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Rast test
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Rast test

I have asthma that is only triggered by upper respiratory infections.  I have frequent post nasal drip which causes a very sore throat. I am now on antibiotics for my third sinus infection in the past three months.  My pullmonologist ordered at rast test.  She said that IGE levels were high, but there was no specific allergen identified.  She really did not offer an explanation for the results other than the reactive airways triggered the high IGE levels.  This does not make sense to me.  Could the test in fact indicate elevated IGE levels without identifying a specific trigger?  The pulmonologist did scope me and found evidence of reflux.  Since I have started nexium, I have had NO heart burn.

My current asthma medications are nasonex, xyzal, advair, singulair and use of saline nose drops and gargling with salt water.  Knock on wood, despite having post nasal drip, sinus infection and a sore throat for the past two weeks, my airway is pretty good.

I had surgery for a deviated septum and had the turbinates removed about 20 years ago with very good results.  I did have a cat scan done as part of an ENT evaluation about 14 months ago.  The cat scan revealed no structural abnormalities.  The sinus cavities had some mucus but otherwise looked good. Would the cat scan have indicated whether one side of of nasal passage was again very narrow?  

I am getting very frustrated by my constant upper resp stuff and really do not feel comfortable with the frequent use of antibiotics.

Any suggestions would be appreciated

Should I go to an allergist with the results from the rast test to further explore whether or not I do have allergies?
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Elevation of serum immunoglobulin E (IgE) occurs with a variety of allergic diseases of the upper respiratory tract, such as allergic fungal sinusitis, and the lower respiratory tract, such as allergic bronchopulmonary mycosis.  The allergic reaction is accompanied by high levels of IgE and the most common causative fungus is Aspergilla, but other fungi can cause the same illnesses, on an allergic basis.  Thus the elevated IgE could be on the basis of bronchial disease or sinus disease.

The standard determination of IgE level is not allergen specific.  It is possible, however, to determine sub-types, specific for a given allergen, such as the fungus, Aspergilla.  One has to have a clinical suspicion of the specific allergen before ordering these tests.

Granted that your CT of the sinuses was relatively unremarkable, that was 14 months ago and, with 3 “sinus infections in 3 months” it might be worth repeating the CT.  In addition, CT or not, bacterial and fungal cultures should be performed on your sinus/nasal drainage.

And, yes, I recommend that you do return to the allergist to further evaluate the elevated IgE and the above.

Good luck.
2 Comments
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I have recently been diagnosed with ABPA... thank heaven for an answer!  Two years out of my life and at 70 can't afford that much time!

Due to bronchitis in the early 90's I was left with the need on an inhaler once a day.  The inhaler (Advair) stopped working in Jan 07..family internist sent me to a Pulmonologist who diagnosed Myco Plasma Pneuminiae.  After 5 months of URI's and many antibiotics which made me sicker that I have ever bveen in my life I ended up in the ER.  The ER Dr took pity on me after hearing my story ..  my blood gas oxygen level was 85 so he was able admit me...and I changed to another pulmonologist group.

The new pulminoligist group ordered a cat scan and an echo ( I had never had before) which were unremarkable...started me back on Advair along with prednisone & an antibiotic.  So the only real difference was going back on Advair and that did the trick for awhile.  2 months later when congestion cleared they ordered PFT's which showed restricted lung disease...not so bad considering how bad I had felt.  I entered a pulmonary rehab to gain my strength...and learn about breathing which was not normal but better.  
Pneumonia, a mild case, hit in Jan 08...breathing down hill .. another URI.  Finally in May 08 no infection but could not breath...on nebulizer at least 4 times a day.  Feared I would not make family vacation in June 08 with all 14 grandchildren for my 70th Birthday!  Family Dr gave me a Depo medrol shot which was perfect...first time I felt normal in a year and a half!  Lasted 2 months .. then down hill again.  Received another shot out of desperation a month later but this time it did not seem to work & I had the worst stomach ache ever and black tarry stools!  That passed after a week but the breathing was no better.  Pulminologist ordered another PFT...35% worse than year before.  Dr said looked like emphesema..added Spireva.  Seemed to work but it must have been the Depo Medrol shot that was still in my system because when it dissapated the Spriva no longer worked.  Back to nebulizer!  
Finally family internist set app. with sleep Dr who was a pulminoligist..he also had an office with an allergist.  (Forgot to mention, the very first pulminoligist had ordered many blood tests...one being an IGE that was 2200.  He said it was high but ignored.) I had told 2nd group of pulminoligists but no one had followed up on that.  This sleep Dr looked at PFT tests & said no emphesema..ordered a cat scan .. compared with one a year before & many blood tests.  Called me at home (a first!) to tell me cat scan was better than previous one .. he said a raging case of asthma, like a young child & we must find the trigger.  Went to his partner, the Allergist, & he ran skin tests .. all normal but allergist had a hunch..tested me for Aspergilla since I had all the symptoms. Yes!!  Skin test was very positive!  I even felt a bit faint.  Then he ordered ntibody blood test but that test was negative.  Their conclusion was,  I have this Aspergilla in the lungs and my body is allergic to that...called ABPA.  They have me on 15mg of prednisone "every other" day along with Advair and Spriva daily...the allergist told me by taking "every other" day the side effects are minimized.  I feel great but not sure what happens from here...no need of nebulizer or rescue inhaler!  I see the Dr again in March.  The Dr. from Jewish Hospital's response to you seems to concur with my diagnosis.  Was this what was wrong with me all along?  No one will say for sure...time will tell I guess.  Maybe my story will lead you in the right direction.  I wish you the best.
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