Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

Description

Policy

Policy Guidelines

No applicable information

Benefit Application

Rationale

Much of the available literature on the accuracy of intradermal dilutional testing (IDT) and serial endpoint testing (SET) is from the 1970s and 1980s. None of these studies showed improvement in allergy related symptoms and/or quality of life based on the testing and, therefore, systematic review is difficult for this type of allergy testing. Nevertheless, IDT has become an established approach to allergy testing by the American Association of Otolaryngology as reported by Krouse. (1) And, in particular, SET is generally considered the method of choice for life threatening and antibiotic related allergies where other testing techniques may not be available or may be dangerous.
The advantages to IDT over other allergy testing are:

• Determination of a safe starting dose
• Reliability of testing greater in many drug related allergies
• Higher sensitivity than skin prick testing for allergies
  

Its disadvantages are:

• Less specific than skin prick testing or serum IgE
• More extensive procedure that can require up to 6 rounds of intradermal injections before the diagnosis is established.
  

Although there is little primary literature on SET and health outcomes, recent guidelines and publications have discussed the need for this more intensive type of testing for certain drug allergies in particular. For example, the Centers for Disease Control (CDC) recommend the use of SET testing in the management of patients with secondary syphilis or neurosyphillis and a history of penicillin allergy. (2)
Thus, use of SET is considered medically necessary in specific situations, i.e., when there is the high likelihood for a severe allergic reaction to specific agents such as antibiotics or other high-risk allergens.

References:

1. Krouse JH, Mabry RL. Skin testing for inhalant allergy 2003: current strategies. Otolaryngol Head Neck Surg 2003; 129(4 suppl):S33-49.
2. Centers for Disease Control and Prevention; Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines 2006: Management of patients who have a history of penicillin allergy.
3. MMWR Morb Mortal Wkly Rep 2006; 55(RR-11):33-5.

Index

Policy History