Clinical immunology in practice, new opportunities.

While research provides new opportunities for diagnosing and treating patients with allergic and immunological disorders, there are significant challenges to putting these advances into use in clinical practice. Each new test may require clinicians in private practice to battle with a health insurer's designated clinical laboratory in an effort to get this new test and other accurate immunological laboratory studies. A new test may or may not be covered by some health care plans and may or may not be available from their designated laboratories. Many of these laboratories send time-sensitive samples across the country with risk of time delays and poor specimen handling leading to inaccurate results and/or the need to send repeat specimens. The growing role of managed care in every medical decision has led to frustrations for the patient and physician. This frequently requires a consult at a tertiary care center, where laboratory studies may be more easily accessible with fewer restrictions. Where are the new opportunities? Some are found in the enhanced ability to make intelligent decisions in the diagnosis and treatment of immunological diseases. There is now a greater selection and availability of intravenous gamma-globulin (IVIG), that can be matched to individual patient needs. The appropriate selection of these products will decrease adverse reactions and increase safety. There was a major advance in the treatment of moderate and severe asthma with the addition of omalizumab therapy. It provides allergists and immunologists with their first monoclonal humanized anti-IgE antibody.