Allergy App?

There is an interesting article referenced on the front page of the Indianapolis Star Monday October 31, 2016  .
The article actually is on page 3A and continues on 14A. It has an eye-catching title, “Think you have allergy? There’s an app for that”.
I am an allergist- one could say that my perspective is slanted and self-serving. I have looked at this with a critical eye. There are a number of things to ask about this app.
The article mentions that testing at an allergist can run as much as $1,200- be careful or now total cost would be $1,499.99 when you add the cost of the ‘app’.
Now I am confused. An ‘app’ in current context is a program or software, designed to fulfill a specific purpose as downloaded to a mobile device. So for $299.99 I can download this allergy app to my Iphone and have allergy testing done and since I have the app, I can continuously use it to monitor my ‘allergies’ in the same manner that I would use Waze to navigate traffic? Or each time I ask the app for service is that another $299.99 of cost generated? Is it a one and done ‘app’?
I first thought that the app would include a lancet for my mobile device for the blood extraction and the wherewithal to make the allergy diagnosis on site without any need to wait two weeks for results.
There are a few talking points on this.
1. I did not see anywhere that this was IgE vs. IgG. IgE is the antibody responsible for type I hypersensitivity reactions. IgG is not linked to any adverse clinical condition (Choosing Wisely Campaign)
2. The specific allergens were general categories- many commonly used panels for the blood testing of allergy contain items that are not seen in Indiana (Bermuda grass). All too often Food Panels contain foods that the child has never ingested. These types of tests have high false positive levels and cannot be used to predict allergy.
3. Allergy testing has been available for many years- through the specialists and through blood tests that are frequently used by primary caretakers. This app provides a diagnostic tool in the hands of the patient, avoiding the need for primary or specialty care.
4. I agree with Dr. Holbreich and I would add that the eye is critical but so are the ears and what is between the ears-the knowledge, training, and experience with allergy. The medical history is the critical part of the evaluation- the experienced ears listen to the story of cause/effect relationships and the expertise of the allergist decides what to look for.
5. I also agree that the safety of this app and the value may lie in the non-detectable result- no detectable antibody and the app diagnoses no allergy. (Any comments on the false negative rates on this?).
Safety? In the world of food allergy there is a concept called tolerance. Observations from oral immunotherapy and from performing oral food challenges indicate that even though antibodies (IgE) are made against a food and that food is ingested without any allergic problems, then there is immunologic tolerance. If that food is avoided, due to a test result and was previously eaten without symptoms, tolerance could be lost and an allergic reaction may occur.
6. Tests like this often include extra comments – like highly or very allergic. They only indicates the presence of the antibody. Severity is not predictable by a skin test nor by a blood test (see the National Guidelines for The Diagnosis and Management of Food Allergy 2010).
7. I would wonder if this is a yes or no type of test- is antibody there yes or no. Blood tests done in our IU Health Lab return with a concentration of IgE antibody per volume (kU/L). Through the allergist’s eyes this reflects the risk of a reaction with exposure. As an example, a blood test for milk would be positive at 0.8 kU/L, but at that value, the risk of an allergic reaction to milk would be <5%.
8. Interpretation, guidance, action plans, natural history, verification, questions, and treatment are then offered – by whom, with what credentials.
Other than having the test available for the patient, this is not new. There are a number of issues to be concerned about.
An allergy app that is needed is one that can quickly tell a mom or dad who happens to be grocery shopping for their food allergic child that a product poses a risk. A bar code scanner that links known allergies of the user to the scanned information on the product.
FEL 10/31/2016

October 31, 2016 · fleickly · No Comments
Tags:  · Posted in: Allergies, Allergy Testing

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