WHY DO GENERALISTS ORDER FOOD ALLERGEN IGE PANELS? A QUALITY IMPROVEMENT NEEDS ASSESSMENT

Abstract

<h3>Introduction</h3> Food allergy (FA) IgE panels are inappropriately ordered by generalists to evaluate eczema and other non-IgE-mediated conditions, resulting in inaccurate diagnosis of FA, increased costs, and potentially increased FA development due to delayed introduction of allergenic foods. We present a needs assessment utilized to plan a quality improvement (QI) project to reduce FA panel utilization funded by the ACAAI Allergists' Foundation Community Grant Program. <h3>Methods</h3> Reasons for ordering FA IgE panels and barriers to change were obtained from a literature review, listening sessions with generalists, and surveys. This study was reviewed and exempted from IRB approval. <h3>Results</h3> The top indications for ordering FA IgE panels were immediate reaction to a meal, eczema, idiopathic urticaria, screening prior to allergen introduction, caregiver request without medical indication, rhinitis and asthma, and difficulty eating. Over 90% of generalists have ordered a FA IgE test. However, generalists report a lack of self-efficacy in interpreting FA IgE testing, educating parents about the pathophysiology of eczema, and about early introduction of food allergens in infancy. Barriers to reducing FA IgE testing include caregiver pressure to test, misinformation caregivers receive about FA testing, lack of patient education materials, and lack of time for face-to-face education. <h3>Conclusion</h3> Eczema is the most common non-IgE-mediated indication for FA IgE testing. Improving generalist knowledge and self-efficacy about eczema diagnosis and management, including the protective benefits of early food allergen introduction, may reduce inappropriate FA IgE testing.