AD 6th Oct issue | Page 12

12 NEWS

12 NEWS

6 OCTOBER 2023 ausdoc . com . au

Call for better shellfish tests

Carmel Sparke IMMUNOLOGY and allergy specialists
are calling for shellfish skin prick tests to be standardised , with an analysis showing wide variability in the allergen extracts used in available tests .
Researchers — including paediatric immunologists from The Children ’ s Hospital at Westmead , Sydney — say skin prick testing ( SPT ) is usually the preferred first-line diagnostic approach . But widely used allergen extracts in commercial SPT kits are generally not standardised , limiting
the diagnostic value of the results and potentially putting lives at risk .
Their study tested 11 crustacean and five mollusc commercial SPT extracts using biochemical and immunological methods and mass spectrometry .
In a research letter , published in Allergy , they said they found that some extracts lacked a sufficient amount of protein and contained a limited diversity of shellfish allergens , which could result in false negatives .
Total protein content in extracts
varied by up to 14-fold ( 0.1-1.4mg / mL ) in five shrimp , two lobster , two oyster and three clam / scallop extracts from six different manufacturers .
In addition , using serum from five shellfish-allergic patients , immunoglobulin E ( IgE ) -binding patterns to 14 out of 16 extracts “ underlined high variance in anticipated in-vitro and in-vivo potency ”, according to the team led by James Cook University , Queensland .
In the case of one shrimp extract and one clam extract , no IgE binding
was observed at all .
“[ This was ] likely because of low protein and allergen content suggesting a high risk of false-negative SPT results with these extracts ,” the authors wrote .
Lead author Dr Thimo Ruethers ( PhD ), from James Cook University ’ s Singapore campus , said improvements in blood tests , along with the development of region-specific allergen extracts , were “ critical ” to achieve better allergy testing . Allergy 2023 ; 21 Aug .
BH6205 Utrogestan Bill Ledger ADG A4 ad _ TRACED . indd 1
8 / 9 / 2023 9:01 am

Fellowship pass rates queried

Paul Smith FRESH concerns have emerged about so-called ‘ pre-competent ’ psychiatry registrars being awarded fellowships after the Royal Australian and New Zealand College of Psychiatrists ditched its OSCE assessment .
A new research paper says that the pass rates for the “ gold-standard ” clinical exam had ranged from 66 % to 72 % in the four years before the COVID-19 pandemic .
As an interim measure , the college introduced its Alternative Assessment Pathway ( AAP ) for 2022 , which involved a portfolio review looking at a candidate ’ s performance across their three most recent in-training assessments .
The pass rate increased to 90 %.
In their research paper , published in Australasian Psychiatry , the authors reanalysed the estimated false-positive rate of the AAP reported in a college communiqué that said it was no worse than that of the OSCE .
They concluded , where the AAP was deemed reliable and failure rates low , the false-positive rate for the portfolio review would be just 1.5 %.
In the worst-case scenario , however , where the AAP was unreliable and failures high , the false-positive rate could have been 35 % — the equivalent of 106 of the 305 AAP candidates passing the assessment in 2022 being substandard .
“[ It ] is not currently possible to confidently estimate how likely it is that current trainees … will have demonstrated a comparable level of competence [ to those who took the OSCE ] before they achieve fellowship ,” wrote Dr Andrew Amos , chair of the section of rural psychiatry at the Royal Australian and New Zealand College of Psychiatrists , and his colleagues . Australas Psychiatry 2023 ; 15 Sep .