Stukus David R, Kempe Erin, Leber Amy, Thornton David, Scherzer Rebecca
Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio; and
Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio; and.
Pediatrics. 2016 Dec;138(6). doi: 10.1542/peds.2016-1602.
Immunoglobullin E (IgE)-mediated food allergies affect 5% to 8% of children. Serum IgE levels assist in diagnosing food allergies but have low positive predictive value. This can lead to misinterpretation, overdiagnosis, and unnecessary dietary elimination. Use of IgE food allergen panels has been associated with increased cost and burden. The scale of use of these panels has not been reported in the medical literature.
We conducted a retrospective review of a commercial laboratory database associated with a tertiary care pediatric academic medical center for food IgE tests ordered by all provider types during 2013.
A total of 10 794 single-food IgE tests and 3065 allergen panels were ordered. Allergists ordered the majority of single-food IgE tests (58.2%) whereas 78.8% of food allergen panels were ordered by primary care providers (PCPs) (P < .001). Of all IgE tests ordered by PCPs, 45.1% were panels compared with 1.2% of orders placed by allergists (P < .001). PCPs in practice for >15 years ordered a higher number of food allergen panels (P < .05) compared with PCPs with less experience. Compared with allergists, PCPs ordered more tests for unlikely causes of food allergies (P < .001). Total cost of IgE testing and cost per patient were higher for PCPs compared with allergists.
Review of food allergen IgE testing through a high volume outpatient laboratory revealed PCPs order significantly more food allergen panels, tests for uncommon causes of food allergy, and generate higher cost per patient compared with allergists. These results suggest a need for increased education of PCPs regarding proper use of food IgE tests.
免疫球蛋白E（IgE）介导的食物过敏影响5%至8%的儿童。血清IgE水平有助于诊断食物过敏，但阳性预测值较低。这可能导致误解、过度诊断以及不必要的饮食限制。使用IgE食物过敏原检测组合与成本增加和负担加重有关。医学文献中尚未报道这些检测组合的使用规模。
我们对一个与三级医疗儿科教学医学中心相关的商业实验室数据库进行了回顾性研究，该数据库包含2013年所有类型医疗服务提供者所开具的食物IgE检测订单。
共开具了10794项单一食物IgE检测和3065项过敏原检测组合。过敏症专科医生开具了大部分单一食物IgE检测（58.2%），而78.8%的食物过敏原检测组合是由初级保健提供者（PCP）开具的（P <.001）。在PCP开具的所有IgE检测中，45.1%是检测组合，而过敏症专科医生开具的订单中这一比例为1.2%（P <.001）。执业超过15年的PCP开具的食物过敏原检测组合数量更多（P <.05），与经验较少的PCP相比。与过敏症专科医生相比，PCP对不太可能引起食物过敏的原因进行的检测更多（P <.001）。与过敏症专科医生相比，PCP的IgE检测总成本和每位患者的检测成本更高。
通过一个大容量门诊实验室对食物过敏原IgE检测进行回顾发现，与过敏症专科医生相比，PCP开具的食物过敏原检测组合明显更多，对不常见食物过敏原因的检测更多，且每位患者产生的成本更高。这些结果表明需要加强对PCP关于食物IgE检测正确使用的教育。
