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Testing for allergy.

Guidelines or standards in medicine provide useful beacons to show practitioners the way through often complex clinical situations. For many of us the diagnosis of allergic diseases and what diagnostic tests to use is just such a maze. To have authority, guidelines must be developed by experts on the subject and be approved by an authoritative body. The guideline on 'Diagnostic testing in allergy' by Motala and Hawarden (1) on behalf of the Allergy Society of South Africa provides a crisp set of definitions of atopy and of allergy and briefly outlines their diseases. The diagnostic approach is clearly outlined with the aid of algorithms.

Allergy diagnosis depends primarily on the clinical history; the history, aided by a physical examination, guides objective tests of IgE sensitivity. Either skin tests or allergen-specific serum IgE measurements (RAST) are used to focus on whether the patient is allergic, whether allergy contributes to the symptoms and what the relevant allergens are. A positive history and positive tests help in rationalising treatment, initiating specific allergen avoidance measures and selecting appropriate immunotherapy. Tests include skin-prick testing, blood tests, multi-allergen IgE antibody screening assays, mast cell tryptase and CAST testing.

Many of the allergy 'diagnostic' tests performed by ecologists and alternative practitioners are of unproven value, time consuming and expensive. These are not to be recommended. This list includes neutralisation provocation (Miller) tests, hair analysis, ALCAT and IgG measurements.
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Title Annotation:Editor's Choice
Publication:South African Medical Journal
Article Type:Brief article
Geographic Code:6SOUT
Date:Jul 1, 2009
Words:232
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