Mainstream Thoughts on the Alcat Test

[Guest guest]

Hi Everyone,

I've noticed that there's been some discussion here on the list recently

regarding allergy and food intolerance testing and I felt that, as the

Moderator, I needed to step in to offer some information that might be

useful to those who - after reading messages posted here - may be

considering having their own child tested.

Aloha,

Georgina

POSITION STATEMENT

ALCAT and IgG Allergy & Intolerance Tests

http://www.allergysa.org/pdfs/intolerance_tests.pdf

We are constantly consulted by colleagues, health funders and practitioners

about the reliability and appropriateness of the ALCAT and IgG food allergy

tests for patients with suspected allergies and other disorders. We would

like to provide the following information to the readership of the journal

and to the public.

The manufacturers and suppliers of ALCAT and the IgG test

claim that the tests have diagnostic value in identifying substances

responsible for allergic and intolerance reactions. These tests are being

marketed directly to the public and health professionals, claiming to be

more effective than traditional skin prick tests or serum specific IgE

tests, particularly for delayed allergic reactions.

The manufacturers of the ALCAT test argue that orthodox allergy

practice does not recognize delayed allergic reactions, when in fact

these reactions are universally acknowledged to play a role in up to

30% of the spectrum of allergic reactions!

To date neither ALCAT nor IgG has been shown to have any

predictive value in the diagnosis ofallergy or intolerances. This is

supported by a recent document released by the Advertising Standards

Authority (UK) reporting that following complaints relating to advertising

statements, the manufacturers of the IgG food test have had to withdraw 13

claims for efficacy/predictability of the test from theirwebsite.i

The ALCAT test measures cellular swelling or cell lysis when cells are

exposed to test substances (e.g. foods) in vitro. The manufactures argue

that

the test is predictive for assessing and diagnosing a variety of conditions

such as:

migraine, headaches, ADD/ADHD, autism, insomnia, depression, anxiety, bed

wetting, allergies, hay fever; asthma, post nasal drip, chronic sinusitis,

irritable bowelsyndrome (IBS), inflammatory bowel disease (Crohn's disease,

ulcerative colitis etc) acne, eczema, psoriasis, urticaria, Candida,

autoimmune diseases (Hashimoto's thyroiditis rheumatoid arthritis, lupus,

multiple sclerosis), fibromyalgia, ME - yuppie flu, metabolic syndrome,

obesity, infertility , gastro oesophageal reflux, poor memory, unexplained

chronic

fatigue and weight loss.

They claim that the test is " The world's gold standard " and

" . . . recently cited as the world's number 1 food sensitivity test " .

The ALCAT was evaluated in the Allergy Unit at Groote Schuur Hospital

in 1994 by the University of Cape Town Respiratory Unit, the University of

Cape Town Gastrointestinal Unit and the Allergy Clinic at the Red Cross

Children's Hospital in patients with asthma, eczema and irritable bowel

syndrome.

The ALCAT's predictive value was found to be extremely poor and

not of benefit in identifying the trigger of the patient's symptoms. There

was no improvement of the patients who were followed up by a doctor and a

dietician, using the diets recommended by these tests.ii, iii, iv

Consensus statements released by Allergy Societies throughout the world

(including the representative body of all European allergy societies,

The European Academy of Allergy and Immunology (EAACI))

do not recommend the use of this test in the evaluation of acute or

delayed allergic or intolerance reactions.v, vi, vii

The American Academy of Allergy Asthma and Immunology (AAAAI) states: " .

.. . no evidence in the recent literature that convincingly changes the

conclusions about the cytotoxicity test(ALCAT) in the evaluation of possible

allergic diseases " .viii

The Allergy Society of South African(ALLSA) published

a consensus statement in the South African Medical Journal in

1992.ix Thisposition statement was subsequently reviewed and a second

position paper published in Current Allergy and Clinical Immunology (the

ALLSA journal) in 1994.

The Australasian Society of Clinical Immunology and Allergy (ASCIA) states:

" It is extremely important to note that there is no place in the diagnosis

of

milk allergy for unproven tests such as Vega testing, kinesiology,

cytotoxic food testing, hair analysis or ALCAT tests. " x

The British Society for Allergy and Clinical Immunology position is:

" The Nutron and ALCAT tests (also known as leucocytotoxic tests) measure

cellular changes in the blood after introduction of various food allergens.

These tests had a poor reliability for diagnosing allergies when they were

subjected to clinical trials according to the European Academy for

Allergology and Clinical Immunology. " xi

The World Allergy Organisation and GLORIA (Global Resources in Allergy)

have recently published their standpoint on the ALCAT:

" Tests with no diagnostic value for any disease under any circumstance

(not based on sound scientific principles): Cytotoxic test,

Antigen leukocyte cellular antibody test (ALCAT) " .xii

These viewpoints have been reiterated in recent international reviews of

allergy diagnostic

tests.xiii,xiv, xv, xvi, xvii, xviii, xix It is significant that there are

also no peer-reviewed publications or any reasonable studies to support a

diagnostic value for any of the non-allergy related conditions for which

ALCAT claims to be of value. It is also significant that not a single

non-allergy clinical society worldwide has supported the use of the ALCAT

for any of the conditions for which ALCAT claims this test has diagnostic

value.

The second test marketed with insufficient documentation is the IgG test for

food allergies.Specific IgE determination and its diagnostic value have been

documented for over three decades in being specific for allergic disorders.

Although IgG does play a role in the allergic response,there is no evidence

to suggest that it has a diagnostic value in predicting food allergens or

other substances that may be affecting individuals.xvi

The IgG test is also marketed as effective inpredicting foods implicated

in Attention Deficit Disorder and obesity.

There is no published evidence for these claims.

Wüthrich states: " Although some papers suggest a possible pathogenetic role

of IgG, IgG4antibody, no correlation was found between the outcome of Double

Blind Placebo Controlled Food Challenge (DBPCFC) and the levels of either

food-specific IgG or IgG4, nor was any difference seen between patients and

controls. The levels of these and other food-specific immunoglobulins of

non-IgE isotype reflect the intake of food in the individual and may thus be

anormal and harmless finding. " xix

Other authors have similarly concluded that strong IgG responses have

been demonstrated to be a normal physiological response to certain proteins

that are frequently ingested under normal circumstances, and are commonly

detectable in healthy adult patients and children, independent of the

presence

or absence of food-related symptoms.xx, xxi, xxii

The Australian Society of Allergology and Clinical Immunology (ASCIA)

Position Statement:

Unorthodox Techniques for the Diagnosis and Treatment of Allergy, Asthma

and Immune Disorders summarises the evidence for IgG in the diagnosis for

food sensitivity/allergy:

" IgG antibodies to food are commonly detectable in healthy adult patients

and

children, independent of the presence or absence of food-related symptoms.

There is no credible evidence that measuring IgG antibodies is useful for

diagnosing food allergy or intolerance, nor that IgG antibodies cause

symptoms. The exception is that gliadin IgG antibodies are sometimes useful

in monitoring adherence to a gluten-free diet in patients with

histologically

confirmed coeliac disease. " xxiii

Enrique et al21. states " We could even foresee future assays for specific

IgG to foods as predictive of clinical tolerance in some disorders. "

For example, in IgE-mediated food allergy, elevated levels of IgG4 to foods

have been correlated with the development of clinical tolerance, and not

with worsening of clinical food allergy.

This is demonstrated in an oral immunotherapy trial of hazelnut allergic

individuals in whom increases in hazelnut-specific IgG4 occurred following

the onset of tolerance to hazelnut.xxii

In fact the exact role of IgG in immune disorders is still unknown.

Teuber and Beyer note " [The role of IgG] is certainly a question

for further research and emphasizes that it is far too early to encourage

patients or insurers to spend money on blood test panels that are suited

for research, and not clinical applications at this time. " xxiv

It is disconcerting that the marketers of the IgG substantiate the use

of their tests with studies which actually argue against the use of the

test.xxv

In our opinion it is wrong to be marketing tests with little scientific

validity.

Both the ALCAT and IgG tests for " panels " of 20-30 allergens, costing

patients up to R3,500.

We have first hand knowledge of patients who have been placed in

financially compromising situations having paid for such tests with

no relief of their conditions.

Furthermore, testing so many (up to 100) foodstuffs without obtaining a

history of possible triggers or personal exposure to foods in the " fixed "

panels is neither economical nor useful for diagnosis. The laboratories do

not take into consideration the patient's history when doing such tests. As

a

result, these unproven techniques lead to misleading advice or treatments,

and their use is thus not evidence based and does not help patients.

Isolated claims for " success " in occasional patients by the manufacturers

may be related to other factors and should be substantiated by double blind

controlled challenge tests using scientific methodology.xix

Inappropriate use of food allergy testing (or misinterpretation of results)

in patients with inhalant allergy, for example, may lead to inappropriate

and unnecessary dietary restrictions, with particular nutritional

implications

in children.22

We would therefore caution patients and doctors to be fully

informed of the sensitivity and specificity of such testing, and to consider

the evidence when contemplating such tests. i

ASA Adjudication - Yorktest Laboratories Ltd.

http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_43386.htm (24 October

2007) iiO'Keefe E, Steinman HA, Potter PC, O'Keefe S. Evaluation of the

ALCAT test in reactions to food in the Irritable Bowel Syndrome. Poster:

South African Gastroenterological Society Annual Congress. October

1993iiiPitt A, Bateman ED, Steinman H, Potter PC. Lack of correlation

between self-reported food intolerance, food challenge testing and results

of the ALCAT system in chronic adult asthmatics. Allergy Society of South

Africa Annual Congress. 1994;October ivPitt A, Bateman ED, Steinman H,

Potter PC. Lack of correlation between self-reported food intolerance, food

challenge testing andresults of the ALCAT system in chronic adult

asthmatics. (Abstract) Current Allergy & Clinical Immunology 1994;7(3):7

vEuropean Academy of Allergology and Clinical Immunology: Sections-Interest

Groups - Allergy Diagnosis - Controversial diagnostictests.

http://www.eaaci.net/site/content.php?l1=91 & sel=323 (06 November

2007)viOrtolani, C.; Bruijnzeel-Koomen, C.; Bengtsson, U.; Bindslev-Jensen,

C.; Bjorksten, B.; Host, A.; Ispano, M.; Jarish, R.; Madsen, C.;Nekam, K.;

Paganelli, R.; Poulsen, L. K.; Wuthrich, B. Controversial aspects of adverse

reactions to food. Allergy. 54(1):27-45, January1999 viiPosition Paper:

Controversial aspects of adverse reactions to food. EAACI Adverse Reactions

to Food Subcommittee.

http://www.eaaci.net/site/Adverse%20reactions%20to%20food.pdf (06 November

2007)viiiAmerican Academy of Allergy Asthma & Immunology: Allergy & Asthma

Disease Management Center - Allergy

Testing.http://www.aaaai.org/aadmc/ate/allergytesting.html. (06 November

2007) ixPotter PC, Mullineux J, Weinberg EG, Haus M, Ireland P, Buys C,

Motala C.The ALCAT test--inappropriate in testing for food allergyin

clinical practice. S Afr Med J. 1992;81(7):384. xAustralasian Society of

Clinical Immunology and Allergy: Cow's Milk (dairy) allergy.

http://www.medeserv.com.au/ascia/aer/infobulletins/hp_allergy_milk.htm (06

November 2007)

xiMedicDirect: Allergy Testing.

http://www.medicdirect.co.uk/site_guide/default.ihtml?step=4 & pid=2458 (06

November 2007)xiiGlobal Resources In Allergy (GLORIAT) - The Diagnosis of

Allergic Diseases. http://www.3bel.dote.hu/oktatas2007/eload2007ang/

Nekam%20TOK%20eloadas%20Allergy.ppt (06 November 2007) xiiiTeuber SS,

Porch-Curren C. Unproved diagnostic and therapeutic approaches to food

allergy and intolerance. Current Opinion in Allergy & Clinical Immunology.

2003;3(3):217-221. xivPassalacqua G, Compalati E, Schiappoli M, Senna G.

Complementary and alternative medicine for the treatment and diagnosis

ofasthma and allergic diseases. Monaldi Arch Chest Dis. 2005;63(1):47-54.

xvNiggemann B, Grüber C. Unproven diagnostic procedures in IgE-mediated

allergic diseases. Allergy. 2004;59(8):806-8.xviBeyer K, Teuber SS. Food

allergy diagnostics: scientific and unproven procedures. Curr Opin Allergy

Clin Immunol. 2005;5(3):261-6.xvii JA. Food allergy and food

intolerance. ASDC J Dent Child. 1985;52(2):134-7. xviiiSenna G, Gani F, Leo

G, Schiappoli M. Alternative tests in the diagnosis of food allergies.

Recenti Prog Med. 2002;93(5):327-34. xixWüthrich B. Unproven techniques in

allergy diagnosis. J Investig Allergol Clin Immunol. 2005;15(2):86-90.

xxPaganelli R, Quinti I, D'Offizi GP et al. Immune-complexes in food

allergy, a critical reappraisal. Ann Allergy 1987; 59: 157-161.xxiTay SS,

AT, Deighton J, King Y, Ewan PW. Patterns of immunoglobulin G

responses to egg and peanut allergens are distinct: ovalbumin-specific

immunoglobulin responses are ubiquitous, but peanut-specific immunoglobulin

responses are up-regulated in peanutallergy. Clin Exp Allergy.

2007;37(10):1512-8.xxiiEnrique E, Pineda F, Malek T, et al. Sublingual

immunotherapy for hazelnut food allergy: a randomized, double-blind,

placebo-controlled study with a standardized hazelnut extract. J Allergy

Clin Immunol 2005;116:107-109. xxiiiASCIA Position Statement: Unorthodox

Techniques for the Diagnosis and Treatment of Allergy, Asthma and Immune

Disorders. Dr J. Mullins on behalf of the Education Committee, ASCIA

October 2004. http://www.allergy.org.au/pospapers/unorthodox.htm(accessed 6

November 2007)xxivTeuber SS, Beyer K. IgG to foods: a test not ready for

prime time. Curr Opin Allergy Clin Immunol 2007;7(3):257-258.xxvSampson HA.

Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy

Clin Immunol 1999;103(5 Pt 1):717-28

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American Academy of Allergy, Asthma, and Immunology

http://www.aaaai.org/aadmc/ate/category.asp?cat=10076

1/29/2008 RE: The ALCAT Test for Food Allergy

What are your thoughts regarding ALCAT testing for food " allergies " ? It

measures changes in leukocyte size from what I understand?

- I believe that the ALCAT is a test of unproven diagnostic efficacy. The

best source of information for you in this regard is the following

reference:

Wuthrich B. Unprudent techniques in allergy diagnosis. Journal of

Investigative Allergology and Clinical Immunology 2005; 15:86-90.

In addition, a search of PubMed did not find any, in my opinion, articles to

support the use of this test. I hope this information is of help to you.

Sincerely,

Phil Lieberman, MD

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http://www.aaaai.org/scripts/upload/readinglist/lists/Reading_List_111406_Final.\

pdf

Unproven and inappropriate diagnostic tests for allergic and immune

deficiency diseases.

Wuthrich B

Unproven techniques in allergy diagnosis.

J Investig Allergol Clinic Immunol 2005;15:86-90

Mainstream allergy diagnosis and treatment is based on classical allergy

testing which involves well-validated diagnostic methods and proven

methods of treatment. By contrast, a number of unproven tests have been

proposed for evaluating allergic patients including cytotoxic food testing,

ALCAT test, bioresonance, electrodermal testing (electroacupuncture),

reflexology, applied kinesiology a.o.

There is little or no scientific rationale for these methods. Results are

not

reproducible when subject to rigorous testing and do not correlate with

clinical evidence of allergy.

Although some papers suggest a possible pathogenetic role of IgG, IgG4

antibody, no correlation was found between the outcome of DBPCFC

and the levels of either food-specific IgG or IgG4, nor was any difference

seen between patients and controls. The levels of these and other

food-specific

immunoglobulins of non-IgE isotype reflect the intake of food in the

individual and may thus be a normal and harmless finding.

The so-called " Food Allergy Profile " with simultaneous IgE and IgG

determination against more than 100 foodstuffs is neither economical nor

useful for diagnosis.

DBPCFC must be the reference standard for food hypersensitivity and any new

test must be validated by it. As a result, all these unproven techniques may

lead to

misleading advice or treatments, and their use is not advised.

----------------------------------------------------

Unproven allergy tests

http://www.nationalasthma.org.au/html/management/infopapers/health_professionals\

/1006.asp

There are several unproven methods that claim to test for allergies. They

include cytotoxicity testing, the provocation neutralisation procedure, Vega

(electrodermal) testing, applied kinesiology, reaginic pulse testing and

chemical analysis of body tissues, such as hair analysis.

Controlled studies of the cytotoxicity test, provocation neutralisation

procedure and Vega tests have shown that the results are not reproducible

and do not correlate with symptoms of allergy.50-52<LE II>

The other methods have not been evaluated in controlled trials for accuracy

nor correlation with allergic symptoms and have not been scientifically

validated.

These methods can be expensive and may lead patients to implement

unnecessary, costly and particularly in the case of dietary manipulations,

dangerous avoidance strategies. The costs of these tests are not rebated by

Medicare and their use is not recommended.

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Allergies: Dubious Diagnosis and Treatment

Barrett, M.D.

www.quack-watch.org/01QuackeryRelatedTopics/Tests/allergytests.html

Many dubious practitioners claim that food allergies may be responsible for

virtually any symptom a person can have. In support of this claim-which is

false-they administer various tests purported to identify offending foods.

Claims of this type may seem credible because about 25% of people think they

are allergic to foods. However, scientific studies have found that only

about 6% of children and 1-2% of adults actually have a food allergy, and

most people with food allergies are allergic to less than four foods [1].

Cytotoxic Testing

The most notorious such test was cytotoxic testing, which was promoted

during the early 1980s by storefront clinics, laboratories, nutrition

consultants, chiropractors, and medical doctors. Advocates claimed it could

determine sensitivity to food, which they blamed for asthma, arthritis,

constipation, diarrhea, hypertension, obesity, stomach disorders, and many

other conditions. However, controlled studies never demonstrated

reliability, and some studies found it highly unreliable [2-5]. For example,

one study found that white cells from allergic patients reacted no

differently when exposed to substances known to produce symptoms than when

exposed to substances to which the patients were not sensitive [6].

Government regulatory actions [7-10] and unfavorable publicity have almost

driven cytotoxic testing from the health marketplace. But a few

practitioners still perform it, and many use similar " food sensitivity "

tests.

ELISA/ACT Testing

Another test claimed to locate " hidden allergies " is the ELISA/ACT,

developed by Jaffe, M.D., Ph.D., and performed by Serammune

Physicians Lab (SPL), of Reston, Virginia, which Jaffe directs. According to

an SPL brochure:

When we think of allergies, we immediately think of an allergy whose

symptoms occur within minutes of ingesting a food or chemical. The symptoms

include hives and itching. . . .

" Hidden " or " delayed " allergies are more difficult to identify because the

onset of symptoms is delayed from 2 hours to 5 days and the symptoms range

from physical pain to unexplained fatigue. Scientific estimates are that as

much as 60% of all illness is due to hidden allergies [11].

The brochure states that any of the following may indicate the presence of

hidden allergies: chronic headaches, migraines, difficulty sleeping,

dizziness, runny or stuffy nose, postnasal drip, ringing in the ears,

earaches, blurred vision, irregular or rapid heartbeat, asthma, nausea and

vomiting, constipation, diarrhea, irritable bowel syndrome, hives, skin

rashes (psoriasis, eczema), muscle aches, joint pain, arthritis, nervous

tension, fatigue, depression, mental dullness, and difficulty in getting

your work done.

The ELISA/ACT is performed by culturing the patient's lymphocytes and seeing

how they react to up to 300 foods, minerals, preservatives, and other

environmental substances. After the test is completed, the practitioner

(typically a chiropractor) recommends dietary modification and supplements.

SPL maintains a referral list of practitioners who perform the test and

suppliers who can provide " special combinations of the suggested supplements

to reduce the number of 'pills' you may have to take. " In 1994, the complete

(300-item) profile plus interpretation cost $695.

Although the ELISA/ACT test can assess the levels of certain immune

responses, these are not necessarily related to allergy and have nothing

whatsoever to do with a person's need for supplements. Moreover, many of the

symptoms listed in SPL's brochure are unrelated to allergy and are not

appropriately treated with supplement products. [Note: This test should not

be confused with the ELISA test, which is a standard test for certain

infectious diseases.]

Other Dubious Tests

In addition to cytotoxic testing and ELISA/ACT, the following procedures are

not valid for managing food allergies:

ALCAT testing, which is said to measure how blood cells react to foods

" under conditions designed to mimic what happens when the foods are consumed

in real life. " [12]

NuTron testing, which supposedly measures the " reactivity " of white blood

cells to food and other substances, is used design a diet that eliminates

foods that cause white cell " activation. " Proponents claim that the diet can

improve overweight and many other conditions " caused by the release of

inflammatory chemicals from the activated white cells. "

The LEAP Program, in which the Mediator Release Test (MRT) is used to

identify " delayed food allergies " and treatment involves dietary

manipulation and possibly supplements and/or herbs.

Provocative testing, in which substances are injected under the skin in

increasing doses until symptoms are reported

Sublingual testing, in which suspected foods are placed under the tongue

Neutralization, in which progressively smaller doses of substances are

administered until the patient no longer reacts

Other food immune complex and IgG tests, which assess immune reactions that

are common but not necessarily related to allergy

Desensitization, in which progressively larger doses of a food are injected.

While desensitization may work for hay fever and other allergies related to

inhaled substances, it is worthless for foods and can be dangerous.

Applied kinesiology, in which the patient's arm strength is tested after

test substances are placed in the patient's mouth or hand.

Nambudripad's Allergy Elimination Technique (NAET), based on the notion that

allergies are caused by " energy blockage " that can be diagnosed with

muscle-testing and permanently cured with acupressure and/or acupuncture

treatments.

Electrodermal skin testing, in which a computerized galvanometer is used to

detect supposed " energy imbalances. " In 1999, the British Advertising

Standards Authority reviewed a pamphlet which alleged that a Bio Resonance

Therapy device could help people suffering from headaches, overweight,

tiredness, bloating, irritable bowel syndrome, skin rashes, arthritis, and

premenstrual tension. In May 1999, after reviewing a manual and other

information about the device, the Authority concluded that the claims were

unsubstantiated [13].

Proper Testing

The correct way to assess a suspected food allergy or intolerance is to

begin with a careful record of food intake and symptoms over a period of

several weeks. Symptoms such as swollen lips or eyes, hives, or skin rash

may be allergy-related, particularly if they occur within a few minutes (up

to two hours) after eating.

Diarrhea may be related to a food intolerance. Vague symptoms such as

dizziness, weakness, or fatigue are not food-related. The history-taking

procedure should note the suspected foods, the amounts consumed, the length

of time between ingestion and symptoms, whether there is a consistent

pattern of symptoms after the food is consumed, and several other factors.

Although nearly any food can cause an allergic reaction, a few foods account

for about 90% of reactions. Among adults these foods are peanuts, nuts,

fish, and shellfish. Among children, they are egg, milk, peanuts, soy, and

wheat [14].

If significant symptoms occur, the next step should be to see whether

avoiding suspected foods for several weeks prevents possible allergy-related

symptoms from recurring. If so, the suspected foods could be reintroduced

one at a time to see whether symptoms can be reproduced. However, if the

symptoms include hives, vomiting, swollen throat, wheezing, or other

difficulty in breathing, continued self-testing could be dangerous, so an

allergist should be consulted.

Proper medical evaluation-done best by an allergist-will include careful

review of your history and skin testing with food extracts (using a prick or

puncture technique) to see whether an allergic mechanism is involved in your

symptoms. In cases where skin testing might be dangerous, a radioactive

allergy sensitivity test (RAST) may be appropriate. The RAST is a laboratory

test in which the technician mixes a sample of the patient's blood with

various food extracts to see whether antibodies to food proteins are present

in the blood. It is not as reliable as skin testing and is more expensive. A

negative prick or RAST test indicates a low probability of allergy to the

test substance. Positive tests, however, have much less predictive value

[1].

The only sure way to diagnose an allergy to a suspected food, food coloring,

or other additive is challenge testing in which the patient ingests either

the suspected food or a placebo [14]. This may be appropriate if the

patient's history suggests a food allergy but the skin or RAST tests are

negative. Because dangerous reactions can occur, challenge testing should be

done in a hospital or office that is specially equipped for that purpose.

For Additional Information

Aetna Policy Coverage Policy Bulletin 0038. Allergy Testing and Allergy

Immunotherapy

BlueCross BlueShield of Tennessee Medical Policy Manual

Food Allergies for Dummies

Institute of Food Technologists Scientific Status Summary on Food Allergies

and Other Sensitivities

The Regence Group (Blue Cross/Blue Shield): Noncovered " investigational "

methods

University of Iowa Virtual Hospital: Food allergy basics

References

Sicherer SH. Manifestations of food allergy: Evaluation and management.

American Family Physician 59:415-424, 1999.

American Academy of Allergy: Position statements-Controversial techniques.

Journal of Allergy and Clinical Immunology 67:333-338, 1980. Reaffirmed in

1984.

Chambers VV and others. A study of the reactions of human polymorphonuclear

leukocytes to various antigens. Journal of Allergy 29:93-102, 1958.

Lieberman P and others. Controlled study of the cytotoxic food test. JAMA

231:728, 1974.

Benson TE, Arkins JA. Cytotoxic testing for food allergy: Evaluations of

reproducibility and correlation. Journal of Allergy and Clinical Immunology

58:471-476, 1976.

Lehman CW. The leukocytic food allergy test: A study of its reliability and

reproducibility. Effect of diet and sublingual food drops on this test. A

double-blind study of sublingual provocative food testing: A study of its

efficacy. ls of Allergy 45:150-158, 1980.

Hecht A: Lab warns cow: Don't drink your milk. FDA Consumer 19(6):31-32,

1985.

Bartola J: Cytotoxic test for allergies banned in state. Pennsylvania

Medicine 88:30, October 1985.

Proposed notice: Medicare program; Exclusion from Medicare coverage of

certain food allergy tests and treatments. Federal Register

48(162):37716-37718, 1983.

Cytotoxic testing for allergic diseases. FDA Compliance Policy Guide

7124.27, March 19, 1985, revised March 1995.

Do you have hidden allergies? ELISA/ACT can help you. Undated brochure

distributed in 1993 by Serammune Physicians Lab.

The ALCAT test: A simple blood test for food and chemical sensitivities

(Flyer). Hollywood, FL: AMTL Corporation, 1995.

British Advertising Standards Organization. Adjudication: Allergy Testing

Service, May 1999.

Sampson HA. Food allergy. JAMA 278:1888-1894, 1997.

This article was revised on January 17, 2008.

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https://www.aaaai.org/

I'm doing a review of the Alcat test, a controversial test for food allergy

(as well as other allergens, including drugs, chemicals, additives, you name

it) and would like to know the AAAA & I's opinion about the test, position

statement if there is any, or any other information available.

- I have reviewed the information on the web site you mentioned as well as a

Medline search and the position papers of the AAAAI.

I have found no evidence in the recent literature that convincingly changes

the conclusions about the cytotoxicity test (Alcat) in the evaluation of

possible allergic diseases as stated in the documents referred to by me

above. The web site of the commercial organization contains entirely

anecdotal testimonials similar to the evidence used by earlier proponents of

this approach. There is no report of blinded, controlled studies. A recent

claim has been made for weight reduction by avoidance of foods to which the

individual is deemed to be " allergic " by the ALCA test (independent of the

amount of decrease in caloric intake). Again, there has been no evidence

from scientifically performed controlled studies to support this contention.

It is always possible that any approach may be of some value. However, such

value must be shown in scientifically sound controlled studies.