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.

Thursday, October 31, 2013

It's been too long since I posted, so this is to let you know that I am starting up again!
There's a lot of news in the allergy world, with the upcoming launch of the first steroid nose spray available over the counter in the U.S. and interesting research findings that I will share with you.
The leaves are falling, but there's still mold and ragweed in the air. This should go after the first heavy frost- but I hope this won't happen too soon!

Monday, September 19, 2011

The pollen estimate for this week

Customized for SOMERVILLE, NJ 08876, September 19, 2011. Courtesy of the Makers of ZYRTEC®.
Local Allergy Levels*
Pollen Chart Range Pollen Chart for SOMERVILLE, NJ
Predominant Pollen: Ragweed, Chenopods and Grass.
Weather Forecast*
September 19
September 20
September 21
September 22

Tuesday, December 21, 2010

Advice for Treating Common Colds

From the National Center for Complementary and Alternative Medicine

Director's Page
Josephine P. Briggs, M.D.

Echinacea—What Have We Learned and Where Are We Going?

December 20, 2010
Everyone gets colds. Doctors' offices are packed with patients seeking relief from symptoms or looking to treat occasional more serious complications. There are also countless home remedies, and store shelves are filled with over the counter medicines and herbal supplements. Among the latter is echinacea—a popular herbal supplement made from the stems, leaves, or roots of the purple coneflower.
As we head into the cold and flu season, it's not surprising that the press has given a lot of attention to the NCCAM-funded study by Barrett et al. in the Annals of Internal Medicine. Although the authors noted that there were small trends in the direction of a benefit from echinacea—an average half-day reduction in duration, or an approximate 10 percent decrease in severity—they concluded that this dose and formulation of echinacea does not significantly change the course of the common cold.
These results and conclusions are consistent with a large body of previous clinical research. That studies of herbals are often not definitively positive or negative is a challenge that we are attempting to address as a major theme of our upcoming strategic plan (to be released in early 2011): the need for basic and translational research on natural products. In particular, the plan calls for better understanding of biological effects and the development of biomarkers or other translational tools prior to the initiation of lengthy, complex, and expensive clinical trials. With such knowledge and tools it will be possible to design clinical studies that test mechanistic hypotheses at the same time that we study clinical outcomes. For example, inclusion of biomarkers derived from basic and translational research would greatly increase insight, particularly into "negative" or equivocal studies.
For now, the best advice for treating the common cold is to stay home, get plenty of rest, and drink lots of fluids.

Monday, August 16, 2010

Allergists Offer Ragweed Survival Guide

Allergists Offer Ragweed Survival Guide  
The start of back-to-school season also marks the start of ragweed misery for one in five Americans. Find relief from the sneezing, stuffy nose and watery eyes caused by this pesky weed. Follow these tips from the American College of Allergy, Asthma and Immunology (ACAAI):
Start taking allergy medications in early August. 
Get treated for pet allergies year-round to make ragweed allergies more  

      tolerable. New research suggests allergies to dogs, cats or dust mites  
      "prime" the system, making hay fever suffering even worse. 
Stay inside between 5 a.m. and 10 a.m. If you must be outside, wear a  

     National Institute for Occupational Safety and Health (NIOSH)-approved
     N95 respirator mask. 
Protect your eyes with glasses or sunglasses that fit close to your face. 
    Steer clear of air pollutants.

Thursday, June 3, 2010

Back to Basics

It looks like Summer is here!  It's hot and humid and everything is green.  There are 4 basics of successful allergy management which I share with every patient. One is often overlooked.  Can you guess which one?
1. Avoidance - if you know what you are allergic to, and can reasonably avoid it, then cut your exposure.
2. If you get an allergeen in your nose, eyes or skin - wash it out (or off!).
3. Take your allergy medicine as directed.
4. Allergy shots (immunotherapy) can build up your immunity so your allergy symptoms last for a shorter period of time and you may need less allergy medicine.

If you guessed (2), you are right!

Often overlooked, but can make a big difference.  If your eyes are itchy and burning, use a long-lasting lubricant eye drop which does not contain any drugs.  I have several good recommendations for my patients.
If your nose is itchy, and you are sneezing a lot, use saline nasal spray or a NetiPot to wash all the bad stuff out!