Computer analysis of allergic histories taken by questionnaire

The patient-computer interview: a neglected tool that can aid the clinician

In this article, I (1) review the process of interviewing patients by computer, (2) summarize computer-interviewing work done in 1968, (3) address the weaknesses of collecting information with the traditional history-taking methods or paper questionnaires, (4) discuss commercial software designed for computer interviewing, and (5) focus on the strengths and weaknesses of interviewing patients with a computer. The strengths of this process compared with traditional interviewing are that computer interviewing allows the physician to gather more data; gives the patient more time to complete an interview; uncovers more sensitive information; provides more adaptability to non-English-speaking patients, patients with hearing impairment, or patients who are illiterate; and provides structured information for research. The weaknesses of computer interviewing are that it generates false-positive responses, is not accepted by a minority of patients, is unable to detect nonverbal behavior, and requires changes in work flow. With the advent of an electronic medical record and the financial rewards for comprehensive history recording, the gathering of history and documentation from patients is increasingly important and favors adaptation to computer interviewing.

The assessment of a computer administered questionnaire in the differential diagnosis of asthma and chronic airflow limitation

We have tested a computer administered respiratory symptom questionnaire in patients with asthma, chronic airflow limitation, and subjects with no evidence of respiratory disease. The questionnaire was highly effective at distinguishing patients with respiratory disease from those without. However, the responses of asthmatic patients and patients with CAL to the majority of questions were similar though the responses to four out of 11 questions were significantly different. We conclude that such a computer administered questionnaire is of limited value in distinguishing patients with asthma and CAL, underlining the importance of objective tests in this differential diagnosis.

Screening for IgE-mediated allergy

Sera from 425 patients were analysed with Phadebas RAST reagents against a panel of 19 allergens and the most commonly positive results were to grass pollen, Dermatophagoides pteronyssinus and cat epithelium. Of the 275 sera RAST-positive to any allergen, 261 were positive by a RAST technique which used a mixture of the three most common U.K. allergens; the remainder were usually positive to a mould. We conclude that 1) when a positive result is obtained after screening by the mixed-allergen RAST and a representative mould RAST, then other positive RAST results are possible, but that the extent of the investigation can be guided by a knowledge of the total serum IgE level and a computer-based history analysis; 2) when a mixed-allergen RAST and a representative mould RAST is negative, then a more specified RAST including all 19 allergens used in this investigation will be negative; 3) a positive mixed-allergen RAST result is likely to be associated with a total serum IgE level over 40 U/ml and a positive symptom pattern score derived from the computer-based history analysis.

The radioallergosorbent test (RAST) in nasal polyposis

The incidence of atopy among 64 adults undergoing polypectomy was 25 per cent. Among these atopic patients it was usual for the polyp IgE level to exceed that in the serum. Similarly, D. pteronyssinus-specific IgE was more commonly identified in polyp fluid by the RAST technique than in serum. However, this was not so for grass pollen-specific IgE, where serum and polyp fluid were equally positive. We conclude that there are atopic and non-atopic polyps.