Can we manage demand for allergy testing by restricting requests to a small number of prime target allergens?
BACKGROUND
Demand for expensive tests such as allergen-specific IgE is expanding far faster than for cheaper tests: at Burton Hospital the annual growth rate is 24%. Different hospitals have different policies on allergen testing. We report a comparison of the effect of requesting policy on diagnostic yield.


METHODS
All results from five years of allergen testing were downloaded from the data warehouse at Burton, and a representative sample of recent results was evaluated from Ipswich Hospital. Statistical analysis by chi(2) test and significance tests for differences of proportions were carried out.


RESULTS
Ipswich hospital used a standard four-allergen panel for respiratory patients and demonstrated a statistically significantly lower positivity rate for three of those four allergens. No relationship between the number of allergens tested and the probability of a positive result was shown - the probability of a positive result was approximately 0.3. Number of allergen-specific IgE tests requested/patient have remained roughly constant over 5(1/2) years but total demand has increased.


CONCLUSIONS
Selective requesting for allergen-specific IgE testing may be more effective than use of a standard panel but this cannot be conclusively proven. It is not appropriate to attempt to limit workload by specifying a maximum number of tests that are allowed for any individual patient.
Reynolds
Timothy M
TM
Department of Chemical Pathology, Queen's Hospital, Burton-on-Trent, Staffordshire DE13 0RB, UK. tim.reynolds@burtonh-tr.wmids.nhs.uk
Twomey
Patrick J
PJ
D000485:Allergens / Q000032:analysis* / Q000191:economics / Q000276:immunology*; D004391:Dust / Q000276:immunology; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood; D017063:Outcome Assessment, Health Care / Q000191:economics; D011058:Pollen / Q000276:immunology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000191:economics / Q000592:standards*; D012882:Skin Tests / Q000191:economics / Q000592:standards*
D000485:Allergens; D004391:Dust; D007073:Immunoglobulin E