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February 2, 2005 |
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Welcome to ACAAI eNews — a bi-weekly aggregated news service
from the American College of Allergy, Asthma & Immunology. To be
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Stories |
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Regulatory Updates |
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Distance Learning |
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Association
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Fellows-in-Training |
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Calendar |
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Archive |
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FIT Archive |
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In my opinion, most patients with chronic
rhinosinusitis should be treated empirically with an
aggressive course of an antibiotic proven effective
against resistant streptococcus pneumoniae. |
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Distance Learning |
From the 2003 ACAAI ANNUAL MEETING
Nov. 7-12, 2003, New Orleans
• Two Symposia Online
Link
• Plenary Sessions CD-ROM and DVD
Link
• XI International Food Allergy Symposium,
General Sessions & Symposia
Audio CD & Audio Tape
Link
From the 2002 ACAAI ANNUAL MEETING
Nov. 15-20, San Antonio
• Five Symposia Online
Link
E-mail:
k.knauer@UHHS.com
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Calendar |
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MARCH
AAAAI Annual Meeting
March 18-22, San Antonio, Tex.
Tel: 414-272-6071
E-mail
Link
JUNE
World Allergy Congress
June 26 – July 1, Munich, Germany
Link
ONGOING
World Allergy Organization Society Meetings
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Sponsored
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Top
Stories |
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Ethnicity may affect risk of asthma hospitalization
South Asian and black people have a higher risk of needing
emergency treatment for asthma than white people, according to a
study in The Lancet. Scientists at University of
Edinburgh examined how asthma symptoms varied among different
ethnic groups by looking at results from 13 previous U.K.
studies. Though south Asian participants had the lowest rates of
symptoms and asthma diagnoses, they were three times as likely
as white participants to be hospitalized for asthma. Black
participants had slightly higher asthma rates than white
participants — and were twice as likely to be hospitalized for
asthma. The researchers suggest that asthma may be experienced
differently among different ethnic groups, and those groups may
benefit from targeted services.
U.S. birth raises asthma risk for
Mexican Americans
Mexican Americans born in the United States are at least
twice as likely as those born in Mexico to develop asthma,
according to a study in the American Journal of Respiratory
and Critical Care Medicine. Researchers from the Centers for
Disease Control and Prevention analyzed data from more than
17,000 Mexican Americans who participated in the Third National
Health and Nutrition Examination Survey (NHANES III) or the
National Health Interview Survey (NHIS). Asthma rates among
U.S.-born Mexican Americans was about 7.5 percent, but among
those born in Mexico it was about 2.7 percent. Researchers also
discovered that asthma rates among Mexican-born subjects
increased in relation to the length of time they had lived in
the United States.
Not necessary to step down fluticasone
propionate
Starting patients with mild-to-moderate asthma on a high
dose of inhaled fluticasone propionate and then stepping down to
a low dose is no more effective than beginning with at a low
fixed dose in reducing sputum eosinophilia and bronchial
hyperresponsiveness, says a study in Chest. Italian
scientists randomly assigned 35 subjects with mild to moderate
asthma, normal lung function and high sputum eosinophil counts
to either a fixed dose of 200 mcg per day of fluticasone
propionate or a step-down starting with 1000 mcg per day and
reducing it to 200 mcg per day. Both approaches reduced
bronchial hyperresponsiveness to methacholine challenge and
sputum eosinophilia to a similar degree.
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 A
word from President Myron Zitt, M.D.
Since 2003 when the Boards of the ACAAI and the AAAAI met
in Chicago and agreed to collaborate on issues that impact
upon both organizations and upon our patients with
allergic and immunologic diseases, task forces made up of
representatives from each society have been extremely
productive. Representative of their efforts are consensus
papers that have been released during the past few months
on rhinosinusitis and smallpox vaccination. The College,
in collaboration with the American College of Chest
Physicians, also developed guidelines on aerosol therapy
devices. These three reports, which have been published in
peer-reviewed medical journals, are highlighted below.
Rhinosinusitis: Guidelines published in
supplements of the December issues of the Journal of
Allergy and Clinical Immunology and Otolaryngology – Head
and Neck Surgery were developed by an expert panel of
30 physicians from a wide range of disciplines including
allergy-immunology, otolaryngology, infectious disease and
radiology. The panel was convened by five national
societies including the American College of Allergy Asthma
and Immunology; the American Academy of Allergy, Asthma
and Immunology; the American Academy of Otolaryngic
Allergy; the American Academy of Otolaryngology – Head and
Neck Surgery; and the American Rhinologic Society. Our
College representative was Richard A. Nicklas, M.D.
This consensus paper, by proposing refined definitions and
categorizations of rhinosinusitis, aimed to establish
standards for clinical research and clinical trial designs
that would allow more appropriate use of pharmacologic,
immunologic and surgical interventions. One of the panel’s
hopes is that the employment of new guidelines by
caregivers and those conducting clinical studies will
reduce the inappropriate use of antibiotics, and curb the
increasing prevalence of antibiotic resistance.
Aerosol Therapy Devices: Evidence-based
guidelines for the selection of aerosol medication devices
published in the January issue of CHEST were
developed by the ACAAI and the American College of Chest
Physicians (ACCP). Richard C. Ahrens, M.D., represented
the College.
The guidelines concluded that health-care providers should
avoid basing device selection exclusively on its efficacy
in delivering medication to the patient, the current
practice of selection. While there are advantages and
disadvantages associated with each, all aerosolized
devices when used properly can work equally well and can
be interchanged. Factors influencing selection include
cost, availability, convenience, patients’ age,
preference, and competency in their use of the device.
Recommendations were put forth regarding device selection
in specific clinical settings, including the Emergency
Department, the Intensive Care Unit and inpatient and
outpatient situations. Regardless of which delivery system
is chosen, patient education is essential to assure
optimal outcomes.
Smallpox Vaccination: A report by the ACAAI/AAAAI’s
Joint Task Force on Smallpox Vaccination for Allergists
was published in the January edition of Annals of
Allergy, Asthma and Immunology. Co-chair Dan Ein,
M.D., represented the College.
Developed in response to the federal government’s
pre-event smallpox vaccination program and post-event
considerations, the report addresses many areas of special
concern for allergists if smallpox is reintroduced into
the population as a result of an act of bioterrorism. The
risk of having serious vaccination complications must be
weighed against that of developing a potentially fatal
(30% mortality rate) smallpox infection. Of particular
concern for the allergist are patients with active eczema
or atopic dermatitis, a history of these or other
exfoliative skin conditions, or are immunosuppressed. As
they are at greater risk of contracting vaccinia infection
when immunized or when exposed to the viral shedding of a
recently immunized individual, neither these patients nor
their family members and household contacts should be
vaccinated. Nonetheless, health care providers, including
allergists who may be at high risk of exposure to
smallpox, can be vaccinated, in spite of potential contact
to immunocompromised patients, if they adhere strictly to
site care and hand washing practices.
Over the coming months, I will highlight other
collaborative efforts of the ACAAI and the AAAAI. Working
together for the benefit of our patients and our peers, we
again demonstrate that “nobody does it better than the
allergist.”
Sincerely,
Myron Zitt, M.D. |
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Regulatory Updates |
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New Congress, same old health care themes
Lawmakers in the 109th Congress are gearing up for session,
with several health care issues on the horizon, including:
• Liability reform
• Medicare
• Medicaid
• Patient safety
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Regulatory Updates |
Altana to launch key Alvesco asthma drug in U.K.
German drugmaker Altana launched inhaled corticosteroid
ciclesonide (Alvesco) in the United Kingdom, and the company
also has plans to market it in Germany within the next month.
Altana's partner for the drug in the United States is
sanofi-aventis, but U.S. regulators have asked for more data
before they can approve the drug.
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Association
News |
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 Patients,
payment, protection-free benefits to you
by joining the Medem network
Through ACAAI’s relationship with Medem as a founding member,
you are able to utilize all of its services with no annual
subscription fees! This is a $195 per year value that is free
as part of your College membership. These services include:
• Customizable Practice Web Site – see
examples
• Secure Messaging and Online Consultation
• Links to many health plan online provider directories
• Secure payment
• Other exciting new services to be launched soon!
Plus, convenience for your patients:
• Improve patient satisfaction by making services and
information more convenient and available after hours for
patients. Through your practice Web site, your patients can
request appointments, look up peer-reviewed health care
information, request an Online Consultation, or prepare
for an office visit, even at night or on weekends. All of
these services can improve practice office efficiencies, as
well.
Revenue for your practice:
• Online Consultation allows you to be paid for your
time consulting your patients online. Recent surveys indicate
that 40 percent of patients are willing to pay for electronic
access to their physician. A growing number of employers and
health plans are reimbursing physicians for Online
Consultations because of the time and cost saving
benefits.
• Gain access to new insured patients from most major health
plans (United, Aetna, CIGNA, Blues plans, and others)
representing nearly 60 million covered lives, through links
from their online provider directories to your Medem Web site.
Currently, there are nearly 600,000 visits per month to Medem
physician practice Web sites by insured patients looking for a
physician, and this number grows significantly each month.
Move online and protect your practice from liability issues:
• eRisk Compliance brings your practice in sync with
guidelines set by medical malpractice liability carriers and
state medical boards.
• All of Medem's services are HIPAA compliant.
Not taking advantage of this valuable, yet free, member
benefit? Register
Your Practice Online or, for more information, please
contact Medem’s Member Service Department at
info@medem.com or
1-877-926-3336.
USA Weekend promotes asthma screening program
The Jan. 23 issue of USA Weekend newspaper supplement
encouraged readers with breathing problems to attend an ACAAI
asthma screening program. “If you are at risk of asthma or
need to determine whether your asthma is under control, use
the free Nationwide Asthma Screen Program. In nine years, NASP
has helped 80,000 people.” The ACAAI Web site was offered for
more information. The circulation of USA Weekend
exceeds 2.5 million, and there are nearly 17,000 visits each
month to its Web site where the announcement also is posted.
Allergy Practice Tip: Keeping
Patients on Time
Advice from The Patient-Centered Allergy Practice
Scheduling is at the heart of most patient flow issues. It
seems simple: Schedule patients so that you have plenty of
time to do everything you need to do for them, and allow some
buffer time for unexpected issues or delays. But it’s not so
simple in practice.
The Arthritis, Allergy and Asthma Center of Gainesville in
Gainesville, Ga., has two doctors that see approximately 50
patients a day, while the staff handles dozens of patients who
come in for allergy shots and lab tests. Their volume of
patients means the Center has had to set up procedures to make
sure their rule about patients showing up on time and being
seen promptly holds true.
“For one thing, doctors won’t see patients who are late,” says
billing manager Kellie Shewbert. “It’s a two-way street: the
doctor will be on time, but the patient has to be, too.”
These tips are created by The Patient-Centered Allergy
Practice, a CME series on practice management that is provided
by Physicians Practice, endorsed by ACAAI and supported by an
educational grant from sanofi-aventis.
To register or get more information about this program, please
call (800) 251-4920, e-mail
info@physicianspractice.com, or visit
www.PatientCenteredAllergyPractice.com. |
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Fellows-in-Training |
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Welcome to the Board Review Corner prepared by Thao Ngoc Tran,
M.D., a representative of ACAAI’s fellows-in-training (FITs) to
the Board of Regents. The Board Review Corner is your chance to
test your Board preparedness.
To refer to a previous Board Review Corner, click the “Archive”
link in the left column.
Immunology Review Corner: Chapter 36 of the 6th edition
of Middleton’s Allergy Principles and Practice, edited by
N. Franklin Adkinson, et al. Review questions were written by
fellows-in-training Drs. Thao Tran, Irena Veksler, Karla Lowe and Todd Levin.
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