A proactive testing plan pairs allergy evaluation (total and specific IgE) with inflammation markers such as blood eosinophils (absolute eosinophil count). Add respiratory virus testing during flares, and consider targeted work-ups (e.g., Aspergillus testing for allergic bronchopulmonary aspergillosis). These labs support screening, diagnostic triage, and monitoring, but they do not replace a clinician’s exam, spirometry or peak flow testing, or urgent care for severe breathing problems.
Signs, Symptoms & Related Situations
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Breathing & chest: wheeze, cough (especially at night/early morning), chest tightness, shortness of breath with exercise or cold air
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Allergy-linked clues: sneezing, itchy/watery eyes, nasal congestion, eczema, symptoms worse with pets, dust, pollen, or mold
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Triggers: viral colds, smoke, air pollution, workplace exposures, strong odors, weather changes, exercise
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Red flags for broader work-up: frequent oral-steroid bursts, recurrent “pneumonia,” bronchiectasis history, marked mucus plugging, adult-onset with nasal polyps
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Seek urgent care now: severe breathing trouble, bluish lips/face, chest pain, confusion, fainting, or symptoms rapidly getting worse
Symptoms require evaluation by a qualified clinician.
Why These Tests Matter
What testing can do
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Identify allergic sensitization (specific IgE) and type-2 airway inflammation patterns (eosinophils, total IgE)
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Reveal viral triggers during acute flares (flu, COVID-19, RSV)
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Support targeted assessments (e.g., Aspergillus testing in suspected ABPA; alpha-1 antitrypsin in early-onset fixed obstruction)
What testing cannot do
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Diagnose asthma by itself—diagnosis relies on symptoms plus lung function (spirometry/bronchodilator response)
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Replace imaging or specialist procedures when indicated (e.g., sinus CT, bronchoscopy)
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Provide treatment or dosing advice—those decisions belong with your clinician
What These Tests Measure (at a glance)
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Absolute Eosinophil Count (AEC, CBC with differential): blood eosinophils rise with eosinophilic/type-2 inflammation; helpful for phenotyping and trend monitoring. Levels can vary with infections, allergies, or recent steroids.
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Total IgE: global allergy context; very high values suggest atopy and can support ABPA evaluation when paired with Aspergillus markers. Not diagnostic on its own.
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Specific IgE (sIgE) to aeroallergens: cat/dog dander, dust mites, cockroach, grasses/weeds/trees, molds—maps sensitization to likely triggers.
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Aspergillus fumigatus testing (ABPA context): specific IgE and/or IgG with elevated total IgE and eosinophilia support allergic bronchopulmonary aspergillosis when clinical signs fit.
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Respiratory viral tests (during flares): influenza, SARS-CoV-2, RSV antigen/PCR—identify infections that worsen asthma.
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CRP (± ESR): nonspecific inflammation context; useful trend in complicated courses, not an asthma diagnosis.
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Alpha-1 Antitrypsin (A1AT) level ± genotype: screens for A1AT deficiency in adults with early/fixed airflow obstruction or family history.
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Office-based (clinician): FeNO (exhaled nitric oxide) indicates airway eosinophilic inflammation; spirometry/bronchodilator response confirms variable airflow limitation. (Performed in clinic, not a lab blood test.)
Quick Build Guide
| Clinical goal |
Start with |
Add if needed |
| Suspected allergic asthma |
CBC with differential (AEC) • Total IgE • Aeroallergen specific IgE panel |
Targeted sIgE (pets/molds/dust mites) based on history |
| Frequent flares / nighttime symptoms |
AEC • Total IgE |
Respiratory viral PCR/antigenduring acute episodes |
| Adult-onset, severe, mucus plugging |
Total IgE • AEC |
Aspergillus fumigatus sIgE ± IgG(ABPA context) |
| Early-onset fixed obstruction or family history |
Alpha-1 Antitrypsin level |
A1AT phenotype/genotype per clinician |
| Occupational or seasonal pattern |
Targeted aeroallergen sIgE |
Regional/environmental panels |
| Baseline health |
CBC • CMP |
CRP (trend context only) |
How the Testing Process Works
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Pick your starting panel: choose AEC, total IgE, and aeroallergen sIgE to profile triggers and inflammation.
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Time your draw: no fasting needed. Avoid testing during a severe cold unless checking for a viral trigger; list recent steroids or antihistamines on your order.
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Provide samples: blood draw for CBC/IgE/sIgE; nasal or throat swab for viral testing during a flare.
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Review results securely: most results post in a few days.
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Plan next steps: interpret with your clinician alongside spirometry/FeNO and your symptom pattern to refine trigger control and monitoring.
Interpreting Results (General Guidance)
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Elevated AEC: supports eosinophilic/type-2 inflammation; trend over time is more informative than a single value.
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Total IgE high: consistent with atopy; very high levels with positive Aspergillus tests and suggestive imaging raise concern for ABPA.
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Specific IgE positive: shows sensitization—use exposure history to decide which triggers matter most.
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Viral test positive: identifies a trigger for the current flare.
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A1AT low: suggests alpha-1 antitrypsin deficiency; confirmatory testing is clinician-directed.
Always interpret results with a qualified healthcare professional; patterns and clinical context drive decisions.
Choosing Panels vs. Individual Tests
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Foundational set (most patients): CBC with differential (AEC) • Total IgE • Aeroallergen sIgE panel
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Targeted adds: Aspergillus sIgE/IgG (ABPA concern), viral PCR/antigen during flares, A1AT for early/fixed obstruction
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Monitoring: repeat selected labs (e.g., AEC, total IgE) on a consistent method to compare trends over time
FAQs
Can blood tests diagnose asthma?
No. Labs support the diagnosis, but spirometry and your symptom pattern confirm asthma.
Do I need to fast?
No. Asthma-related blood tests generally do not require fasting.
What’s the difference between total IgE and specific IgE?
Total IgE reflects overall atopy; specific IgE pinpoints which allergens you’re sensitized to.
Are blood allergy tests as good as skin tests?
Both are used. Blood sIgE is helpful when skin testing isn’t available or medicines interfere. Your clinician chooses the best method.
What is ABPA and when should I test for it?
Allergic bronchopulmonary aspergillosis occurs in some people with asthma and causes high total IgE, positive Aspergillus sIgE/IgG, mucus plugging, and sometimes bronchiectasis. Testing is considered when symptoms are severe or recurrent.
Should I test for viruses during a flare?
Yes, when results could change decisions (school/work notes, infection precautions, or clinical guidance).
How often should I repeat eosinophils or IgE?
Timing varies. Many people retest every 3–12 months to track trends—follow your clinician’s plan.
Related Categories & Key Tests
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Inflammation Tests Hub
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Environmental Allergy Tests • Animal Dander Allergy Tests • Respiratory Tests • Pneumonia & Viral Respiratory Panels • Immunoglobulins
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Key Tests: CBC with Differential (AEC) • Total IgE • Specific IgE (aeroallergens: cat, dog, dust mite, cockroach, pollens, molds) • Aspergillus fumigatus sIgE/IgG • CRP • Alpha-1 Antitrypsin Level ± Genotype • Influenza/COVID-19/RSV PCR or Antigen
References
- Global Initiative for Asthma (GINA) — Strategy report on assessment and phenotyping.
- AAAAI/ACAAI — Practice parameters for allergy testing and asthma evaluation.
- American Thoracic Society — FeNO interpretation and airway inflammation guidance.
- ERS/ATS — Severe asthma and ABPA diagnostic recommendations.
- CDC — Respiratory virus testing guidance (influenza, SARS-CoV-2, RSV).
- Clinical reviews on eosinophilic asthma biomarkers and A1AT deficiency screening.
Available Tests & Panels
Your Asthma Tests menu is pre-populated in the Ulta Lab Tests system. Use filters to build a foundational panel (AEC, total IgE, aeroallergen sIgE), add Aspergillus testing when ABPA is suspected, include viral testing during flares, and consider alpha-1 antitrypsin in adults with early/fixed obstruction. Review results with your clinician and align them with spirometry/FeNO and your symptom history to guide next steps.
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