Clinical Practice

Deciding Who Gets Tested: Patient Selection for a 382-Food Panel

A 382-food, four-marker panel earns its place when the right patient receives it. How practitioners, dietitians, chiropractors and covered union members can be selected sensibly.

Most conversations about food sensitivity testing focus on what to do with the report. The earlier decision matters just as much: which patients on your schedule should be offered the panel in the first place. IS382 COMPLETE measures markers linked to 382 foods across IgE, IgG, IgG4 and complement C3b/d. That is a substantial amount of information. It is most useful when it lands in a case where you already have a question the markers can help you think about.

The Argument Against Testing Everyone

NIH studies indicate that at least 20% of the American population have food sensitivities. That is a large group, and it is tempting to read it as a mandate for universal screening. In practice, a panel ordered without a clinical question attached tends to produce a document nobody knows what to do with. Elevated markers exist in people who feel fine. Unremarkable panels appear in people who are genuinely unwell for other reasons. The markers inform judgement; they do not substitute for it, and judgement needs something to work on.

So the selection question is not "who might have elevated markers" but "whose care plan would change depending on what the panel shows".

Who Tends to Be a Reasonable Candidate

Across the practice types we work with, the same patterns recur:

• Symptoms that persist after the obvious causes have been ruled out or addressed
• Complaints that fluctuate without a clear pattern the patient can identify
• Patients already attempting dietary changes on their own, without structure
• Cases where an elimination trial is being considered anyway and you would rather narrow it before you start
• Recurrent inflammatory presentations that respond to treatment and then return

What these have in common is an existing decision point. The panel gives you something objective to sequence against, rather than starting a broad elimination based on guesswork.

For Practitioners: Selection Happens During a Visit You Already Have

In a clinic setting, the selection conversation usually fits into a visit that was already scheduled for something else. A patient describing fatigue, bloating or skin changes that have outlasted your first line of investigation is the natural moment. You are not adding a consultation to identify candidates; you are recognising them in the ones you already see.

Because collection happens at home, offering the panel does not require chair time, phlebotomy capacity or new equipment. That removes the practical reason to be stingy about who gets offered it, and leaves the decision on clinical grounds where it belongs.

For Dietitians: Selection During Intake

In a virtual nutrition practice, intake is where selection is decided. The patient who arrives with a food diary, a list of suspected triggers and no consistent results is a strong candidate — you are being asked to bring order to a process they have already started badly. So is the patient who has eliminated so much that their diet has narrowed to a point that concerns you, where marker data can help you argue for reintroduction rather than further restriction.

The patient with a single, clearly reproducible trigger they have already identified is a weaker candidate. They may still benefit from the breadth of a 382-food panel, but be honest that you are widening the picture rather than answering a question they have.

For Chiropractors: The Complaint That Keeps Coming Back

Selection in a chiropractic setting often turns on recurrence. A patient whose soft tissue responds to treatment and then flares again on a timescale that does not track with activity or load is worth a conversation about dietary contributors. A patient with a clear mechanical explanation and a normal recovery curve is not.

This is where the complement marker earns attention. Complement C3b/d can amplify a reaction substantially, which is part of why some patients report symptoms out of proportion to what their intake would suggest. Knowing whether that pathway shows activity changes how you frame the recurrence with the patient.

For Unions: When Cost Is Not the Filter

Where members can access testing at no cost through their insurance, price stops doing any of the selection work. That is a genuine advantage, and it also removes a filter that clinicians have quietly relied on for years.

The practical answer is to publish clear guidance to members and referring providers about who the panel is intended for, rather than letting availability set the volume. Coverage should widen access for members with unresolved complaints; it should not turn the panel into a default add-on for everyone attending a health fair. Panels ordered with intent produce reports that get used.

When You Decide Not to Test

Be direct about it. "I don't think this would change what we do next" is a defensible answer, and patients generally accept it when the reasoning is explained. Note the decision in the chart, along with what would prompt you to revisit it — a symptom that persists past a set point, a treatment course that fails to hold. Selection is not a permanent judgement. It is a decision made with what you know at that visit, and the patient who is not a candidate in March may be an obvious one in September.

The panel is a diagnostic input. Like every other input in your practice, it works when it is aimed at a question you actually have.