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  • Oral presentation
  • Open Access

Allergy testing at OLCHC

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Clinical and Translational Allergy20155 (Suppl 3) :O19

https://doi.org/10.1186/2045-7022-5-S3-O19

  • Published:

Keywords

  • Food Allergy
  • Health Care Worker
  • Medical Practitioner
  • Grass Pollen
  • Cost Efficiency

Background

Allergy is a growing problem in the western world. However, education of health care workers in the field of allergy has not kept up with clinical need. There has been much evidence that medical practitioners use diagnostic tests inaccurately, declaring food allergy where there is none. Removal of food from a patient's diet, especially a child's, has significant nutritional implications that can be irreversible and have a lifelong effect. Furthermore the cost of inappropriate tests is escalating. Guidelines have recently been set indicating that allergy focused history must guide all allergy orders: http://www.ifan.ie.

Aims of this audit

1. To optimise the allergy testing service provided for both clinicians and patients.

2. To examine whether allergy testing was in line with current guidelines.

3. To look for areas where cost efficiency could be improved.

4. To gather local data that can be incorporated into education sessions for clinicians.

Methodology

All sIgE tests ordered through the laboratory at Our Lady's Children's Hospital, Crumlin, from May 8th to Nov 7th 2013, were made available in the form of an excel spread sheet. The outcomes of 4 tests were evaluated, according to age of patient and department from where order originated.

  • House Dust Mite sIgE

  • Grass sIgE

  • Common food panel

  • Fruit sIgE

Results

  1. 1.
    HDM sIgE
    • 679 tests were ordered

    • 25% of all tests were ordered on those <2 yrs and only 15/153 (10%) were positive.

     

Table 1

 

Negative

Positive

< 1yr

77 (90%)

8(10%)

1-2yr

76

7

Average age

3.8+/-3.6

6.3 +/-4.2

  1. 2.
    Grass pollen sIgE
    • 638 tests were ordered

    • 73% were negative

     
Positivity increased with age consistent with all international data.

Table 2

 

Negative

Positive

Average age

3.8 + /-3.8

7.4 +/-4.2

Median age

3yr

7yr

< 1yr

83(100%)

0

1-2yr

83 (98%)

2

Figure 1

  1. 3.
    Testing for fruit allergy
    • All of these tests were negative

     

Table 3

Food

Total

Positive

 

Origin

Orange

15

0

 

80% CPs

Strawberry

11

0

 

56%CPs

  1. 4.
    The common food panel:
    • 519 tests were performed

    • 59% of these were entirely negative

     

Figure 2

Table 4

Conclusions

Recommendations

Target date

Responsible person

Clinicians have a poor understanding of how to use sIgE testing

Formal lecture to NCHDs

January 2014 (achieved)

Dr Aideen Byrne

Tests are being run inappropriately with considerable cost implications

Establish hospital protocol for ordering of IgE tests

May 2014

Dr Cathryn O Carroll

Dr Aideen Byrne

Laboratory staff are unclear how to judge appropriateness of test order.

Establish clear guidelines for laboratory staff

May 2014

Joe McNamara

Specific IgE testing for aeroallergens being ordered in wrong population

Orders for sIgE to HDM and Grass pollen not to be accepted under 2 years

May 2014

Aideen Byrne Joe McNamara

Authors’ Affiliations

(1)
OLCHC, AMNCH, Dublin, Ireland

Copyright

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