BlueCross BlueShield of Tennessee Medical Policy Manual

In Vitro Particle Size Measurement for Screening Hypersensitivity Reactions to Foods and Chemicals

DESCRIPTION

In vitro particle size measurement for screening hypersensitivity reactions involves the measurement of the aggregate release of inflammatory mediators from an individual's immunocytes after exposure to various food extracts and chemicals (e.g., food additives). A determination is made of the difference in volume of circulating immunocytes and plasma before and after an in vitro antigen challenge.

An example of this technology is the Mediator Release Test® or MRT®.  For this test, portions of an individual's blood sample are incubated with various food extracts and food additives (typically 150 different substances). The degree of reactivity is determined by the degree of mediator release from the cells. A response, change in cellular and plasma volume, is thought to indicate a hypersensitivity reaction and results are used as a basis for modifying an individual’s diet. The MRT® is one component of the Lifestyle Eating and Performance (LEAP®) Program of oligoantigenic dieting. This type of testing has been promoted for individuals with, among other conditions, irritable bowel syndrome, chronic fatigue syndrome, migraine headaches, and dermatologic conditions (e.g., eczema, dermatitis).

POLICY

IMPORTANT REMINDER

ADDITIONAL INFORMATION

Well-designed studies in peer-reviewed journals are not available regarding the use of this test in screening for hypersensitivity reactions to foods (e.g., sensitivity to cow's milk) and chemicals. These studies are needed to determine the efficacy of this technology and to substantiate any potential health benefits associated with its use.

SOURCES

American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma & Immunology and the Joint Council of Allergy, Asthma & Immunology. (2014). Food allergy: a practice parameter update – 2014. Retrieved October 20, 2016 from https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Food-Allergy-A-Practice-Parameter-Update-2014.pdf.

European Academy of Allergy and Clinical Immunology. (2014). EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Retrieved October 20, 2016 from the National Guideline Clearinghouse. (NGC:010562).

National Institute for Health and Care Excellence. (2011). Food allergy in under 19s: assessment and diagnosis. Retrieved October 20, 2016 from www.nice.org.uk.

National Institute of Allergy and Infectious Diseases. (2010). Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. Retrieved October 20, 2016 from http://www.jacionline.org.

ORIGINAL EFFECTIVE DATE:  5/1/2004

MOST RECENT REVIEW DATE:  10/26/2017

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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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