DESCRIPTION
A food allergy is a disorder in which symptoms result from immunologic responses to specific food antigens. Food antigens may cause respiratory, skin or gastrointestinal symptoms. The following diagnostic tests are used to determine food allergies:
Double Blind Food Challenge Test
With this test, the individual ingests increasing doses of the food to which sensitivity is suspected. Both the individual and the physician are "blinded." Tested items are disguised within other food or beverage products or in a capsule in the form of dried food. Only one food item or placebo is tested per day. This is usually done at home, but in some instances of extreme suspected hypersensitivity, it may be performed in the office setting.
Provocative Tests for Food or Food Additives
Provocative tests attempt to duplicate the individual's symptoms. There are three variations of provocative testing for food allergies that can be performed. The variations, which differ in the route of administration for the test allergen, are: intracutaneous, subcutaneous or sublingual. Aside from route, each type of testing involves the same basic method. The method includes administration of the food extract, followed by observation for any of a broad variety of subjective and objective signs and symptoms that could be interpreted as the presence of a food allergy. These tests are used primarily for research.
POLICY
A double blind food challenge test for the diagnosis of a food allergy is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
A provocative test for the diagnosis of an allergy to food or food additives is considered investigational.
See also: General Policy for Allergy Testing and Treatment
MEDICAL APPROPRIATENESS
A double blind food challenge test is considered medically appropriate when:
The individual has signs and symptoms that are highly suggestive of ingestion related hypersensitivity, and
The offending agent cannot be determined by skin testing.
ADDITIONAL INFORMATION
These tests should not be performed when anaphylaxis has followed the ingestion of a food.
A provocative test for the diagnosis of an allergy to food or food additives does not meet the following technology evaluation criteria:
The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.
The technology must improve the net health outcome.
The technology must be as beneficial as any established alternatives.
The improvement must be attainable outside the investigational settings.
SOURCES
American Academy of Allergy, Asthma & Immunology. (1981). Physician reference materials: Position statement 8. Controversial techniques. Retrieved January 7, 2002 from http://www.aaaai.org/professional/physicianreference/positionstatements/ps08.stm.
Complete Guide to Medicare Coverage Issues [Computer software]. (2005, November). Food allergy testing and treatment - not covered (NCD 110.11, p. 2-52). St. Anthony Publishing.
Complete Guide to Medicare Coverage Issues [Computer software]. (2005, November). Challenge ingestion food testing (NCD 110.12, p. 2-52). St. Anthony Publishing.
Hill, D. J., Hosking, C. S., & Reyes-Benito, L.V. (2001). Reducing the need for food allergen challenges in young children: A comparison of in vitro with in vivo tests. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 31 (7), 1031-1035. Retrieved January 7, 2002 from PubMed database.
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EFFECTIVE DATE |
8/10/2006 |
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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