PMID- 15245356
OWN - NLM
STAT- MEDLINE
DCOM- 20041106
LR  - 20061115
IS  - 0105-4538 (Print)
IS  - 0105-4538 (Linking)
VI  - 59 Suppl 78
DP  - 2004 Aug
TI  - The utility of specific immunoglobulin E measurements in primary care.
PG  - 35-41
AB  - BACKGROUND: The identification of atopic patients may not be considered a 
      necessary step in the diagnosis process in primary care. This study investigated 
      the impact of the addition of a specific immunoglobulin E (IgE) antibody test on 
      the current management by primary-care physicians of patients with respiratory 
      and skin symptoms. METHODS: The study had a prospective before-after design. It 
      was conducted in two geographic areas of Italy and Spain and consisted of two 
      parts, Part I and Part II. In each part patients were recruited according to 
      inclusion and exclusion criteria. After the clinical examination, the patients 
      were classified into one of the following categories using a physician's 
      classification: allergic, nonallergic or uncertain. A blood sample was taken from 
      each included patient for specific IgE antibody determination using a Pharmacia 
      CAP System, including either Phadiatop Infant (0-5 years of age) or Phadiatop and 
      food mix (fx5e) (>5 years of age). If a positive result was found, an additional 
      6-26 specific IgE tests were performed. In Part I the result of the specific IgE 
      antibody determinations was not available before the physician's classification 
      was made. In contrast, in Part II, the result of the IgE test was available at 
      the time when the physician's classification was made. Between Part I and Part II 
      an educational intervention for physicians to improve their knowledge of blood 
      testing for IgE-mediated allergy was carried out. RESULTS: A total of 721 
      patients were included in the study. The agreement between classifications based 
      on clinical data and IgE antibody results changed from a kappa coefficient of 
      0.13 in Part I to 0.86 in Part II. With regard to the allergic status the 
      proportion of uncertain cases was reduced from 26.3% in Part I to 4.1% in Part 
      II. The proportion of patients that were advised to avoid allergens increased 
      from 18% in Part I to 62% in Part II in the group of patients classified both by 
      the clinician and the IgE test. CONCLUSIONS: The use of specific IgE antibody 
      determinations improves the clinical management of patients with allergy related 
      symptoms in primary care, allowing advice to be given on specific allergen 
      avoidance. However, the applicability of this diagnostic tool in different areas 
      and countries should be further assessed in cost-effectiveness studies.
CI  - Copyright 2004 Blackwell Munksgaard
FAU - Duran-Tauleria, E
AU  - Duran-Tauleria E
AD  - Institut Municipal d'Investigacio Medica, Barcelona, Spain.
FAU - Vignati, G
AU  - Vignati G
FAU - Guedan, M J A
AU  - Guedan MJ
FAU - Petersson, C J
AU  - Petersson CJ
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - Denmark
TA  - Allergy
JT  - Allergy
JID - 7804028
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Dermatitis, Atopic/*diagnosis/therapy
MH  - Female
MH  - Humans
MH  - Immunoglobulin E/*blood
MH  - Immunologic Tests
MH  - Infant
MH  - Italy
MH  - Male
MH  - Primary Health Care
MH  - Respiratory Hypersensitivity/*diagnosis/therapy
MH  - Spain
EDAT- 2004/07/13 05:00
MHDA- 2004/11/09 09:00
CRDT- 2004/07/13 05:00
PHST- 2004/07/13 05:00 [pubmed]
PHST- 2004/11/09 09:00 [medline]
PHST- 2004/07/13 05:00 [entrez]
AID - ALL566 [pii]
AID - 10.1111/j.1398-9995.2004.00566.x [doi]
PST - ppublish
SO  - Allergy. 2004 Aug;59 Suppl 78:35-41. doi: 10.1111/j.1398-9995.2004.00566.x.