Can we manage demand for allergy testing by restricting requests to a small number of prime target allergens?

Ann Clin Biochem 2007;44:467-470
© 2007 Association for Clinical Biochemistry


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Original Articles

Timothy M Reynolds and
Patrick J Twomey

Department of Chemical Pathology, Queen’s Hospital, Burton-on-Trent, Staffordshire DE13 0RB, UK;
Department of Clinical Biochemistry, The Ipswich Hospital, Heath Road, Ipswich, Suffolk IP4 5PD, UK

Background: Demand for expensive tests such as allergen-specificIgE is expanding far faster than for cheaper tests: at BurtonHospital the annual growth rate is 24%. Different hospitalshave different policies on allergen testing. We report a comparisonof 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 x2 test and significance tests for differencesof proportions were carried out.

Results: Ipswich hospital used a standard four-allergen panelfor respiratory patients and demonstrated a statistically significantlylower positivity rate for three of those four allergens. Norelationship between the number of allergens tested and theprobability of a positive result was shown – the probabilityof a positive result was approximately 0.3. Number of allergen-specificIgE tests requested/patient have remained roughly constant over5½ years but total demand has increased.

Conclusions: Selective requesting for allergen-specific IgEtesting may be more effective than use of a standard panel butthis cannot be conclusively proven. It is not appropriate toattempt to limit workload by specifying a maximum number oftests that are allowed for any individual patient.

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