Issues surrounding consumer-bought food-allergy testing.

BACKGROUND: Allergy is increasingly reported by patients and members of the public, and there is evidence that the prevalence is increasing. Not all diagnoses have been made by clinicians, as direct-to-consumer (DTC) allergy tests are widely available online. AIM: To determine if DTC allergy tests are processed in accredited laboratories and utilize validated methods, while providing an overview of the DTC allergy tests available. METHODS: Internet searches using 'allergy test kit' and 'intolerance test' were performed to identify DTC food-allergy tests. Each company was contacted to enquire if they had ISO15189 accreditation, what methods of testing they used and what was the extent of individual clinical input used to guide the test requested or result interpretation. RESULTS: In total, 24 online companies providing DTC food-allergy testing were identified, of which 22 were contactable. One laboratory had ISO15189 accreditation, which was also the only laboratory using clinically recognized specific IgE testing and had a clinician involved in the process. Other laboratories used bioresonance or IgG and involved a nutritionist at most. CONCLUSION: Online DTC food-allergy tests are largely misleading to the consumer and provided by unaccredited laboratories using controversial methodology. The dermatologist must politely discount these results and assess the role of food allergy in a patient's skin disease on the merit of clinical history, supported by specific IgE testing as appropriate.

Faecal calprotectin in dermatology practice.

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory condition of the bowel with two primary subtypes: Crohn disease and ulcerative colitis. Extraintestinal manifestations are common in IBD and, after musculoskeletal involvement, dermatological lesions are the most common. Currently, colonoscopy and biopsy are the most definitive tests for a diagnosis of IBD. However, in the past decade, faecal markers have emerged as new diagnostic tools to detect and monitor intestinal inflammation, and faecal calprotectin (FCP) in particular has gained popularity owing to its high sensitivity and specificity for detection of organic bowel disease. This review aims to explore whether there is a role for FCP measurement when encountering cutaneous manifestations associated with IBD.

Lactate dehydrogenase in dermatology practice.

Lactate dehydrogenase (LDH) is used in dermatology practice, particularly as a prognostic marker for cutaneous lymphoma. LDH is an intracellular enzyme involved in anaerobic glycolysis, and is found at low concentrations in the blood. LDH is produced in every tissue, thus cell damage releases LDH into the circulation, so the causes of elevated LDH levels are multiple. The utility of LDH in dermatology practice is reviewed, alongside current diagnostic and staging guidelines.

Delivering a quality-assured fracture liaison service in a UK teaching hospital-is it achievable?

UNLABELLED: To determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting. INTRODUCTION: UK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt. METHODS: Performance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015. RESULTS: The FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78-79 % were still taking medication. CONCLUSIONS: Preliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models.

Prevalence and determinants of white coat effect in a large UK hypertension clinic population.

White coat hypertension (WCH) is common and termed white coat effect (WCE) in those on treatment for hypertension. The UK guideline suggests that all patients in stage 1 and 2 hypertension, but not stage 3 hypertension, should have ambulatory blood pressure monitoring (ABPM) performed before commencing treatment. The relationship between office blood pressure (BP) and ABPM and the factors that influence the WCE were examined in a large British cohort (n=2056) from 2 hypertension clinics (1998-2011). Data were collected prospectively: the median age was 56 years: 53% were female, 76% Caucasian, 9% African Caribbean, 15% South Asian and 86% taking antihypertensives. Fifty-one percent had WCE and differences between clinic BP and ABPM measurements increased with the stage of hypertension varying from 2/4 (normotensive), 13/10 (stage 1 hypertension), 24/14 (stage 2) and 40/20 mm Hg (stage 3). The degree of difference is greater in this study than described in other populations. A positive correlation was found between clinic systolic and diastolic BP and the WCE (r=0.74 and r=0.56, respectively, P<0.0001). Significant (P<0.05) independent associations of systolic WCE were clinic systolic BP (ß=0.707), Caucasian ethnicity (South Asian ß=-0.06; African Caribbean ß=-0.043), female gender (male ß=-0.047), nonsmoking status (smoker ß=-0.100) and reduced renal function (estimated glomerular filtration rate ß=-0.036). Significant independent associations of diastolic WCH were clinic diastolic BP (ß=0.624), age (ß=0.207), female gender (male ß=-0.104), Caucasian ethnicity (South Asian ß=-0.052, African Caribbean ß=-0.079) and being a nonsmoker (ß=-0.082) or ex-smoker (ß=0.046). The results support current UK guidelines but suggest those with stage 3 hypertension would also benefit from ABPM.