| Coverage Policy Manual | |
| Policy #: | 2006021 |
| Category: | Laboratory |
| Initiated: | July 2006 |
| Last Review: | August 2023 |
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| Food and Chemical Sensitivity Testing | |
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| Description: |
Food or food additive intolerance or sensitivity is thought by some to be responsible for symptoms of irritable bowel syndrome, migraine headaches, chronic fatigue syndrome, some dermatologic conditions, and arterial plaquing and calcification. Adverse reactions to foods may be the result of an IgE-mediated reaction but may also occur due to non-IgE-mediated immunologic and nonimmunologic mechanisms. Food allergy causes the immune system to synthesize and release reactive chemical agents such as histamines, cytokines, lymphokines, and interferons. The Academy of Allergy, Asthma and Immunology, in 2006 specifically advise “Other tests have not been adequately studied in the diagnosis of food allergy. These include the measurement of food specific total IgG or IgG4 antibody, immune complexes, hair analysis, cytotoxic tests to foods that use automated machinery, and applied kinesiology (muscle strength testing). These tests should not be used for the diagnosis of food allergy. There is no specific coding for these services. CPT 86849-unlisted immunology procedure, should be used. |
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Policy/ Coverage: |
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
Laboratory testing, including but not limited to mediator release test or food specific IgG, to detect food or food additive sensitivity, does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
The preponderance of opinion in the medical literature indicates that additional study is necessary before measurement of IgG subtypes, serum antibodies, or serum antigens to various food types can be accepted as standard diagnostic tests for identification of causative agents for cardiac, gastrointestinal, or any other organ system complaint.
For members with contracts without primary coverage criteria, laboratory testing other than food challenge, including but not limited to the mediator release test or food specific IgG, detect food or food additive sensitivity, is considered investigational and is not covered. Investigational services are an exclusion in the member benefit contract.
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| Rationale: |
Few studies have been published in peer-reviewed medical literature involving the use of this test in screening for hypersensitivity reactions to food and chemicals. There is a paucity of medical literature reporting results of dietary modification as a result of any kind of testing. The American College of Gastroenterology does not recommend this type of testing for Irritable Bowel Disease.
Zar et al reported on 108 IBS patients, many of whom had significantly higher IgG4 titers when compared to a control group to beef, pork, lamb and wheat out of 16 foods that were tested. They concluded that response to an exclusion diet based on elevated food-specific IgG4 in future studies might be useful in establishing the significance of their findings.
In a study of 25 patients Zar et al queried patients at 3 and 6 months after starting an exclusion diet based on results of IgG4 titers. Significant improvement was reported in pain severity, pain frequency, bloating severity, satisfaction with bowel habits, and the effect of IBS on life in general was reported at 3 months that was maintained at 6 months. Rectal compliance and sensitivity were measured in 12 patients at baseline and at 6 months. Rectal compliance increased without change in thresholds for urge to defecate/discomfort.
The Food Allergy Practice Parameter by the American College of Allergy, Asthma and Immunology contains the following statements:
2012 Update
A search of the MEDLINE database conducted through July 2012 did not reveal any new information that would prompt a change in the coverage statement.
2014 Update
A literature search conducted using the MEDLINE database through July 2014 did not reveal any new information to prompt a change in the coverage statement.
2015 Update
A literature search conducted using the MEDLINE database through July 2015 did not reveal any new information to prompt a change in the coverage statement.
2016 Update
A literature search conducted through June 2016 did not reveal any new information that would prompt a change in the coverage statement
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through June 2018. No new literature was identified that would prompt a change in the coverage statement.
2019 Update
A literature search was conducted through July 2019. There was no new information identified that would prompt a change in the coverage statement.
2020 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2020. No new literature was identified that would prompt a change in the coverage statement.
2021 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2021. No new literature was identified that would prompt a change in the coverage statement.
2022 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2022. No new literature was identified that would prompt a change in the coverage statement.
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2023. No new literature was identified that would prompt a change in the coverage statement.
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| References: |
American College of Gastroenterology Functional Disorders Task Force.(2002) Evidence-based position statement on the management of irritable bowel syndrome in North America. Am J Gastroenterol 2002; 97 (Suppl):S1-5. Atkinson W, Sheldon TA, et al.(2004) Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial. Gut 2004; 53:1459-64. Cash BD, Chey WD.(2004) Review article: irritable bowel syndrome – an evidence-based approach to diagnosis. Aliment Pharmacol Ther 2004; 19:1235-45. Cash BD, Chey WD.(2005) Diagnosis of irritable bowel syndrome. Gastroenterol Clin N Am 2005; 34:205-20. Chapman JA, Bernstein IL, et al.(2006) Food allergy: a practice parameter. Ann Allergy Asthma Immunol, 2006; 96 (3 Suppl 2):S1-S68. Floch MH.(2005) Use of diet and probiotic therapy in the irritable bowel syndrome: an analysis of the literature. J Clin Gastroenterol 2005; 39 (5 Suppl):S243-6. O’Sullivan M, O’Morain C.(2003) Food intolerance: dietary treatments in functional bowel disorders. Curr Treat Options Gastroenterol 2003; 6:339-45. Signet Diagnostic Corp.(2006) Is your food making you sick. www.nowleap.com, accessed 6/27/2006. Somers SC, Lembo A.(2003) Irritable bowel syndrome: evaluation and treatment. Gastroenterol Clin N Am 2003; 32:507-29. Van Ree R, Vieths S, Poulsen LK.(2006) Allergen-specific IgE testing in the diagnosis of food allergy and the event of a positive match in the bioinformatics search. Mol Nutr Food Res 2006 [Epub ahead print]. Whorwell P, Lea R.(2004) Dietary treatment of the irritable bowel syndrome. Curr Treat Options Gastroenterol 2004; 7:307-16. Zar S, Benson MJ, Kumar D.(2005) Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome. Am J Gastroenterol 2005; 100:1550-7. Zar S, Mincher L, Benson MJ, Kumar D.(2005) Food specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome. Scand J Gastroenterol 2005; 40:800-7. Zuo XL, Li YQ, et al.(2007) Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia. Clin Exp Allergy, 2007; 37:823-30. |
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Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association. |
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