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Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available. Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools. Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management. Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness. Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment. SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home‐administered SLIT-tablets over SCIT.

Allergy/immunology specialists in the US prescribing allergy immunotherapy (AIT) have placed a heavy value on practical experience and anecdotal evidence rather than research-based evidence. With the extensive research on AIT conducted in the last few decades, the time has come to better implement evidence-based medicine (EBM) for AIT. The goal of this review was to critically assess EBM for debated concepts in US AIT practice for respiratory allergies in the context and quality of today's regulatory standards. Debated topics reviewed were the efficacy and safety of AIT in various subgroups (e.g., polyallergic patients, older patients, patients with asthma, pregnant women), diagnosis topics (e.g., skin prick test vs allergen-specific serum IgE, factors affecting skin prick tests, use of nasal or conjunctival allergen challenges, and telemedicine for diagnosis), and dosing topics (e.g., optimal dosing for subcutaneous immunotherapy and sublingual immunotherapy tablets, US liquid allergen extract history, duration of treatment, biomarkers of efficacy). In addition, EBM for patient-centered AIT issues (e.g., adherence, use of practice guidelines, pharmacoeconomics) and the approach to implementation of AIT EBM in future clinical practice was also addressed. The EBM for each concept was briefly summarized, and when possible, a practical, concise recommendation was given.

To assess total and allergic rhinitis (AR)-related healthcare costs among AR patients residing in the United States with a focus on patients persisting with AIT.AR patients were identified in the IBM MarketScan database between 1 January 2014 to 31 March 2017. Patients receiving allergy immunotherapy (AIT) were identified with relevant billing codes (earliest AIT claim = index date); non-AIT patients were identified with claims containing a diagnosis code for AR (earliest AR claim = index date). AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. All patients were required to have continuous enrollment for 12 months preceding and following index.A total of 2,334,530 AR patients were included; 103,207 had at least 1 AIT claim, with 45,279 (43.9%) of these patients reaching maintenance, and 24,640 AIT patients (23.9%) never presenting a single injection claim. Compared to non-AIT patients, patients initiating AIT presented higher rates of baseline comorbidities, including asthma (30.1% vs. 7.5%) and conjunctivitis (21.7% vs. 4.4%). During the follow-up period, patients reaching the maintenance phase of AIT incurred lower total costs than the overall AIT cohort ($10,431±$16,606 vs. $11,612±$24,797), and also presented lower follow-up hospitalization costs ($698±$7,248 vs. $1,281±$12,991) and total medical costs ($7950±$13,844 vs. $8989±$22,019).Continued efforts are needed to increase patient awareness of available options and adherence to AIT, along with reducing wastage. Despite AIT patients presenting fairly progressed disease at the time of treatment initiation, this therapy remains an economical treatment option, as it was not accompanied by substantial increases in overall healthcare expenditure, and may promote positive societal impacts beyond the direct medical costs.What is known on this topicThe prevalence of allergic diseases has increased over the past 50 years and affects between 10-30% of the world population.Allergic rhinitis (AR) poses a significant economic burden in the form of both direct and indirect costsAllergy immunotherapy (AIT) is the only treatment option able to modify the underlying course of the disease.What this study addsSpecific all-cause and AR-related healthcare costs decreased following the initiation of AIT among patients diagnosed with AR, with the largest decreases observed among AIT patients reaching the maintenance phase of treatment, while non-AIT patients showed increases in all categories assessed over a similar follow-up period.Cost decreases among AIT patients were observed despite increased levels of comorbidities compared to non-AIT patients, as the AIT cohort presented elevated rates of atopic dermatitis (7.1% vs. 2.7%), conjunctivitis (21.7% vs. 4.4%), asthma (30.1% vs. 7.5%), and chronic sinusitis (22.6% vs. 4.9%).An analysis of patients' index subcutaneous AIT consultation revealed substantial variability in the initial treatment costs, with nearly 20% of paid amounts exceeding $1,000; given nearly 1 in 4 AIT patients who get AIT mixed never came back for their first injection, this highlights an opportunity to target frontloaded billing practices and the timing of mixing/injection as an area to minimize healthcare waste.

Background: There is a dearth of real-world evidence studies focused on allergy immunotherapy (AIT) use among patients with allergic rhinitis (AR). Objective: This study examined claims data of AR patients residing in the United States to assess patient characteristics and health outcomes. Methods: AR patients were identified in the IBM MarketScan database between January 1, 2014, and March 31, 2017. Patients receiving AIT were identified with relevant billing codes (earliest AIT claim for vaccine as the index date); patients without AIT were identified with claims that contained a diagnosis code for AR (earliest AR claim as the index date). All the patients were required to have continuous enrollment 12 months prior to and following their index date. AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. Patients were assessed for demographic characteristics, comorbid conditions, and health care utilization. Results: A total of 2,334,530 AR patients were included; 103,207 had at least one AIT claim, with 45,279 (43.9%) of these patients reaching maintenance. Patients who reached AIT maintenance presented higher rates of baseline comorbidities than both the full AIT cohort and the patients with no AIT claims, including asthma (34.6% versus 30.1% versus 7.5%) and upper respiratory tract infections (63.1% versus 60.3% versus 34.2%). From baseline to follow-up, maintenance AIT patients demonstrated reductions in all AR-related comorbidities assessed, along with reductions in all-cause and AR-related service utilization. Conclusion: Patients initiating AIT presented the greatest need for therapeutic intervention, as evidenced by higher allergy-related comorbidities; those who reached maintenance demonstrated improved outcomes following the initiation of therapy. Continued efforts to increase patient awareness and adherence to AIT are needed.

Nurse practitioners (NPs) are at the frontline of treating asthma patients in primary, specialty, and acute care and work closely with those patients to optimize their outcome. The NP's care of a patient with asthma includes both preventive management and acute treatment. Overcoming the challenges of maintaining long-term asthma control and addressing episodes of loss of acute control require an individualized approach to patient care. In view of the importance of quickly and effectively treating any acute loss of control to prevent further sequelae, this investigation addresses related management options and offer evidence-based treatment considerations for NPs.

Anaphylaxis is widely recognized as a life-threatening condition, yet there is a gap between what patients know and need to know in an emergency situation. Anaphylaxis falls into a category of severe and dangerous conditions that places the supreme responsibility of symptom recognition and immediate life-saving treatment directly on the patient. Recent research illuminates that patients are unable to readily recognize the symptoms of anaphylaxis and often do not have an epinephrine autoinjector available for self-treatment. Because most anaphylactic reactions occur outside of the medical office, every possible opportunity to teach patients how to self-treat should be optimized.

Asthma is often considered a disease of childhood, but it is becoming increasingly prevalent among older adults. Asthma significantly reduces both the psychological and physical quality of life among older adults and accounts for exorbitant health care costs. There are more asthma-related deaths among older adults than in any other age group. Managing asthma in this age group is complicated by existing comorbidities, adverse side effects to common medications, and nonspecific symptoms that often go unrecognized. This article reviews evidence-based asthma management of older adults.

Chronic urticaria (CU) is a challenging and frequently encountered diagnosis characterized by the presence of evanescent wheals that persist for greater than 6 weeks. It is estimated that 15% to 25% of the US population are affected at some time in their lives with urticaria and that 33% of all urticaria cases are considered to be chronic. Although acute urticaria is generally benign and self-limiting, serious medical illness may occur with CU. The incidence of CU is estimated to be as high as 5% in the general population and greater than 10% when surveying allergy and dermatology patients. CU is an episodic, pruritic disorder in which 45% to 90% of patients will not have an identifiable cause and occurs 4 times more often in females than males. The average disease duration of CU is between 2 and 5 years, and its typical onset is in the third to fourth decade of life. CU is thought to have the most impact on quality of life than any other allergic disease. This article will provide a clinical update and review on the management and treatment of CU.

Purpose Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A woman's respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence-based approach that recognizes the patient's changing needs. Data sources Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion With the implementation of evidence-based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.

Purpose. Improving the quality of care provided to patients with pulmonary disorders is imperative, but properly performed and correctly interpreted spirometry is typically missing in primary care. There are increasing calls for widespread training efforts to mitigate this deficiency. This article describes why spirometry is needed in primary care and how it is performed and evaluated. Data Sources. The latest spirometry recommendations from the National Heart, Lung, and Blood Institute; the Global Initiative for Chronic Obstructive Lung Disease; the American Thoracic Society/European Respiratory Society; the American College of Physicians; the American College of Chest Physicians; and the US Preventive Services Task Force were consulted. Conclusions. Using spirometry to evaluate lung function is one of the simplest, most common pulmonary function tests. Nurse practitioners (NPs) will undoubtedly encounter these patients in their practice, and having comprehensive knowledge about spirometry will be a great asset to both their patients and health care team. NPs are often in a unique position with spirometry testing as they both perform and interpret the procedure. Implications for Practice. To better serve their patients, NPs need the knowledge to properly perform and correctly interpret spirometry.

Food allergy is increasingly prevalent in the US, with as many as 3 million individuals reporting allergies to peanuts or tree nuts and more than 6.5 million to seafood. Food-induced allergic reactions are responsible for a host of symptoms involving the gastrointestinal tract, respiratory tract, and skin. Though it is possible for any food to provoke an allergic reaction, relatively few foods are responsible for the majority of food-related reactions. Ongoing research seeks to identify new therapeutic strategies for treatment of food allergy; however, the only current treatment for patients is avoidance of their food trigger.

Introduction Much has been written regarding poor physician adherence to the National Asthma Education, Prevention Program (NAEPP) guidelines, but no data are available regarding nurse practitioners (NP) adherence. This descriptive study compared NP adherence to figures reported for medical doctors (MDs) in the 2001 and 2007 analyses by Cabana and colleagues. Method A national, cross-sectional survey approach was used to assess NP knowledge, attitudes, and behaviors regarding the NAEPP guidelines. The survey was adapted from Cabana’s 48-item questionnaire. Results NPs provided more prescriptions of inhaled corticosteroids (ICSs) to patients with daily symptoms than did physicians (NPs, 79%; MDs, 54%). Overall, compared with MDs, NPs reported higher adherence on three of the four NAEPP guideline components surveyed, two of which were statistically significant. Discussion This survey suggests that NPs have greater adherence to prescribing ICSs than do MDs. However, improved adherence still needs to be a goal for all providers because prescription of ICSs is the cornerstone of management of persistent asthma.

Black children bear a disproportionate burden of asthma when compared to other segments of the population. This study assessed the role of symptom scores, spirometry testing, and serum-specific immunoglobulin E in the primary care management of asthma in Black children.

The National Association of Pediatric Nurse Practitioners worked collaboratively with other pediatric health care provider organizations to develop and implement an innovative pediatric asthma program using a train-the-trainer model with a goal to increase the availability of pediatric asthma education in medically underserved areas/health care provider shortage areas. Course content was developed using the National Asthma Education and Prevention Program Expert Panel 3 guidelines. Participants in the program are now teaching pediatric asthma programs in their own communities and making an impact on pediatric asthma care.

Allergic diseases are common throughout the world and affect all age groups. Allergen immunotherapy is the only available treatment that can reduce symptoms, improve quality of life, alter the course of the disease, and induce long-term clinical remission safely and effectively in patients with allergen sensitivity. In January 2011, the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI), published Allergen Immunotherapy: A Practice Parameter Third Update. This most recent update aims to ensure the optimal practice of allergen immunotherapy (IT) for patients with allergic disease. This update accesses the latest research to establish guidelines for the safe and effective use of allergen IT practice. As asthma and allergy educators, it is important to be familiar with the Allergen Immunotherapy: Practice Parameter Third Update so as to increase our value to patients and improve their health outcomes. This article presents a summary of the Joint Task Force’s update and discusses its applicability to asthma and allergy educators.

Introduction Children, particularly African American children, bear a disproportionate burden of asthma and are at highest risk for associated morbidity and mortality. The under-utilization of the National Asthma Education and Prevention Program (NAEPP) guidelines across all demographics and the under use of inhaled corticosteroids (ICS) as controller therapy in these children are well-documented. The primary aim of this study was to increase health care provider (HCP) adherence to the NAEPP guidelines by means of a guideline reminder tool, the Multi-colored Simplified Asthma Guideline Reminder, consequently increasing the prescription of ICS in this population. Method This study had a pre-experimental design with descriptive analysis. Results The Multi-colored Simplified Asthma Guideline Reminder was effective in increasing HCP adherence to the NAEPP guidelines as evidenced by increased use of ICS as controller therapy. Discussion Despite the increasing prevalence and burden of asthma in African American children, the associated prescriptive use of ICS has not increased substantially in the past decade. The greatest obstacle in the scope of improving asthma outcomes is the underuse of ICS by HCPs.

An estimated 22.9 million adults and 6.8 million children in the United States have asthma. Historically, high asthma prevalence and alarming morbidity trends continue to be a major cause of disability, placing a huge burden on children, adults, and their families. Research demonstrates that the use of clinical guidelines for the management of asthma improves patient outcomes. The National Asthma Education and Prevention Program (NAEPP) first developed clinical practice guidelines offering specific advice for the management and treatment of asthma in 1991. Despite the availability of these evidence-based guidelines for 19 years, their recommendations for asthma management are underutilized in practice. This integrative literature review chronicles the development of NAEPP guidelines and their utilization in current practice. Database searches included MEDLINE, PubMed, OVID, and CINAHL.

More than 22 million Americans have asthma. It is one of the most common chronic diseases of childhood, affecting about 6 million children. With these statistics in mind, The National Heart, Lung, and Blood Institute of the National Institutes of Health recently released the 2007 asthma guidelines, "Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma." Because of the continued burden and impact asthma has on our patients, a broad and marked change is needed in our treatment approach. Nurse practitioners can lead that change with the implementation of the new asthma guidelines.

Background Although adolescent substance use can have direct effects on asthma symptoms and interact with medications used to treat asthma, no validated health-related quality of life (HRQL) instrument exists for adolescents 17 to 19 years of age with asthma. Purpose The American Academy of Pediatric's HRQL instrument, the Child Health Survey for Asthma (CHSA)–Child version, was modified with a substance use subscale to address outcomes specific to adolescents ages 17 to 19 years with asthma. Methods Two cohorts (N = 70) were recruited for instrument testing at pediatric primary care practices and two university clinics. A small methodological study with 24 adolescents was conducted to obtain initial support of the psychometric properties for the CHSA-Teen version at baseline, day 14, and day 16. A follow-up study included 46 teens to provide further support. Results The psychometric properties of the CHSA-Teen version were good and comparable with the CHSA-Child version for feasibility, reliability, and validity. Conclusions Health care providers need to be aware of each adolescent's substance use to personalize counseling related to asthma medications.

Vitamin D deficiency and asthma share risk factors. Epidemiologists suggest that the U.S. prevalence of Vitamin D deficiency has increased as a result of the Westernization of culture and less time spent outdoors. Numerous studies support a patient's Vitamin D deficiency as a contributing cause to increased asthma symptoms, lower lung function levels, increased airway reactivity, and worsening asthma control. The purpose of the review article is to discuss the emerging role of Vitamin D in asthma management.A review of original research identified through MEDLINE and CINAHL and published in English was performed.Research suggests promising benefits of Vitamin D supplementation in asthma patients with low (30 ng/mL) Vitamin D levels. Evidence supports several possible mechanisms, including downregulation of allergen sensitivity and enhanced steroid responsiveness. Studies demonstrate that Vitamin D modifies airway hyperresponsiveness by minimizing airway inflammation. Ongoing studies seek to further evaluate the effects of Vitamin D supplementation on asthma and asthma morbidity.While there is no consensus on the use of Vitamin D as a mainstay in asthma treatment, research supports its consideration for use in asthma patients with low Vitamin D levels. Current evidence reinforces the need to measure Vitamin D levels for all asthma patients.

Asthma, a chronic inflammatory lung disease, is one of the most common and costly diseases in the United States, affecting people of all ages and all ethnic groups. While there is no cure for asthma, optimal disease control and quality of life are possible with proper management and treatment.

Background Asthma education reimbursement continues to be an issue in the United States. Among the greatest barriers is the lack of a standardized curriculum for asthma self-management education recognized by a physician society, non-physician health care professional society or association, or other appropriate source. The applicable Current Procedural Terminology codes for self-management education and training are 98960 through 98962, stating that "if a practitioner has created a training curriculum for educating patients on management of their medical condition, he or she may employ a non-physician health care professional to provide education using a standardized curriculum for patients with that disease." Without a standardized curriculum, reimbursement from payers is beyond reach. Objective Representatives from the Joint Council of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; American Academy of Allergy, Asthma, and Immunology; American Lung Association; American Thoracic Society; National Asthma Educator Certification Board; American College of Chest Physicians; and Association of Asthma Educators gathered to write a standardized curriculum as a guideline for payer reimbursement. Methods The Task Force began with a review of the American Lung Association and American Thoracic Society's Operational Standards for Asthma Education. Board members of the National Asthma Educator Certification Board incorporated comments, rationale, and references into the document. Results This document is the result of final reviews of the standards completed by the Task Force and national health care professional organizations in September 2014. Conclusion This document meets the requirements of Current Procedural Terminology codes 98960 through 98962 and establishes the minimum standard for asthma self-management education when teaching patients or caregivers how to effectively manage asthma in conjunction with the professional health care team.