Allergic rhinitis (AR), a condition characterized by sensitivity to allergens leading to poor quality of life, including disrupted sleep, reduced vitality, lowered mood, changes in blood pressure limited frustration tolerance, impaired focus, decreased performance in academic and professional settings, and millions of missed work and school days every year. Approximately 20–40% of individuals in the United States are affected by AR, which carries notable clinical and financial burdens. Interestingly, there is a strong link between AR and asthma to the extent that countries with a high prevalence of rhinitis have asthma rates ranging from 10% to 25%. Research has indicated that Allergen Immunotherapy (AIT) is associated with improved AR symptoms, a potential to resolve the AR over time, a decreased likelihood of asthma exacerbations and incidence of pneumonia in individuals with concurrent asthma, which are advantages that persist for years even after the cessation of treatment. 

Although patients presenting with allergies are first seen and treated in the primary care setting, gaps in training and the lack of available guidance for primary care practitioners have significantly impacted the quality of care for these patients with persistent AR symptoms, resulting in inefficient use of healthcare resources. To complicate matters, there is an insufficiency of allergists and immunologists, impacting the capacity to provide next-level care to the number of AR patients who could benefit from AIT. Hence, there is a critical need to equip primary care providers with educational experiences on essential concepts related to immune responses in allergies and asthma, recognizing the significance of the common airway in treating these entities and familiarization with the scientific evidence supporting various options for AIT. 

The development and implementation of medical education and algorithms designed to assess diverse patients’ symptoms, pharmacotherapy approaches, and situations where AIT can be initiated or sustained are warranted. The present commentary proposes a workflow model of the critical steps for managing and treating mild to moderate respiratory allergies via AIT in primary care settings. In addition, the initial development of medical education programs to minimize the burden on allergy-specialized care while, importantly, actively improving patient outcomes will be discussed.

Sources:

https://pubmed.ncbi.nlm.nih.gov/25951791/ 

https://pubmed.ncbi.nlm.nih.gov/34523884/ 

Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program 

https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0010/22240/kessler-psychological-distress-scale-k101.pdf 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264048/ 

https://www.health.harvard.edu/diseases-and-conditions/is-stress-making-your-allergy-symptoms-worse 

https://journals.sagepub.com/doi/full/10.1177/1945892419884789

What's the culprit behind summer allergies?

Various grass species, such as Bermuda grass, Timothy grass, Kentucky bluegrass, and ryegrass, produce pollen during their reproductive cycles. These pollen grains are light and quickly dispersed by the wind, making them highly prevalent in the environment during the summer months. Grass pollen allergies are common, affecting a significant portion of the population. The prevalence and demographics of affected individuals may vary based on factors such as geographical location, climate, and genetic predisposition.

The COVID-19 pandemic has left an indelible mark on the healthcare landscape. A byproduct of the pandemic is a major need for population based mental health screenings in all primary care and pediatric settings. Presentation of mental health concerns is now at an all-time high, especially among children and adolescents. 

The U.S. Preventive Services Task Force is an "independent, volunteer panel of national experts in disease prevention and evidence-based medicine" that makes recommendations specifically towards prevention. The Task Force recently released a comprehensive report regarding the need to screen children and adolescents for mental health concerns, especially anxiety, and concluded that screenings for anxiety in children and adolescents aged 8 to 18 years are recommended as a best practice in primary care. Similar recommendations indicating all adults under 65 should be screened for anxiety were released by the expert panel in September 2022. 

Our children and grandchildren have suffered numerous losses throughout the pandemic, from the challenges of remote learning to setbacks on standardized testing. For example, a recent report from NPR cites that "reading scores saw their largest decrease in 30 years, while math scores had their first decrease in the history of the testing regimen behind the study, according to the National Center for Education Statistics, a branch of the U.S. Education Department." Without a doubt, anxiety levels for our children are at an all-time high. Yet, our children are the future, and how are we meeting their needs and mitigating the risks of underdiagnosed anxiety? The report shows that the "success of a screening initiative depends on the availability of a sensitive and specific screening process for detecting a disorder and safe and effective treatments for persons identified." 

QHSLab, Inc. recently launched the "Q-Scale" Assessment, or "Quality of Life" Scale, a digital medicine assessment tool for screening patients potentially who may be suffering from mental and emotional health-related issues. The Q-Scale is a 10-question digital health 10-item questionnaire designed to measure psycho-emotional factors in patients, even pediatric patients, who might be at risk of mental health issues. Five categorical ratings are available for response to each item, ranging from "'None of the time" to "'All of the time."' If responses to the Q-Scale indicate potential mental health troubles, patients are directed to the Patient Health Questionnaire (PHQ), General Anxiety Disorder (GAD) assessment and Kessler-6 questions within the assessment to identify their clinical risk of anxiety and depression for further specialized evaluation. If the responses to the questions categorize the patient as "at risk" for mental health issues, including anxiety and depression, QHSLab will inform physicians through a simple-to-read report of the need for a more focused evaluation during their encounter with the patient or active referral to a mental health specialist. 

Pediatricians and primary care physicians are on the frontline of healthcare. They are often the first resource patients turn to when expressing a mental health concern - or uncovering an undiagnosed mental health condition. These physicians desperately need digital tools to help them screen for conditions, including mental and emotional health concerns. QHSLab provides efficient screening that aligns with reimbursement guidelines but also offers a suite of digital patient education content through podcasts and other mediums - covering various topics, including physical activity, nutrition, sleep, chronic pain, progressive relaxation, and mindfulness exercises. Therefore, the physician can screen, diagnose and provide easy-to-access education programs to assist most patients suffering from mild to moderate anxiety and depression and help improve the trajectory of the next generation's mental health.

Immunotherapy continues to make headlines throughout the healthcare newswires, and for a good reason. Now more than ever, researchers are looking inward to cure diseases, leveraging the power of one’s immune system to reduce symptoms and even reverse conditions. A recent study titled “REACT” analyzed claims data spanning ten years. Claims must have a confirmed diagnosis of allergic rhinitis, with or without asthma, and treatment of allergen immunotherapy additionally listed on the claim. 

First, what exactly is “allergen immunotherapy?” Allergen immunotherapy is the repeated administration of specific allergens to patients with IgE-mediated conditions to protect against the allergic symptoms and inflammatory reactions associated with natural exposure to these allergens. The exact mechanism of action is unknown but may involve an increase in allergen-specific IgG antibodies, particularly IgG4, a decrease in IgE synthesis, and an alteration in T-lymphocyte activity. In other words, immunotherapy is the prevention or treatment of disease with substances that stimulate the immune response. Allergen immunotherapy is a long-term treatment for people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy), or atopic dermatitis. Allergen immunotherapy is also known as allergy shots, desensitization, or hyposensitization.

Highlights from this study:

• This study examined 46,024 patients undergoing allergy immunotherapy treatments. 

• Allergen immunotherapy was consistently associated with greater reductions than control subjects in allergic rhinitis and asthma prescriptions, including asthma controller and reliever prescriptions. 

• AIT group also had a significantly greater likelihood of stepping down asthma treatment and a greater reduction in severe asthma exacerbations.

• Reductions in pneumonia with antibiotic prescriptions, hospitalizations, and duration of inpatient stays were all in favor of AIT.

• This study concluded the longer-term and sustained effectiveness of AIT, and in patients with concurrent asthma, AIT was associated with a reduced likelihood of asthma exacerbations and pneumonia.

AllergiEnd® uses a three-step system to screen, test, and treat allergies. Primary care physicians are often the first practitioners that patients turn to when suffering from allergy and asthma symptoms. With more than 60 million Americans suffering from allergies annually, and only 3,000 allergy specialists in practice, there’s a demand for tools to expedite the diagnosis and treatment process and to leverage the power of primary care. 

First, get a baseline of your patient’s allergy symptoms and severity. Our user-friendly assessment tracks patient responses to allergy symptoms, triggers, history, and severity scores for the SNOT-22, Asthma Control, and Respiratory Allergy Prediction tests. This digital assessment can be sent to patients ahead of time to be completed or can be completed in under five minutes while patients wait for their appointment - and provides physicians with critical insights at a glance. This service saves provider time while increasing your practice revenue through reimbursements through CPT code 99358. 

Next, confirm the findings from the digital screening with a needle-free skin test designed for administration in primary care settings. AllergiEnd®’s skin tests are FDA-cleared and safe for pediatric patients. Results from these skin tests are available in just 15-20 minutes, and physicians can provide a diagnosis to patients during the same appointment - saving patients the time and expense of a specialist appointment. These allergy skin tests are also reimbursable, revenue-generating services from your practice under CPT code 95004. 

Finally, offer your patients the best in immunotherapy treatments if a diagnosis is confirmed. AllergiEnd® offers two types in the form of injections or sublingual drops. Our pharmacy creates patient-specific allergy treatments shipped directly to our clients if treatment is needed. Again, this is a reimbursable service to providers through CPT code 96165. 

Allergen immunotherapy is a long-term, effective, and practical approach to treating the root causes of allergy symptoms and the suffering associated with the disease. As the fall season is upon us, many practices are seeing an uptick in patients presenting with allergy symptoms. Begin screening, testing, and treating your patients today and improve clinical outcomes while increasing your practice revenue.

Learn more about our evidence base here, and click the button below to get started.

It's back-to-school time for many children across the United States. But unfortunately, while it may be an exciting time for youngsters starting a new school year, many parents find themselves anxious about their children's allergies, especially food allergies. Between classroom treats and shared lunch spaces in the cafeteria, allergic triggers loom in schools. So while many pediatricians and family medicine doctors are conducting back-to-school physicals, screening, testing, testing, and treating pediatric patients - checking in with the parent or guardian of those children regarding their anxiety surrounding these allergies is essential. 

A recent study examined the emotional and mental toll on parents of children with a food allergy. In summary, the study finds that:

"Parental emotional distress and anxiety contribute to reduced health-related quality of life for children with food allergy and their families and may impact allergy management. However, it is unclear how allergists in busy specialist clinics should identify parents with food allergy-related distress who could benefit from psychosocial interventions. This systematic review characterizes the constructs of food allergy-specific distress and anxiety and points to gaps in current assessment scales. This work represents a critical first step in developing clinical tools to improve the assessment, monitoring, and management of anxiety in families living with food allergies."

So what can physicians do?

Physicians must have the tools to screen patients (including pediatric patients) for their allergy symptoms, frequency, and severity. Other questions peel back the layers and provide insight into a patient's lifestyle, mental health, and more. AllergiEnd® and QHSLab, Inc. offer easy-to-use digital assessments completed by patients from the comfort of their homes or your waiting room before their appointment. These assessments provide physicians valuable insights through an intuitive dashboard into their patient's allergy symptoms and much more.

First, screen your pediatric patients to determine the frequency and severity of their allergy symptoms. 

If pediatric patients report nasal itching, irritation, discharge, congestion, sneezing, itchy eyes, ears or palette, fatigue, or appetite changes, allergies might be to blame. Especially with the fall and winter wave of COVID looming, it's more important to get a baseline of allergy symptoms. Send them the allergy assessment from QHSLab to be completed from the comfort of your patient's home or your waiting room - plus get reimbursed for the service through CPT code 99358. The physician dashboard provides robust yet easy-to-interpret insights into individual patient and population health. 

Next, test to confirm the findings in the screening. 

One of the best ways to mitigate anxiety for parents and guardians is to understand what causes allergic reactions in their children. Our testing kits are FDA-cleared and thoughtfully designed for primary care and pediatric settings. Features include air-tight locking kits, the proprietary asymmetrical orientation of applicators, and alphanumeric numbering. These needle-free, virtually painless skin tests provide quick, in-office results to give your patients (and their parents) peace of mind and clarity about their allergic triggers - even the most common food triggers (and often some of the most dangerous for pediatric patients). Testing is reimbursable under CPT code 95004. 

Finally, treat with immunotherapy treatments if appropriate. 

Our pharmacy creates patient-specific allergy treatments shipped directly to our clients if treatment is needed. We offer two forms of immunotherapy treatments, allergen immunotherapy injections or convenient sublingual drops. In addition, physicians can treat the root causes of allergy suffering and be reimbursed by providing immunotherapy treatments through CPT code 95165. 

Bonus! If you're a family practice and treat patients of all ages and stages and notice patients reporting anxiety, even from a situation like this, QHSLab offers a suite of mental health assessments that not only give physicians essential insights into a patient's stress, mental health, and more but is also a reimbursable service through proven CPT codes.

AllergiEnd® improves the quality of patients' lives by empowering non-allergist physicians, such as primary care doctors and pediatricians, with the education, knowledge, and tools necessary to provide safe, innovative, and effective allergy testing and treatment solutions directly to their patients. 

Ready to get started for free? Book your consultation here.