Month: March 2020

Telemedicine Services Available!

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Allergy, Asthma & Food Allergy Centers has been using the doxy.me platform for telemedicine visits since Thursday, March 19, 2020, and this has been working very well for patients at all of our current locations (Swansea, Illinois; Bloomsdale/Ste. Genevieve, Missouri, and south county). Telemdicine appointments can also be done for those currently scheduled to be seen in our Chesterfield (west county) location at 16216 Baxter Rd. Suite 299, Chesterfield, MO 63017. As you know, we have moved most of our patients to telemedicine visits in the interest of public safety to decrease the spread of COVID-19 in our community while continuing to provide essential medical care.

If you are scheduled for any upcoming office visits, other than for biologic medication administration, our staff will continue to contact you before your appointment to convert your appointment to a telemedicine visit. The telemedicine visits enable new and established patients to keep their originally scheduled visits to discuss medical problems, treatment plans, allergy shots, and prescription medications while following the “stay at home” rules. These visits will be increasingly important for patients and families as the spring tree pollen season ramps up. The spring pollen season gets busy, and appointments can be scarce in the greater St. Louis area, but Allergy, Asthma & Food Allergy Centers has 8 active providers who are able to see patients via telemedicine even during these troubled times. Call 314-849-8700 or 618-233-8700 to schedule your telemedicine visit to help you stay healthy during this allergy season.

Telemedicine Frequently Asked Questions:

  1. How does telemedicine work?
    1. A staff member will call you in the morning on the day of your scheduled appointment to collect insurance information and copays.
    2. You will receive a text in most cases (an email if you cannot receive texts or prefer to do the visit using a computer/laptop/tablet) with a link from doxy.me. You can watch a brief instructional video here and/or review this document.
    3. Open the link through your phone or use Chrome browser when on a computer/laptop. You will need a strong internet connection and will need to give permission for the website to use your camera and microphone.
    4. Sign in with the patient’s first and last name and click the “Check In” box, which will place you in the virtual waiting room. You can also review the telemedicine consent and test your connection while in the waiting room.
    5. Once the visit has started, your provider will be able to see you, and you will be able to see them. Your provider may not always be looking at the camera, because they will have another screen open with your medical record so they can document and review your information. Please be assured that if the provider looks away, they are not being distracted from the visit, and your medical care is their sole focus during your appointment.
  2. Do I need to download any program or application?
    1. No, because the doxy.me platform is web-based, you can access it from a browser on an internet connected device.
  3. What type of device do I need?
    1. You need an internet connected smartphone, tablet, computer, or laptop that has a camera and microphone. You will have to give the camera and microphone permission to access your web browser, which you should be able to do in the settings of your device, and we recommend you confirm this before your appointment.
  4. What else should I do to prepare for the visit?
    1. If you have a thermometer, please take your temperature before the visit to let the provider know so they can document it in your chart.
    2. Please take your pulse manually (instructions here) or with an apple watch, fitbit, or other device before the visit and let your provider know so they can document it in your chart.
    3. You can also review the telemedicine consent form here.
  5. Is the telemedicine visit secure?
    1. Yes, the doxy.me telemedicine platform is secure and HIPAA compliant. 
  6. What if I do not receive a text or an email?
    1. If it is 5 minutes past your scheduled appointment and you have not received a text or email, please call our office.
  7. Is telemedicine more expensive than an office visit?
    1. No, you will have the same copay as you would with an in person office visit, but you do not have to leave the comfort of your home.
  8. I have read that insurance companies are waiving copays for telemedicine visits, so why do I have a copay?
    1. Insurance policies vary on this. If your insurance pays for the telemedicine visit, including the cost of the copay, you will receive a refund. You should be able to determine this by the explanation of benefits (EOB) that you will eventually receive from your insurance company.
  9. What if my primary allergist is not available for a telemedicine visit?
    1. Do not worry! Our fantastic advanced practice providers, Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus, FNP-BC can see you if your primary allergist is not available.

Allergy, Asthma & Food Allergy Centers Telemedicine COVID-19 update 3/20/20

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Dear Allergy, Asthma & Food Allergy Centers Patients and Families,

As we informed you a couple of days ago, our professional societies released COVID-19 Pandemic Contingency Planning for Allergy and Immunology on Tuesday, March 17, 2020. We implemented the guidelines in order to continue providing essential medical care for our patients while keeping our community safe. Social distancing remains one of the centerpieces of prevention, and we are minimizing the amount of time patients may have to spend outside the home. We have updated the information regarding telemedicine visits from the blog posted on Wednesday March 18, 2020. 

  1. Anyone who is currently scheduled for a new patient office visit or a follow up office visit through April 3, 2020, will have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The telemedicine platform we are using is https://doxy.me/. You do not have to sign up for an account. You will receive a link to the virtual appointment via text message or email, which you should access through your mobile phone, tablet, or a computer with a video camera and microphone.  Starting on Saturday, March 21, 2020, the telemedicine visits will be billed to your insurance carrier and appropriate copays (depending on your insurance) will be collected over the phone. We will also read you a verbal consent form, which you can review here (informed consent).
  2. If you are on biologic injections (ex. Xolair, Nucala, Fasensra), you should keep your appointment as long as you are not acutely ill with any symptoms suggestive of an infection. However, there may be issues with delivery of the biologic medications, so please confirm with our office on the morning of your appointment to make sure we have received the shipment of the medication.
  3. If you are on allergy shots and have an annual visit coming up at which time you planned on receiving your allergy shots, you can keep that in person office visit.
  4. Patients currently on allergy shots may also continue to receive their injections in our office. However, if you have been building up once weekly, you may start coming every 2 weeks for your buildup phase during this time period. If you are currently on maintenance dosing receiving injections every 2 or every 3 weeks, you may increase your interval to every 4 weeks.
  5. If you are having acute environmental allergy or asthma symptoms, please contact the office to schedule an acute telemedicine visit with one of our providers.
  6. Office based food challenges, oral immunotherapy (OIT) new starts, and OIT dose escalations will need to be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office. However, if you need more capsules, please make sure to inform the staff member who calls.
  7. If you are ill with fever, cough, and shortness of breath, have any possible COVID-19 exposures, or have traveled (domestic or international) in the past 2 weeks,  please do not come to the office. If you suspect you need testing, please check with the following screening resources:
    1. MO hotline:  877.435.8411
    2. IL hotline:  800.889.3931
    3. Mercy screening:  314.251.0500
    4. SSM Virtual screening:  www.ssmhealth.com

 

For more information regarding COVID-19, please see the CDC website: http://bit.ly/CDC-COVID-19_info 

While COVID-19 is appropriately on all of our minds, allergy season is also upon us. If you have not already started your seasonal allergy medications, you should do so ASAP. In addition, remember to follow routine environmental controls:

  • Keep doors and windows closed in your home to prevent pollen from coming inside.
  • Keep sunroofs and windows on vehicles closed and use recirculation mode for the vehicle’s air conditioner.
  • Bathe or shower and change your clothes after spending time outside during the spring pollen allergy season, because pollen can settle into your clothing and hair. This will also decrease the spread of pollen throughout the home.

We will continue to post updates on Facebook in this evolving situation. Stay safe and healthy. 

Allergy, Asthma & Food Allergy Centers COVID-19 Update 3/18/20

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Dear Allergy, Asthma & Food Allergy Centers Patients and Families,

Our professional societies released COVID-19 Pandemic Contingency Planning for Allergy and Immunology on Tuesday, March 17, 2020. We are implementing these guidelines in order to continue providing essential medical care for our patients while keeping our community safe. As the virus spreads through our community, social distancing remains one of the centerpieces of prevention. Therefore, we are looking to minimize the amount of time patients may have to spend outside the home and are instituting the following:

 

  1. All food challenges and oral immunotherapy (OIT) new starts currently scheduled through April 3, 2020, will be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office at this time.
  2. All OIT dose escalations (updosing) currently scheduled through April 3, 2020, will need to be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office at this time. However, if you need more capsules, please make sure to inform the staff member who calls.
  3. Patients currently on allergy shots may continue to receive their injections. However, if you have been building up once weekly, you may start coming every 2 weeks for your buildup phase. If you are currently on maintenance dosing receiving injections every 2 or every 3 weeks, you may increase your interval to every 4 weeks. In the spirit of social distancing, if you have flexibility, please try to avoid any peak times to minimize the number of people in the waiting room. We have decreased the seating capacity in the waiting room. However, if you are uncomfortable coming into the office, you may skip injections during this period of social distancing.
  4. If you are on biologic injections (ex. Xolair, Nucala, Fasensra), you should keep your appointment as long as you are not acutely ill with any type of infection.
  5. Anyone who is currently scheduled for a new patient office visit through April 3, 2020,  will have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The cost for the telemedicine visit will be $200 for the new patient appointment. We will collect payment at the time of service. Please contact your insurance company to see about reimbursement for your out of pocket costs.
  6. Anyone who is currently scheduled for a follow up visit through April 3, 2020, will also have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The cost will be $50-$100 out of pocket depending on the complexity and duration of the telemedicine visit. This amount may be less than an in person office visit copay for some patients depending on their insurance.
  7. If you are having acute environmental allergy or asthma symptoms, please contact the office to schedule an acute telemedicine visit with one of our providers.
  8. If you are ill with fever, cough, and shortness of breath, have any possible COVID-19 exposures, or have traveled (domestic or international) in the past 2 weeks,  please do not come to the office. If you suspect you need testing, please check with the following screening resources:
    1. MO hotline:  877.435.8411
    2. IL hotline:  800.889.3931
    3. Mercy screening:  314.251.0500
    4. SSM Virtual screening:  www.ssmhealth.com

 

For more information regarding COVID-19, please see the CDC website: http://bit.ly/CDC-COVID-19_info 

We as a practice will continue to follow the precautionary measures recommended by the CDC and our professional societies to keep our office as safe as possible for our patients, families, and staff. Please continue to monitor our Facebook page for updates. Thank you for your understanding and continuing to partner with us to improve health outcomes. Working together in our local community and as a nation, we will overcome this crisis. Stay safe and healthy.

Singulair (montelukast) Black Box Warning

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On March 4, 2020 the U.S. Food & Drug Administration (FDA) decided to add a “Boxed Warning” to the oral medication montelukast (brand name, Singulair) due to an elevated concern regarding the risk of neuropsychiatric events, including suicidal thoughts and actions. Because of this new warning, the FDA is now recommending that montelukast only be used to treat patients with allergic rhinitis and asthma that do not tolerate or do not respond to alternative medications.

Montelukast is a leukotriene receptor antagonist that has been used to treat patients with asthma, allergic rhinitis and other conditions such as chronic urticaria (hives) since the drug was approved in the U.S. in 1998. There were no major reported safety concerns with this drug until 2007, when the manufacturer of Singulair updated the prescribing information and patient information to include post-marketing adverse events such as behavior/mood changes (i.e. agitation, anxiety, depression) and suicidality (suicidal thinking and behavior). 

Data collected by the FDA between 1998 and 2019 through their Adverse Event Reporting System identified 82 cases of completed suicide in patients taking montelukast, with 19 cases in patients under age 18. Interestingly, further data from the FDA’s Sentinel System collected between 2010 and 2015 did not show an increased risk of neuropsychiatric events in approximately 450,000 asthmatics older than age 6 taking montelukast vs. inhaled corticosteroids. Other observational studies also did not find an increased risk of mental health side effects. That being said, the reports of suicide along with evidence that montelukast crosses the blood-brain barrier in animal models persuaded the FDA to strengthen their warning.

Our medical providers at Allergy, Asthma & Food Allergy Centers are dedicated to providing the best possible treatment options for our patients while also keeping their safety in mind. Although the overall prevalence of severe neuropsychiatric events including suicide appears to be extremely low given the number of patients in the U.S. taking montelukast, we understand that our patients and caregivers may be hesitant to start or continue taking this medication. If you are already taking this medication it is safe to stop immediately, if you are not comfortable continuing it. However, we strongly advise that you contact our office to schedule an appointment to discuss alternative treatment options. As with any medication, either prescription or over-the-counter, we are more than happy to discuss the risks and benefits with you. If you are not having any problems while on montelukast, it is likely safe to continue the medication.