Parkview Health Laboratory: Test Directory

Tetracycline IgE, Allergen

Last Modified: 2/11/2019 4:11:22 PM

Medicare Medical Necessity Restrictions May Apply

Medical Necessity Documentation:

Client Notes:

Patient Preparation:

Specimen Requirements:

1.0 mL Serum from a Red Top Tube in a Plastic Vial

Collection Instructions:

Allow to clot in ambient temperature for 30 minutes and centrifuge for 10 minutes

Minimum Volume: 0.3 mL

Transport & Storage: Temperature/Stability: 4 weeks Ambient
4 weeks Refrigerated
Indefinite Frozen

Rejection Criteria: Unlabeled: Lipemic

Reference Range:

Specific                                                 Level of Allergen
IgE Class               kU/L                       Specific IGE Antibody
---------                    ------------                ---------------------

0 <0.10 Absent/Undetectable

0/1 0.10 - 0.34 Very Low Level

1 0.35 - 0.69 Low Level

2 0.70 - 3.49 Moderate Level

3 3.50 - 17.4 High Level

4 17.5 - 49.9 Very High Level

5 50 – 100 Very High Level

6 >100 Very High Level

Critical Ranges:

Test Comments:

Methodology: In vitro

Clinical Significance: This assay is used to detect allergen specific-IgE using the original RAST method. In vitro allergy testing is the primary testing mode for allergy diagnosis. - See more at: http://www.viracor.com/Test-Catalog/Detail/Tetracycline-IgE--87810E#sthash.s6OxrvfX.dpuf

Documentation:

Custom Panel: No

PRODUCTION SCHEDULE

Turn Around Time: 4 to 6 days

Days Performed: Monday, Tuesday, Wednesday, Thursday, Friday

Sites Performed: Eurofins (Previously Viracor)

PHL Test Code: MSOT

EPIC Test Code: IMO223

Alternate Test Names: Allergen, Tetracycline IgE

Included Tests:

CPT Coding: 86003

Parkview Laboratory: Test Directory

Tetracycline IgE, Allergen

PRODUCTION SCHEDULE