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March 13, 2008 — Allergy testing is essential in the effective management of patients with allergic conditions. When combined with a detailed medical history, it can identify the causes of allergy symptoms and provide the basis for avoidance, environmental control and immunotherapy.
“Use of appropriate medication is important in controlling allergic conditions, but may not be effective unless combined with avoidance of offending causative factors,” said Jay M. Portnoy, M.D., president of the American College of Allergy, Asthma and Immunology (ACAAI) and chief, section of allergy, asthma & immunology at Children’s Mercy Hospitals & Clinics in Kansas City, Mo. “While allergy evaluation may sound simple, it requires an appropriately trained physician with expertise in management of allergic diseases to properly interpret the medical history and test results.”
It is important that a complete history be obtained so that likely triggers and exposures can be identified. Once a careful history is gathered, allergy skin or blood testing is used to confirm or rule out suspected causes of allergic diseases.
“Random testing with large panels can give misleading results that can lead to problems. Testing for possible allergic respiratory symptoms needs to be targeted to the patient’s symptoms and should be supported by knowledge of local measures of exposure to pollens and mold spores. Interpretation of allergy tests (both skin and blood) needs to be done carefully and positive or negative results should be considered in light of information obtained from the medical history,” said Dr. Portnoy.
Today allergy tests are more convenient and accurate than ever before according to updated evidence-based medical guidelines developed by allergists representing three organizations.
The joint guidelines, “Allergy Diagnostic Testing: An Updated Practice Parameter,” are published this month in Annals of Allergy, Asthma & Immunology, the ACAAIґs scientific journal. The Joint Task Force on Practice Parameters, representing the ACAAI, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Joint Council of Allergy, Asthma and Immunology (JCAAI), has published 20 practice parameters for the field of allergy-immunology.
The guidelines include:
· Detailed descriptions of diagnostic methods, encompassing both IgE and cell-mediated in vivo (skin and patch) and in vitro tests for a wide spectrum of inhalant, food and contactant allergens.
· New recommendations on a variety of laboratory immunologic techniques commonly used to corroborate the diagnosis of non-IgE clinical immunologic diseases.
· Section on allergens, providing the most relevant sources of plant, animal, and chemicals to which North American patients are exposed.
· Optimal utilization and integration of evidence-based diagnostic methods for various clinical situations, which include inhalant, food, insect venom, drug and contact sensitivities.
This document covers testing for a broad spectrum of immunologic disorders and will serve as a valuable resource document for the practicing physician noted task force co-chair Richard A. Nicklas, M.D., clinical professor of medicine, George Washington Medical Center, Washington, D.C.
“The practice parameters are designed to inform the reader about optimal utilization of diagnostic techniques for confirming suspected clinical allergy symptoms,” Dr. Portnoy said. “By describing the best evidence-based practice currently available, the hope is that allergy testing will become more standardized and accurate, and ultimately our patients will benefit from this. After all, how could they not benefit from improved quality?”