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Updated April 08, 2015.

Deceptive allergy testing practices potentially expose your child to suboptimal care, treatment and raise the potential for fraudulent care.

Tonya Winders, President and CEO of Allergy & Asthma Network (AAN), recommends either in vitro IgE or skin prick testing to help identify potential asthma and allergy triggers for your child’s asthma.

Deceptive Allergy Testing Practices

The AAN points out that some primary care offices enter into agreements with 3rd party companies to test for allergies and recommend treatment.

The AAN feels that the use of “certified allergy technicians” is a potentially deceptive practice and that many patients who are recommended sublingual immunotherapy do not realize that the treatments are not yet approved by the United States Food and Drug Administration. Further, the AAN is concerned that patients do not realize that the “certified allergy technicians” are not fully trained board certified allergists and that the recommended treatments may not be compliant with established standards in allergy and immunology. Finally, the AAN is concerned that patients are sometimes not fully informed and fail to understand the risks of the recommended treatment.

The AAN points out that testing and treatment is not without risks including anaphylaxis.

Not Everyone Agrees

There is another side to the story however. The Academy of Allergy & Asthma in Primary Care, a not for profit promoting the interests of primary care physicians promoting allergy testing and immunotherapy, and United Allergy Services, a for profit provider of allergy testing and immunotherapy services, filed a lawsuit against several organizations representing board certified allergists and immunologists.

The lawsuit alleges that the professional organizations are engaging in anti-competitive practices.

The lawsuit alleges that the organizations representing board certified allergists and immunologists have inappropriately encouraged insurance and managed care companies to deny payment to primary care physicians providing allergy services. The lawsuit alleges further anti-competitive practices such as intimidation, coercion and boycotting primary care physicians who provide the services with the assistance of United Allergy Services. The lawsuit also alleges that the allergist defendants are generating complaints to state medical boards related to primary care physicians providing these services in their office and that the allergist seek to restrict self administration of allergy shots, which significantly improves the financial position of the defendants.

“Allergy care is critical for millions of Americans. Too often patients are suffering from allergy symptoms because they do not have access to adequate care. Lack of care can lead to asthma attacks and emergency room visits creating a preventable burden on the healthcare environment. Allergist and family physicians need to work together to ensure appropriate care for all allergy sufferers,” said Dr. Jeff Bullard, M.D., President of AAAPC and a UAS physician partner, in a press release. “As a board-certified family care physician, allergy services are within the scope of my practice and are a valued service for my patients. By treating seasonal and perennial allergy patients in the primary care setting, allergists can be freed up to care for patients, such as those with potentially fatal food allergies that absolutely require specialized care.”

“With 50 million allergy patients and only approximately 5,000 practicing allergists, the lack of allergy care has become an epidemic,” said Peggy Binzer, executive director, AAAPC in the press release. “Given this situation, it is unfortunate that the national allergist organizations are hindering care and fighting efforts to increase access to care for the millions of underserved patients. Patients deserve much better. It is our hope that allergists will soon realize the value of collaborating with primary care physicians to deliver timely, personalized care to all allergy sufferers—seasonal and perennial allergy patients that can be treated by family physicians and serious allergy sufferers that require specialty care from allergists.”

Conclusions

I have seen battles like this occur in a number of areas of medicine where one group of doctors seeks to prevent another group of doctors from preforming certain testing and treatment, thus, excluding these doctors from certain aspects of care. It is usually not pretty, often unprofessional, and the vultures come out over money when everyone involved should be most concerned about their patients.

While I do not choose to offer the allergy services in my practice that AAN feels are more appropriate for an allergist, it does not mean that a primary care physician cannot receive adequate training to perform the services in question. I do choose to refer to a board certified allergist when I think referral is appropriate, because I do not have appropriate training to provide these services. Additionally, it is my belief that primary care physicians would require significant training if they want to provide these services. I agree with AAN that if patients are not fully informed as to what “certified allergy technicians” are, this is problematic and possibly deceptive. Finally, if a primary care physician is entering into a 3rd party agreement for testing and treatment services, especially if the primary care MD is personally profiting from the arrangement, that this should be fully explained and disclosed to the patient.

What do you think?

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Sources

1. Allergy & Asthma Network. Deceptive Allergy Testing Practices. Accessed on March 28, 2015.
2. United Allergy Services. The Academy of Allergy & Asthma in Primary Care and United Allergy Services file federal antitrust lawsuit against allergist organizations: AAAAI, ACAAI and JCAAI. Accessed on March 28, 2015.