Tag Archives: American College of Allergy

Health Care Changes Will Affect Your Asthma Regimen

 

Europe and the United States differ on many things including how we look at war and how often we pick our noses…yes it’s true about rhinotillexomania (nose picking).  Perhaps this is why Europeans will reach for a nose spray FIRST to treat allergies and then go for antihistamines.  Yes, there’s even a Dr Oz video on the subject: http://www.oprah.com/oprahshow/Dr-Oz-on-Health-and-Hygiene

So what is the point of all this nonsense?  Treatment of asthma also differs between the United States and Europe.

The Misuse of Asthma Drugs

Gene L Colice Expert Rev Resp Med. 2013;7(3):307-320. 

There are three major problems with asthma care in the USA today and misuse of asthma drugs contributes to each.

This is where the information comes from!
This is where the information comes from!

First, multiple sources document that symptom control of most Americans with asthma in the general population does not meet standards established in the National Asthma Education and Prevention Program Expert Panel Report III (EPR3). In the CHOICE survey, 1000 patients with asthma randomly chosen across the USA were asked about their care and burden of disease.  Almost half of these patients (49%) reported that they did not use asthma controller medications, although 79% had evidence of persistent disease. Of the 51% of the patients reporting the use of asthma controller medications in this survey, 85.7% had not well controlled or very poorly controlled disease. Numerous previous surveys of asthma patients in the USA and Europe, using either telephone interviews or questionnaires, have reported similarly high levels of uncontrolled disease. In the Exercise-Induced Bronchospasm Landmark Survey, 78.8% of the children with asthma and 83% of adults with asthma described respiratory symptoms with exercise. Children and adults with asthma commonly described being limited in their ability to perform sports and outdoor activities by their disease in this survey. 

I know most patients would like to stop their asthma medications ASAP, but it comes at the cost of losing asthma control.  I’ve previously discussed when to stop asthma medications…I’d like to know what you think?  Are doctors prescribing unneccesary medications?

 Second, in addition to difficulties with symptom control on a daily basis, patients with asthma in the USA frequently suffer exacerbations.

Grandpa can't breathe! --that's what exacerbation means
Grandpa can’t breathe! –that’s what exacerbation means

In the CHOICE survey, 5% of the patients reported being hospitalized and 14.4% described either an emergency department (ED) or urgent outpatient visit for an asthma exacerbation in the past year. Patients interviewed in this survey with more severe, persistent or uncontrolled asthma were more likely to have suffered asthma exacerbations. Previous surveys have reported similarly high rates of asthma exacerbations resulting in ED visits and hospitalizations. Data from the US CDC confirm that nationwide rates of ED visits and hospitalizations for asthma exacerbations remain unacceptably high.

So what are parents to do?  The choice between giving your child steroids and having to rush to the emergency room for an asthma flare can be a “no win” proposition. 

 Third, asthma is an expensive disease.

If only!
If only!

The CDC has recently estimated that asthma costs the US economy approximately US$56 billion annually. On average, an asthma patient has been calculated to generate approximately US$2000–$4000 more in healthcare costs per year than a nonasthma control patient. Indirect costs due to work loss, school absenteeism, reduced productivity and so on, further contribute to the economic impact of asthma. Healthcare costs of asthma increase in patients with more severe disease. In patients with moderate and severe persistent asthma, exacerbations will further substantially increase healthcare costs.

I know the most common reason that patients stop their medication is simple: medications are too expensive.  Here are some tips to reduce the cost of your prescribed medications for asthma:

  1. Make sure the medications you are picking up at your pharmacy are needed year round.  Some patients need asthma inhalers only during the cold winter months.
  2. Educate yourself…know your triggers for asthma attacks to keep you out of the ER and better yet to use inhalers as prevention! (I have links to the American College of Allergy and the American Academy of Allergy, Asthma, and Immunology)
  3. Monitor your symptoms with a peak flow meter and pay attention to how much exercise you can do, and how well you sleep.  Both of these indicators will tell you several days in advance if your asthma is flaring.
  4. Use coupons for your inhalers.  In years past, pharmacy reps would leave samples for us to hand out to get patients started on asthma prevention.  This is no longer the case because of health care reform.  But….coupons are available for a similar value.  Just don’t forget to take the coupon in to your pharmacist when you pick up your inhaler. 

  In summary, having reviewed the data, the EPR3 predisposes to under treatment of asthma. The tendency is for healthcare providers to underestimate asthma severity and to correspondingly undertreat the disease. In most asthma patients, the result will be persistent asthma symptoms. In important subsets of asthma patients, particularly smokers, the efficacy of ICS seems impaired. For a given categorization of asthma severity (even if accurately calculated by the healthcare provider), the corresponding recommended treatment with ICS in the EPR3 might be insufficient in smoking and obese asthma patients. Again, the consequence will be persistent asthma symptoms.  Asthma tragedies occur all the time…let’s make sure it doesn’t happen to someone you know!

Stay Up to Date with Food Allergy

I always enjoy National Medical Meetings….good food, meeting old friends, and yes, even learning something!  The College of Allergy annual meeting was held in California just one week ago……and what are the hot topics this year? 

Here’s an article and interview from Medscape about this year’s meeting.  Why am I interested? Dr. Portnoy was my mentor (professor) during my fellowship training in allergy.  Way to go Jay! 

Here’s what he had to say–This international food allergy conference features the latest on eosinophilic esophagitis, unusual and “off the beaten track” food allergies, spice allergies, and developments in food immunotherapy.

“Food allergy is always something that people are interested in,” Jay Portnoy, MD, professor of pediatrics at the University of Missouri, Kansas City, and Mercy Children’s Hospital, told Medscape Medical News

Children’s Mercy Hospital entrance

Dr. Portnoy, who chaired this year’s abstract committee, highlighted a few of the presentations on food allergy that he considers particularly noteworthy.

“Researchers at Northwestern University in Chicago have found that kids with egg and milk allergy are more likely to outgrow those allergies than if they have tree nut or shellfish allergy. So when the doctor says your child will probably outgrow their egg or milk allergy, they’re not too far off,” he said.

Another study examines how people who are allergic to hen eggs might be able to tolerate them when they are baked. “It turns out that baking the egg actually denatures or neutralizes the allergen, more so than if you just partially cook it. If you introduce cakes and cookies into your diet, you will be able to most likely broaden your diet and improve the quality of your life,” he said. 

One presentation of definite note is on a newly identified and possibly life-threatening allergic reaction to mammalian meat. Researchers have determined that the lone star tick is the primary reason for meat-induced alpha-gal allergic reactions.

“This new food allergy, alpha-gal, is more common than we thought. There is a high prevalence in some areas of the country, particularly in the central and southern regions of the United States,” Dr. Portnoy explained.

Alpha-gal is a sugar found in red meats such as beef, pork, and lamb. In the study to be presented, positive alpha-gal rates were 32% higher in areas with a lone star tick population than in other areas of the United States.

Symptoms of alpha-gal allergic reactions range from mild hives to potentially life-threatening anaphylaxis.

“The reaction is delayed. A lot of people have experienced this, and now we know what it is. This is why it is so important to come to the annual meeting and learn about these unusual allergic reactions,” he said.

The topic of spice allergies is also on the meeting agenda.

According to a statement issued by the ACAAI, spices are one of the most widely used products, and are found in foods, cosmetics, and dental products. The US Food and Drug Administration does not regulate spices, which means that they are often not noted on food labels.

As a result, they are one of the most difficult allergens to identify and avoid.

“While spice allergy seems to be rare, with the constantly increasing use of spices in the American diet and a variety of cosmetics, we anticipate that more and more Americans will develop this allergy,” said Sami Bahna, MD, DrPH, from the Louisiana State University Health Sciences Center in Shreveport.

“Food allergy is a very important topic for allergists because we need to understand the most current research; recently, the field has seen a lot of changes,” ACAAI President Stanley Fineman, MD, from the Atlanta Allergy and Asthma Clinic in Georgia, told Medscape Medical News.

“There is a lot of new understanding about food allergies, new diagnostic tools, and some potential treatments,” he said. “This is the place to find out the latest information; when you go back to your practice, you [will] be on the cutting edge.”

Back by popular demand is the annual literature review course, where experts present what they feel are the key articles of the year on topics such as immunology, allergic rhinitis, ocular allergies, and immunology. “We have almost 500 people already registered for this program. Some people look forward to this program all year long to catch up on the literature. It’s a very popular feature of the meeting,” Dr. Fineman said.

The slogan for this year’s meeting is “Over the Horizon: Expanding Expertise,” which captures the essence of what the conference is about, he noted.

“The program committee selected this theme to help us see what is going on in the future, to expand our expertise, to make sure that we are able to keep current, and to hone our skills so we can adapt to any changes in healthcare and any new research involved with treating our patients,” Dr. Fineman explained.

“Most allergists go to the meeting to find out what’s new in allergy, to keep their skills up, to interact with colleagues, and to validate what they do. Because, like most allergists and most physicians, if you are in practice and you don’t interact with other physicians, you can start to develop quirky styles of practice that may not be the best practices. It’s really a good idea to touch base with colleagues, interact, and hone your skills,” Dr. Portnoy added.

“At this meeting, allergists will hear about an unusual case and then remember a patient who had the same thing. That’s how advances in our field are made,” he said.

I could say it better.  With all the controversy swirling around health care reform, it’s refreshing to learn about what really matters for taking care of patients….that’s why I keep going to work every day!

What do docs really do?

Most patients never know what doctors do when they’re NOT in the office.  One of those activities is attending national meetings in our chosen specialty.  For me, the American College of Allergy, Asthma, and Immunology is a yearly highlight.  You ask why?  Who wouldn’t want to see a distinguished doctor dress up and discuss hives?  Seriously, the ACAAI in Boston was a great opportunity to network and stay up to date on changing treatments for allergy & asthma!  It’s posted here.

Attendees of the ACAAI Annual Meeting voted Dr. David Khan winner of “The Great Chronic Idiopathic Urticaria Raft

What we do at Allergy meetings!

Debate: After Antihistamines, What’s Best for Next In-Line Treatment” based on his discussion of Hydroxychloroquine/dapsone.