Patients seen in the clinican’s office with symptoms suggesting asthma likely have allergy playing a role in their illness. While the “hygiene hypothesis” suggests that asthma risk is decreased with childhood exposure to certain environmental antigens, the IgE-mediated allergic response is both a progenitor and sustainer of airway inflammation leading to acute and chronic asthma symptoms in both children and adults. New National Asthma Education and Prevention Program (NAEPP) guidelines encourage evaluation of our patients with persistent asthmatic symptoms with allergy testing to help identify factors responsible for aggravating and fomenting underlying airway inflammation. Immunoassay testing for the presence of antigen-specific IgE antibodies in asthma patients is now available in the office or hospital setting and should play an important diagnostic role in patient evaluation. In addition to the use of inhaled corticosteroids, the confirmation of allergy by in vitro testing may support the use of specific medications to reduce mast cell mediator cytokine release or cell signaling in the allergic cascade (cromolyn, nedocrimil, zyleuton, monteleukast), or use of anti-IgE therapy (omalizumab). Most importantly, knowledge of a patient’s allergic predisposition, or atopy, encourages the physician to stress preventative environmental exposure reduction and provide the patient with practical advice on how to accomplish this in their home and lifestyle as a complementary and important part of their treatment program.

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