G.W.CanonicaG.W.Canonica

GARDGARDWorkingWorking Group Group 44

ALLERGY DIAGNOSISALLERGY DIAGNOSIS

World Allergy Organization (WAO)

The World Allergy Organization is an The World Allergy Organization is an

international coalition of international coalition of

7777regional and national allergy and clinical regional and national allergy and clinical

immunology societies. immunology societies.

Survey on Allergy Diagnosis ProceduresSurvey on Allergy Diagnosis Procedures

Survey on Prevalence of AllergensSurvey on Prevalence of Allergens

Simple and cheap diagnostic testsSimple and cheap diagnostic tests

developmentdevelopment

Project on Project on AllergyAllergy DiagnosisDiagnosis

in in GARDGARD

Circulate a questionnaireCirculate a questionnaire

to all WAO member societies to all WAO member societies

to collect data about theto collect data about the

diagnostic proceduresdiagnostic procedures

used in the country/regionused in the country/region

1st STEP 1st STEP AA

Questionnaire on

Respiratory Allergy

Questionnaires on

Drug Allergy

Questionnaires on

Food Allergy

At may 15, 2008

�� 77 Allergy and Clin. Immunology Societies in 77 Allergy and Clin. Immunology Societies in WAO coalitionWAO coalition

�� ? Globally sent surveys? Globally sent surveys

��14 responding countries14 responding countries

NORTH NORTH

&&

LATINLATIN

AMERICAAMERICA

USA (AAAAI)

PANAMA

BRAZIL

CHILE ARGENTINA5 countries5 countries

AFRICAAFRICA

&&

MIDDLE EASTMIDDLE EAST

EGYPT

1 country1 country

ASIAN PACIFICASIAN PACIFIC

BANGLADESH

THAILAND

JAPAN

AUSTRALIA

&

NEW ZELAND

4 countries4 countries

EUROPEEUROPE

PORTUGAL

GERMANY

RUSSIA

ROMANIA

4 countries4 countries

RESPIRATORY ALLERGY PRICKPRICK--TESTINGTESTING

ROUTINARY ADOPTED IN 11/14 COUNTRIES

11/1411/14

�� INFERIOR LIMIT OF AGE: INFERIOR LIMIT OF AGE: 6 MONTHS in 3/146 MONTHS in 3/142 YEARS in 1/142 YEARS in 1/143 YEARS in 3/143 YEARS in 3/14

�� MODALITY: Skin Prick Test with lancets/needles MODALITY: Skin Prick Test with lancets/needles ((monotipmonotip))

�� SKIN SURFACE: SKIN SURFACE: FOREARM 7/14FOREARM 7/14FOREARM / BACK FOREARM / BACK 4/144/14BACK BACK 1/14 1/14

�� POSITIVE WHEAL: POSITIVE WHEAL: 3mm 6/143mm 6/144mm 2/144mm 2/145mm 1/145mm 1/146mm 1/146mm 1/1410mm 1/1410mm 1/14

�� NEGATIVE CONTROL used in NEGATIVE CONTROL used in 11/1411/14�� ADRENALINE RESCUE KIT AVAILABLE in 14/14 ADRENALINE RESCUE KIT AVAILABLE in 14/14

RESPIRATORY ALLERGY RESPIRATORY ALLERGY PRICKPRICK--TESTINGTESTING

RESPIRATORY ALLERGY

INTRADERMALINTRADERMAL--TESTINGTESTING

ROUTINARY ADOPTED IN 3/14 COUNTRIES

NEGATIVE CONTROLS USED IN 7/14

DILUITION RANGES BETWEEN 1:10 TO 1:10.000

LECTURE TIME 15’-30’

3/143/14

� ROUTINARY ADOPTED:

LUNG in 7/14

EYE in 0/14

NOSE in 6/14

� Lecture time 15’-20’

� OUTCOMES: nasal symptoms, respiratory symtoms

FEV 1 decline

RESPIRATORY ALLERGY

PROVOCATION PROVOCATION -- TESTINGTESTING

RESPIRATORY ALLERGY

IN VITRO IN VITRO -- TESTINGTESTING

AVAILABLEAVAILABLE ROUTINARYROUTINARY

TOTAL IgE COUNTTOTAL IgE COUNT 13/1413/14 12/1412/14

BLOOD CELLS BLOOD CELLS COUNTCOUNT

13/1413/14 12/1412/14

SPUTUM CELLSSPUTUM CELLS

EXAMINATIONEXAMINATION

11/1411/14 6/146/14

IgE Ab ESSAYIgE Ab ESSAY

1st generation1st generation (RAST, (RAST,

MAST, EAST)MAST, EAST)

2nd generation2nd generation(AutoCAP, Alast, (AutoCAP, Alast, HyTech, Matrix, HyTech, Matrix, MagicLite)MagicLite)

3rd generation3rd generation(ImmunoCAP, (ImmunoCAP, Immulite2000, Immulite2000, Microassays)Microassays)

10/1410/14

7/147/14

9/149/14

8/148/14

3/143/14

6/146/14

DRUG ALLERGYTEST AVAILABILITY

-PROVOCATION TEST

-SPECIFIC IgE 12/14

-PRICK TEST

-INTRADERMO TEST

11/14

-PATCH TEST

9/14

-TRIPTASE meas.

-Histamine release

6/14

-Basophiles degran.

-LTT

-CAST 5/14

-Sulph. Leukotrienes

4/14

-Basophiles activation test

3/14

�� The The questionnairesquestionnaires werewere circulatedcirculated bybyWHO WHO toto allall thethe membersmembers

�� TheyThey willwill bebe presentedpresented at the 2008 at the 2008

WAO WAO MemberMember SocietiesSocieties ForumsForums

�� JuneJune 12, at the EAACI 12, at the EAACI CongressCongress in Barcellonain Barcellona

�� JuneJune 21 , at SLAAI in 21 , at SLAAI in IslaIsla MargaritaMargarita--VenVen. .

� BETA LACTAMS

PRICK TEST

INTRADERMO

SPECIFIC IgE 10/14

PROVOCATION TEST 7/14

� OTHER ANTIBIOTICS

INTRADERMO & PROVOCATION TEST 4/14

SPECIFIC IgE, HISTAMINE RELEASE,

PRICK TEST ,CAST

BASOPHIL DEGRAN. 3/14

DRUG ALLERGY

� MYORELAXANTS

PRICK TEST 6/14

INTRADERMO & CAST

5/14

SPECIFIC IgE 4/14

PROVOCATION TEST 3/13

� NSAID

INTRADERMO

PROVOCATION TEST 4/14

DRUG ALLERGY

� HORMONES

INTRADERMO 7/14

PRICK TEST 6/14

PROVOCATION TEST

5/14

� GENERAL ANESTHETICS

INTRADERMO

PRICK TEST 7/14

DRUG ALLERGY

� LOCAL ANESTHETICS

INTRADERMO 9/14

PRICK TEST 7/14

PROVOCATION TEST 5/14

� IODINE RADIOCONTRAST MEDIA

INTRADERMO 5/14

PRICK TEST 4/14

� HETEROLOGOUS SERA

LTT 4/14

PRICK TEST 3/14

HISTAMINE RELEASE

BASOPHILS DEGRAN.

FOOD ALLERGY

Prick test 13/14

Prick Plus Prick

&

Rast 11/14

Atopy Patch

Test 6/14

Open food

Challenge 12/14

DBPC food

Challenge 10/14

TEST AVAILABILITYTEST AVAILABILITY

FOOD ALLERGY

Prick test

available in 13 /14 countries

routine use in 13/14

Open food challenge

available in 12/14 countries

routine use in 11/14

13/14

11/14

ROUTINE USEROUTINE USE

FOOD ALLERGY

Prick Plus Prick

And

RAST Unicap

Available in 11/14 countries

Routine use in 10/14

DBPC food challenge

Available in 10/14 countries

Routine use in 7/14

ATOPY PATCH TEST

Available in 6/14 countries

Routine use in 5/14

7/14

10/14

5/14

ROUTINE USEROUTINE USE