Allergy Testing - Nasal Challenge Test
DESCRIPTION
The nasal challenge test (i.e., nasal provocation testing) for confirming/excluding allergic rhinitis and causative allergens involves applying a small amount of allergen solution directly to the nares. If the initial nasal allergen response is negative after 15 minutes, the extract concentration is increased 3-fold. Doses are increased every 15 minutes in this fashion until a positive result is obtained, or until maximum concentrations have been administered with no response. Response to the allergen is determined by nasal peak expiratory flow rate (NPEFR), number of sneezes, and presence of rhinorrhea. Cellular changes may also be evaluated.
POLICY
Nasal challenge testing is considered investigational.
ADDITIONAL INFORMATION
There are no randomized controlled trials that substantiate this technology.
SOURCES
Allergic Rhinitis and its Impact on Asthma (ARIA) Workshop Group. (2001, November). Allergic rhinitis and its impact on asthma. The Journal of Allergy and Clinical Immunology, 108 (5), S147-334.
Allergy Clinic. (2006, November). Allergy challenge tests. Retrieved April 1, 2008 from http://www.allergyclinic.co.uk/tests_challenge.htm.
American Academy of Allergy, Asthma & Immunology. (2007). Tips to remember: What is allergy testing? Retrieved April 1, 2008 from http://www.aaaai.org/patients/publicdmat/tips/whatisallergytesting.stm.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2006). Serial Endpoint Testing for the Diagnosis and Treatment of Allergic Disorders (2.01.23). Retrieved April 1, 2008 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer software]. (2007, November). Food allergy testing and treatment - not covered (NDC 110.11, p. 2-54). St. Anthony Publishing.
Day, J. H., Ellis, A. K., Rafeiro, E., Ratz, J. D. & Briscoe, M. P. (2006, February). Experimental models for the evaluation of treatment of allergic rhinitis. Annals of allergy, asthma & immunology, 2006 (96), 263-278. (157 articles and/or guidelines reviewed)
Litvyakova, L. I., & Baraniuk, J. N. (2001). Nasal provocation testing: a review. Annals of Allergy, Asthma, & Immunology, 86 (4), 355-365.
Wilson, A. M., Sims, E. J., Orr, L. C., Robb, F., & Lipworth, B. J. (2003). An evaluation of short-term corticosteroid response in perennial allergic rhinitis using histamine and adenosine monophosphate nasal challenge. British Journal of Clinical Pharmacology, 55 (4), 354-349.
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EFFECTIVE DATE |
5/8/2008 |
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ID_BT
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