Reminder of referral guidelines for allergy, asthma patients
Fall is allergy season. Philip Halverson, MD, Allergy and Asthma Specialists, says, “There is an under-appreciation of the morbidity of allergic rhinitis and its impact on quality of life. This disease doesn’t get the respect it deserves.”
Referral guidelines developed by the American Academy of Allergy, Asthma and Immunology (AAAAI) range from allergic bronchopulmonary aspergillosis to urticaria/angioedema and include allergies to drugs, foods and even insects.
According to the AAAAI, allergists offer allergy and asthma services not usually available in primary care, including:
Specialists also can help manage chronic conditions where allergy is not always identified, such as rhinosinusitis, conjunctivitis, asthma, cough, urticaria/ angioedema, eczema and anaphylaxis.
Primary care physicians have referred to specialists for years, often using their own guidelines, according to David Brockway, MD, Richfield Medical Group. “If someone with respiratory issues doesn’t respond to antihistamines, steroid nasal sprays or a non-steroid leukotriene inhibitor like Singulair®, I will refer to a specialist,” he says.
Cherie Zachary, MD, Midwest ENT Specialists, recommends that primary care providers refer when the patient experiences one or more urgent care or emergency visits for asthma or is hospitalized. She also wants to see patients who take moderate to high doses of inhaled steroids or oral prednisone more than once a year.
“They are candidates for evaluation,” Zachary says, “especially pediatric patients because prednisone and inhaled corticosteroids can cause adverse growth effects.”
“Medical literature is clear when it comes to the treatment of patients with asthma,” Zachary adds. “Allergists are more cost-effective because patients end up in the hospital less frequently.”
Halverson says the time to refer an asthma patient is when he or she has moderate to severe or persistent asthma requiring ongoing therapy with a controller. “We can determine whether a chronic cough is actually asthma or perhaps post-nasal drainage or reflux, each of which is treated differently,” he says.
Mee Lee Nelson, MD, an allergy and asthma specialist with Southdale Pediatric Associates, encourages primary care physicians to seek a board-certified allergist for patients with difficult-to-treat allergies or asthma.
“Patients who have had chronic hives, with or without angioedema, for six weeks or more should also probably see an allergy specialist,” adds Halverson.
Nelson says, “Food-related allergies should always be treated by a specialist. We know how to interpret blood test results, which can sometimes produce false positives. We also know that patients sometimes outgrow food allergies and can resume eating troublesome foods after a period of time.”
For more information on referral guidelines for patients with allergies or asthma, visit Fairview Physician Associate’s specialty referral guide, or go to the American Academy of Allergy, Asthma & Immunology website at www.aaaai.org.
ALLERGY SEASON COMES EARLY DUE TO UNUSUALLY MILD WINTER
The “winter that wasn’t” in conjunction with a warm March could deliver one of the strongest allergy season’s we’ve seen in quite some time.
“The warmer weather approaching melting the snow contributes to an increase of mold spores, this followed by an early release of pollen could deliver a very strong, and long, allergy season”, said Dr. Zachary, a board-certified allergist and immunologist at Midwest Allergy & Asthma in Eagan, Burnsville, and Maplewood MN.
As a rule Dr. Zachary recommends for patients with yearly seasonal allergies to start taking their medications by St. Patrick’s Day; this often helps her patients to circumvent allergy symptoms altogether. This year is no exception and with our recent warm up Dr. Zachary is already seeing patients for allergy symptoms.
“Usually the upsurge in allergy symptoms starts in late April”, she said. “However, in the last week we have seen an increase in the number of people with various complaints of a runny nose; sneezing; nasal congestion; itchy eyes, ears and throat; and wheezing” Zachary said.
Conditions could change to make this allergy season more manageable. For example a rainy spring would wash the pollen out of the air. But dry, windy, warm days make things worse. In addition to taking your allergy medications at the start of symptoms or before, Dr. Zachary also suggests some simple precautions, to reduce your exposure to pollen. Keeping windows closed and turning on the air conditioner helps to keep pollen out of the indoor air. Showering and changing clothes following work outdoors is also helpful. It is important for allergy sufferers to be aware that this March could be the start of a very strong and long pollen season. Taking steps to reduce pollen exposure and treat your symptoms through your allergy medications before they start will help individuals to avoid the pitfalls of their allergy symptoms and enjoy this beautiful weather.