From the Guidelines
A patient with elevated Immunoglobulin E (IgE) and allergies to egg white and house dust mite should be referred to an allergist/immunologist for further management. These specialists have specific training in diagnosing and treating allergic conditions and immune system disorders. The allergist will likely perform additional testing such as skin prick tests or specific IgE blood tests to confirm allergic sensitivities and determine their severity, as recommended by the clinical practice guideline on allergic rhinitis 1. They can develop a comprehensive management plan that may include allergen avoidance strategies, medications like antihistamines, leukotriene modifiers, or nasal corticosteroids, and possibly allergen immunotherapy (allergy shots) for dust mite allergy, which has been shown to be effective in reducing symptoms and improving quality of life 1. For egg allergy, they will provide dietary guidance and emergency management plans including epinephrine auto-injector prescriptions if needed. Elevated IgE levels indicate an overactive allergic immune response, and the allergist can monitor these levels while addressing both immediate symptom relief and long-term immune modulation to improve the patient's quality of life and prevent complications like asthma exacerbations or anaphylaxis.
Some key considerations in the management of this patient include:
- The use of allergen immunotherapy, which has been shown to be effective in reducing symptoms and improving quality of life in patients with dust mite allergy 1
- The importance of avoiding known allergens, such as egg and house dust mites, to reduce symptoms and prevent exacerbations 1
- The need for comprehensive management plans that address both immediate symptom relief and long-term immune modulation to improve the patient's quality of life and prevent complications 1
- The potential benefits of sublingual immunotherapy (SLIT) or subcutaneous immunotherapy (SCIT) for patients with dust mite allergy, which can be determined by patient and doctor preferences 1
From the Research
Allergy Referral Options
For a patient with elevated Immunoglobulin E (IgE) and allergies to egg white and house dust mite, the following options are available for referral:
- Allergist/Immunologist: A specialist who can provide allergy testing and immunotherapy, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) 2, 3, 4.
- Otolaryngologist: An ear, nose, and throat specialist who can diagnose and treat allergies, including those related to house dust mites 4.
- Pediatrician or Family Practitioner: A primary care physician who can diagnose and treat allergies, although they may not always use allergy testing 4, 5.
Immunotherapy Options
Immunotherapy is a long-term treatment that can provide symptom relief for patients with house dust mite allergies:
- Subcutaneous Immunotherapy (SCIT): A type of immunotherapy that involves injecting small amounts of the allergen into the skin 2, 3.
- Sublingual Immunotherapy (SLIT): A type of immunotherapy that involves placing a tablet or liquid under the tongue 2, 3.
- Gene-specific Immunotherapy: A new type of immunotherapy that targets specific genes involved in the allergic reaction 6.
Diagnosis and Treatment
Diagnosis and treatment of house dust mite allergies can be challenging:
- Skin prick test and specific IgE testing can be used to diagnose allergies, but may be confounded by cross-reactivity 5.
- Component-resolved diagnosis using purified and recombinant allergens can improve the accuracy of specific IgE testing 5.
- Treatment options include avoidance, pharmacotherapy, and immunotherapy, although evidence for their efficacy is variable 5.