In Vitro Particle Size Measurement for Screening Hypersensitivity Reactions to Foods and Chemicals
DESCRIPTION
In vitro particle size measurement for screening hypersensitivity reactions involves the measurement of the aggregate release of inflammatory mediators from an individual's immunocytes after exposure to various food extracts and chemicals (e.g., food additives). A determination is made of the difference in volume of circulating immunocytes and plasma before and after an in vitro antigen challenge.
An example of this technology is the Mediator Release Test® or MRT®. For this test, portions of an individual's blood sample are incubated with various food extracts and food additives (typically 150 different substances). The degree of reactivity is determined by the degree of mediator release from the cells. A response, change in cellular and plasma volume, is thought to indicate a hypersensitivity reaction and results are used as a basis for modifying an individual’s diet. The MRT® is one component of the Lifestyle Eating and Performance (LEAP®) Program of oligoantigenic dieting. This type of testing has been promoted for individuals with, among other conditions, irritable bowel syndrome, chronic fatigue syndrome, migraine headaches, and dermatologic conditions (e.g., eczema, dermatitis).
POLICY
In vitro particle size measurement for the purpose of screening hypersensitivity reactions to food and chemicals is considered investigational.
IMPORTANT REMINDER
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
ADDITIONAL INFORMATION
Well-designed studies in peer-reviewed journals are not available to determine the efficacy of this technology related to hypersensitivity reactions to foods and chemicals.
SOURCES
American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology. (2020). Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis. Retrieved March 17, 2022 from https://www.aaaai.org.
American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma & Immunology and the Joint Council of Allergy, Asthma & Immunology. (2014). Food allergy: a practice parameter update - 2014. Retrieved February 26, 2021 from https://www.aaaai.org.
Centers for Medicare & Medicaid Services. CMS.gov. NCD for cytotoxic food tests (110.13). Retrieved May 3, 2023 from http://www.cms.gov.
European Academy of Allergy and Clinical Immunology. (2014). Food allergy and anaphylaxis guidelines. Translating knowledge into clinical practice. Retrieved March 17, 2022 from www.medialibrary.eaaci.org.
National Institute for Health and Care Excellence. (2011). Food allergy in under 19s: assessment and diagnosis. Retrieved October 20, 2016 from www.nice.org.uk.
National Institute of Allergy and Infectious Diseases. (2010). Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. Retrieved October 20, 2016 from http://www.jacionline.org.
National Institute of Allergy and Infectious Diseases. (2017). Addendum guidelines for the prevention of peanut allergy in the United States: Report of the NIAID-sponsored expert panel. Retrieved February 26, 2021 from http://www.jacionline.org.
ORIGINAL EFFECTIVE DATE: 5/1/2004
MOST RECENT REVIEW DATE: 6/8/2023
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.