Molecular diagnostics improves diagnosis and treatment of respiratory allergy and food allergy with economic optimization and cost saving
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Keywords
Allergen immunotherapy, Component resolved diagnosis, Cost-saving, Food allergy, Respiratory allergy
Abstract
Background: Component resolved diagnosis (CRD) allows to precisely identify the sensitization to specific molecules of a given allergenic source, resulting in an important improvement in clinical management, particularly of polysensitized subjects. This will end in the correct prescription of allergen immunotherapy (AIT) for respiratory allergy and inadequate avoidance diets or prescription of self-injectable adrenaline in food allergy.
Objective: The aim of this multicenter, real-life study is to evaluate the percentage change of the diagnostic-therapeutic choice in polysensitized patients with respiratory allergy and in patients with food allergy, after using CRD compared to a first-level diagnosis, along with an economic analysis of the patient’s overall management according to the two different approaches.
Methods: An overall number of 462 polysensitized patients, as suggested by skin prick tests (SPT), and with clinical symptoms related to a respiratory (275 pts) or food (187 pts) allergy, were recruited. All patients underwent CRD for specific IgE against food or inhalant recombinant molecules, which were chosen according to medical history and positivity to SPT. The first diagnostic-therapeutic hypothesis, based only on medical history and SPT, was recorded for each patient while the final diagnostic therapeutic choice was based on the results from CRD. The rate of change of the diagnostic-therapeutic choice from the first hypothesis to the final choice was statistically evaluated. The economic impact of CRD on the overall management of the allergic patients was analyzed to evaluate whether the increase in the diagnostic costs would be compensated and eventually exceeded by savings coming from the improved diagnostic therapeutic appropriateness.
Results: An approximate 50% change (k index 0.54) in the prescription of AIT for respiratory allergy as well as a change in the prescription of self-injectable adrenaline (k index 0.56) was measured; an overall saving of financial resources along with a higher diagnostic-therapeutic appropriateness was also detected.
Conclusion: There is moderate agreement concerning prescription of AIT and self-injectable adrenaline before and after performing CRD: this highlights the usefulness of CRD, at least in polysensitized patients, in indicating the risk assessment and therefore the correct therapy of respiratory and food allergy, which results in a cost-saving approach.
References
2. Koplin JJ, Mills EN, Allen KJ. Epidemiology of food allergy and food-induced anaphylaxis: is there really a Western world epidemic? Curr Opin Allergy Clin Immunol. 2015;15:409-16.
3. Canani RB, Nocerino R, Terrin G. Hospital admissions for food-induced anaphylaxis in Italian children. Clin Exp Allergy. 2012;42:1813-4.
4. AAITO, SIAAIC, SIAIP, FNOMCeO. Documento condiviso su allergiese intolleranze alimentary; 2015.
5. Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133:291-307.
6. Savage J, Johns CB. Food allergy: epidemiology and natural history. Immunol Allergy Clin North Am. 2015;35:45-59.
7. Nwaru BI, Hickstein L, Panesar SS. The epidemiology of food allergy in Europe: a systematic review and meta-analysis. Allergy. 2014;69:62-75.
8. Lin RY, Anderson AS, Shah SN. Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990-2006. Ann Allergy Asthma Immunol. 2008;101:387-93.
9. Dyer AA, Lau CH, Smith TL. Pediatric emergency department visits and hospitalizations due to food-induced anaphylaxis in Illinois. Ann Allergy Asthma Immunol. 2015;115:56-62.
10. Rudders SA, Banerji A, Vassallo MF. Trends in pediatric emergency department visits for food-induced anaphylaxis. J Allergy Clin Immunol. 2010;126:385-8.
11. Bousquet J, Khaltaev N, Cruz AA. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization GA(2)LEN and AllerGen). Allergy. 2008;63:8-160.
12. Reed SD, Lee TA, McCrory DC. The economic burden of allergic rhinitis: a critical evaluation of the literature. Pharmacoeconomics. 2004;22:345-61.
13. Blaiss MS. Allergic rhinitis: direct and indirect costs. Allergy Asthma Proc. 2010;31:375-80.
14. Barnett SB, Nurmagambetov TA. Costs of asthma in the United States: 2002-2007. J Allergy Clin Immunol. 2011;127:145-52.
15. Marcellusi A, Viti R, Incorvaia C. Direct and indirect costs associated with respiratory allergic diseases in Italy. A probabilistic cost of illness study. Recenti Prog Med. 2015;106:517-27.
16. Domínguez-Ortega J, Phillips-Anglés E, Barranco P. Costeffectiveness of asthma therapy: a comprehensive review. J Asthma. 2015;52:529-37.
17. Miles S, Fordham R, Mills C. A framework for measuring costs to society of IgE-mediated food allergy. Allergy. 2005;60:996-1003.
18. Muraro A, Agache I, Clark A. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community. Allergy. 2014;69:1046-57.
19. Fox M, Voordouw J, Mugford M. Social and economic costs of food allergies in Europe: development of a questionnaire to measure costs and health utility. Health Serv Res. 2009;44:1662-78.
20. Fox M, Mugford M, Voordouw J. Health sector costs of self-reported food allergy in Europe: a patient-based cost of illness study. Eur J Public Health. 2013;23:757-62.
21. Jansson SA, Protudjer JL, Arnlind-Heibert M. Socioeconomic evaluation of well-characterized allergy to staple foods in adults. Allergy. 2014;69:1241-7.
22. Protudjer JL, Jansson SA, Heibert Arnlind M. Household costs associated with objectively diagnosed allergy to staple foods in children and adolescents. J Allergy Clin Immunol Pract. 2015;3:68-75.
23. Patel DA, Holdford DA, Edwards E. Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States. J Allergy Clin Immunol. 2011;128:110-5.
24. Flabbee J, Petit N, Jay N. The economic costs of severe anaphylaxis in France: an inquiry carried out by the Allergy Vigilance Network. Allergy. 2008;63:360-5.
25. Macchia D, Melioli G, Pravettoni V. Guidelines for the use and the interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy. 2015;13:27.
26. Soares-Weiser K, Takwoingi Y, Panesar SS. The diagnosis of food allergy: a systematic review and meta-analysis. Allergy. 2014;69:76-86.
27. Lorenz AR, Lüttkopf D, May S. The principle of homologous groups in regulatory affairs of allergen products - a proposal. Int Arch Allergy Immunol. 2009;148:1-17.
28. Canonica GW, Ansotegui IJ, Pawankar R. A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013;6:17.
29. Hankin CS, Cox L. Allergy immunotherapy: what is the evidence for cost saving? Curr Opin Allergy Clin Immunol. 2014;14:363-70.
30. Cox L. Allergy immunotherapy in reducing healthcare cost. Curr Opin Otolaryngol Head Neck Surg. 2015;23:247-54.
31. Simoens S. The cost-effectiveness of immunotherapy for respiratory allergy: a review. Allergy. 2012;67:1087-105.
32. Kleine-Tebbe J, Matricardi PM, Hamilton RG. Allergy work-up including component-resolved diagnosis: how to make allergenspecific immunotherapy more specific. Immunol Allergy Clin North Am. 2016;36:191-203.
33. Sastre-Ibanez ˜ M, Sastre J. Molecular allergy diagnosis for the clinical characterization of asthma. Expert Rev Mol Diagn. 2015;15:789-99.
34. Melioli G, Passalacqua G, Canonica GW. Component-resolved diagnosis in pediatric allergic rhinoconjunctivitis and asthma. Curr Opin Allergy Clin Immunol. 2013;13:446-51.
35. Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015;35:61-76.
36. Incorvaia C, Rapetti A, Aliani M. Food allergy as defined by component resolved diagnosis. Recent Pat Inflamm Allergy Drug Discov. 2014;8:59-73.
37. Hoffmann-Sommergruber K, Pfeifer S, Bublin M. Applications of molecular diagnostic testing in food allergy. Curr Allergy Asthma Rep. 2015;15:56.
38. Passalacqua G, Melioli G, Bonifazi F. The additional values of microarray allergen assay in the management of polysensitized patients with respiratory allergy. Allergy. 2013;68: 1029-33.
39. Sastre J, Landivar ME, Ruiz-García M. How molecular diagnosis can change allergen-specific immunotherapy prescription in a complex pollen area. Allergy. 2012;67:709-11.
40. Stringari G, Tripodi S, Caffarelli C. The effect of component resolved diagnosis on specific immunotherapy prescription in children with hay fever. J Allergy Clin Immunol. 2014;134:75-81.
41. Borghesan F, Bernardi D, Plebani M. In vivo and in vitro allergy diagnostics: it’s time to re-appraise the costs. Clin Chem Lab Med. 2007;45:391-5.
42. Lepage-Nefkens I, Van der Maas M, Rijnen M. A cost-effectiveness model evaluating component-resolved diagnosis (CRD) versus standard testing method (skin prick testing (SPT)) in the diagnosis and treatment of allergic rhinitis in the Netherlands. Value Health. 2015;18:359.
43. Antonicelli L, Massaccesi C, Braschi MC. Component resolved diagnosis in real life: the risk assessment of food allergy using microarray-based immunoassay. Eur Ann Allergy Clin Immunol. 2014;46:30-4.
44. Zuberbier T1, Lötvall J, Simoens S. Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review. Allergy. 2014;69:1275-9.
45. Tripodi S, Frediani T, Lucarelli S. Molecular profiles of IgE to Phleumpratense in children with grass pollen allergy: implications for specific immunotherapy. J Allergy Clin Immunol. 2012;129:834.
46. Melioli G, Bonifazi F, Bonini S. The ImmunoCAP ISAC molecular allergology approach in adult multi-sensitized Italian patients with respiratory symptoms. Clin Biochem. 2011;44:1005-11.
47. Darsow U, Brockow K, Pfab F. Allergens. Heterogeneity of molecular sensitization profiles in grass pollen allergy–implications for immunotherapy? Clin Exp Allergy. 2014;44:778-86.
48. Pascal M, Munoz-Cano ˜ R, Reina Z. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy. 2012;42:1529-39.
49. Cardona V, Luengo O, Garriga T. Co-factor-enhanced food allergy. Allergy. 2012;67:1316-8.
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