study of the week

Choose…But Choose Wisely, Part 8

On to the American Academy of Allergy, Asthma & Immunology’s list.

1.  Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.
There’s a lot of talk out there about food allergies.  IgE- mediated food allergies are the scary kind- the kind you think about when you think of peanut allergies.  Face swelling, hives, throat closing up stuff.  Scary.  Hey, I can show you what it looks like.  My son Alex is allergic to fish, as we discovered last year when we fed him stuffed cod.  Here’s a picture.  Note the swollen eyes and lips and the hives around his eyes and nose.  I think I aged about 10 years that night.

Anyway, that’s an IgE-mediated food allergy.  This recommendation states that when a child has a suspected food allergy, do targeted IgE testing.  For example, Alex was tested for shellfish, crustaceans, and fin fish.  Nothing else was checked.  However, there’s also a lot of talk, especially among the alternative medicine crowd, about IgG testing.  These are blood tests that claim to show sensitivities to a bunch of different foods.  I’ve had patients bring in blood tests results done by other practitioners that claim to show that they are allergic to literally dozens of foods.  They are basically eating brown rice and boiled chicken.  No joke.  These tests have NO evidence to support them.  None.  Don’t do them, and don’t get them done.
2.  Don’t order sinus computed tomography (CT) or indiscriminately
prescribe antibiotics for uncomplicated acute rhino sinusitis.
Already discussed here, but takes it one step further by reminding us that CT scans are not needed in the management of sinusitis. 

3.  Don’t routinely do diagnostic testing in patients with chronic urticaria.

Chronic urticaria is a fancy way of saying hives.  Chronic hives are miserable.  The constant itching can drive you nuts.  Hmmm…might I be speaking from personal experience?  I had hives in med school.  Luckily, they seemed to go away after a year or two.  Like most people with hives, I never figured out what caused them.  Testing is rarely helpful- time and effort should be spent on managing symptoms.
4.  Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines

are demonstrated.
Some people have an immunoglobulin deficiency, which can lead to increased susceptibility to infections.  However, low immunoglobulin levels don’t always need to be treated- the levels need to be clinically significant.

5.  Don’t diagnose or manage asthma without spirometry.
 Spirometry is a test that can be done in the office.  It measures how much air is getting out of the lungs in a breath.  It’s a great test to diagnose and monitor asthma, and can help guide treatment.

Wow, one list left!  Still with the weird formatting.  I should just pretend that I’m doing it intentionally.

2 thoughts on “Choose…But Choose Wisely, Part 8”

  1. I really like reading these. How on earth do you have time to do all of them!? That's quite the pic of your son. I can see how it would stress you right the heck out. Do you ever read the vital signs section of discover magazine? Another fav of mine.


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