Tuesday, November 26, 2013

Food-Allergic Kids Need Current Epi Script

From the recent ACAAI Meeting

Food-Allergic Kids Need Current Epi Script

BALTIMORE — Just 30% of food-allergic children presenting to a pediatric outpatient clinic have a current prescription for an epinephrine autoinjector, with far fewer having chart documentation of how to administer it, according to a new study.
"It was a surprise," lead investigator Christopher Couch, MD, told Medscape Medical News before presenting the findings here at the American College of Allergy, Asthma & Immunology (ACAAI) 2013 Annual Scientific Meeting.
"This study started as a quality-improvement project. There's room for much improvement ― and some of those quality-improvement measures include physician education," said Dr. Couch, a pediatric resident at the University of Nevada School of Medicine in Las Vegas.
The retrospective chart review of outpatient visits at 2 pediatric resident clinics included 57 patients (mean age, 6 years).
Most of the patients, 53%, were allergic to peanut, with 30% allergic to egg, 26% to shellfish, 18% to tree nut, 5% to milk, and 4% to wheat.
Although 67% of the charts documented the prescription of an epinephrine autoinjector at some time, only 30% of patients had a current prescription, with just 18% having documentation of administration instructions, and 14% having documentation of a food allergy action plan.
The study also found that 58% had received a referral to an allergist and that 58% had undergone laboratory testing for allergy-specific serum IgE levels.
Three quarters of the patients had Medicaid insurance, and 21% were Spanish speaking.
There's room for much improvement ― and some of those quality-improvement measures include physician education. Dr. Christopher Couch
Current guidelines from the National Institute of Allergy and Infectious Diseases on the management of food allergies recommend that patients be prescribed epinephrine autoinjectors on a yearly basis, that instructions be given regarding use and administration of the medication, and that an emergency action plan be discussed with the patient and written down, said Dr. Couch. A plan for monitoring expiration dates should also be outlined with the family, he said.
"Many residents aren't aware that the prescription does expire," he added. "We have paper charts, but with electronic records, it's a great opportunity to have pop-up reminders 1 year after the prescription is written."
Dr. Couch pointed out that the results may reflect physician oversight "or could simply be a lack of documentation in the chart. We cannot conclude that the prescriptions were not filled by the patient."
Asked by Medscape Medical News to comment on the findings, Ronna Campbell, MD, from the Mayo Clinic Department of Emergency Medicine, in Rochester, Minnesota, said, "Food allergy in children is frequently a lifelong condition that requires ongoing reassessment and management. I agree with the authors' conclusions that development of quality-improvement strategies would be helpful in ensuring consistent and appropriate long-term management so that patients are adequately prepared to manage anaphylaxis should it occur."
Dr. Campbell's recent review on this topic pointed to evidence that many clinicians do not know how to properly demonstrate autoinjector use (Pediatr Emerg Care 2012;28:938-942).
"In a study of junior and senior medical staff demonstrating the use of the EpiPen, Mehr et al revealed that, in 37% of cases, the physician's demonstration would have failed to deliver epinephrine to a patient," Dr. Campbell wrote in the review. "Furthermore, 16% of the physicians would have self-injected their thumb had they been using an actual EpiPen."
Asked whether failure to prescribe autoinjectors might be related to physician lack of confidence or knowledge in this area, she said, "One could speculate that that is a possible cause, but it is more likely that it just gets overlooked because there are no systematic ways of ensuring that the prescription is renewed."
Dr. Couch and Dr. Campbell report no relevant financial relationships.
American College of Allergy, Asthma & Immunology (ACAAI) 2013 Annual Scientific Meeting: Abstract 5. Presented November 10, 2013.

Tuesday, November 12, 2013

Allergy Myths

Defining Allergy Fact from Fiction
The greatest allergy myths and misconceptions, debunked
BALTIMORE, MD. (November 7, 2013) – From gluten allergy and hypoallergenic pets, to avoiding the flu shot because of an egg allergy, there are a lot of common myths and misconceptions about allergies. Many might be shocking due to a great deal of false information in the media and on the Internet. And some of the misconceptions can be damaging to your health if vaccinations are skipped and extreme dietary avoidances are taken.
But where did all of these misconceptions come from? According to a presentation being given at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), previously held beliefs from medical experts and public perception are partially to blame.

“Many early medical beliefs have been proven to be incorrect as research has advanced,” said allergist David Stukus, MD, ACAAI member and presenter. “Unfortunately, some of these beliefs are still on the Internet, where an astonishing 72 percent of users turn to for health information.”

In his presentation, Dr. Stukus outlined some of the greatest allergy myths, and explained why they are false.
  1. I’m Allergic to Artificial Dyes – There is no scientific evidence to support a link between exposure to artificial coloring and allergies. Controversy exists regarding evidence for artificial coloring and behavioral changes in children, as well as dyes causing chronic urticaria and asthma.
  2. I Cannot Have Vaccines Due to an Egg Allergy – Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever and rabies shots. However, it’s now safe to get the flu shot, which can help prevent serious illness.
  3. At-Home Blood Tests Reveal All You’re Allergic To – These tests might be able to reveal sensitization, but being sensitized to a certain allergen, like milk, doesn’t mean you’re allergic. These sort of at-home screening tests are not reliable and can often lead to misinterpretation, diagnostic confusion and unnecessary dietary elimination.
  4. Highly Allergenic Foods Shouldn’t be Given to Children until 12 Months of Age – For most children, there is no evidence to support avoidance of highly allergenic foods past four to six months of age. New evidence emerging shows that early introduction of highly allergenic foods may promote tolerance.
  5. I’m Allergic to Cats and Dogs, but Can Have a Hypoallergenic Breed – Unfortunately, there is no such thing as a truly hypoallergenic dog or cat. Allergens are released in saliva, sebaceous glands and perianal glands. It’s not the fur people are allergic to. It is true that some breeds are more bothersome for allergy sufferers than others.
  6. I’m Allergic to Shellfish and Cannot Have Iodine Imaging – Radiologists and cardiologists often use iodinated contrast during CT scans and other procedures for better imaging. Since shellfish contain iodine, many physicians have linked a contrast reaction to a shellfish allergy. However, this is false, and a shellfish allergy has nothing to do with the reaction. In fact, iodine is not and cannot be an allergen as it found in the human body.
  7. I Can’t have Bread, I’m Allergic to Gluten – You can have a gluten intolerance, but it’s extremely rare to have a true allergy. Most allergic reactions to these foods stem from wheat. Many people self-label as having gluten allergy and avoid gluten without any medical indication.
With information being widespread online via social media portals, how do you know what to believe and what not to believe?

“If you think you may have an allergy, you should see a board-certified allergist for proper evaluation, testing, diagnosis and treatment,” said Dr. Stukus. “Misdiagnosis and inappropriate treatment can be dangerous.”

The ACAAI Annual Meeting is being held Nov. 7-11 at the Baltimore Convention Center in Baltimore. For more news and research being presented at the meeting, follow the conversation on Twitter #ACAAI.