When allergy testing isn't necessary, we all foot the bill
By Natasha Persaud
The American Academy of Allergy, Asthma & Immunonology (AAAAI) wants to clear the air: Certain allergy and asthma tests are overused or misused; and the amount of money spent on them is wasteful.
So, as part of the Choosing Wisely initiative by the American Board of Internal Medicine, the AAAAI has released a list of 5 practices doctors and patients should question. If your doctor orders one of these tests, procedures or treatments, ask if it’s truly necessary. Only in rare cases, will it be.
1. Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.
To diagnose and treat allergies, doctors should order specific IgE (skin or blood) tests based on a patient’s history and physical exam.
2. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
Imaging tests, such as the CT, usually are not needed to diagnose rhinosinusitis. In addition, most acute cases of sinus infection resolve without treatment in two weeks. Only when a bacterial infection is present that needs to be treated—an infrequent occurrence, since most infections are viral—should the doctor prescribe the antibiotic amoxicillin.
3. Don’t routinely do diagnostic testing in patients with chronic urticaria.
For most patients, the culprit behind chronic urticaria or hives is uncertain. If the doctor does suspect a cause, limited and targeted testing can be used. Otherwise, extensive testing is a waste of resources.
4. Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.
Immunoglobulin (gammaglobulin) replacement is expensive, and it’s usually not warranted. The exception: a person has a genetic defect that impairs his immune response to vaccines or natural infections, or he has extremely low levels of IgG.
5. Don’t diagnose or manage asthma without spirometry.
A spirometer measures how well the lungs expel air. Spirometry readings are essential to confirm that a person has asthma and to gauge asthma’s severity.
Before you have a medical test for any reason, you may want to ask the following questions:
- How accurate is the test? Are other tests more accurate?
- How much does the test cost? Is there a less expensive option?
- What are the risks of the test? benefits?
- What will the results show?
- Will the results change treatment?
As we move closer and closer to patient-centered health care, it pays to stay informed.
Choosing Wisely: Five Things Physicians and Patients Should Question. American Academy of Allergy, Asthma & Immunology.
News release, American Academy of Allergy, Asthma & Immunology. April 4, 2012.