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 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 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.
Serial dilution endpoint titration 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. (2006). Tips to remember: What is allergy testing? Retrieved May 26, 2005 from http://www.aaaai.org/patients/publicedmat/tips/whatisallergytesting.stm.
Behrman, R. E., Kliegman, R. M., & Jenson, H. B. (Eds.). (2000). Nelson Textbook of Pediatrics (16th ed., pp. 650-653). Philadelphia: W. B. Saunders Company.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2005). Serial endpoint testing for diagnosis and treatment of allergic disorders (2.01.23). Retrieved May 25, 2006 from BlueWeb.
Krouse, J. H., & Krouse, H J. (2000). Efficacy of immunotherapy based on skin end-point titration. Otolaryngology-Head and Neck Surgery, 123 (3), 183-187.
Krouse, J. H., & Marby, R. L. (2003). Skin testing for inhalant allergy 2003: Current strategies. Otolaryngology-Head and Neck Surgery, 129 (4), S33-S49.
Li, J. T., Lockey, R. F., Bernstein, I. L., Portnoy, J. M., & Nicklas, R. A. (2003). Allergen immunotherapy: A practice parameter. Annals of Allergy, Asthma, & Immunology, 90(1, Suppl. 1), 1-40.
National Guideline Clearinghouse. Institute for Clinical Systems Improvement (ICSI). (2003, May). Rhinitis. Retrieved May 26, 2006 from http://www.guidelines.gov/summary/summary.aspx?doc_id=3875&nbr=003084&string=Rhinitis.
The Technology Evaluation Center. (2002, July). Serial endpoint testing for the diagnosis and treatment of allergic disorders (Vol. 17, No. 6). Chicago: BlueCross BlueShield Association.
U. S. Food and Drug Administration. (2002, August). Allergenics. Retrieved May 25, 2006 from http://www.fda.gov/cber/allergenics.htm.
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EFFECTIVE DATE |
6/22/2006 |
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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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