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Study: Household cleaning sprays increase asthma risk
Regularly using household cleaning sprays or air freshener sprays could increase your risk of developing asthma, according to a study in the American Journal of Respiratory and Critical Care Medicine. Researchers at the Centre for Research in Environmental Epidemiology at the Municipal Institute of Medical Research in Barcelona, Spain, used a 10-country database, the European Community Respiratory Health Survey, to identify more than 3,500 people without any history of asthma or asthma symptoms. All subjects reported responsibility for the cleaning of their homes. After an average of about nine years, researchers conducted follow-up interviews to give lung function tests and to find out what types of cleaning products subjects used and how often, as well as to ask if an asthma diagnosis was received or any asthma medications were used during the study period. Weekly use of a spray cleaner increased current asthma risk by 45 percent in women and 76 percent in men. Among those who used cleaning sprays at least four days a week, asthma risk more than doubled.

22 new centers added to upcoming study of American children
The National Children's Study, to be the largest study about environmental and genetic impacts on American children’s health, will be directed from 22 additional centers (joining seven previously named) across the United States, organizers said at a recent special news conference. The study, which will follow 100,000 children from before birth to age 21, is a collaboration by the U.S. National Institutes of Health, the Centers for Disease Control and Prevention, and the Environmental Protection Agency. The first participants enrolled are scheduled to be recruited as early as next year. The study will concentrate on a wide range of conditions, including birth defects, premature births, autism, asthma, diabetes, heart disease, obesity, mental health and learning disorders.

Eating more fish, veggies may lower kids’ asthma risk
Children who eat fish and “fruity” vegetables may be less likely to develop allergic disease and asthma than their peers, according to a study in Pediatric Allergy and Immunology. Researchers at the University of Crete, Heraklion, Greece, followed 460 children, periodically interviewing their parents during the children’s first 6.5 years of the life. Questions related to factors that affect a child’s allergic disease risk, such as prenatal diet, breastfeeding, secondhand smoke exposure, allergic disease and allergy family history. Even considering these factors, diet was strongly related to the children’s asthma and allergic disease risk. Children who ate the most fish were 57 percent less likely to develop allergic disease than their peers who ate the least amount of fish. Children who ate the most “fruity” vegetables, such as tomatoes, eggplant, zucchini and green beans, were 62 percent less likely to have wheezing problems, compared with their peers who ate the least amount. Fruit and other types of vegetables were unrelated to asthma and allergic disease risk.

House doesn’t override Bush veto
of child insurance bill
The U.S. House of Representatives recently failed to override a veto by President Bush of a children's health insurance bill that opponents said was too expensive. With a 273 to 156 vote, the bill ended 13 votes short of the two-thirds majority needed for an override.

A message from ACAAI President Dr. Daniel Ein

It’s that time again when America engages in its quadrennial exercise in democracy — the presidential elections. The campaigns have started earlier than ever and candidates are out on the trail and weighing in on those issues of concern to voters. Among these, health care is repeatedly cited as near the top, right after the war in Iraq and terrorism.

For those of you who intend to vote in your state primaries (and I hope you do), you will want to familiarize yourselves with the candidates’ positions on the issues, especially health care.

All the major candidates have articulated policies for health care reform, and comparing them is interesting — and instructive. In broad terms, the approaches are predictable by party affiliation. Democrats (Clinton, Obama, Edwards) want universal coverage, which they want to implement by mandating insurance for all individuals, with government as a backup to the private insurance market.

Republicans (Giuliani, Romney, McCain) resist mandates and expansion of a government role. Instead, they believe in the power of the free market to provide coverage and call for easing individuals’ purchase of private health insurance through tax incentives.

For both parties, the operative phrase is “individual responsibility” for insurance coverage, but also for taking care of one’s health.

Democrats want employers to provide insurance and/or allow individuals to purchase insurance from a federal program, such as the one covering federal employees. They are all in favor of expanding Medicaid and SCHIP. They all call for increasing the use of information technology and preventive medicine. None of them call for medical liability reform except for John Edwards (surprisingly) who wants to reduce frivolous suits by requiring that two experts certify the merits of a case.

None of the major Democratic candidates (Clinton, Obama, Edwards) call for a government-run system, but all want access, when private coverage is not an option, to government insurance. Some critics say this will inevitably lead to a government-run system because the private sector cannot compete on price with the public system.

There are not many differences among the proposals. Obama does not ask for an individual mandate, unlike the other candidates, but other differences are small. All build on the current system and fine tune it, but with an emphasis on moderate insurance industry reform, (such as eliminating community rating, an idea which has been floating around for at least 20 years), increasing public health initiatives, encouraging adoption of information technology and using the government as the insurer of last resort.

All propose to finance universal coverage by repealing the Bush tax cuts, among other measures, to raise money for the program.

The Republican candidates have not been as comprehensive in their plans as the Democrats. There really is less to say about their platforms, and therefore this section is shorter. All want medical liability reform. They all want to ease access to Health Savings Accounts.

Mitt Romney’s proposal is arguably the most complete, in part because he presided over health care reform in Massachusetts, and he builds on that experience. He calls for increased cancer research funding. (None of the candidates asked for more allergy research funding!) He and Giuliani want to work through the states as laboratories of innovation in health care delivery. Giuliani calls for use of information technology. He wants to streamline FDA drug approval processes as a way of reducing drug costs. McCain supports community health centers and SCHIP expansion.

I have not included the ideas of the second-tier candidates because, well because they are second-tier and are unlikely, at this point, to become their parties’ candidates. I encourage you to look at them yourselves by logging on to their Web sites, if you are interested.

Don’t forget to vote for the candidate of your choice, at least in the general election. It is a privilege and, I believe, an obligation that we have as citizens. And so much hangs in the balance with the ever-increasing calls for health care reform that physicians must weigh in. Our futures, and the futures of our patients, are at stake.

NAEPP asthma guidelines summary document now available
Dr. William W. Storms, Colorado Springs, Colo., the College’s representative to the NHLBI NAEPP (National Asthma Education Prevention Program) Committee, provides the following report on the recent Committee meeting.

The new guidelines are titled EPR-3 2007 (Expert Panel Report #3). The full source document with all the supporting data is available on the Internet. The summary document is 60 pages long and also is available on the Web at
http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.htm .

The new guidelines were put together by an ad hoc committee that was formed specifically to develop evidence-based asthma guidelines for this EPR-3 Report. Another committee, the Guidelines Implementation Panel (GIP), was formed to develop the messages of the guidelines and ways of implementation.

View the ACAAI Annual Meeting final program online
The final program for the ACAAI Annual Meeting in Dallas, Nov. 8-14, is now online. View the wide array of scientific programs, workshops and Meet the Professor Breakfasts offered. Browse through the abstract titles and presentation times. For entertainment and relaxation with your colleagues, check out the social events. Spread the word about the special programs the College offers for fellows-in-training, allied health professionals, office administrators and asthma educators.

Although online registration is closed, advanced registration continues until Nov. 2. Download and fax in your registration forms today. Housing and transportation information is also available online.

We invite you to join your colleagues at the state-of-the-art Gaylord Texan Resort and Convention Center, situated on 150 acres on Lake Grapevine in the heart of Texas wine country. The resort’s restaurants are the finest in regional cuisine, offering live music, entertainment, dining and dancing at the Glass Cactus overlooking the lake. Shoppers can visit the unique stores and markets on site, or take the free shuttle to downtown Grapevine or Grapevine Mills, the largest shopping mall in Texas.

For recreation and relaxation, there is something for everyone, including:
• Biking, jogging trails and horseback riding
• World class spa and fitness center, a contemporary outdoor pool and a 20-meter indoor lap pool
• 18-hole golf course at nearby Cowboy Golf Club
• Boating, waterskiing, jet skiing and fishing on Lake Grapevine.

Remember to purchase tickets for the Annual Meeting Fundraising Dinner and performance by world-renowned vocalist and entertainer Wynonna Judd on Sunday evening, Nov. 11, benefiting the Foundation. The event is supported in part by grants from Alcon Laboratories Inc., AstraZeneca LP, Sepracor Inc., and Teva Specialty Pharmaceuticals.

Dynamic and motivational Annual Meeting
scientific programs you won’t want to miss
The ACAAI Annual Meeting in Dallas, Nov. 8-14, is chock full of practical scientific programs you and your patients can implement immediately. Learning is intensified at these exciting, interactive state-of-the-art programs.

The Great Asthma Raft Debate: Saturday, Nov. 10 – Experts involved in asthma management are adrift in a life raft. There’s enough food and water in the raft for only one to survive, and the surrounding waters are teeming with sharks. Each expert has exactly 15 minutes to make his case on what causes asthma. Come and see who gets tossed to the sharks!

Practitioner’s Edge: Sunday, Nov. 11 – Learn about the new asthma treatment guidelines in a new innovative, case-based interactive symposium that provides attendees with cutting-edge medical education in a peer-to-peer discussion format. The program engages the practicing physician by linking discussion of the latest scientific data with its application in the clinical setting.

Medical Crossfire: Monday, Nov. 12 – Through debate and authoritative peer-exchange this Medical Crossfire will confront issues related to optimal management of seasonal and perennial rhinitis. This session will include an interactive exchange where panel members will share clinical data and insights on the impact and action plan for the use of OTC and prescription agents.

Wyeth Pharmaceuticals announces OTC CFC-MDI phase-out
As you may know, on Sept. 20, the Food and Drug Administration (FDA) announced a proposed change to its regulation on the use of chlorofluorocarbons (CFCs) in metered dose inhalers (MDIs) for epinephrine. The rule would remove the “essential-use” designation that allows the use of CFCs in these medications. The Proposed Rule has a 60-day public comment period, which began Sept. 20 and ends Nov. 19.

FDA proposes that any rule finalizing the removal of the essential use for OTC epinephrine MDIs have an effective date of Dec. 31, 2010. Should this rule become final, epinephrine MDI users will have to obtain a prescription for alternative drug products if a non-CFC epinephrine inhaler still does not exist.

Wyeth Consumer Healthcare, the manufacturer of the OTC epinephrine MDI Primatene Mist®, notified the College that they will comply with the FDA’s Final Rule that will outline the final date that OTC MDIs must be off store shelves, and they do not plan to reformulate.

“The Proposed Rule has no immediate effect on our ability to sell Primatene Mist®,” wrote Thomas J. Croce, Jr., RpH, senior director of professional affairs, Wyeth Pharmaceuticals. “We will continue to make Primatene Mist® available and phase the product off the market in accordance with the timeline outlined in the FDA’s Final Rule.”

“We understand FDA’s decision may create concern among consumers about how they will treat their mild asthma. We hope to work with you to encourage patients to consult their health care providers about obtaining alternative asthma therapies,” he noted.

Welcome to the AMA Corner prepared by Dr. Alnoor A. Malick, ACAAI Delegate to the AMA House of Delegates, to keep you abreast of important AMA news and developments impacting allergy-immunology.

AMA, AARP urge Senate to avert Medicare physician payment cuts
A joint television ad from the AMA and AARP is airing in select areas of the country and Washington, D.C., to spur congressional action to preserve Medicare patients’ access to health care. Over the next two years, Medicare will cut payments to physicians 15 percent, while practice costs increase 20 percent. And since 2000, Medicare patients have seen their premiums double. In the joint TV ad, the AMA and AARP ask, “If doctors are forced to downsize their practices and Medicare premiums rise even higher, how will you get the care you need?”

The AMA and AARP are calling on the U.S. Senate to take action similar to the House of Representatives, which passed legislation to eliminate $54 billion in excess payments to private insurers offering Medicare Advantage plans. Only one in five seniors is enrolled in Medicare Advantage, but these excess payments to insurers are coming out of everybody’s pockets.

Learn about health savings accounts
The AMA has published the second edition of “Health Savings Accounts at a Glance,” an advocacy brochure first published in 2004, following the authorization of health savings accounts (HSAs). This resource uses question-and-answer format to explain how HSAs work, why they should be considered and where to find additional information about them. The new edition updates HSA dollar limits, reflects legislative changes and features two new sections offering practical guidance to patients and physicians. It is anticipated that “Health Savings Accounts at a Glance” will continue to serve as a valuable, concise primer on HSAs.

Wanted: examples of inaccurate health plan provider listings
The AMA Practice Management Center seeks examples of inaccuracies contained in health plan's physician provider listings. These inaccurate listings cause confusion among patients, interfere with the patient-physician relationship and require physicians and their staff to spend a significant amount of time and effort to get them corrected. If you have experienced inaccurate health plan provider listings, please send the example(s) that identify the health insurer and include a brief description of the inaccuracy to practicemanagementcenter@ama-assn.org or fax them to (312) 464-5541. The AMA Practice Management Center will use this information to identify health insurer inaccuracies that require further action.

We hope you can attend the ACAAI Annual Meeting in Dallas, Nov. 8-14. The program looks especially attractive for FITs. The College meeting is a great opportunity for new FITs to get exposed to timely topics from leaders in the field. For FITs near the end of their training, the Doctors Job Fair is an excellent opportunity to explore available positions and network.

Along with the daily scientific sessions, remember also to take advantage of the workshops and Meet the Professor breakfasts that are available to FITs at a reduced price. These have limited space and are a great opportunity to hear from leaders in the field in a smaller forum. Some popular programs among FITs include: the Literature Review Course; A Practical Approach to Aeroallergen Identification (W-1); Introductory Course in Rhinolaryngoscopy (W-4); plus workshops on patch testing, diagnostic allergy testing, immunotherapy tips and much more!

Other events for FITs include: the complimentary Welcome Reception, the FIT breakfast with the program directors, and the popular FIT Bowl. This is a Jeopardy-style forum of fun with all programs encouraged to have a team compete.

The FIT business meeting will be Monday, Nov. 12, at which a new vice chair (Junior ACAAI National Fellow-in-Training Representative), as well as Canadian Fellow-in-Training Representative and International Fellow-in-Training Representative will be elected.

Per the Rules of Order for the FIT Section, nominations must be received prior to the FIT Business Meeting. No nomination can be accepted during the business meeting. The application form for these positions is on the FIT page of the ACAAI Web site.

Dr. Soo Kim-Delio, Senior National Fellow-in Training Representative
Dr. Bret Haymore, Junior National Fellow-in-Training Representative

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