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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