Laboratory Tests for Specific IgE - RAST Testing Billing Policy

For example if you request: Our fees for different allergen types Single $5 Three single @ $5 $15 Mixed $10 Two mixed allergens @ $10 $20 Allergen Components $40 One allergen component @ $40 $40

Billing policy for allergy testing Your patient will receive an invoice for $100 (which includes our allergen test fee of $25). Our policy is to respect your request for the allergens and decode them according to our best practice. Even Practically, this means we will not accept a bulk- billed if you have requested more allergens than our allowance request for more than four single allergens, two under Medicare, we will bill your patient according to mixed allergens, or allergen components. the pricing using the key above. If you have nominated Please note that eligible patients may be able to the patient to be bulk-billed or if the patient has signed claim a rebate on four occasions per year for testing a Medicare assignment form, this billing policy will still performed on four separate blood collections, with apply for all tests above our allowance under Medicare. each episode at least 14 days apart. You will see in our Allergen Menu that we now list a Ordering allergy tests price for each allergen reagent and that this is organised We ask that you specifically nominate which allergens you into different allergen classes: single allergens are $5, would like tested. Please do not write the allergens to be mixed allergens are $10. Our highly specialised allergen tested in the clinical notes section of the request form. components are $40. A comprehensive menu of allergens that we test for is If the price of the allergens requested is more than the available in this brochure. If allergens are not available we Medicare rebate of $22.80, the laboratory will not accept may use cross-reactive ones or advise you on the report. bulk-billing for the request and the patient will be billed Some “allergy symptoms” may result from intolerance according to the price on the menu with our additional mechanisms (salicylates, amines, MSG, metabisulphite) allergen test fee of $25 and may claim a rebate of and detection of IgE to them is not useful or possible. You $22.80, subject to coning. can request the allergens using their alphanumeric codes. To assist staff performing data entry, we would appreciate if you precede these codes by “Specific IgE for” or “Allergy serology for” or “RAST for”.

Initial Investigation Panels A1: CHILD 6 years or less A2: ADULT, or CHILD over 6 years If you write “RAST” or “Allergy serology”, but do Total IgE Total IgE not specify the allergens, we will perform the tests F2 Cow’s milk M6 Alternaria listed under A1 (for a child 6 years or less) or A2 D1 D. Pteronyssinus (Dustmite) E1 Cat (Adult, or child over 6 years). F1 E5 Dog F13 Peanut D1 D. Pteronyssinus (Dustmite) Any subsequently requested additional allergens F14 Soy G5 Grass are charged according to the billing policy outlined (Perennial Rye grass) above. For panels A1, A2 or A3 we will accept the Medicare rebate.

A3: FOOD & INHALANTS FX5 Staple Foods (egg white, G5 Grass Pollen D1 D. Pteronyssinus (Dustmite) M6 Alternaria cow's milk, peanut, soy, (Perennial Rye grass) , and codfish) 3 Background and Testing Strategies

Diagnostic use of sIgE testing As with other tests in pathology, diagnostic accuracy is ƒƒ Testing for IgE to specific ƒƒ This information provides a ƒƒ Due to Medicare funding not 100 percent, ie. the presence of sIgE to a particular allergens (“RAST” testing) is an summary of how this testing can constraints, the laboratory is sIgE is usually measured to confirm an allergic aetiology for symptoms when there is a history that suggests a allergen is not 100 percent diagnostic of clinical reactivity important step in the diagnosis be best utilised and outlines the unable to accept bulk billing to that allergen and absence of sIgE to a particular of allergy cost of testing requests for more than very possible allergic cause. sIgE measurements are used in allergen does not 100 percent exclude clinical reactivity basic allergy testing requests the diagnostic algorithm of Type I allergy as presented in Figure 2. to that allergen. Testing for sIgE is not affected by medications. While the level of sIgE correlates with the likelihood of Background “RAST” tests, which due to new laboratory techniques, Interpretation of sIgE testing is very dependent on the allergy, it does not correlate with the severity of an allergic Immediate (Type I) refers to a specific type are more accurately referred to as specific IgE (or) sIgE clinical picture. reaction. ie. severe reactions may occur in those with low of immune response in which (IgE) tests, detect the presence of specific IgE in the serum level sIgE and vice versa. plays a central role. Clinical manifestations of immediate and were introduced into clinical practice in the early 1980’s. Techniques for detection of allergen-specific IgE hypersensitivity most commonly involve the skin History and examination (urticaria), eyes (), respiratory tract ( have improved significantly since this time. and ) and cardiovascular system (hypotension). Melbourne Pathology has introduced a new platform IgE is produced after first exposure to an allergen on which sIgE testing is performed – the Phadia (an environmental molecule that induces an allergic ImmunoCap 250. As the majority of published studies in response). This IgE subsequently binds to mast cells in allergy use this testing method, it is widely considered the benchmark for quantifying sIgE. Suggest Type I allergy Doesn’t suggest Type I tissues, such as those mentioned above. Subsequent allergy exposure to allergen causes activation of the mast cells, to which the allergen-specific IgE is bound, causing release of chemicals that cause the clinical manifestations of allergy (see Figure 1 below).

sIgE positive sIgE negative sIgE testing is not indicated* First Exposure to Allergen *Please note: If sIgE testing has been done inadvertently Allergy confirmed Allergy not excluded in this situation and is positive, consider referral to an allergist.

IgE Avoidance or consider desensitisation Referral to allergist, if IgE mediated production ( and stinging pathology is considered highly likely Allergen B cell insect allergy) clinically, or if the risks of a false negative IgE attachment result are high (eg. Allergen associated to mast cell with ) Second Exposure to Allergen Figure 2

Exposure to allergen

Mast cell with Allergen attachment and allergen-specific IgE degranulation of mast cell

Figure 1

4 5 Allergens for which sIgE can be measured Clinical vignettes Conclusion Several hundred allergens are available for testing. Targeted testing after a good clinical history allows maximisation 1. A 35 year old female presents with a history of sIgE testing is very useful for confirmation of an allergic of predictive values of sIgE tests. recurrent upper airway swelling following pesto. In aetiology in the setting of a history that suggests a between episodes, she has tolerated pinenut. Pesto specific allergic cause for symptoms. Allergens can be conveniently grouped according to Clinical Syndrome: often contains cashew nuts, so a cashew specific IgE is ordered and returns a result of 37 kIU/L. Dr Gary Unglik FOOD As she has tolerated other tree nuts in between MBBS, FRACP, FRCPA Clinical manifestations of immediate hypersensitivity include one or more of acute urticaria, , wheeze episodes, she is told that she can continue to eat Immunology or hypotension. them cautiously (with the knowledge that there is a After graduating from Monash University  Most common in children: Cow’s milk, egg, peanut, tree nuts (most commonly cashew nut), seed, small risk of reacting to cross contaminating cashew) in 1997, Dr Unglik trained at the Royal soy and wheat and supplied with an adrenaline auto-injector and Melbourne and Alfred Hospitals.  Most common in adults: Peanut, tree nuts, “shellfish” (especially crustacean), fish, seeds and egg anaphylaxis plan to improve her safety, should she He obtained combined fellowship with have accidental exposure. both the Royal Australasian College of AEROALLERGENS Physicians and the Royal College of 2. A 17 year old male with a history of Clinical manifestations include one or more of rhinitis, asthma and occasionally . Pathologists of Australasia in 2007. only manifest in the spring has specific IgE ordered Perennial for (HDM), Cat, Dog and “Perennial Dr Unglik joined Melbourne Pathology in February 2010 as a Consultant Immunopathologist. He is also a Consultant Clinical  House dust mite, pet dander and less commonly moulds (eg. Penicillium/aspergillus) and cockroach Rye Grass” (a grass that only pollinates in the spring Immunologist and Allergist in the Department of Clinical Immunology Seasonal in Victoria). HDM returns a result of 1.5 kIU/L, and Allergy at the Royal Melbourne Hospital where he is also  Spring: Perennial Rye grass/Bermuda grass “Perennial Rye Grass”, 3kIU/L with Cat and Dog Consultant Immunopathologist in the Department of Pathology. giving results of <0.35 kIU/L. Due to the seasonal  Summer: Bermuda grass and moulds (eg. Cladosporium, Altenaria) He is also a member of the Australasian Society of Clinical nature of the symptoms, the HDM result is likely to  Late winter/spring: Trees (eg. Oak, Plane, Birch, Mimosa/Wattle, Cupressaceae) Immunology and Allergy. be a clinical false positive. He underwent VENOMS “Perennial Rye Grass” specific immunotherapy Clinical manifestations of an immediate generalised reaction – large local reactions are not an indication for testing (desensitisation) with good effect. eg. Honeybee, Yellowjacket, Paper . 3. A 13 year old female with Type I diabetes is suffering from post prandial bloating and cramping. The DRUGS/MEDICATIONS/OTHER symptoms follow seemingly unrelated foods, but Clinical Manifestations of an immediate hypersensitivity include one or more of acute urticaria, angioedema, wheeze or a sIgE is performed to “exclude” an allergic cause. hypotension eg. Penicillin, Latex. Milk and codfish sIgE are elevated at 1.3 and 0.9 respectively. She is told to avoid milk and fish and Allergens available The significance of these phenomena can be has mild improvement in her symptoms. As she is still symptomatic, coeliac serology is ordered and A full list of allergens is provided in our Allergen Menu. summarised in the following two statements: Deamidated Gliadin IgG is significantly elevated. She 1. If pre-test probability of allergy is low and RAST Pitfalls in sIgE testing goes on to have an endoscopy and biopsy which is low positive, post-test probability of allergy is confirms and her symptoms resolve Clinical false positives and false negatives still low. with the institution of a strict gluten free . She The presence of sIgE is required, but not alone sufficient 2. If pre-test probability of allergy is high and RAST reintroduces milk and fish without consequence. It for clinically apparent Type I allergic disease, ie. sIgE is test is negative, post-test probability of allergy is likely that these represented clinical false positives not infrequently detected in individuals who do not suffer is still significant. ie. In the case of potentially in the setting of low pre-test probability for these from allergy. Indiscriminate use of these tests, therefore, life- threatening (food, insect sting, drug), allergies. The avoidance of milk may have lead can lead to a significant number of positive results that referral for formal allergy assessment should be to mild improvement due to a lactose intolerance are not clinically significant. considered. associated with poorly controlled coeliac disease, Furthermore, while the presence of sIgE on the surface not cow’s milk allergy. Unselected Panel Testing of mast cells is a requirement for Type I allergic disease, some individuals possess mast cell bound IgE without This can be seen as a screen for . The relevant detectable circulating IgE in the serum. Thus, if there is a allergen might not be included in an unselected panel, high pre-test probability of allergy and the corresponding thus reducing sensitivity of the test. Conversely, testing sIgE test is negative, it may be a clinical false negative. unselected panels makes it more likely that an allergen which is not suspected based on the clinical history will 6 yield a clinical false positive result. 7 AllergenAllergen Menu Menu Allergen Menu

Single Allergens $5 each Single Allergens $5 each Note: Requests for more than four of these will exceed our allowance under Medicare Note: Requests for more than four of these will exceed our allowance under Medicare

ANIMAL & AVIAN Chymopapain C209 MOULDS, YEASTS & MITES (HOUSE DUST & STORAGE) PARASITES VENOMS Budgerigar droppings E77 Gelatin bovine C74 Alternaria alternata M6 Acarus siro D70 P4 Dolichovespula maculata I2 (White-faced hornet) Budgerigar feathers E78 Insulin human C73 Aspergillus flavus M228 Blomia Tropicalis D201 Ascaris P1 Honey (Apis mellifera) I1 Canary bird feathers E201 Morphine C260 Aspergillus fumigatus M3 Dermatophagoides farinae D2 TREE Paper wasp (Polistes spp.) I4 Cat epithelium & dander E1 Penicilloyl G C1 Aspergillus niger M207 Dermatophagoides microceras D3 Acacia T19 Polistes dominulus (European I77 Chicken droppings E218 Penicilloyl V C2 Aspergillus terreus M36 Dermatophagoides pteronyssinus D1 paper wasp) American beech T5 Chicken feathers E85 Pholcodine C261 Aureobasidium pullulans M12 Euroglyphus maynei D74 Vespa crabro (European Hornet) I75 Australian pine T73 Chicken serum proteins E219 Suxamethonium (Succinylcholine) C202 Botrytis cinerea M7 Glycyphagus domesticus D73 Yellow hornet (Dolichovespula I5 Birch T3 Cow dander E4 Tetanus toxoid C208 Candida albicans (yeast) M5 House dust H2 arenaria) Box-elder T1 Dog dander E5 Cephalosporium acremonium M202 Lepidoglyphus destructor D71 Yellow jacket (Vespula spp. I3 GRASS & GRAIN POLLENS T206 Common wasp) Duck feathers E86 Chaetomium globosum M208 Tyrophagus putrescentiae D72 Bahia grass G17 Cottonwood T14 Finch feathers E214 Cladosporium herbarum M2 Barley grain G201 Cypress T222 Goat epithelium E80 Curvularia lunata M16 Bermuda grass G2 Date T214 Goose feathers E70 Epicoccum purpurascens M14 Brome grass G11 Elm T8 Guinea pig epithelium E6 Fusarium moniliforme M9 Cultivated oat G14 Eucalyptus T18 Horse dander E3 Helminthosporium halodes M8 Cultivated wheat G15 Grey alder T2 Mouse epithelium E71 Malassezia spp. M227 Grass pollen (Fescue) G4 Italian cypress T23 Mouse serum proteins E76 Mucor racemosus M4 Johnson grass G10 Japanese cedar T17 Mouse urine proteins E72 Penicillium glabrum M209 Meadow grass G8 Melaleuca T21 Parakeet droppings E197 Penicillium notatum M1 MISCELLANEOUS Perennial Rye grass G5 Mountain juniper T6 Parakeet feathers E196 Phoma betae M13 Cotton crude fibres O1 Sweet vernal grass G1 Oak T7 Parrot feathers E213 Rhizopus nigricans M11 Seminal fluid O70 WEED AND CROP POLLENS Timothy grass G6 Oil palm T223 Pigeon droppings E7 Staphylococcus enterotoxin A M80 Tetramin fish feed O203 Canola () W203 Velvet grass G13 Olive T9 Pigeon feathers E215 Stemphylium botryosum M10 Tobacco leaf O201 Careless weed z Peppertree T217 Rabbit epithelium E82 Tilletia tritici M201 Common pigweed W14 INSECTS OCCUPATIONALS Pine T213 Rabbit serum proteins E206 Trichoderma viride M15 Common ragweed W1 Berlin beetle I76 Alphagal K048 Privet pollen T210 Rabbit urine proteins E211 Trichophyton ment. var. M211 Dandelion W8 Blood worm I73 interdigitale Rat epithelium E73 Castor bean K71 Red cedar T57 English plantain W9 Cockroach American I206 Trichophyton rubrum M205 Rat serum proteins E75 Chloramin T K85 Sweet gum T211 False ragweed W4 Cockroach Oriental I207 Trichosporon pullulans M203 Rat urine proteins E74 Ethylene oxide K78 Sycamore, London plane T11 Goosefoot Lamb`s quarters W10 Cockroach (Blatella germanica) I6 Ulocladium chartarum M204 Sheep epithelium E81 /Formalin K80 White ash T15 Lupin W207 Fire ant (Solenopsis invicta ) I70 Swine epithelium E83 Green coffee bean K70 White pine T16 Mugwort W6 Green nimitti (Cladotanytarsus) I72 Swine serum albumin E222 Isocyanate HDI K77 Willow T12 Ox-eye daisy W7 Grain weevil (Sitophilius granarius) I202 Turkey feathers E89 Isocyanate MDI K76 Parietaria judaica W21 Horse fly I204 Isocyanate TDI K75 Rough marshelder W16 Mediterranean Flour Moth I203 DRUGS Ispaghula K72 Saltwort Russian thistle W11 spp (Aedes communis) I71 Amoxicilloyl C6 Latex, Hevea braziliensis K82 Sheep sorrel W18 Moth I8 Ampicilloyl C5 Silk K74 Sunflower W204 Cefaclor C7 Silk waste K73 Western ragweed W2 Chlorhexidine C8 Sunflower seed K84 Wormwood W5 8 Trimellitic Anhydride TMA K86 9 Allergen Menu Allergen Menu

Single Allergens $5 each Single Allergens $5 each Note: Requests for more than four of these will exceed our allowance under Medicare Note: Requests for more than four of these will exceed our allowance under Medicare

FRUIT & VEGETABLES Orange F33 Beans - Soya F14 SPICES Mackerel F206 MISCELLANEOUS F49 F293 Brazil nut F18 F271 Octopus F59 Cacao F93 Apricot F237 Passionfruit F294 F11 Basil F269 Oyster F290 Carob (E410) F296 Asparagus F261 F95 Canola F316 Bay leaf F278 Red Snapper F381 Cochineal (Carmine red, E120) F340 Aubergine (eggplant) F262 Pear F94 Cashew nut F202 Black pepper F280 Salmon F41 Coffee F221 F96 Persimmon F301 Chickpea F309 Caraway F265 Sardine (Japanese Pilchard) F61 Guar, guar gum (E412) F246 Bamboo shoot F51 F210 Coconut F36 Cardamon F267 Scallop F338 Gum arabic (E414) F297 F92 Plum F255 Common millet F55 Chilli pepper F279 Shrimp F24 Honey F247 Beetroot F319 Potato F35 Corn F8 F220 Snail F314 Hop (fruit cone) F324 Blackberry F211 Pumpkin F225 Fenugreek F305 Coriander F317 Sole F337 Malt F90 Blueberry F288 Raspberry F343 Gluten F79 (Santa Maria) F281 Squid F258 Mushroom (champignon) F212 Broccoli F260 Red currant F322 Hazel nut F17 Fennel seed F219 Swordfish F312 Tea F222 Brussel sprouts F217 Rockmelons F87 Japanese millet F57 F270 Trout F204 Tragacanth (E413) F298 Cabbage F216 Rose hip F330 Lentil F235 Green pepper (unripe seed) F263 Tuna F40 Yeast (S. cerevisiae) F45 Carrot F31 Spinach F214 Linseed F333 Mint F332 Whitefish F384 Cauliflower F291 F44 Lupin F335 Mustard F89 F85 Sweet potato F54 Macadamia nut F345 Oregano F283 Cherry F242 F25 Oat F7 sweet pepper F218 Cucumber F244 Watermelon F329 Pea F12 Parsley F86 Date F289 Peanut F13 Sage F344 Fennel (fresh) F276 Thyme F273 F27 Fig F328 Vanilla F234 Chicken meat F83 Garlic F47 Mutton F88 FISH & SHELLFISH Grape F259 F26 Abalone F346 Grapefruit F209 Rabbit meat F213 Anchovy F313 Guava F292 MILK Turkey meat F284 Blue mussel F37 Alpha lactalbumin F76 Kiwi fruit F84 Pecan nut F201 Pine nut (pignoles) F253 Catfish F369 Beta lactoglobulin F77 POULTRY Pistachio F203 Clam F207 Casein F78 Chicken meat F83 Poppy seed F224 Crab F23 Cheese Cheddar-type F81 Egg white F1 Pumpkin seed F226 Crayfish F320 Cheese Mould-type F82 Egg F75 Quinoa F347 Eel F264 Cow’s whey F236 Turkey meat F284 Lemon F208 Rice F9 Codfish F3 Goat milk F300 Lettuce F215 Rye F5 Grouper F410 Milk F2 SEED, & NUTS Lime F306 Sesame seed F10 Haddock F42 Sheep milk F325 Almond F20 Lychee F348 Spelt wheat F124 Hake F307 Sheep whey F326 Barley F6 Mandarin F302 Sweet Chestnut F299 Halibut F303 Beans - green F315 fruit F91 Walnut F256 Herring F205 Beans - Lima F182 Olive (black fresh) F342 Wheat F4 Jack mackerel (Scad) F60 Beans - Red kidney F287 Onion F48 White bean F15 Lobster F80 10 11 Allergen Menu Allergen Menu

Mixed Allergens $10 each Mixed Allergens $10 each Note: Requests for more than two of these will exceed our allowance under Medicare Note: Requests for more than two of these will exceed our allowance under Medicare

HOUSE DUST Tree Mix 6 Box elder, Birch, TX6 (T1 T3 T5 T7 T10) COMBINATION INHALANT MIXES FOOD MIXES American Beech, Oak, Dust & Mite Mix Dust and mite mix HX2 (H2 D1 D2 I6) Walnut Inhalant 3 Bermuda grass, RX3 (G2 G5 G17 W1 W9 W10) Cereal Mix Wheat, Oat, Maize, FX3 (F4 F7 F8 F10 F11) Perennial Rye grass, Sesame seed, Tree Mix 7 Olive, Willow, White TX7 (T9 T12 T16 T18 T19 T21) Bahia grass, Common Buckwheat ANIMAL DANDER MIXES Pine, Eucalyptus, Ragweed, English Acacia, Melaleuca Plantain, Goosefoot Fruit Mix Orange, Apple, FX15 (F33 F49 F92 F95) Animal Mix 1 Cat dander, Horse EX1 (E1 E3 E4 E5) Lamb’s Quarters Banana, Peach dander, Cow dander, Tree Mix 8 Box elder, Birch, TX8 (T1 T3 T4 T7 T11) Dog dander Hazel, Oak, Sycamore Inhalant 4 Sweet Vernals grass, RX4 (G2 G5 G1 W1 W6 W9) Meat Mix Pork, Beef, Chicken FX73 (F26 F27 F83) Bermuda grass, Nut Mix Peanut, Hazel nut, FX1 (F13 F17 F18 F20 F36) Animal Mix 2 Cat dander, Dog EX2 (E1 E5 E6 E87 E88) Tree Mix 9 Grey Alder, Birch, TX9 (T2 T3 T4 T7 T12) Perennial Rye grass, dander, Guinea pig Hazel, Oak, Willow Brazil nut, Almond, Common Ragweed, Coconut epithelium, Rat, Mugwort, English Mouse Tree Mix 10 Grey Alder, TX10 (T2 T3 T4 T15) Birch,White Ash Plantain Seafood Mix Fish, Shrimp, Blue FX2 (F3 F24 F37 F40 F41) Animal Mix 3 Guinea pig epithelium, EX70 (E6 E82 E84 E87 E88) mussel, Tuna, Salmon Rabbit epithelium, OCCUPATIONAL MIXES Spice Mix 1 Tarragon, Marjoram, FX70 (F272 F274 F273 F275) Hamster epithelium, WEED POLLEN MIXES Thyme, Lovage Rat, Mouse Chemicals 1 Isocyanates (TDI, PAX5 (K75 K76 K77 K79) Weed & Flower Common ragweed, WX5 (W1 W6 W7 W8 W12) MDI, HDI), Phthalic Spice Mix 2 Caraway, Mace, FX71 (F265 F266 F267 F268) Bird Mix Budgerigar feathers, EX72 (E78 E201 E196 E213 Mix Mugwort, Ox-eye anhydride Cardamon, Canary bird feathers, E214) Daisy, Dandelion, Parakeet feathers, Golden rod Chemicals 2 Ethylene oxide, PAX6 (K78 K79 K80 K85) Spice Mix 3 Basil, Fennel seed, FX72 (F269 F219 F270 F271) Parrot feathers, Finch Phthalic anhydride, Ginger, Anise feathers Weed Mix 1 Common ragweed, WX1 (W1 W6 W9 W10 W11) Formaldehyde, Mugwort, English Chloramin T Staple Food Mix Egg white, Milk, FX5 (F1 F2 F3 F4 F13 F14) Feather Mix Goose feathers, EX71 (E70 E85 E86 E89) Plantain, Goosefoot Fish, Wheat, Peanut, Chicken feathers, Lamb’s Quarters, Occupational 4 Wheat & Soy flour, PAX4 (F4 F14 K87 I202) Soybean Duck feathers, Turkey Saltwort alpha-amylase, feathers Sitophilus granarius Vegetable Mix Carrot, Potato, FX19 (F31 F35 F214 F244) Weed Mix 2 Western ragweed, WX2 (W2 W6 W9 W10 W15) Spinach, Cucumber Mugwort, English Food Mix 7 Tomato, Yeast, Garlic, FX7 (F25 F45 F47 F48 F85) GRASS POLLEN MIXES Plantain, Goosefoot Lamb’s Quarters, Onion, Celery Grass Mix 1 Cocksfoot, Meadow GX1 (G3 G4 G5 G6 G8) Scale Lenscale Food Mix 20 Wheat, Rye, Barley, FX20 (F4 F5 F6 F9) Fescue, Perennial Rye Rice grass, Timothy grass, Meadow grass MOULD MIXES Food Mix 26 Egg white, Cow’s milk, FX26 (F1 F2 F13 F89) Peanut, Mustard Grass Mix 2 Bermuda grass, GX2 (G2 G5 G6 G8 G10 G17) Mould Mix 1 Penicillium MX1 Perennial Rye grass, chrysogenum, Food Mix 74 Cod, Herring, FX74 (F3 F205 F206 F254) Timothy grass, Cladosporium Mackerel, Plaice Meadow grass, herbarum, Aspergillus Johnson grass, Bahia fumigatus, Alternaria grass alternata

Grass Mix 4 Sweet Vernal grass, GX4 (G1, G5, G7, G12, G13) Mould Mix 2 Penicillium MX2 (M1 M2 M3 M5 M6 M8) Perennial Rye grass, chrysogenum, Common reed, Cladosporium Cultivated rye, Velvet herbarum, Aspergillus grass fumigatus, Candida albicans, Alternaria alternata, TREE POLLEN MIXES Setomelanomma rostrata Tree Mix 1 Box elder, Birch, Oak, TX1 (T1 T3 T7 T8 T10) Elm, Walnut Mould Mix 4 A. fumigatus, A. niger, MX4 (M3 M207 M36 M228) A. terreus, A. flavus Tree Mix 2 Box elder, Oak, Elm, TX2 (T1 T7 T8 T14 T22) Cottonwood, Pecan Hickory

Tree Mix 3 Mountain Juniper, TX3 (T6 T7 T8 T14 T20) Oak, Elm, Cottonwood, Mesquite

Tree Mix 4 Oak, Elm, Sycamore, TX4 (T7 T8 T11 T12 T14) Willow, Cotttonwood

Tree Mix 5 Grey Alder, Hazel, TX5 (T2 T4 T8 T12 T14) Elm, Willow, Cottonwood

12 13 Allergen Menu Notes

Allergen Components $40 each

ANIMALS TREES rCan f1 (recombinant dog) E101 rBet v 1 PR-10, Birch Betula verrucosa T215 rCan f2 (recombinant dog) E102 MOULDS rFel d1 (recombinant cat) E94 rAlt a 1 (component alternaria) M229 nBos d 6 BSA, Cow Bos spp. E204 rAsp f 3 (recombinant aspergillus) M220 nCan f 3 Dog serum albumin Canis familiaris E221 rAsp f1 (recombinant aspergillus) M218 nFel d 2 Cat serum albumin Felis domesticus E220 rAsp f2 (recombinant aspergillus) M219 FOODS rAsp f4 (recombinant aspergillus) M221 nBos d 4 a-lactalbumin, Milk Bos spp. F76 rAsp f6 (recombinant aspergillus) M222 nBos d 5 b-lactoglobulin, Milk Bos spp. F77 LATEX nBos d 8 Casein, Milk Bos spp. F78 rHev b 1 Latex Hevea brasiliensis K215 nBos d Lactoferrin, Milk Bos spp. F334 rHev b 3 Latex Hevea brasiliensis K217 nGal d 1 Ovomucoid, Egg Gallus spp. F233 rHev b 5 Latex Hevea brasiliensis K218 nGal d 2 Ovalbumin, Egg Gallus spp. F232 rHev b 6.01 Latex Hevea brasiliensis K219 nGal d 3 Conalbumin, Egg Gallus spp. F323 rHev b 6.02 Latex Hevea brasiliensis K220 rAra h 1 Peanut Arachis hypogaea F422 rHev b 8 Profilin, Latex Hevea brasiliensis K221 rAra h 2 Peanut Arachis hypogaea F423 rHev b 9 Latex Hevea brasiliensis K222 rAra h 3 Peanut Arachis hypogaea F424 OCCUPATIONAL ALLERGENS rAra h 8 PR-10, Peanut Arachis hypogaea F352 nCar p 1 Papain, Papaya Carica K201 rAra h 9 LTP, Peanut Arachis hypogaea F427 nAsp o 1 a-amylase Aspergillus oryzae K87 rCor a 1 PR-10, Hazel nut Corylus avellana F428 rCor a 8 LTP, Hazel nut Corylus avellana F425 OTHERS (to exclude CCD reactivity) rGad c 1 Cod Gadus morhua F426 nAna c 2 Bromelin, Pineapple Ananas comosus K202 rPen a 1 Tropomyosin, Shrimp Penaeus aztecus F351 nO214 MUXF3 CCD, Bromelin O214 rPru p 1 PR-10, Peach Prunus persica F419 MISCELLANEOUS rPru p 3 LTP, Peach Prunus persica F420 Alpha-gal (Gal-alpha-1,3-Gal Thyroglobulin, bovine) U953 rPru p 4 Profilin, Peach Prunus persica F421 rTri a 19 Omega-5 Gliadin, Wheat Triticum spp F416 Note: These allergens are priced as single allergens ($5 ea)

VENOM rApi m 1 Phospholipase A2, Honey Bee I208 rVes v 1 Phospholipase A1, Common Wasp I211 rVes v 5 Common Wasp I209 rPol d 5 European Paper Wasp I210

14 15 Head Office & Central Laboratory Regional Laboratories

103 Victoria Parade Collingwood, Victoria 3066 Ballarat Switchboard 9287 7700 63 Victoria Street 3350 5331 6429 Bendigo Facsimile 9419 1486 First Floor, 1 Chum Street 3550 5444 2382 Results 9287 7777 Box Hill Couriers 9287 7788 Epworth Eastern Medical Centre Helpdesk 9287 7799 1 Arnold Street 3128 9899 3830 Accounts Department 9287 7888 Frankston Frankston Private Hospital www.mps.com.au 24–28 Frankston-Flinders Rd 3199 9783 5582 Heidelberg Suite 11, 210 Burgundy Street 3084 9459 7404 Mornington The Bays Hospital, Vale Street 3931 5973 5811 Mulgrave The Valley Private Hospital Suite 4, 529 Police Road 3170 9790 1388 Richmond Epworth Centre Suite 2.2, 32 Erin Street 3121 9429 2222

Details correct at time of printing – November 2013