In this article Dr. Cameron also addresses the CDC’s guidance to ignore any positive IgMs for Lyme disease after the first month of illness.
My comment:
I called LabCorp last week and I was told that physicians can still order a stand alone Western blot. What physicians can no longer order is a stand-alone EIA test. If the EIA is positive, then a Western blot will automatically be run, which was not the case before. If the EIA is negative, a Western blot will not be run, but a physician can still order it separately. So my question is, “are different people being told different things about what this new policy means?” Several patients in my online support groups have said that even before this policy was in place, that they were denied Western blots from LabCorp when their EIAs were negative. I for one would like to see LabCorp make a public statement clarifying their new policy.
In either case, the CDC’s endorsement of the two-tier serology test is the root of the problem here. Patients from Lyme endemic areas already know how the two-tier serology test has failed so many people. Yet the CDC continues to stand behind their flawed studies and support the test. For one, I move to transfer the CDC Lyme office from their isolated enclave in Boulder CO to a Lyme endemic area like Poughkeepsie NY. Then the CDC officers will see for themselves how unreliable the two-tier serology test is, because they will witness their own children, families, friends, and neighbors falling ill with chronic disabling illness, because so few doctors will treat without a positive test.
KarlaL
LABCORP TO DENY PHYSICIANS ACCESS TO WESTERN BLOT TESTS FOR LYME DISEASE
Labcorp will not offer a western blot test for individuals unless they are positive or equivocal for the Enzyme Immunoassay (EIA) or Immunoflorescense (IFA) screening tests for Lyme disease as of August 11, 2014.[1]
Physicians have been disappointed by the poor sensitivity of the EIA or IFA screening tests for Lyme disease. The sensitivity of the whole-cell enzyme-linked immunosorbent assay (ELISA) to the B31 strain typically falls between 33-49% for patients presenting with an EM.[2-4] The sensitivity of the Food and Drug Administration (FDA) approved complement peptide C6 (C6-peptide) was 37% in 89 clinically well-defined individuals with LD [5] and 66.5% 403 sera from patients with an EM rash.[6]
Physicians have commonly ordered the western blot test for Lyme disease even in the absence of positive or equivocal testing. An IgM Western blot test can persist for at least 2 years in individuals with established Lyme disease infection. A IgM WB can persist for months to years in LD even if an individual is treated with antibiotics.[7-9] An IgG can be positive in individuals with a negative screening test.
LabCorp’s decision to deny physician assess to western blot test for Lyme disease only makes testing sensitive than it already is.
It important that LabCorp reverse their position and allow physicians to continue to order western blot tests for Lyme disease even if the EIA and/or IFA are negative. Until then, clinicians may have to direct their patients to other labs.
I can tell you that my primary care Dr. tried to order a WB test from Quest Diagnostics and they ran an EIA test instead...
When my Dr. called and asked why they said their policy is to always run the EIA and if it is positive then they will run the WB. If it is negative they will not do the WB.
They said they will not do a WB even when specifically asked to do it. They will do the EIA first anyway and no WB if the EIA is negative.
I ended up having to go to Labcorp and pay out of pocket for the WB. Labcorp did the WB without the EIA with no issues.