BlueCross BlueShield of Tennessee Medical Policy Manual

Allergy Testing - Conjunctival Challenge Test

DESCRIPTION

Conjunctival challenge test may be performed by applying a single drop of allergen solution directly to the conjunctiva or by dispensing a defined concentration of allergen into the air of an enclosed air-conditioned challenge chamber. Response assessment may involve measuring conjunctival vascular reaction to an allergen using specialized video equipment with computerized image analysis. However, evaluation of test results has traditionally relied on a subjectively determined degree of tearing, redness, swelling, or itchiness in response to the allergen.

POLICY

• The conjunctival challenge test in the diagnosis of the allergic individual is considered investigational.

IMPORTANT REMINDERS

• Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

• We develop Medical Policies to provide guidance to Members and Providers.  This Medical Policy relates only to the services or supplies described in it.  The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy.  For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed.  If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

ADDITIONAL INFORMATION

There is a severe lack of published evidence supporting this technology. The current literature does not validate the use of the conjunctival challenge test for diagnosing allergic rhinitis or to predict allergic symptoms.

SOURCES  

Friedlaender, M. H. (2002). Conjunctival prevocational testing: Overview of recent clinical trials in ocular testing. Current Opinion in Allergy Clinical Immunology, 2 (5), 413-417. (Level 5 Evidence)

Hayes. Medical Technology Directory. (1998, May). Allergy Testing, In Vivo. Retrieved May 25, 2006 from www.Hayesinc.com/subscribers. (55 articles and/ or guidelines reviewed)

Radcliffe, M., Lewith, G., Prescott, P., Church, M., & Holgate, S. (2006) Do skin prick and conjunctival provocation tests predict symptom severity in seasonal allergic rhinoconjunctivitis? Clinical Experimental Allergy, 36 (12), 1488 - 1493. (Level 4 Evidence)

Sacchetti, M., Lambiase, Al., Aronni, S., Griggi, T., Ribatti, V., Bonini, S., et al. (2006). Hyperosmolar conjunctival provocation for the evaluation of nonspecific hyperreactivity in healthy patients and patients with allergy. Journal of Allergy and Clinical Immunology, 118 (4), 872 - 877. (Level 4 Evidence)

Wallace, D. V., Dykewicz, M. S., Bernstein, D., Blessing-Moore, J., Cox, L., Khan, D., Lang, D., et al. (2008). The Diagnosis and management of rhinitis: An updated practice parameter. Journal of Allergy Clinical Immunology, 122(2 Supplement), S1 - 84. (Level 5 Evidence)

ORIGINAL EFFECTIVE DATE:  10/12/1998   

MOST RECENT REVIEW DATE:  4/12/2012

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.

This document has been classified as public information.