Engaging and Educating Patients to Improve AD Care: A Practical Toolkit for Clinical Teams

Intended Audience: Physicians, Nurse Practitioners, Physician Assistants, and Nurses

• Activity Overview
• CE Details & Instructions
• Faculty Disclosures

Did you know that patients who learn about their own health conditions and partner with their clinical teams to decide on the best treatments are much happier and achieve better outcomes with their care?

This inclusive guide provides clinicians with materials and resources to engage and educate patients, individually or through group education, about atopic dermatitis (AD) and help build a strong foundation for informed decision-making regarding treatment goals, preferences, and plans.

Included in this guide: 

• Patient-friendly slide deck with helpful speaker notes on AD triggers and risk factors, associated comorbidities, and available treatment options
• Brief video with guidance on organizing and delivering the patient education sessions
• Tips for engaging patients in open and collaborative learning so they become active players in their own care
• Resources for implementing shared decision-making and motivational interviewing in your practice

Physicians completing this program will earn AMA PRA Category 1 Credit™ classified as Enduring material.

Monograph access

Early antibiotic exposure and development of asthma and allergic rhinitis in childhood

Abstract

Background

The prevalence of pediatric allergic diseases has increased rapidly in the United States over the past few decades. Recent studies suggest an association between the increase in allergic disease and early disturbances to the gut microbiome. The gut microbiome is a set of intestinal microorganisms that begins to form during birth and is highly susceptible to disturbance during the first year of life. Early antibiotic exposure may negatively impact the gut microbiota by altering the bacterial composition and causing dysbiosis, thus increasing the risk for developing childhood allergic disease.

Methods

We performed a retrospective chart review of data in Loyola University Medical Center’s (LUMC) Epic system from 2007 to 2016. We defined antibiotic exposure as orders in both the outpatient and inpatient settings. Inclusion criteria were being born at LUMC with at least two follow up visits. Asthma and allergic rhinitis diagnoses were obtained using ICD 9 and ICD 10 codes. We controlled for multiple confounding factors. Using Stata, bivariate logistic regression was performed between antibiotics from 0 to 12 months of life and development of disease. This analysis was repeated for total lifetime antibiotics. We defined statistically significant as p < .05.

Results

The administration of antibiotics within the first 12 months of life was significantly associated with lifetime asthma (OR 2.66; C. I 1.11–6.40) but not allergic rhinitis. There was a significant association between lifetime antibiotics and asthma (OR 3.54; C. I 1.99–6.30) and allergic rhinitis (OR 2.43; C. I 1.43–4.11).

Conclusion

Antibiotic administration in the first year of life and throughout lifetime is significantly associated with developing asthma and allergic rhinitis. These results provide support for a conservative approach regarding antibiotic use in early childhood.

Jeffrey Ni, Hannah Friedman, Bridget C. Boyd, Andrew McGurn, Piotr Babinski, Talar Markossian, and Lara R. Dugas

BMC Pediatr. 2019; 19: 225.

Published online 2019 Jul 5. doi: 10.1186/s12887-019-1594-4

Abstract

Background

The prevalence of pediatric allergic diseases has increased rapidly in the United States over the past few decades. Recent studies suggest an association between the increase in allergic disease and early disturbances to the gut microbiome. The gut microbiome is a set of intestinal microorganisms that begins to form during birth and is highly susceptible to disturbance during the first year of life. Early antibiotic exposure may negatively impact the gut microbiota by altering the bacterial composition and causing dysbiosis, thus increasing the risk for developing childhood allergic disease.

An update to the Milk Allergy in Primary Care guideline

• Clinical and Translational Allergy     Letter to the Editor
• OPEN ACCESS

• Adam Fox, 
• Trevor Brown, 
• Joanne Walsh, 
• Carina Venter, 
• Rosan Meyer, 
• Anna Nowak-Wegrzyn, 
• Michael Levin, 
• Hannah Spawls, 
• Jolene Beatson, 
• Marie-Therese Lovis, 
• Mario C. Vieira & 
• David Fleischer 

Clinical and Translational Allergyvolume 9, Article number: 40 (2019) | Download Citation

Abstract

The Milk Allergy in Primary (MAP) Care guideline was first published in 2013 in this journal. MAP aimed to provide simple and accessible algorithms for UK clinicians in primary care, detailing all the steps between initial presentation, through diagnosis, management and tolerance development. Despite its UK focus, it soon became clear that MAP was being accessed internationally and thus an updated International Milk Allergy in Primary Care (iMAP) guideline was published in 2017. Both guidelines used existing international consensus guidelines to develop accessible algorithms accompanied by patient information leaflets. In 2018, the guidelines were criticised for 3 distinct reasons: promoting the overdiagnosis of cow’s milk allergy (CMA), negatively impacting breastfeeding and the possibility of industry influence on the guidelines. The authors address these criticisms using available evidence and, in the context of this and in consultation with patient groups, members of the General Practice Infant Feeding Network and other infant feeding healthcare leads, have collaboratively produced updated algorithms and an information leaflet to support breastfeeding. We believe iMAP is now closer to its original aim of facilitating early and accurate diagnosis of CMA, whilst minimising, as far as possible, any concerns around overdiagnosis or a risk to breastfeeding rates. We continue to welcome open and constructive engagement about how best to achieve these aims to provide evidence-based, practical guidelines for the primary care practitioner.

Presentation of suspected cow’s milk allergy (CMA) in the 1st year of Life

The Milk Allergy in Primary Care guideline was first published in 2013 in this journal by five authors [1], four of whom had been involved in the development group of the UK National Institute for Health and Care Excellence (NICE) 2011 clinical guideline on the ‘Diagnosis and assessment of food allergy in children and young people in primary care and community settings’ [2].

Prevalence and Severity of Sesame Allergy in the United States

JAMA Network Open Original Investigation 

Allergy

Christopher M. Warren, PhD¹; Avneet S. Chadha, BS¹; Scott H. Sicherer, MD²; et alJialing Jiang, BA¹; Ruchi S. Gupta, MD, MPH¹

Author Affiliations Article Information

JAMA Netw Open. 2019;2(8):e199144. doi:10.1001/jamanetworkopen.2019.9144

Question  What is the current population-level burden of sesame allergy in the United States?

Findings  Using a cross-sectional population-based survey, an estimated 0.49% of the US population reported a current sesame allergy, whereas 0.23% of the population had a convincing sesame allergy using confirmatory symptom report criteria.

Meaning  The findings suggest that sesame allergy is a relatively common, frequently comorbid food allergy that affects patients of all ages, resulting in severe reactions and health care utilization.

Alpha Gal Meat Allergy: Interview with Prof Michael Levin

A EAACI drug allergy interest group survey on how European allergy specialists deal with β‐lactam allergy

POSITION PAPER  Free Access

Maria Jose Torres  Gulfem Elif Celik  Paul Whitaker  Marina Atanaskovic‐Markovic  Annick Barbaud Andreas Bircher  Miguel Blanca  Knut Brockow  Jean‐Christoph Caubet  Josefina Rodrigues Cernadas Anca Chiriac  Pascal Demoly  Lene Heise Garvey  Hans F. Merk  Holger Mosbech  Alla Nakonechna Antonino Romano 

Allergy. 2019 Jun;74(6):1052-1062. doi: 10.1111/all.13721
Abstract

An accurate diagnosis of β‐lactam (BL) allergy can reduce patient morbidity and mortality. Our aim was to investigate the availability of BL reagents, their use and test procedures in different parts of Europe, as well as any differences in the diagnostic workups for evaluating subjects with BL hypersensitivity. A survey was emailed to all members of the EAACI Drug Allergy Interest Group (DAIG) between February and April 2016, and the questionnaire was meant to study the management of suspected BL hypersensitivity. The questionnaire was emailed to 82 DAIG centres and answered by 57.

Characteristics, quality of life and control of respiratory allergic diseases caused by house dust mites (HDMs) in Spain: a cross-sectional study

Clinical and Translational Allergy Research letter OPEN
Beristain Ana, Fernando de la Torre  the EpidMite Study Group

Clinical and Translational Allergy volume 9, Article number: 39 (2019)

Abstract

This multicentre, cross-sectional study conducted in Spain assessed the clinical characteristics and quality of life of patients who were aged 14–55 years and had allergic rhinitis and/or asthma, which was due to house dust mite sensitisation, for at least 2 years.

Genome-wide association analysis of 350 000 Caucasians from the UK Biobank identifies novel loci for asthma, hay fever and eczema.

Åsa Johansson, Mathias Rask-Andersen, Torgny Karlsson, Weronica E Ek

Human Molecular Genetics, ddz175, https://doi.org/10.1093/hmg/ddz175

Abstract

Even though heritability estimates suggest that the risk of asthma, hay fever and eczema is largely due to genetic factors, previous studies have not explained a large part of the genetics behind these diseases.