods, and it is recommended that the testing be performed in conjunction with a clinical history and physical examination. For many years, skin prick testing by an allergy specialist was the only method available. Skin prick testing measures the actual allergic reaction, which is the last phase of the allergic reaction cycle. Today, blood testing provides reliable clinical evidence to aid in your diagnosis. The most common blood tests measure specific IgE antibodies in the patient’s serum that are produced by the plasma cells in phase 2. Therefore, serum testing may detect one’s likelihood to react to one or many allergens and potentially predict the severity of the reaction, without the need to induce an allergic reaction. Select the images below to learn more about the basics of each testing method. Skin Prick Test (In vivo) Limitations Limitations Description Description Description Allergens are scratched into the patient’s skin Potentially negative reactions are monitored A positive result is defined as a wheal ≥3 mm in diameter Skin Prick Testing 1.10_skinpricktest.mp3 In traditional skin prick allergy tests, where an allergen is scratched onto a patient’s skin, it is specifically this release of histamine that causes the red welts to appear if a patient is sensitized to the allergen being tested. 1.10_limitations.mp3 Antihistamines medication is typically discontinued for a week to 10 days prior to skin prick allergy testing to prevent interference with the test, which may lead to discomfort. The variability of allergen extracts among manufacturers leads to a lack of consistency, making it difficult to compare different products and test results. Also, the interpretation of the results is very subjective, since it is dependents on the person evaluating the results. The sensitivity and specificity for food allergens in testing ranges broadly from 30-90% and 20-60% respectively, indicating that the accuracy of test results can vary widely. Limitations Skin prick tests can be uncomfortable, and potentially dangerous, if a severe reaction is triggered. Discontinue use of medications Lack of consistency Subjective interpretation Broad results Blood Test (In vitro) A single blood draw measures amount of IgE antibodies in blood Total IgE measures IgE antibodies Specific IgE measures the level of specific IgE antibodies to individual allergens or allergenic components A small amount of IgE antibodies is normal A larger amount of IgE may mean the patient has an allergy Advantages Advantages Description Description Description Blood Test 1.11_bloodtest.mp3 The in vitro blood testing is performed by using a small serum sample. The laboratory then measures specific IG E antibodies to many different allergens. With a blood test, the reaction occurs in an instrument, not on the skin, so there is no risk of sensitizing the patient or triggering an anaphylactic reaction. 1ml of serum can yield up to 10 specific allergen determinations. Blood testing allows for earlier and/or preemptive detection of allergy. 1.11_advantages.mp3 This method doesn't require discontinuation of medication or patient adherence to pretest instruction. It also gives fewer false positives for patients with sensitive skin, hives, and eczema. Moreover it can offer component testing in some food allergies, meaning the test can determine the exact proteins that could trigger a response and can even predict the severity of a potential reaction. In vitro allergy testing is designed to provide value to clinicians and their patients, making testing and diagnosing simple, fast, and affordable, regardless of case complexity. More quantifiable results Fewer false positives for patients with sensitive skin Doesn't require discontinuation of medication Enables component testing in food allergies Advantages Blood tests can predict the severity of the allergy, as opposed to just its presence.  ? Molecular Allergens Whole Extract Allergens Industry standard tool for IgE detection Refined extract mixture Allergenic and non-allergenic proteins Component / Molecular Allergens  Additional information on cross-reactivity and component-resolved diagnosis Also identify disease-eliciting allergens Known allergenic peptide for high affinity IgE binding What is cross-reactivity? Cross-reactivity takes place when different allergens that contain similar binding sites (epitopes) become bound to the same specific IgE antibodies. Allergens that cross-react may or may not be biologically similar, but they always have certain molecular similarities. Note: This marker contains audio. Molecular Allergens 1.12_molecularallergens.mp3 The quality of allergen material used in testing remains paramount for both in vitro and in vivo testing methods. The traditional/historical method for measurement of sIgE has been to use crude extract allergens containing both allergenic and non-allergenic proteins. But within the past 10 years, molecular biology has significantly contributed to the study of allergic diseases, providing us with an understanding of allergen structure, function, and biochemical properties. 1.12_crossreactivity_marker.mp3 As a result of cross-reactivity, patients with a history of shrimp allergy, for example, often (but not always) test positive for crustaceans such as crab, lobster, and crawfish and should avoid these foods. Other common examples of cross-reactivity include birch pollen/apple, ragweed/cantaloupe, latex/banana, mugwort/celery, and grass/soybean. ? Identify treatment options for different type of allergies How can we treat allergies? How Can We Treat Allergies? ? Treatment Options Avoidance Eliminate the allergens in your environment. Treatment for food or chemical allergies. Medication (Pharmacotherapy) Effective prescription drugs such us antihistamines can reduce your allergy symptoms with few side effects. Treatment for inhalant allergies. Immunotherapy (Allergy shots) Immunotherapy is used to desensitize the patient to inhalant allergens. Treatment for insect venoms and many kinds of aeroallergens. 1. Bulat Lokas S, et al. J Clin Lab Anal. 2017;31:e22047. 2. Pollart-Squillace S. AAFP. 1998. 3. Sasai K, et al. J Pediatr. 1996;128:834-40. Treatment Options 1.14_treatment.mp3 Depending on what allergens are causing the reaction, there are 3 treatment options available. First is avoidance. This entails the conscious removal of allergens from the diet and environment and a hygiene and skin-care regimen. This is the mainstay treatment for food or chemical allergies, for which there is no known cure Second is medication or pharmacotherapy. This includes second-generation antihistamines, known as nonsedative antihistamines (NSA). The primary advantage of most of these second-generation allergy drugs is that they do not cross the blood-brain barrier and, unlike those of the first generation, do not cause sedation and drowsiness. Both first- and second-generation antihistamines have been shown to be effective in controlling typical allergy symptoms, such as rhinorrhea, congestion, itch, skin rashes, hives, and watery eyes. Last is the immunotherapy or allergy shots. This is an effective treatment option for insect venoms and many kinds of aeroallergens. While results vary with the individual, immunotherapy is the only treatment that has been effectively used to cure certain types of allergic diseases. Historically, only allergists/allergologists performed immunotherapy. In recent years, however, a few pharmaceutical companies have begun offering an innovative prescription service, which has enabled general practitioners to offer immunotherapy to their allergy patients. ? Course Review Congratulations. You have completed the Introduction to Allergy Testing Online Training course. Select the numbered buttons below to review the material before proceeding to the final assessment. Note: Select the Resource tab on the upper right corner to download an Allergy Infographic for patients. Describe what happens during an allergic reaction Recognize the importance of allergy testing 1 1 1 2 2 2 3 3 3 4 4 4 Identify causes and symptoms of allergies Identify allergy testing methods and treatment options Course Review Identify allergy testing methods and treatment options The guideline for allergy diagnosis includes a medical history, physical exam, and allergy test. Allergy testing methods: Skin prick test (In vivo) Blood test (In vitro) Allergy treatment options: Avoidance Medication Immunotherapy Identify causes and symptoms of allergies A Foods a Mold a Trees a Grass A Bee A Mite A Dog Cat A Pills A Sneez A Red eye A GI Pain A Rash A Asthma Common Allergens Allergy Symptoms Foods Mold and mildew Grasses Pollen Insect bites Dust mites Latex Animals Medications Rhinitis Asthma Rash Streaming eyes Upset stomach Describe what happens during an allergic reaction An allergic response occurs when an individual’s immune system responds to an allergen and produces immunoglobulin E (IgE) antibodies IgE antibodies stimulate other cells to release chemicals such as histamine, leukotrienes, and prostagladins to cause an allergic reaction Granules releasing chemicals Allergens Granules with chemicals IgE Antibodies Recognize the importance of allergy testing Reported allergies are more prevalent than ever before and are sending more and more people to hospitals on a global scale Chronic allergic inflammation can lead to acute tissue damage in critical organs, such as the lungs Timely identification of allergic causes may directly influence the course of treatment and proper management of the patient as they can mitigate symptoms and stop the progression of the allergy march Disclaimer Please note that the learning material is for training purposes only. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. © Siemens Healthcare GmbH 2023 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com ? Disclaimer Assessment Start ? This assessment will test your retention of the presented content. A passing score of 80% or higher is required to complete the course and earn your certificate . Assessment questions must be answered completely to receive full credit. Partial credit will not be given for assessment questions that require multiple answers. You may repeat the assessment as many times as needed. Assessment ? Select three (3) answers. Question 1 of 5 Which of the following chemical modulators cause allergic reaction? Histamines Leukotrienes Proteins Prostaglandins Multiple Answer Incorrect One or more answers are incorrect. Correct Select the best answer. ? Eczema Asthma Question 2 of 5 Which of the following conditions associated with the allergy march is most commonly found in infancy as an early symptom of food allergies? Gastrointestinal disorders Allergic rhinitis Multiple Choice Incorrect Asthma is not typically an early symptom of a food allergy. Incorrect Incorrect Allergic rhinitis is not typically an early symptom of a food allergy. Incorrect Gastrointestinal disorders are not typically early symptoms of a food allergy. Check patient’s medical history Perform complete physical exam Run allergy tests 3. 2. 1. ? Drag each response to place the list in the correct order. What is the correct order of the allergy diagnostic process? Question 3 of 5 Sequence Incorrect One or more answers are incorrect. Correct ? Select two (2) answers. Question 4 of 5 Pulmonary function test Pulmonary function test Pulmonary function test Which of the following are allergy testing options? Skin prick test Blood test Chest X-ray test Multiple Answer Incorrect One or more answers are incorrect. Correct Select the best answer. ? Immunotherapy Exercise Question 5 of 5 Which of the following is a treatment option for allergies? Breathing treatments Relocation to another region Multiple Choice Incorrect Although following an exercise program is felt to be beneficial, it is not typically used in the treatment of allergies. Incorrect Incorrect Moving to another region may provide temporary relief, but allergy sufferers often develop allergic reactions to allergens encountered in the new region. Incorrect Breathing treatments are not typically used in the treatment of allergies. Assessment Results YOUR SCORE: PASSING SCORE: Review Retry Retry Continue Continue Continue %Results.ScorePercent%% %Results.PassPercent%% ? Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course.. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. ? You have completed the Introduction to Allergy Testing Online Training course. Completion Navigation Help Select the icon above to open the table of contents and the glossary. Click Next to continue. Next Welcome Slide The timeline displays the slide progression. Slide the orange bar backwards to rewind the timeline. Click Next to continue. Next Tmeline Select the CC icon to display closed captioning (subtitles). Click Next to continue. Next Caption Icon Select the buttons to learn more about a topic. 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Assessment Slide Question Bank 1 HILS2311 | Effective Date: 24 Mar 2023 Allergy Patient Infographic Allergic asthma Partial or complete blockage of airways Allergic rhinitis Itchy, runny nose Anaphylaxis Systemic allergic reaction that can lead to difficulty breathing; inflammation of eyes, lips, and/or throat; unconsciousness; and death Atopic dermatitis Eczema, itchy, red rash Conjunctivitis Red, itchy, watery eyes Eosinophilic gastroenteritis Bloated feeling, discomfort in abdominal region Eosinophilic rhinitis Difficulty breathing through nose Otitis media Middle-ear pain, discomfort Rhinosinusitis Sinus pressure, pain Urticaria Hives, itchy rashes 1.1 Welcome 1.2 Why Do We Need Allergy Testing? 1.3 Allergy: Increasing Prevalence 1.4 What is an Allergy? 1.5 Allergic Reaction 1.6 Triggers & Symptoms 1.7 How Do We Diagnose an Allergy? 1.8 Allergy Diagnostic Process 1.9 Testing Methods 1.12 Molecular Allergens 1.13 How Can We Treat Allergies? 1.14 Treatment Options 1.15 Course Review 1.16 Disclaimer 1.17 Assessment