Allergy Testing - Conjunctival Challenge Test
DESCRIPTION
Conjunctival challenge tests, also known as provocation tests, are proposed as a method to confirm an allergy diagnosis, study the signs and symptoms of the allergic reaction, sample the cells and mediators of the allergic reaction, and evaluate anti-inflammatory therapy. The test is performed by applying a single drop of allergen solution directly into the conjunctival sac of the eye followed by observation for redness, itchiness, tearing and other similar symptoms. These tests are often used in research protocols that require an objective standard for evaluating clinical sensitivity to an allergen.
POLICY
The conjunctival challenge test for the diagnosis of allergies is considered investigational.
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ADDITIONAL INFORMATION
Published peer-reviewed, scientific literature has not established the role of conjunctival challenge/provocation testing in the diagnosis and management of allergies.
SOURCES
Anantasit, N., Vilaiyuk, S., Kamchaisatian, W., Supakomthanasam, W., Sasisakulporn, C., Teawsomboonkit, W., et al. (2013). Comparison of conjunctival and nasal provocation tests in allergic rhinitis children with dermatophagoides pteronyssinus sensitization. Asian Pacific Journal of Allergy and Immunology, 31 (3), 227-232. (Level 2 evidence)
Annals of Allergy, Asthma, & Immunology. (2008, March). Allergy diagnostic testing: an updated practice parameter. Retrieved July 2, 2014 from https://www.aaaai.org.
Fauquert, J.L., Jedrzejczak-Czechowicz, M., Rondon, C., Calder, V., Silva, D., & Kvenshagen, B.K, et al, on behalf of the Interest Group on Ocular Allergy (IGOA) from the European Academy of Allergy and Clinical Immunology. (2017). Conjunctival allergen provocation test: guidelines for daily practice. Allergy, 72 (1), 43-54. (Level 1 evidence)
Köther, J., Mandl, A., Allekotte, S., Astvatsatourov, A., Chwieralski, J., Liedtke, J.P., et al. (2018). Early nonreactivity in the conjunctival provocation test predicts beneficial outcome of sublingual immunotherapy. Clinical and Translational Allergy, 8, 28. (Level 2 evidence)
Kruse, K., Gerwin, E., Eichel, A., Shah-Hosseini, K., & Mäsges, R. (2015). Conjunctival provocation tests: a predictive factor for patients’ seasonal allergic rhinoconjunctivitis symptoms. The Journal of Allergy and Clinical Immunolgy in Practice, 3 (3), 381-386. Abstract retrieved December 15, 2015 from PubMed database.
Krzych-Falta, E. (2022). The conjunctival allergen provocation test and the nasal allergen provocation test as specific alternatives to the oral food challenge. Postepy Dermatologii I Alergologii, 39 (2), 245-250. (Level 5 evidence)
Lindvik, H., Lødrup, Carlsen, K.C., Mowinckel, P., Navaratnam, J., Borres, M.P., & Carlsen, K.H. (2017). Conjunctival provocation test in diagnosis of peanut allergy in children. Clinical and Experimental Allergy, 47 (6), 785-794.
Schröder, J., & Mösges, R. (2018). Conjunctival provocation tests: prediction of seasonal allergy. Current Opinion in Allergy and Clinical Immunology, 18 (5), 393-397. Abstract retrieved August 7, 2018 from PubMed database.
ORIGINAL EFFECTIVE DATE: 10/12/98
MOST RECENT REVIEW DATE: 8/10/2023
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