Allergy Testing Guides Avoidance, Targets Treatment

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 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.