Do you want the best science to support the medical decisions made by your doctor?
If the answer is yes, then go to http://www.choosingwisely.org/ and under “lists,” you can find a short lists provided by experts in their respective fields. Here is the list for Allergy & Immunology:
1. Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.
- Appropriate diagnosis & treatment of allergies requires speciﬁc IgE testing (either skin or blood tests) based on a patient’s clinical history. The use of other tests or methods to diagnose allergies is unproven and can lead to inappropriate diagnosis and treatment. Appropriate diagnosis and treatment is both cost effective and essential for optimal patient care.
2. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis (the common cold).
- Viral infections cause the majority of acute rhinosinusitis (colds) and only 0.5-2% progress to bacterial infections. Most acute colds resolve without treatment in 2 weeks. Uncomplicated acute colds are generally diagnosed clinically and do not require a sinus CT scan or other imaging. Antibiotics are not recommended for patients with uncomplicated acute colds who have mild illness and assurance of follow-up. If a decision is made to treat, amoxicillin should be ﬁrst-line antibiotic for most acute colds.
3. Don’t routinely do diagnostic testing in patients with chronic hives (urticaria).
- In the overwhelming majority of patients with chronic hives, a deﬁnite etiology is not identiﬁed. Limited laboratory testing may be warranted to exclude underlying causes. Targeted laboratory testing based on clinical suspicion is appropriate. Routine extensive testing is neither cost effective nor associated with improved clinical outcomes. Skin or serum-speciﬁc IgE testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as provoking or perpetuating the hives.
4. Don’t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.
- Immunoglobulin (gammaglobulin) replacement is expensive and does not improve outcomes unless there is impairment of antigen-speciﬁc IgG antibody responses to vaccine immunizations or natural infections. Low levels of immunoglobulins (isotypes or subclasses), without impaired antigen-speciﬁc IgG antibody responses, do not indicate a need for immunoglobulin replacement therapy. Exceptions include IgG levels <150mg/dl and genetically deﬁned/suspected disorders. Measurement of IgG subclasses is not routinely useful in determining the need for immunoglobulin therapy. Selective IgA deﬁciency is not an indication for administration of immunoglobulin.
5. Don’t diagnose or manage asthma without spirometry.
- Clinicians often rely solely upon symptoms when diagnosing and managing asthma, but these symptoms may be misleading and be from alternate causes. Therefore spirometry is essential to conﬁrm the diagnosis in those patients who can perform this procedure. Recent guidelines highlight spirometry’s value in stratifying disease severity and monitoring control. History and physical exam alone may over- or under-estimate asthma control. Beyond the increased costs of care, repercussions of misdiagnosing asthma include delaying a correct diagnosis and treatment.
At Family Allergy & Asthma Care of Montana, we support and follow these guidelines. For high value, cost-effective care, we must all “choose wisely”!
This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.