COLUMBUS, Ohio – Many people with allergy-like symptoms could get the test they need, and the right treatments for their symptoms, from their primary care physician if managed care practice guidelines encouraged the use of the test.
The savings nationally might equal the costs of an additional doctor's visit to a specialist for more than 20 million Americans. A typical charge for an office visit to an allergy specialist is around $100, about twice the cost of a visit to a family doctor.
A new study suggests that family physicians could better serve their patients with symptoms related to hay fever, or allergic rhinitis, by using a definitive blood test to screen for actual allergies. The test can easily be administered in a physician's office, and the test results are easy to interpret.
Instead of testing for allergies, most family physicians are likely to prescribe medications or suggest that their patients use over-the-counter drugs to help control suspected allergy symptoms, said Sheryl Szeinbach, the study's lead author and a professor of pharmacy practice and administration at Ohio State University. And most people with allergy symptoms first seek help from their family doctor.
With hay fever season nearly upon us, anywhere from 20 to 50 million Americans will develop allergic rhinitis. Symptoms include red and watery eyes, irritated nasal passages, a runny nose and sneezing and coughing. Having a definitive diagnosis is key to treatment, Szeinbach said.
"Family physicians need to use a blood test that specifically tests for the allergens that trigger allergic rhinitis," she said, adding that some doctors already use blood testing. "Knowing whether or not allergy-like symptoms are actually caused by an allergy is key for determining the appropriate course of treatment."
Szeinbach is referring to a blood test that evaluates the reaction of Immunoglobulin E (IgE) to specific allergens, such as pollen from grass and trees. IgE is an antibody that helps fight off toxins and also triggers allergic reactions.
“Part of the reason that the majority of family physicians don’t use the IgE test is that managed care guidelines generally don't call for this kind of test,” Szeinbach said. “It needs to become a standard procedure for family doctors, as many people have these kinds of allergy symptoms.”
She and her colleagues reported their findings on March 22 in San Antonio at the annual meeting of the American Academy of Allergy, Asthma and Immunology.
The researchers collected questionnaires from 577 patients whose medical and prescription records showed a diagnosis of allergic rhinitis. Participants were asked about the severity and type of allergy symptoms they had, and whether or not they had seen a physician for treatment.
The researchers placed patient responses into one of three groups: patients who received care from a family physician (240); patients who were treated by an allergist (172); and those who chose to self-manage their symptoms (165).
While all groups had fairly high quality-of-life scores, people under the care of a family physician reported slightly more symptoms – and a greater severity of those symptoms – than did patients treated by an allergist and even those who self-managed their allergy symptoms after being diagnosed by a physician.
“Optimal quality-of-life outcomes are assured if allergists continue to perform skin tests and if family and primary care physicians can provide specific IgE blood testing,” Szeinbach said. “For more severe cases, these doctors could refer patients to an allergist or other specialist.”
Family doctors need a better way to accurately diagnose allergic rhinitis, as the symptoms are often similar to those found in asthma and rhinosinusitis, a condition where the sinuses and nasal passages become swollen and inflamed. But the treatment for each disorder is different
“The specific IgE blood test provides valuable information to help determine if a patient is truly allergic to pollen, and it also helps allergists hone in on specific allergens during skin testing,” Szeinbach said. People who see an allergist are almost always given a skin test. Small amounts of known allergens – pollen from different plants in the case of allergic rhinitis – are placed on the patient's skin. The skin is then pricked with a needle so the allergens can enter the blood stream.
If the skin reddens or swells, the patient is considered allergic to that pollen. With this kind of test, a person often must wait up to two hours to see if there is a reaction. The skin test also requires extensive training and experience to properly interpret the results, which family physicians may not have.
"The specific-IgE test requires the time it takes to draw a vial of blood," Szeinbach said. "The results can tell a physician whether or not her patient truly has an allergy. If so, she can then send that patient on to an allergist if further evaluation is warranted.
"Our findings suggest that family physicians can effectively use the specific IgE test on their patients,” she said. “Managed care protocols need to be changed to allow increased use of this test. The change in practice could result in the savings of billions of dollars in healthcare costs every year."
Several years ago, Szeinbach did a study and found that nearly two out of three patients treated for allergies were not truly allergic.
"Millions of people suffer unnecessarily because they really don't have allergies," she said. "They're often prescribed medications such as antihistamines that don't help the problem, so it’s important that they be correctly diagnosed in the first place."
Szeinbach conducted the study with P. Brock Williams, of the University of Missouri School of Medicine in Kansas City; Susan Kucukarslan, of the Henry Ford Health System in Detroit; and Hanaa Elhefni, of the University of Alabama School of Medicine.
Funding for this work came from Pharmacia Diagnostics, Inc., makers of the ImmunoCap IgE test.
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