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. Objectives: 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. Method: 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. Conclusion: 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. (C) 2003 Elsevier Ltd. All rights reserved.