I was pleased to see Allergy Testing reviewed in Best Tests (Dec, 2011), but have some concerns. The most important part in treating allergies is recognition and education, and general practice is ideally placed to provide this. Recognition is mainly based on clinical history, but testing can be useful, in particular if wheat, dairy or multiple food avoidance is being suggested for more than a few weeks test period. Dr Vincent St Aubyn Crump has written an excellent guide to diagnosing allergies in General practice which is available at:
My concern is that if the allergy is not accurately diagnosed the patient may not be receiving adequate education. Education should involve action plans, antihistamines (and occasionally adrenaline), avoidance advice and follow-up. Schools are required to have action plans for children with allergies and we will be increasingly asked to complete them, which is a good thing for best practice. The Australasian Society of Clinical Immunology and Allergy (ASCIA) action plans and the New Zealand School Guidelines, along with many other resources, are available at: www.allergy.org.nz
In a recent large study in Melbourne,* 10% of the 2,884 one-year-olds had food challenge proven IgE food allergy. Food allergies are increasing, more people have multiple allergies and they are lasting longer. So "containing" the budget as suggested may not be feasible, but aiming to have a balanced approach of judicious testing based on appropriate clinical history from an informed medical workforce is.
ASCIA provides excellent online training for health professionals, which takes about an hour and is endorsed for CME points: http://etraininghp.ascia.org.au/
There are also two excellent books I would recommend for anyone interested in finding out more, both are also available from Allergy New Zealand:
"Allergies. New Zealand's growing epidemic" by Dr Vincent St Aubyn Crump, 2009.
"The Allergy Epidemic. A Mystery of Modern Life" by Dr Susan Prescott, 2011.
Dr Kylie Morse
General Practitioner Wellington, Allergy NZ board member
* Osbourne N, Koplin J, Martin P, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based
sampling and pre-determined challenge criteria in infants. J Allergy Clin Immunol 2011;127(3):668-76