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PCPs order excessive, costlier food allergen panels vs. allergists
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Compared with allergists, primary care providers ordered significantly more food allergen panels and generated higher cost per patient, according to recent study findings.
Affecting approximately 5-8% of children, food allergies have become increasingly prevalent in recent years, driving the need for rapid and accurate diagnosis in the primary care office. While oral food challenges remain the ‘gold standard’ to confirm a food allergy diagnosis, other methods such as percutaneous skin prick testing and laboratory assays are widely available, often advertised as more convenient and cost-effective.
“Current clinical guidelines strongly discourage indiscriminate use of skin prick and food [serum immunoglobulin E (sIgE)] testing, which are both associated with poor sensitivity and high rates of falsely elevated and clinically insignificant results,” David R. Stukus, MD, from the division of allergy and immunology at Nationwide Children’s Hospital, and colleagues wrote. “Interpretation of food sIgE results without consideration of the clinical history can lead to overdiagnosis of food allergy, increased cost of evaluation, unnecessary dietary elimination and the potential for adverse consequences for the patient and their family, including decreased quality of life and potential nutritional deficiencies.”
To quantify and characterize the orders of food-specific sIgE tests made by PCPs and allergists, the researchers conducted a retrospective review of all food sIgE tests ordered in 2013 provided in the electronic database located in the pathology and laboratory medicine department at Nationwide Children’s Hospital.
Stukus and colleagues analyzed 2,637,438 billable laboratory tests for number and type of food-specific sIgEs, in addition to all panels including at least one food allergen. The researchers performed serum IgE testing for aeroallergens and food allergens using ImmunoCAP Allergen specific assays on the Phadia Immunoassay Analyzer (ThermoScientific, Portage, Michigan). Additionally, the researchers assessed the level of practice experience and time since residency or fellowship program for each clinician through licensure review and medical staffing privileges.
During the study period, 10,794 single-food sIgE tests and 3,065 allergen panels with at least one food allergen were ordered by individual clinicians from 16 different medical and surgical specialties.
Data indicated allergists ordered more total sIgE tests per physician compared with PCPs (mean, 154.98 ± 247.01 vs. 16.35 ± 60.52); however, PCPs ordered more panels compared with allergists (45.1% vs. 1.2; P < .001). Further, PCPs who had been in practice for 15 years or less ordered about 50% fewer sIgE panels vs. PCPs who had been in practice longer than 15 years.
“PCPs further removed from residency training ordered more sIgE tests overall, especially panels, which suggests a possible lack of understanding or slow adoption of up-to-date food allergy clinical guidelines,” the researchers wrote.
Stukus and colleagues also determined that PCPs ordered more sIgE tests associated with foods with lower allergen levels, which in turn elevated the overall costs for testing ordered by PCPs. Compared with allergists, the total cost for all sIgE tests ordered per patient by PCPs was nearly twice as expensive ($192.22 vs. $399.10).
“Dissemination of evidence-based clinical practice guidelines and ongoing research regarding the impact of food allergy IgE testing will ideally assist PCPs in the ordering and interpretation of
these tests,” the researchers wrote. — by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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