Why Aren't More PCPs Ordering Allergen Tests?

Medscape

16-05-2025

Few primary care providers (PCPs) are testing patients with asthma who have suspected allergen triggers, which may delay treatment that could improve outcomes, new data suggested.
Mridula Sree Naagendran, MBBS, internal medicine resident at UConn Health in Farmington, Connecticut, presented the information in a poster at the Society of General Internal Medicine 2025 Annual Meeting in Los Angeles, Florida.
'The absence of PCP-initiated allergen testing represents a critical missed opportunity for early identification and management of asthma triggers,' the authors wrote. 'As outlined in the Global Initiative for Asthma guidelines, prompt allergen identification could reduce exposure to known triggers and potentially prevent exacerbations.'
Tests Relatively Inexpensive
Testing may also lower healthcare costs, the authors noted. Given that allergen testing is relatively inexpensive ($200-$300) compared with the cost of asthma-related hospitalizations (upwards of $9000), implementing routine allergen testing in PCP offices for high-risk patients with asthma could significantly improve patient outcomes and reduce costs not only of hospitalizations but unnecessary medications and emergency department visits.
Blood inhalant allergy testing is 'already available and can be seamlessly embedded into routine clinical practice,' Naagendran told Medscape Medical News .
The researchers conducted a retrospective review of 151 patients with asthma treated at a medically underserved primary care clinic. Data collected included allergen testing rates, hospitalization rates for asthma flares, allergen sensitization profiles, referral patterns, and treatment delays.
None of the Testing Was Initiated by PCPs
They found that among 151 patients with asthma, only 15 (9.93%) underwent blood inhalant allergen testing. For these 15 patients, none of the testing was initiated by PCPs. Pulmonology referrals occurred for 53 (35.1%) of patients with asthma, and only three of those were referred to an allergist.
Sensitization was found to common allergens: Dog dander (26.7%), cat dander (20%), dust mites (20%), oak pollen (13.3%), and cockroach (6.7%). There were 15 asthma-related hospitalizations over 2 years.
'The gap we identified is not necessarily in knowledge, but in awareness and workflow integration,' Naagendran said. 'Environmental or indoor allergen triggers are not often addressed in primary care settings, not because they are unimportant but because they are not part of a standardized process. By remembering risk factor screening and targeted blood IgE [immunoglobulin E] testing in routine asthma evaluations, we can shift from reactive care to proactive management.'
Doctor Says Information Will Change His Practice
Michael Antolini, DO, family medicine physician in Fayetteville, West Virginia, said the information presented will change practice for him.
He told Medscape Medical News that he works in a federally qualified health center, and because there's an allergist in their provider community, the tests are ordered by the allergist. But he said this study has him wondering why he hasn't been ordering the tests himself.
He said he took a straw poll in his practice and none of the PCPs were ordering the tests. He checked and found out they were readily available and could be ordered within seconds and results would take only 3-5 days. Additionally, the tests are typically well-covered by insurance, he said.
He said he doesn't see the change resulting in more time for physicians. 'We're already having discussions on environmental triggers of asthma anyway. This would probably be a better utilization of time if we could get some answers on what, specifically, they should stay away from. I would make the time if I'm preventing a hospitalization.'
Currently, in his practice, the patients are getting the tests, 'but we're waiting until the allergist does it,' he said. 'This is easy stuff we could be doing. Some people can't afford to go to the allergist, frankly, so it puts the tool in our hands. I can provide whole-person counseling on what things patients should avoid.'
The results of the test, he noted, don't necessarily provide a cause-and-effect relationship with potential false-positive results that are not really related to a patient's asthma, but he added it's always a good idea to avoid possible triggers.
'This could help me in my practice by providing the care that some folks who are underserved need,' he said.
Naagendran and Antolini reported no relevant financial relationships.