DESCRIPTION
Serial dilution endpoint titration (SDET or Rinkel Therapy) and intradermal (intracutaneous) skin test (IDST) are two types of allergy tests to confirm adverse reactions to offending agents.
Serial dilution endpoint titration involves two steps, titration and immunotherapy. Titration consists of administering increasing concentrations of allergen. The endpoint is reached with the first dilution that initiates a wheal 2-mm larger than that produced by the preceding dilution. This endpoint is intended to determine the optimal dose with immunotherapy beginning with 0.5 ml of the endpoint dilution.
Intradermal skin test involves injecting a small amount of antigen extract (one dilution) into the skin. The response is noted 15 to 30 minutes after the injection. The number of IDSTs required for each individual may vary widely, depending upon the individual's history, but rarely number more than 20.
These two techniques are essentially the same except SDET involves the use of several dilutions of each allergen instead of one dilution. With this method, increasing concentrations of allergen (as many as nine) may be injected into the skin.
POLICY
Intradermal skin test for the diagnosis of allergies is considered medically necessary.
Serial dilution endpoint titration for the diagnosis of allergies is considered investigational.
See also: General Policy for Allergy Testing and Treatment
ADDITIONAL INFORMATION
There is insufficient evidence supporting the use of serial dilution endpoint titration for the diagnosis of allergies.
SOURCES
Adkinson, N. F., Bochner, B. S., Busse, W. W., Holgate, S. T., Lemanske, R. F. & Simons, F. E. (Eds.). (2008). Middleton’s Allergy: Principles and Practice (7th ed., pp. 1267-1278). Philadelphia: Elsevier.
American Academy of Allergy Asthma & Immunology. (2007). Tips to remember: What is allergy testing? Retrieved April 2, 2009 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergytesting.stm.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2006). Serial endpoint testing for diagnosis and treatment of allergic disorders (2.01.23). Retrieved April 6, 2009 from BlueWeb. (3 articles and/or guidelines reviewed)
Haydon, R. C. (2008). Allergic rhinitis-Current approaches to skin and in vitro testing. Otolaryngologic Clinics of North America, 41 (2), 331-346.
Hayes. Medical Technology Directory. (2006, August). Allergy testing, in vivo. Retrieved April 6, 2006 from www.Hayesinc.com/subscribers. (55 articles and/or guidelines reviewed)
Joint Task Force on Practice Parameters. (2003). Allergen immunotherapy: A practice parameter. Annals of Allergy, Asthma, & Immunology, 90 (1, Suppl. 1), 1-40.
Joint Task Force on Practice Parameters. (2007). Allergen immunotherapy: A practice parameter second update. The Journal of Allergy and Clinical Immunology, 120 (Suppl. 3), S25-S85.
Krouse, J. H., & Marby, R. L. (2003). Skin testing for inhalant allergy 2003: Current strategies. Otolaryngology-Head and Neck Surgery, 129 (4), S33-S49.
National Guideline Clearinghouse. (2008, January). Diagnosis and treatment of respiratory illness in children and adults. Retrieved April 6, 2009 from http://www.guidelines.gov.
Stingone, J. A., & Claudio, L. (2008). Disparities in allergy testing and health outcomes among urban children with asthma. The Journal of Allergy and Clinical Immunology, 122 (4), 748-753.
U. S. Food and Drug Administration. (2007, February). Allergenics. Retrieved April 6, 2009 from http://www.fda.gov/cber/allergenics.htm.
ORIGINAL EFFECTIVE DATE: 10/12/1998
MOST RECENT REVIEW DATE: 5/14/2009
ID_BT
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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