Allergy testing is essential in the effective management of patients with allergic conditions

Mar 11 2008

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 ACAAI's 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 updated practice parameter emphasizes how validated technological advancements during the past decade are being incorporated into the diagnostic armamentarium of allergists/clinical immunologists,” said chief editor I. Leonard Bernstein. M.D., clinical professor of medicine and environmental health, University of Cincinnati College of Medicine, Cincinnati, Ohio.

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?”

Patient information on allergic diseases is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org.

An allergist-immunologist is a physician who specializes in the diagnosis and treatment of asthma and other allergic diseases. The allergist is specially trained to identify the allergic and non-allergic factors that trigger asthma and other allergic diseases. Allergists help people treat or prevent their allergy problems. After earning a medical degree, the allergist-immunologist completes a three-year residency training program in either internal medicine or pediatrics. Next the allergist completes two or three more years of study in the field of allergy-immunology in order to prepare for certification by the American Board of Allergy and Immunology.

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.