Update on Laboratory Testing to Identify Individuals With Inhalant Allergies

Abstract

The quality and cost of health care in the United States is increasingly a focus of media and political debate. Breakthroughs in medical technology and the discovery of new treatment options for a variety of diseases, alongside serious concerns about increasing health care costs and the rising number of uninsured Americans, make frequent headlines. In the midst of discoveries and debates that are shaping the future of American health care, an unlikely topic has been getting a surprising amount of attention: allergy testing. Although the newest diagnostic technologies related to the identification and treatment of individuals with inhalant allergies are more than a decade old and hardly breaking news, allergy testing has been highlighted in recent articles in both The New York Times 1 and The Wall Street Journal, 2 as well as in several industry publications. So why all the attention being given to allergy testing? The simple answer may be that while the technology related to allergy testing is not new, the paradigm for using it is. Allergy testing, once the exclusive domain of specialists, has been more recently marketed to primary care physicians (PCPs), sparking an intense debate over what constitutes clinically-appropriate and cost-effective use of this testing. Consider this: more than 50% of Americans identify themselves as seasonal allergy sufferers. 3 Clinical evidence suggests that among these individuals, more than half in fact do not have an inhalant allergy. 4-6 Moreover, the majority of these individuals are treated by PCPs and rarely see an allergy specialist, which means few of them ever receive objective diagnostic testing to confirm whether their symptoms are truly caused by an inhalant allergen or not. The result is a large number of patients being presumptively diagnosed and treated for allergies, many of whom do not in fact have an allergy-mediated disease. 7 This can be costly for patients, physicians, and insurance companies who share the burden of ineffective treatment and inadequate outcomes.