Aspirin therapy may lower women’s asthma risk
An every-other-day, 100-milligram dose of aspirin may reduce asthma risk in women, according to a study in Thorax. Scientists at Brigham and Women's Hospital in Boston studied data from the Women's Health Study, during which approximately 37,000 healthy women were assigned to take aspirin, vitamin E, both, or neither. The findings indicated a 10-percent reduction in asthma risk with aspirin therapy, but the benefit wasn’t seen in obese women. The study’s authors emphasize that more studies are needed, however, before recommending aspirin therapy solely for this purpose.

Free drug samples can mean higher drug expenses
People receiving free prescription samples from their physicians have significantly higher out-of-pocket costs for their prescriptions in the long run than people who don't receive free samples, according to a study in Medical Care. Researchers at University of Chicago Medical Center collected data about 5,709 patients who participated in the Medical Expenditure Panel Survey, conducted by the U.S. Agency for Healthcare Research and Quality. The data showed that patients who received free samples spent about $166 in out-of-pocket costs on prescription drugs in the six months before receiving the samples, $244 for the six months during which they received samples, and $212 for the six months after receiving the free drugs. Patients who didn't get free samples spent about $178 on prescription drugs over six months.

Message from ACAAI President Dr. Jay M. Portnoy

What is the College going to do about it?

In the last few weeks, I have received numerous e-mails and phone calls related to two different, but related, issues. The first issue involves a company that has been sponsoring dinner programs across the country directed to primary care physicians, during which those physicians are encouraged to perform specific IgE testing of their patients to determine whether they have allergies. The stated rationale is that an accurate diagnosis is the best guide for choosing the best treatment. Who could argue with that? Allergists are understandably concerned about this message, because it appears to encourage physicians to order possibly unnecessary tests, which they often misinterpret. And, it may lead to fewer referrals to allergists of patients who could benefit from a specialist’s input. In addition, the implication of this message is that a dinner lecture is equivalent to 2 years of fellowship training in allergy.

Intertwined with concerns about the dinner programs are concerns about a recent television broadcast discussing a controversial clinic for the “chemically sensitive” in Texas, which offers patients a multiple-chemical-sensitivity treatment program. During the interview, a clinic patient describes how mercury in vaccines continues to cause harm (mercury has been removed from required childhood vaccines for the last 4 years), and how what sounds like provocation/neutralization has significantly improved her life (despite the fact that it was shown to be ineffective in a controlled study published in the New England Journal of Medicine about 10 years ago). The most interesting aspect of the piece is that the patient needs to spend periods of time in a completely chemical- and mold-free environment that is coated in aluminum foil, yet she is interviewed in a horse barn, which is probably the most contaminated environment one could inhabit, displaying no adverse health effects. Dr. David Khan did an excellent job on the program of explaining the limitations of this type of thinking.

The main question I receive about these types of issues is, “What is the College going to do about it?” Well, what indeed is the College going to do about it?

The question itself implies that something needs to be done and that the College should do it. With respect to specific IgE testing, the College has entered into a dialogue with an official at that company. When the executive committee agreed to this dialogue, this individual stated that this was “amazing.” He told me that representatives of his company have tried to discuss the role of specific IgE in clinical decision-making with allergists for years without success because the official party line has been that skin tests are the gold standard and that measurement of specific IgE should be reserved only for rare situations in which skin testing could not be done.

Refusal to discuss the role of IgE testing in clinical practice assumes that companies that offer such testing will simply disappear, which is not realistic. Instead, they do what they have to do to survive, approaching primary care providers directly. By entering into a dialogue, allergists can participate in altering the message delivered at these dinner programs, so that it more accurately reflects reality, which is that in-vitro measurement of specific IgE has its place in clinical decision-making. The question isn’t, “Which test is better?” But rather, “How can clinical information be used to make decisions about the best treatment to offer to our patients?” When the message changes to how primary care providers and allergists can work together to help allergic patients, everyone wins.

The question of what to do about suspect “cures” is more challenging. Some individuals will always be attracted to pseudoscience as an explanation for their ailments for reasons that I do not understand. For such true believers, there is very little that can be done. Since the supply of such individuals seems to be unlimited, the College will never be able to eliminate those claiming to offer “miracle cures.” What the College can do is to ensure that patients who genuinely want the best allergy care know how to get it. That is the purpose of the College’s public awareness campaign. By making the public aware of the expertise that allergists have, we can at least ensure that allergic individuals have access to the best care that is available based on scientific, evidence-based medicine.

So what should we do if we see what appears to be false or misleading claims about allergies? I usually get a little upset. I then realize that some individuals will seek that type of care regardless of the evidence, and I proceed to provide the best care I can to my patients. That, in my opinion, is the best thing that any of us can do.

ACAAI Annual Meeting: Embracing the Challenges of Change

• Space Needle – a 41-second elevator ride takes you up 520 feet to the observation deck or to SkyCity, the revolving restaurant at the top.
  
  
• Seattle's Pike Place Market – 200 businesses operating year-round, 190 craftspeople and 120 farmer booths, plus street performers, musicians
  
  
• Seattle waterfront – bustling collection of attractions, restaurants and shopping, as well as starting points for ferries, cruise ships, the Victoria Clipper and Argosy boat tours
  
  
• The state ferry system – taking passengers and their vehicles from Seattle and nearby departure points to Vashon Island, the Kitsap Peninsula, the San Juan Islands and Canada.
  
  
• Bill Speidel’s Underground Tour – guiding visitors through the hidden subterranean passages that once were the main roadways and storefronts of old downtown Seattle and telling stories of the frontier people who lived and worked there.

Join your colleagues in the vibrant city of Seattle for a state-of-the-art, dynamic scientific program built on 65 years of experience. Save the date of the ACAAI Annual Meeting, Nov. 6-11.

Improve patient safety and enhance your liability protection
Patient safety and medical liability protection requires that you are well-informed about patient safety issues quickly and reliably. New free services can help your practice improve the speed and efficacy of these important alerts.

The College supports the numerous medical liability carriers, the FDA, medical societies and other organizations that have worked together to bring this service, the Health Care Notification Network (HCNN) to you.

Enroll today in the HCNN and receive FDA-related patient safety alerts online. You will need to input basic demographic information, including your preferred email address. This process will take less than 2 minutes.

Thank you for taking this important step and working with us to enhance patient safety and improve liability protection.

College members invited to join lobbying activities on Capitol Hill
College members are invited to join the ACAAI Board of Regents’ fifth annual trip to Capitol Hill on May 1, 2008, at their own expense. Activities include a legislative workshop and meetings with Congressional representatives and staff. For more information about participating in the legislative visits, contact president@acaai.org.

View vodcasts of the Named Lectures
Presentations from the Named Lectures at the 2007 ACAAI Annual Meeting, are vodcast weekly.

The new vodcasts include:

• “Edward J. O’Connell Lecture: Improving Safety in Allergy Practice” – by Dr. Donald W. Aaronson
  
  
• “Bernard Berman Memorial Lecture: Abnormal Antibody Responses: When to Intervene?” – by Dr. Mark Ballow

Each vodcast contains the original audio and presentation slides. Future vodcasts will feature named lectures and the symposium, “Allergic Rhinitis and the Allergist.” Previous vodcasts are archived for continued viewing.

Dmrkynetec, a survey firm with extensive experience in the area of physician practice finance, will soon begin contacting randomly selected physicians and practice managers in order to collect their confidential responses. If you are selected to participate in it, please complete it thoroughly and accurately and encourage your staff to make this information available.

Board Review Corner
Welcome to the Board Review Corner prepared by Drs. Bret R. Haymore and Jennifer W. Mbuthia, Senior and Junior Representatives of ACAAI’s fellows-in-training (FITs) to the Board of Regents. The Board Review Corner is an opportunity to help hone your Board preparedness.

To refer to a previous Board Review Corner, click the “FIT Archive” link in the left column.

Review Questions: Chapter 23 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al. Review questions were written by Dr. Bret R. Haymore, Walter Reed Army Medical Center.