Allergy Diagnosis and Treatment
****Please disregard this post and see my post here for an explanation of what's wrong with this one.****
[This series is based on my own opinions and reading, and on the experiences of myself and others. It is for informational and discussion purposes only. Please do not take it as medical advice.]
Here you will find a summary of the issues I have covered to date, with links to posts discussing each problem in more detail. I plan to add more information, including critiques of recent study results, as my research progresses.
[Please note that I am not advocating self-diagnosis or treatment of allergies.
Ideally, everyone would have access to a good doctor who would be thorough and careful in testing and treatment so that each patient would have the best care possible without having to worry about questioning things or doing their own research. We would have plenty of funding for allergy research, excellent protocols used without fail for diagnosis and treatment, and a cure for allergies.
In the absence of a perfect world, I hope this post will help to bring awareness to some of the issues, helping both doctors and patients understand each other and some of the complications of allergies.
If you have any questions or concerns about your treatment, it is important to discuss them with your doctor.]
##########
Both the medical community and the general public need to be more fully educated about allergies. It is urgent that we develop better systems for diagnosing and treating allergies.
Until that happens, atopic patients will be at a significantly higher risk of illness or death--not because of the allergies themselves, but because of the potentially deadly level of ignorance in those trusted to treat them.
[This series is based on my own opinions and reading, and on the experiences of myself and others. It is for informational and discussion purposes only. Please do not take it as medical advice.]
Here you will find a summary of the issues I have covered to date, with links to posts discussing each problem in more detail. I plan to add more information, including critiques of recent study results, as my research progresses.
[Please note that I am not advocating self-diagnosis or treatment of allergies.
Ideally, everyone would have access to a good doctor who would be thorough and careful in testing and treatment so that each patient would have the best care possible without having to worry about questioning things or doing their own research. We would have plenty of funding for allergy research, excellent protocols used without fail for diagnosis and treatment, and a cure for allergies.
In the absence of a perfect world, I hope this post will help to bring awareness to some of the issues, helping both doctors and patients understand each other and some of the complications of allergies.
If you have any questions or concerns about your treatment, it is important to discuss them with your doctor.]
##########
- Many doctors believe that IgE testing is the only accurate way to diagnose allergies. However, such tests are not always accurate.
- Skin-prick testing is generally considered to be the simplest and most reliable test for allergies. But some patients develop a wheal (positive reaction) to the negative control used in skin-prick allergy testing. This can make test results impossible to interpret, yet allergists do not necessarily employ alternate testing methods in this situation.
- Studies that attempt to determine the prevalence and severity of allergies are often badly flawed. Empirically proving allergic reactions by observation alone is difficult, and many studies set parameters or methods that seriously handicap their chances of getting accurate statistics.
- Unfortunately, the attitude from doctors that allergic reactions aren't real because they're uncommon, don't fit into a certain tightly-defined set of symptoms (usually limited to athsma, hives and airway restriction), or are unverified by a particular test is all too common.
Doctors often operate based on statistics drawn from flawed studies and assumptions about paranoid patients (or parents) who supposedly overreport or imagine allergies. They can fail to look at each patient as an individual and take that person's particular situation, specific risk factors and symptoms seriously. - Even life-threatening anaphylactic reactions are likely to be discounted or misdiagnosed. Both the medical community and the community at large have an appallingly inadequate understanding of allergic reactions and their treatment.
Both the medical community and the general public need to be more fully educated about allergies. It is urgent that we develop better systems for diagnosing and treating allergies.
Until that happens, atopic patients will be at a significantly higher risk of illness or death--not because of the allergies themselves, but because of the potentially deadly level of ignorance in those trusted to treat them.
Copyright 2009. All rights reserved.
Posted by purple_kangaroo at 10:18 PM[Permanent link]
5 Comments:
I'm irritated by the poor state of allergy testing - I feel that some desperate parents are being exploited and some children have serious issues that are not being addressed.
You give a fine overview of the problems with current testing strategies.
Regards - Shinga
Thank you for responding to my comment on the PGR. I stand by my previous comment and I refer you and the readers to the post on my blog on Allergy diagnosis and testing (http://allergyasthma.wordpress.com/2006/11/08/diagnosis-and-testing-for-allergies/) and the American Academy of Allergy and Immunology website (www.aaai.org)
The interpretation of any diagnostic test requires years of study and experience, which is why it is recommended that general physicians consult with a specialist in that field and it is part of the specialist's job to explain to patients the meaning and relevance of test results.
With regards to your post, I unfortunately do not have the time to pursue every single point at this time, but can only refer you and the reader to the resources linked on my blog or to your friendly neighborhood Allergy specialist for further explanation.
Wow, one of the links finally worked! Clicking on the link you left on the PGR post leads to a "page does not exist" message for me.
Thank you for taking the time to comment.
I am still quite confused as to what exactly you disagree with in my article. I cannot tell from your comments whether you actually read the article, or if you are just responding to the fact that it was written by an allergy sufferer rather than a doctor.
The four methods of allergy testing I discussed were skin prick testing, physician-supervised elimination and reintroduction of the food, IgE blood tests, and double-blind placebo-controlled food challenges.
Which of those four testing methods are you referring to as not being scientifically accepted?
I do think it's important for patients to understand some of the issues with allergy testing, only because allergists often do not explain them accurately if at all to patients.
There are a large number of allergists that simply do one skin test and give absolutely no explanation of the results beyond "avoid these food and don't worry about those ones."
I have talked to many people, including myself and several family members, as well as members of a number of online allergy forums, who have not received proper education or care from their board-certified allergists.
It is very common, for example, for people to have a strong positive result to the negative control and never even be told that this can affect the accuracy of results, much less offered RAST testing or a food challenge.
It is also very common for people to be told to go ahead and eat foods they have awful reactions to simply because a skin test was negative, with no other testing or follow-up.
My daughter tested positive to foods I have seen no reaction to, and I tested negative to foods I have had multiple severe reactions to (if you can call it a negative, since I had a positive reaction to the negative control and the "negative" result was at least 3mm larger in welt size than other wheals besides the control).
In both cases, our allergist flat-out refused to do more testing or RAST testing (saying it would only lead to "more false positives") and offered no guidance whatsoever in doing any kind of food challenge. We were on our own.
The treatment we received from this allergist was really appalling. It is explained in more detail in the articles linked under the last two bullet points in the above article.
There are only two pediatric allergy-immunology MDs in our town, which is a fairly large urban city. Both are similarly inadequate.
Until very recently, I simply trusted the doctors and allergists and took their word for it. However, my own health and my child's health has suffered enough as a result that I am no longer willing to accept without question everything a doctor tells me.
I am not by any means recommending that any lay person try to self-interpret tests. I am arguing that we need more and better research into allergy testing, and better treatment from doctors.
I'm sure you may be a very good allergist, but there are many board-certified MDs specializing in allergy treatment who are not.
If you doubt that, please visit any forum for patients or parents of children with food allergies. Better yet, visit one geared towared a specific allergy other than one of the top 8.
Ask the allergy sufferers about their experiences with doctors and allergists. You might find it very revealing.
Since you insist, here goes:
The page you linked to in PGR is chock full of inaccuracies and the link to studies that do not support the points you are trying to make and reveal a lack of understanding of the important medical issues that you make statements about, for example:
1) You state that”Even life-threatening anaphylactic reactions are likely to be discounted or misdiagnosed.”, and then you link to a study that in fact states that epinephrine is underused in the ER in the treatment of anaphylaxis and does not talk at all about misdiagnosis or underdiagnosis of anaphylaxis.
2) You state that
“Many doctors believe that IgE testing is the only accurate way to diagnose allergies. However, such tests are not always accurate.” and then you link to a Pubmed page that does not say this at all, but at most states that the “accuracy of these tests may vary”, which is a far cry from saying that they are not accurate. In fact, the accuracy of skin and RAST tests range from 80-95% when interpreted appropriately.
3) You state that the sensitivity and reliability of skin tests is as low as 15% but then link to a study comparing atopy patch testing and food skin testing in patients with eczema, which is not always an IgE mediated disease (unlike, asthma, anaphylaxis, and rhinitis). Again, this reveals a lack of understanding of basic allergic mechanisms.
It is dangerous and irresponsible to make statements about medical issues that you do not fully understand. I suggest you take your own advice and increase your education and awareness about basic allergy issues before making such pronouncements.
Thank you very much. I will take a look at those things.
Post a Comment
<< Purple Puzzle Place Home