Doctors Deficient in Anaphylaxis Care

Having just returned from the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, we’re spoiled for choice of news. But among all the science there was one stand out shocker.  In a session on Sunday, physicians presented the results of a survey, sponsored by the Asthma and Allergy Foundation of America (AAFA). During this, they revealed that a disturbingly high proportion of primary care and emergency physicians don’t know how to treat anaphylaxis.

Interviews with 318 physicians indicated that:

• substantial numbers do not always provide epinephrine to patients – even those  they believe are having anaphylactic reactions
• they often fail to refer anaphylaxis patients for follow-up care
• they believe incorrectly that some patients should not receive epinephrine auto-injectors

Myron Zitt, MD, says the results reveal “likely deficiencies in physician knowledge,” and corroborate results from earlier chart review studies.

In the telephone-based survey, researchers conducted interviews lasting an average of 19 minutes with approximately 100 emergency room physicians, 100 allergists, 50 adult primary care physicians, and 50 pediatricians.

82% to 99% of respondents in each group said they had treated at least one anaphylaxis case.

Although epinephrine is supposed to be given to all patients having such reactions, about 10% of emergency room physicians and 20% of primary care and pediatric physicians said they had done something else.  These “something else’s” included prescribed another drug, sending the patient to a hospital, or an “other” action.

Prescribing of auto-injectors for patients to take home also was far from universal. Barely 60% of emergency room physicians said they did. In fact, emergency physicians were generally bad at all phases of follow-up care. They rarely referred patients for diagnostic tests, they almost never demonstrated use of an auto-injector, and seldom explained that auto-injectors have an expiration date.

Another disturbing finding from the survey, Zitt said, was that many physicians of all types – even the allergists – mistakenly believed that some patients should never receive epinephrine.

In the same session, Akhil Chouksey, MD, reported that anaphylaxis care in a major teaching hospital usually failed to meet guidelines established by a consortium of allergy societies including the ACAAI.  In a 10-year review of anaphylaxis cases only 15% met the standards of care recommendations i.e. that epinephrine be administered within 30 minutes of triage, that auto-injectors be prescribed at discharge, and that patients be referred to an allergist or immunologist for follow-up investigations and treatment.

The review also found that in 26% of cases in which anaphylaxis was definitively confirmed, the patients never received epinephrine.  Antihistamines, such as benadryl (diphenhydramine), were given in nearly all cases but epinephrine was omitted in one-quarter. In fact, epinephrine was only the third most commonly administered medication, with corticosteroids such as methylprednisolone, taking the second spot after antihistamines.

During the question-and-answer period, an audience member suggested that, when patients present with relatively mild symptoms, the treating physicians may decide that epinephrine isn’t needed at that point.  Zitt countered, that this was a very dangerous approach.

The national guidelines state explicitly that there are no absolute contraindications to epinephrine. Nevertheless, 16% of the pediatric allergists and 32% of the other allergists said there were such contraindications, as did 38% of adult primary care and emergency physicians.

Also common were beliefs that schools, restaurants, and ambulances always stock epinephrine. In fact, Zitt said, there are no general requirements for schools or restaurants to do so, and approximately half of all ambulances do not have epinephrine on hand.

Clearly there is much work still to be done in terms of education.  SRxA’s Word on Health suggests a first step would be to instill a healthy fear of anaphylaxis into doctors and the general public while simultaneously removing the fear of epinephrine.

Or as Dr Zitt says, “Give epinephrine first, ask questions later.”

Who’s to blame for your allergies?

Are you one of the 35 million Americans who suffer from seasonal allergies? If so you’re probably not cheering the official end of winter.  But before you start blaming Persephone – goddess of Spring, for your symptoms you may want to look a little closer to home.

Many of the everyday things you’re doing, from what you eat to how you clean your home may be interfering with relief from your stuffy nose, sneezing, sniffling or other symptoms.

“People with spring allergies often don’t realize how many things can aggravate their allergy symptoms so they just muddle along and hope for an early end to the season,” says allergist Myron Zitt, M.D.“But there’s no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable.”

The American College of Allergy, Asthma and Immunology (ACAAI) advises people with spring allergies to be on the lookout for five things that can aggravate suffering.

1. Eating fruits and vegetables – Many people with seasonal allergies also suffer from pollen food allergy syndrome (also called oral allergy syndrome), a cross-reaction between the similar proteins in certain types of fruits, vegetables and the allergy-causing pollen. 1:5 people with grass allergies and as many as 70% of people with birch tree allergies suffer from the condition, which can make your lips tingle and swell and your mouth itch.

If you’re allergic to birch or alder trees, you might have a reaction to celery, cherries or apples. If you have grass allergies, tomatoes, potatoes or peaches may bother you. Usually the reaction is simply annoying and doesn’t last long. But up to 9% of people have reactions that affect a part of their body beyond their mouth and almost 2% can suffer a life-threatening anaphylactic reaction.

2. Using the wrong air filter – Using an air filter to keep your home pollen-free is a good idea, but be sure it’s the right kind. Studies show inexpensive central furnace/air conditioning filters and ionic electrostatic room cleaners aren’t helpful – and in fact the latter releases ions, which can be an irritant. Whole-house filtration systems do work, but change the filters regularly or you could be doing more harm than good.

3. Opening your windows – When your windows are open, the pollen can drift inside, settle into your carpet, furniture and car upholstery and continue to torture you. So keep your house and car windows shut during allergy season.

4. Procrastinating – You may think you can put off or even do without medication this spring, but the next thing you know you’re stuffed up, sneezing and downright miserable. Instead, get the jump on allergies by taking your medication before the season gets under way.

5. Self medicating – Perhaps you’re not sure exactly what’s making you feel awful so you switch from one medication to the next hoping for relief.

This spring, your best bet is to see an allergist, who can determine just what’s triggering your symptoms and suggest the most appropriate treatment.

Be S.A.F.E.

SRxA’s Word on Health was deeply saddened to hear of the seven-year-old girl from Chesterfield County, Virginia who died this week after suffering an allergic reaction at school.  According to news reports she was given a peanut from another child who was unaware of her allergy.

Our heartfelt condolences go out to her family and friends. We dedicate this blog as a tribute to her and all the other children who have lost their lives to anaphylaxis.

Although there’s no cure for food allergies, as we’ve reported in the past, such deaths are almost entirely preventable with proper education and immediate treatment with epinephrine.   And even though we don’t know all the details of this case, what we do know is that food allergies are on the rise. 8% of children under age 18 in the United States have at least one food allergy.

Now, we’d like your help to prevent a similar tragedy from happening in the future.

The American Academy of Allergy, Asthma and Immunology’s  Be S.A.F.E. campaign is dedicated to educating patients and healthcare professionals on the steps needed to save lives. We urge you to read the campain’s action guide and share it with your colleagues, friends, and relatives. If you have kids in school, make sure the teachers are aware of it. If you use a gym, make sure the trainers know. Tell your favorite restaurant, share with your employer…the list goes on and on.

Seek immediate medical help. Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.

Identify the Allergen. Think about what you might have eaten or come in contact with – food, insect sting, medication, latex – to trigger an allergic reaction. It is particularly important to identify the cause because the best way to prevent anaphylaxis is to avoid its trigger.

Follow up with a Specialist. Ask your doctor for a referral to an allergist/immunologist, a physician who specializes in treating asthma and allergies. It is important that you consult an allergist for testing, diagnosis and ongoing management of your allergic disease.

Carry Epinephrine for emergencies. If you are at risk for anaphylaxis, make sure that you carry an epinephrine kit with you at all times, and that family and friends know of your condition, your triggers and how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.

So there you have it. 4 simple steps that could save lives. Go share them!

Halloween: A scary time for those with asthma and allergies.

Most parents of kids with food allergies are well aware of the potential dangers of trick-or-treat candy and have strategies in place to avoid Halloween horrors. However, teaching your kids to just say no to Snickers bars may not be enough.   According to experts from the American College of Allergy, Asthma and Immunology (ACAAI) there are many more unexpected allergy and asthma triggers that can pose a threat to trick-or-treaters, including dusty costumes, fog machines and makeup. “When people think of Halloween-associated allergies, they focus on candy and often overlook many other potential triggers,” said Dr. Myron Zitt, former ACAAI president in a news release. “By planning ahead, you can ensure not only safe treats, but also safe costumes, makeup, accessories and decorations.” The ACAAI advises parents to be on the lookout for six potential triggers they may not be expecting, including:

• Gelatin  – Although it’s a less common trigger, research published in the Annals of Allergy, Asthma and Immunology shows gummy bears and other candies may contain this potential allergen. Parents can have their child tested for specific allergies and develop a food allergy treatment plan. They may also want to have some non-candy treats, such as stickers or small toys, on hand to swap for candy.
• Nickel – Costume details and accessories, such as belts, tiaras and swords may contain nickel — one of the most common causes of allergic contact dermatitis, which can make skin itchy.
• Dust mites – Old costumes packed away in attics or closets may be filled with dust mites, which trigger asthma and allergies. Parents should either buy or make new costumes or wash old ones before kids put them on.
• Makeup –  Some types of face and body makeup may include preservatives that may cause allergic reactions. Buying higher quality theater makeup can help avoid this trigger. Also be sure to test the makeup on a small patch of skin before applying it over a larger area of skin at least a few days before Halloween.
• Fog – Real fog or fog machines can trigger asthma in some people.
• Pumpkins – Allergies to pumpkins are rare, but they can develop suddenly — especially when they are moldy or dusty. As a result, pumpkins purchased at a busy grocery store are less likely to trigger an allergy.

You have been warned!!!  Please stay safe out there this Halloween.

Hot Tips for Cold Weather

While the blizzard of Christmas 2010 may have brought misery to many, it probably brought much-needed relief  to hayfever and outdoor allergy sufferers.

However, winter brings with it a whole new set of allergy and asthma triggers including dust, pet dander and mold. The American College of Allergy, Asthma and Immunology (ACAAI) offers tips on how to stay sneeze and sniffle free indoors this winter.

• Reduce moisture in your home to keep dust mites in check. Maintain humidity below 55%, and don’t use a humidifier or a vaporizer.
• Filter out dust and other allergens by installing a high efficiency furnace filter with a MERV rating of 11 or 12, and be sure to change it every three months.
• Banish allergens from the bedroom. Keep pets and their dander out, and encase mattresses and pillows with dust-mite proof covers. Limit curtains – use blinds that can be washed instead.
• Keep it clean. A clean home is especially important for allergy sufferers, who should wear a NIOSH-rated N95 mask while dusting, a chore that should be done regularly.
• Wash bedding and stuffed animals in hot water every 14 days and use a vacuum with a HEPA filter.
• Turn on the fan or open the window to reduce mold growth in bathrooms (while bathing) and kitchens (while cooking). Wear latex-free gloves and clean visible mold with a five-percent bleach solution and detergent.
• Don’t overlook the garage. Noxious odors or fumes can trigger asthma, so move insecticides, stored gasoline and other irritants to a shed, and don’t start the car and let it run in the garage.
• Box up books and knick-knacks and limit the number of indoor plants. When you are buying new furniture, like chairs or sofas, opt for leather or other nonporous surfaces to make cleaning easier.

Need more advice on allergies?  Want to get the word out about your allergy brands?  SRxA’s team of world-class allergy advisors can help.

Bad Breath? – Doctors speak doctor while Patients speak patient

While attending the ACAAI congress in Phoenix, SRxA’s Word on Health learned that despite the increasing availability of effective treatments, overall asthma care in the U.S. is suboptimal.

In a survey of almost 4,000 asthma patients, doctors and members of the general population, 71% of the asthma patients had disease that was either not well or very poorly controlled according to definitions established by current guidelines.

On the other hand, the majority of asthma patients said they thought their disease was well controlled, suggesting that many patients don’t understand the meaning of the term “adequate asthma control”.

The so-called Asthma Insight and Management study was a national survey of three populations, with responses from 2,500 asthma patients age 12 and older, 1,090 adults in the general population, and 309 health care providers.  It was conducted by SRxA Advisors, Michael Blaiss,  Eli Meltzer and colleagues, Drs Kevin Murphy, Robert Nathan and Stuart Stoloff

Among some of the more surprising results, researchers found:

• 64% of asthma patients thought their disease was well controlled because they had two or more months between exacerbations.
• 61% thought their asthma was well controlled because they had only been forced to go to the emergency room for asthma once in the previous year.
• Only 6% agreed their disease was either not well or very poorly controlled.
• Only 48% of patients reported that they followed the advice of their doctor.

Despite this, the disease burden is high.  63% of the patients said their asthma persisted throughout the year and 41% reported that the illness interfered with their life “some” or “a lot.”  Compared with the general population, Blaiss and colleagues found, asthma patients reported poorer general health, greater limitations on activity, and taking more than twice as many sick and disability days off work.

According to another SRxA Advisor, Dr. John Oppenheimer,  the study confirms what many clinicians have long suspected. He told us, “While there are many possible causes for suboptimal management, one of the problems is doctors speak doctor and patients speak patient.”

Both physicians and the manufacturers of asthma drugs need to make more of an effort to understand why asthma patients don’t use medications as directed  in order to help them improve both their health and quality of life.

What are your thoughts on this?  Word in Health is waiting to hear from you.

Pass the Nuts!

Although living with an acute peanut allergy can be scary and potentially life-threatening, according to the latest research from the American College of Allergy, Asthma and Immunology (ACAAI) it doesn’t mean that schools and airlines should totally eliminate peanuts from their surroundings.

“People with severe peanut allergies can work with their allergist to develop an action plan to prevent or manage attacks,” said ACAAI President, Dr. Sami Bahna.

Highly allergic people may react after ingesting minute hidden quantities of peanuts or even after touching or smelling peanuts. These patients often live in fear they will come in contact with peanuts but however much they try to avoid them, there is no guarantee that specific allergens can be removed entirely from an environment.

“Unfortunately, life is not risk-free,” said Dr. Bahna. “A minority of people are severely allergic to peanuts, but it is not reasonable or possible to expect schools or airlines to be peanut-free. Consideration should be also given to the freedom of the vast majority of non-allergic persons. Also, peanut is not the only food that can cause severe allergy.”

Dr. Bahna suggests that people and parents of children with severe peanut allergies check to be sure the school and airline carry emergency treatment and educate their personnel about food allergies, rather than call for an out and out ban.

Hold That Call!

Could you be allergic to your phone?  In the second of our series of stories emanating from this year’s American College of Allergy, Asthma and Immunology allergists warn that “increased use of cell phones with unlimited usage plans has led to more prolonged exposure to nickel.”

According to allergist Luz Fonacier, MD, “Patients come in with dry, itchy patches on their cheeks, jaw lines and ears and have no idea what is causing their allergic reaction.”

Nikel is one of the most common contact allergens, and affects up to 17% of women and 3% of men. Contact with objects containing nickel, such as keys, coins and paper clips are generally brief, so the nickel allergy may not occur on the area of contact. However, the risk is increased by frequent, prolonged exposure to nickel-containing objects, such as cell phones.

Symptoms of nickel allergy include redness, swelling, itching, eczema, blistering, skin lesions and sometimes oozing and scarring. Avoidance of direct skin contact is the best solution and experts suggest that if you have a nickel allergy or are experiencing symptoms that you try using a plastic film cover, a wireless ear piece, or switch to a phone that does not contain metal on surfaces that contact the skin.

Those who suspect they have allergies to cosmetics, tattoos or nickel should be tested by an allergist – a doctor who is an expert in diagnosing and treating allergies and asthma.

To learn more about allergies and asthma, take a free relief self-test or find an allergist near you visit www.AllergyAndAsthmaRelief.org.

Love Hurts!

SRxA’s Word on Health team just returned from a memorable trip to Phoenix, Arizona.  In addition to managing a number of highly successful events, meeting many of our wonderful clients and spending some quality time with our Advisors; we were able to catch up with all the latest news from the field of asthma, allergy and immunology.

During one of the more memorable sessions, we learned that kissing and um, er, let’s just say, more intimate contact, can be fraught with danger for those with allergies, while in another we found out that everything from our makeup, to our cell phones might be making us sick.

Over the coming days we’ll be sharing the congress highlights with are readers, but in the meantime, let’s get back to kissing…

According to Dr. Sami Bahna, President of the American College of Allergy, Asthma and Immunology (ACAAI), while allergic reactions from kissing are relatively uncommon, they do occur.

Apparently, allergens from food substances can linger in a partner’s saliva up to a full day following ingestion, irrespective of tooth-brushing, rinsing, flossing  or other interventions such as chewing gum.

And if you’re one of the 7 million Americans who suffer from food allergies we’re not just talking about a passionate kiss. Even a kiss on the cheek or the forehead from a partner who has consumed an identified allergen can cause a severe reaction ranging from lip-swelling, throat-swelling, rash, hives, itching, and/or wheezing immediately after kissing.

And kissing isn’t the only form of romantic activity that can trigger allergic reactions in the highly sensitive. The ACAAI notes that sexual intercourse can pose its own hazards, given that some patients are allergic to chemicals found in spermicides, lubricants and/or latex condoms.  Even sperm can prompt an allergic reaction in some, as can the more general emotional and physical exertion of intercourse itself.

When it comes to semen allergy, Bahna said antihistamines can sometimes help with mild issues, as can immunotherapy treatments offered by allergists. Condoms can also help, as long as a person is not allergic to latex!

Despite these warnings, Bahna stressed, “I do not want this discussion to cause all people with allergies to live in fear. If your girlfriend or your wife is not very allergic to peanuts she won’t be affected by a kiss from a person who ate peanuts.”

Additionally, allergists can help determine what’s causing the allergy and find the right treatment. They have the training and expertise to treat more than just symptoms. They can identify the source of your discomfort and develop a treatment plan to eliminate it.

You can follow the ACCAI annual meeting on Twitter at #ACAAI2010.

Word on Health Goes West

SRxA’s Word on Health in-house team of healthcare experts and many of our renowned Clinical Advisors are about to head out for the annual American College of Asthma Allergy and Immunology (ACAAI) congress, which, this year, is taking place in Phoenix, AZ; from November 11-16.

In addition to educating ourselves on all that’s new in this exciting specialty, we are available to meet with our existing and potential new clients.

Our multitalented, multinational team has, between us, decades of experience in clinical practice, clinical research, regulatory strategy, compliance, professional education, publications, pharmaceutical sales and marketing, advocacy, thought leader development, health outcomes and consulting.

If you are looking for help with:

• Strategic planning
• Product support
• Professional marketing
• Clinical development
• Regulatory strategy
• Social media outreach
• Peer-to-peer education
• …and so much more

we’d love to meet you and explain how SRxA can transform your challenges into opportunities.

Contact us today to set up an appointment.