By Gary Fitzgerald
What’s the future of allergy and asthma care? New research, programs and panel discussions at the American College of Allergy, Asthma & Immunology (ACAAI) annual meeting Nov. 5-10 in San Antonio provided a glimpse of what’s on the horizon for patients and healthcare professionals.
On Nov. 6, Allergy & Asthma Network hosted the 2015 Asthma Coalition Summit, with more than 70 healthcare professionals representing coalitions in 26 states in attendance. They heard from experts on innovative, community-based approaches to asthma care, the impact of climate change on allergy and asthma, and the emerging role of telehealth.
In his “State of Asthma in the United States” address, James Sublett, MD, outgoing president of ACAAI, suggested there would be a greater focus on severe asthma in the future, with new medications called biologics aimed at stopping symptoms before they can start. He also said patient adherence to prescribed medications and encouraging lifestyle changes – diet, weight loss, exercise and increased vitamin D levels – remain critical to treatment.
Healthcare professionals can bring those messages to communities in increasingly innovative ways.
Examples discussed at the summit included Women Breathe Free program, an in-home one-on-one program that helps women learn asthma management skills; the Managing Asthma Through Case-management in Homes (MATCH) program to help assess homes for potential asthma triggers; and Asthma Ready® Communities and Asthmania Academy, which provide education programs for parents and children with asthma.
Asthma coalitions can help patients “expect more from themselves” in terms of managing asthma, says Elena Kaltsas, who manages Women Breathe Free with the Center for Managing Chronic Disease at the University of Michigan. “Patients need to know they can have a life symptom-free. It’s something that not enough patients aspire to.”
Parents of children with severe asthma can improve outcomes with a coordinated healthcare team focused on the needs of the patient, said Susan Steppe of Le Bonheur Children’s Hospital in Memphis. Le Bonheur’s CHAMP (Changing High-risk Asthma in Memphis through Partnership) program helps families establish teams and provides asthma education.
Telehealth Is Coming
Another way healthcare professionals can reach out to people with asthma and allergies is telehealth – using online portals, videoconferencing and mobile apps to support long-distance clinical healthcare or patient education.
More doctors are adding telehealth to their practices. And patients are receptive to it. A recent report predicted the number of people worldwide using telehealth will jump to 7 million in 2018, up from 350,000 in 2013 – a 1,900 percent increase.
“The field of allergy and asthma is prime for telemedicine,” says Tania Elliott, MD, with Doctor on Demand, one of several companies that help facilitate doctor-patient telehealth visits.
Impact of Climate Change
Jay M. Portnoy, MD, of Children’s Mercy Hospital in Kansas City briefed the coalition summit on the link between climate change and asthma and allergies. Dr. Portnoy explained how warmer, wetter winters are associated with an increase in pollen and lengthened pollen seasons.
Rising temperatures are causing plants and trees to bloom earlier, releasing more pollen and mold spores into the air – and leading to an increased risk of asthma flares and allergy symptoms, according to Dr. Portnoy.
“Obviously as individuals we can’t fix climate change, but each of us can do a little bit,” Dr. Portnoy said, such as becoming more energy efficient at home or carpooling to work or school.
More time indoors means greater exposure to indoor asthma triggers such as mold and dust mites. Michael McKnight, of Baltimore-based Green & Healthy Homes Initiative (GHHI), detailed efforts to conduct home interventions with families, especially in inner cities, to evaluate and improve indoor air quality.
“Home-based triggers cause 40 percent of asthma episodes,” McKnight said.
Biologics For Severe Asthma
One of the main topics of conversation at the ACAAI annual meeting was the use of biologic medications to treat severe asthma. These medicines help stop airway inflammation before it can start. They require an IV treatment or injection every two weeks or once a month.
“Traditional asthma treatments don’t work for some people, and their asthma is uncontrolled,” said Kevin Murphy, MD. “Biologics are at the cutting edge of asthma treatment because they have the potential to be personalized – to be formulated to treat those cells which are the mechanism, or pathway, that leads to allergic inflammation and makes it so hard for people to breathe.”
Omalizumab (brand name Xolair®) was the first biologic treatment currently on the U.S. market, but more are expected to arrive. On Nov. 4, the U.S. Food and Drug Administration (FDA) approved another biologic, mepolizumab (Nucala®), as an add-on treatment for poorly controlled, difficult-to-treat asthma.
Get Tested for Penicillin Allergy
Another study presented at ACAAI’s annual meeting addressed the importance of testing people for penicillin allergy, including those who have previously been told they are penicillin-allergic.
“We found intravenous penicillin to be safe for repeat use in patients who had been told they were allergic,” said allergist David Khan, MD, professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas and author of the study.
Approximately 10 percent of Americans think they are allergic to penicillin, according to ACAAI.
“An allergist will work with you to find out if you’re truly allergic, and to determine what your options are for treatment if you are. If you’re not allergic to penicillin, you’ll be able to use medications that are safer, often more effective and less expensive,” Dr. Khan said.
Food Allergy Research
Several studies on food allergies were presented during ACAAI’s International Food Allergy Symposium at the annual meeting.
One study revealed that siblings of children with a documented food allergy are not necessarily also allergic. In fact, food allergy testing in siblings of kids with food allergies should be limited to decrease the possibility of misdiagnosis. “Testing for food allergies if a reaction hasn’t taken place can provide false positives,” said Ruchi Gupta, MD, MPH, associate professor of pediatrics at Northwestern Medicine in Chicago and lead study author. “More than half of the kids in the study had a sensitivity to a food, but they weren’t truly allergic.”
Another study of 1,714 Missouri children with food allergy revealed they had significantly lower height and weight than children without food allergies. Are parents of food-allergic children creating diets that inadvertently cut out too many calories? Or is it due to increased energy burned to fight off allergic inflammation? Additional research is underway.
A presentation on common Google search terms reflected misconceptions about food allergies. “Peanut oil,” for example, was a frequent search term even though it’s not a common cause of peanut allergy.
Outreach in the San Antonio Community
During ACAAI’s annual meeting, Allergy & Asthma Network partnered with San Antonio allergists from South Texas Allergy & Asthma Medical Professionals to conduct asthma screenings.
The screenings, held Nov. 7 at the “River Relay” family event at Mission County Park and Nov. 8 at the AccessAbility Fest at Market Square, included breathing tests, symptom evaluation and consultations with allergists.
“We have hosted asthma screenings at the last two ACAAI annual meetings, meeting people in the community where they are, while giving back to the host cities,” said Tonya Winders, president and CEO of Allergy & Asthma Network. “In addition to the screenings, we raised awareness, provided educational materials and tools to help people understand and better manage their condition.