April 2019

Allergic rhinitis continues to exact a high toll on the quality of life of Americans, according to a survey presented here at the American Academy of Allergy, Asthma and Immunology (AAAAI) 2011 Annual Meeting.

"The data are timely, as they were collected from patients who have allergies in surveys less than 1 year ago," study presenter Gary Gross, MD, from the Dallas Allergy and Asthma Center, Texas, told Medscape Medical News. "The results are more of a stimulus to try to improve the care for these patients whose lives are so dramatically influenced by allergies."

Reached for comment, Neeta Ogden, MD, an adult and pediatric allergist at Englewood Hospital and Medical Center in New Jersey, and member of the AAAAI, noted that "the quality-of-life impact can be overlooked in clinical practice."

"People may think allergies are not as 'life-threatening' as other medical problems like diabetes or high blood pressure, etc. However, untreated allergies, especially during the peak pollen months, can lead to daily impairment that affects work/school and quality of life," Dr. Ogden said.

Comparative Look at NASL 2010 and AIA 2006

At the AAAAI's annual gathering, Dr. Gross presented results of the 2010 Nasal Allergy Survey Assessing Limitations (NASL) Survey, looking at the effect allergic rhinitis currently has on the quality of life of Americans.

As part of the survey, 400 people aged 18 years and older who had been diagnosed with allergic rhinitis and who had experienced nasal allergy symptoms or taken medication for their condition in the past 12 months were interviewed. The findings were compared with 2500 respondents from the 2006 Allergies in America Survey (AIA) to determine the degree to which allergic rhinitis still affects patient quality of life.

A look at the 2 data sets suggests no apparent easing of the emotional toll of allergic rhinitis, the researchers say.

Table. Comparison Between NASL 2010 and AIA 2006

"The survey reminds us all that these patients suffer far beyond the congestion, runny nose, and sneezing that are characteristic symptoms of allergic rhinitis, and that they need more effective treatment to be productive and to improve their quality of life," Dr. Gross told Medscape Medical News.

He advised clinicians to "question patients who have allergic rhinitis more thoroughly regarding how allergic rhinitis impacts the quality of the patients' lives, and then try to determine the best approach to treatment."

The NASL 2010 survey also confirms that allergic rhinitis limits peoples' ability to participate in social activities (29%), to have or play with pets (34%), and to participate in outdoor (52%) and indoor (13%) activities.

Mirroring the AIA 2006 survey, 33% of respondents in NASL 2010 reported their symptoms affected them "a lot" or a "moderate" amount during the month when nasal symptoms were at their worst. In NASL 2010, work productivity was roughly 71% when nasal symptoms were at their worst; the figure was nearly the same (72%) among AIA 2006 respondents.

Nasal symptoms of allergic rhinitis also contribute to "substantial" sleep disturbances, including trouble falling to sleep and staying asleep, according to other data from the NASL 2010 Survey reported separately at the meeting.

New Data "Not Surprising"

In Dr. Ogden's view, the NASL 2010 findings are "not surprising, especially since allergy symptoms seem to be more intense than ever and people are experiencing new-onset allergies and worsening of existing allergies in the last few years."

"In terms of seasonal allergies," she said, "this has been attributed to global warming leading to more intense, longer seasons. People seem to have worse symptoms and often express breakthrough allergy symptoms even on doses of medications that used to help them before."

Following up with patients is key, Dr. Ogden said, "because there are a number of therapies out there that can be added if the first medication doesn't work. In addition, getting patients on your and their own radar in terms of allergy so they can start medications 2 to 3 weeks before the peak season is also important."

Dr. Gross and Dr. Ogden have disclosed no relevant financial relationships.

American Academy of Allergy, Asthma and Immunology 2011 Annual Meeting: Abstract 838. Presented March 20, 2011.

Source: http://www.medscape.com/viewarticle/739928 Megan Brooks

Spring allergy season is again off to an early start in many parts of the country, and doctors say there are some signs it may be even more miserable than usual this year.

Last year was the fourth warmest winter on record, with consistently mild temperatures. That led to record-breaking pollen counts that struck about a month earlier than normal in some places.

But this year, many areas got a false spring. Temperatures rose briefly and then dipped again. The swings caused pollen levels to rise, then fall, then rise again.

That pattern of pollen release sets people with allergies up for something called "the priming effect," says Stanley M. Fineman, MD, an Atlanta-based allergist and past president of the American College of Allergy, Asthma and Immunology.

“When patients are exposed, then the pollen goes away for a while, there’s a weather change or whatever, then they are re-exposed to that pollen, they can have an even more significant effect because their system is primed to respond,” Fineman says.

“It results in patients having a lot more difficulty with significantly worse symptoms” that may be tougher to get under control, he says.

Some parts of the South and East Coast began logging high tree pollen counts in January. Then pollen levels dropped in early February before climbing again by the end of the month. Plenty of allergy-prone people were caught unprepared.

At the Allergy and Asthma Center of Georgetown, in Texas, doctors say they began seeing people with seasonal allergies about a month earlier than usual.

“The typical symptoms are congestion, runny nose, itchy eyes, sneezing, watery eyes, sore throat, itchy throat, headaches, itchy ears,” not to mention all the patients who have asthma that’s triggered by allergies, says Sheila Amar, MD. “It’s pretty miserable."

Blame Climate Change

The bad news is that these amped-up spring allergy seasons probably aren’t flukes. Scientists say that as climate change accelerates, so will allergies.

“Springs are coming earlier,” says Jake Weltzin, PhD, executive director of the USA National Phenology Network, a government project to track the effects of climate change on the habits of plants and animals.

As the weather gets warmer earlier in the year, more plants and trees start to bloom at the same time, creating “a pollen bomb,” Weltzin says.

What’s more, experiments show that plants exposed to higher levels of the greenhouse gas carbon dioxide make more pollen. The pollen they make also has higher levels of proteins that trigger allergies, which makes it more potent.

Beat Allergy Symptoms

Doctors say the best time to treat allergies is before they flare up.

“Once your immune system is revved up and reacting to the allergens, it’s always harder to get it under control,” Amar says. “In general, being proactive is a much better approach.”

That can be tough to do when winter weather is unpredictable. If allergies already have you in their grips, some common-sense steps can cut the misery:

• On higher-pollen-count days, avoid going outside, especially in the morning when pollen levels are highest. If you have to go out, take your allergy medications with you.
• Keep windows and doors closed. Run the air conditioner instead.
• Wear a mask if you have to work outdoors.
• Take a shower at the end of the day to wash sticky pollen grains from your hair. That can help you get a better night’s sleep.

Source: http://www.medscape.com/viewarticle/780516 Brenda Goodman

More than one in five cases of anaphylaxis that occur in schools happen in people with no known allergies, and school staff are not always properly trained to handle them, a new study suggests.

"Bottom line, I think our findings underscore the need for continued education in the school setting," Martha White, MD, director of research at the Institute for Asthma and Allergy in Wheaton, Maryland, told Medscape Medical News.

Dr White presented the findings here at the American Academy of Pediatrics (AAP) 2015 National Conference.

The study highlights two different scenarios: people who experience their first anaphylaxis event and would benefit from epinephrine autoinjectors stocked by the school, and people with a diagnosis of anaphylaxis who may or may not have their injectors handy.

"We want to have this lifesaving medication at school," said session organizer and moderator Mandy Allison, MD, from the University of Colorado in Aurora.

Several states now have passed or are passing legislation that allows the school to stock lifesaving medication not designated to a specific person, she reported.

The data come from a web-based survey of schools participating in the EpiPen4Schools program, developed by Mylan Specialty, which distributes epinephrine autoinjectors to more than 30,000 elementary and high schools, free of charge, in the United States.

Of the 32,387 schools invited to participate in the survey from May to July 2014, 6019 responded. Most were completed by the school nurse.

There were 919 anaphylactic events reported by 607 (11%) of 5683 schools.

Information on the anaphylactic event was included in 852 of the completed surveys. People with no known allergies experienced 187 (22%) of the events, and students experienced 757 (89%) of the events. Of the 757 events experienced by students, 32% were in grade school, 19% were in middle school, and 49% were in high school.

Food, Insect Bites, Other Triggers

Triggers were included in 847 of the surveys: 62% of the triggers were food, 20% were unknown, 10% were insect bites, 7% were environmental or related medication or health factors, and 1% were latex.

Treatments were included in 851 of the surveys: 75% were epinephrine autoinjectors, 24% were antihistamines, and 1% were unknown.

"Epinephrine is the only approved treatment, yet even in the schools that received free EpiPens, only 75% used them," Dr White pointed out. "That is an opportunity for education, because antihistamines won't stop anaphylaxis."

There were no deaths reported, suggesting that those who received antihistamines most likely had mild symptoms that would have cleared anyway, she pointed out.

Of the 636 epinephrine-treated events, 49% used autoinjectors from the school supply and 45% used the person's personal autoinjector.

Use of the school supply does not necessarily mean the individual did not have their own autoinjector with them. It might just have been easier for the school nurse to grab the stock pen than to go searching for the personal pen in an emergency, Dr White explained.

And, of course, the stock pen would have been used in all of the cases of first-time anaphylaxis treated with epinephrine, she added.

Trained to Treat

Of the 5613 schools that responded to questions about staff training, 36% reported that the only people trained to recognize the signs of anaphylaxis were the school nurse and a small number of others, 29% reported that most staff members were trained, and 31% reported that all staff members were trained. However, 54% of the schools permitted only the school nurse and select staff members to administer epinephrine.

"Teach the kids how to use the devices themselves, as long as they're mature enough to do it. For the adolescents, try to reinforce non-risk-taking and the avoidance of triggers. They need to be told this can kill you," Dr White advised.

"There's not always a nurse in every school, so other folks need to be trained to use these medications," Dr Allison told Medscape Medical News. "We still have a long way to go in terms of when to use epinephrine autoinjectors and what the indications are. They're probably being underutilized," she said.

"Our training should focus on school nurses, but also on the folks who are more likely to be present at the moment the reaction occurs. That's not always the nurse," she pointed out.

This can be a real problem if, for example, a child has an anaphylaxis event on the playground, said Dr White. In such a scenario, "the teacher has to transport the kid to the health room to get treated. That's an opportunity for education as well," she said.

She noted that many of her teenage patients know how to administer the epinephrine themselves, and that many teenage babysitters are trained to use the devices for their charges. "If I can train teenagers to do it, I'm sure the schools could train the teachers."

Dr. Allison said that these data are fairly consistent with those from other publications, although there is not a huge database to compare them with. And, she said, these results are not ideal because of the extent of the missing data, both in the overall response rate and in the answering of individual questions.

"It's not the perfect study, but it is some of the better data that we have on a national level. It's starting to give us an idea of what's going on in schools," she added.

Dr White is a consultant for Mylan and has worked with most of the other companies that make allergy- and asthma-related products. Dr Allison has disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2015 National Conference. Presented October 24, 2015.

Source: http://www.medscape.com/viewarticle/853486 Miriam E. Tucker