A Retrospective Clinical Audit of the ImmunoCAP ISAC 112 for Multiplex Allergen Testing.

INTRODUCTION: Complex cases of multiple allergies can be particularly difficult to diagnose using standard methods such as skin prick tests and assessment of a patient's allergic history. Multiplex allergy testing may improve outcomes for allergy patients by avoiding misdiagnosis and providing reassurance. The ImmunoCAP Immuno Solid-Phase Allergen Chip (ISAC) 112 is a CE-marked, molecular, multiplex, allergy test that can test for IgE antibodies to 112 components from 51 allergen sources. However, its clinical utility is unknown and is difficult to estimate due to the complexity of the diagnostic pathway in which it is used. OBJECTIVE: To assess how the ImmunoCAP ISAC 112 is currently being used in UK practice. The patient populations in which it may have the most benefit were examined, and the sequence of other tests implemented alongside ISAC was determined. METHODS: A retrospective audit of 100 patient cases from 2 UK tertiary allergy clinics was performed. Fifty paediatric and fifty adult cases were selected for audit. The indications for ordering an ISAC test, the other tests used alongside ISAC, and changes in management actioned by the ISAC test were investigated. RESULTS: 73.6% of paediatric and 78% of adult patients referred for an ISAC test were suspected to have multiple sensitizations. The sequence of testing varied greatly between cases, but 70% of adult and 98% of paediatric patients had at least one other investigation prior to an ISAC test. In most cases, ISAC testing confirmed clinical suspicion. CONCLUSIONS: A prospective research study is necessary to further investigate the clinical utility and cost-effectiveness of the ISAC. A UK national registry would be of great benefit but will require a large resource base.

Travel-Associated Salmonella mbandaka Sacroiliac Osteomyelitis in a Healthy Adolescent.

Pyogenic infections of the sacroiliac joint are rare and usually caused by Staphylococcus aureus. We describe a case of a 16 year-old gymnast who was subsequently diagnosed with Salmonella mbandaka sacroiliac osteomyelitis with adjacent psoas abscess and hepatitis one week after returning from a holiday in Crete. This case highlights a rare presentation of a common travel-associated foodborne infection.