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Test Code IFAP ALLERGEN INFANT FOOD PANEL

Additional Codes

Software Test Code
SoftID IFAP
EPIC LAB10266

Performing Laboratory

NorDx Laboratories

Useful For

Establishing the diagnosis of an allergic disease and defining the allergens responsible for eliciting signs and symptoms.

Panel includes: Egg white (F1C), Egg yolk (F75C), Milk, cow (F2C), Peanut (F13C), Soybean (F14C), and Wheat (F4C)

If an IgE, total, is desired, please order individually “IGET”.

Clinical Significance

When an “R” precedes the test name to a specific allergen, it indicates that the test was developed and its performance characteristics determined by NorDx.

It has not been cleared or approved by the FDA.

Method Name

ImmunoCAP® Fluorescence Enzyme Immunoassay (FEIA)

Reference Values

< 0.10 kU/L : Undetectable (Normal)

0.10-0.34 kU/L: For specialist use only:

Clinical Relevance Undetermined

0.35-0.69 kU/L: Low level of allergy, indicative of ongoing sensitization

0.70-3.49 kU/L: Moderate level of allergy, indicative of stronger ongoing sensitization

3.5-17.49 kU/L: High level of allergy, indicative of high level sensitization

17.5-49.9 kU/L: Very high level of allergy, indicative of very high level sensitization

50-99.9 kU/L: Very high level of allergy, indicative of very high level sensitization

≥ 100 kU/L: Very high level of allergy, indicative of very high sensitization

CONCENTRATION (kU/L) RESULTS EQUIVALENT TO ALTERNATIVE SCORING METHOD:

CLASS
0: <0.22

CLASS 0/1: 0.22-0.31

CLASS 1: 0.31-0.55

CLASS 2: 0.55-1.4

CLASS 3: 1.4-3.9

CLASS 4: 3.9-19

CLASS 5: 19-100

CLASS 6: >100

Days and Times Test Performed

Monday through Friday

Report Available

1 Day

Profile Information

Individual Test Description

EGG WHITE IGE
EGG YOLK IGE
MILK, COW IGE
PEANUT IGE
SOYBEAN IGE
WHEAT IGE

Specimen Type

Serum

Preferred Container

Serum Separator Tube (SST)

Preferred Volume

Serum: 2 mL (Serum Separator Tube (SST))

Minimum Volume

Serum: 1.5 mL (Serum Separator Tube (SST))

Specimen Collection and Handling

Spin specimen, separate from clot and send refrigerated.

Specimen Stability Information

Specimen Type: Serum

Frozen: 3 Months

Refrigerated: 7 Days

Must be spun/separated within: 2 Hours

Note: Avoid freeze/thaw cycles

Add On Capable

Yes

Advance Beneficiary Notice Requirements

This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen.

CPT Code Information

CPT Code

CPT Description

CPT Disclaimer

86003 x6 Allergen Specific IgE, Quantitative or Semiquantitative, Crude Allergen Extract, Each

Acceptable Alternative Container(s)

Green Top Tube (Sodium Heparin) – This container/specimen type is only acceptable with departmental approval. Do not use for routine sample collection and analysis.

Red Top Tube

Keywords

ALLERGEN-MULTIPLE

ALLERGENS

Performing Laboratory Location

NorDx Laboratories