Author: Lindsay Van Quaethem

Q: How long have you worked at AAFA Centers?

A: I have worked at AAFA Centers for 4 years- and a lot has changed over that time! Three new offices and many new medical services. It’s been an amazing experience to be part of the growth.

Q: What inspired you to be a physician assistant? 

A: I am also a Registered Dietitian and previously worked in pediatrics (particularly Cystic Fibrosis). I wanted to be able to provide complete medical care and not only nutrition therapy. One of the pulmonologists I worked with encouraged me to pursue Physician Assistant studies. I wanted to work in a field where I could utilize my nutrition and PA background, so here I am!

Q: What do you like to do in your free time? 

A: Pre-COVID, we traveled all over the country to see friends and family and explore the outdoors. Now, my husband and I have gotten a little more creative to keep exploring the local outdoors with our 2 little girls.

Many people who live with asthma manage their symptoms by identifying and avoiding triggers, taking daily oral and inhaled medications, and using a quick-relief inhaler. Recently, many new drugs known as biologics have been approved for treating moderate-to-severe asthma. Biologic therapies are antibodies (immune proteins) that target specific molecules that contribute to poorly controlled asthma.

There are many new biologic therapy options available to treat severe asthma. They work by disrupting the pathways that lead to inflammation in the body that causes asthma symptoms. Xolair and Nucala are approved for patients as young as six years old, while Dupixent and Fasenra are approved for patients as young as 12 years old. Cinqair is approved for adults 18 years and over. 

Biologic therapy may not work for everyone and it may require the use of other treatments as well, but the vast majority of patients on biologic therapy have significant improvement in their asthma symptoms and also require far less if any oral steroids. It is important to see an asthma specialist in order to learn if biologic treatment is right for you. Our experts at AAFAC can help you identify what triggers your asthma and find the treatment that is unique to you and your needs.

Source: verywellhealth.com/biologics-for-severe-asthma-4788216

Our practice is compliant with USP 797 guidelines – what does that mean, and what is USP?

In the early 1800s, when people needed medicine, they went to their local apothecary, where the druggist would mix together a medical preparation derived from hand-collected plants and minerals. But the potential consequences of inconsistent or poor-quality medicinal ingredients or a mistake by the person behind the counter could be serious. Two hundred years ago, the types and quantities of the drug ingredients varied widely. Patients were sometimes given too little or too much. There were often multiple names for the same medicine, and medicines with the same name didn’t always share the same properties. Medical professionals did their best, but in some instances, the treatment could be more dangerous than the ailment. 

In the years following the American Revolution, as poverty increased and America’s water and air became more polluted, people grew sicker. Mainstream medicine became increasingly ineffective. Americans began to seek out non-conventional medicine and people who embraced these methods. Tensions grew between trained doctors and the American public looking for more effective cures. This growing distrust of traditional medicine was one factor that drove one of the most groundbreaking periods for medical inventions in the 19th century, along with the development of modern medicine in general.

Rising from this tension, Lyman Spalding, a physician and professor from New York, became alarmed when he observed inconsistent and poor-quality medicines threatening the health of his patients. He, with the help of Samuel Mitchill, an American physician, naturalist, and politician from New York, convinced other physicians to meet in January 1820 at the United States Capitol to form the United States Pharmacopeia (USP). They put in place standards for the quality of medicines that would protect the public’s health. Reflecting the spirit of the young nation, the group would not be part of the government but instead would remain an independent organization that relied on the latest science to build trust in medicines. 

They created a well-defined and clearly described roster of the best understood medicinal substances and preparations of the day that could be used by medical professionals across the newly established United States of America to prepare medicines consistently and to establish independence from Britain. This first edition of the U.S. Pharmacopeia was written in both English and Latin, making it broadly accessible, and was printed at a low cost to make it easily affordable. 

Move forward almost 100 years.  In 1911 immunotherapy for grass pollen-induced hay fever was used by collecting grass pollen, creating an extract, and injecting it into patients.  Over the ensuing decades, companies took on the role of collecting and purifying pollens and other allergens and making them available to Allergists in practice worldwide.  Most Allergists used these commercial materials to compound allergy extracts to administer to their patients, although there was often a lack of agreement on what and how much to use for treatment.  

Fast forward to today and the modern practice of Allergy.  The USP has regularly met and revised guidelines and recently has established a set of standards that apply to the practice of Allergy and compounding of allergy extracts used in allergen immunotherapy.  

The current USP Chapter 797 provides standards unique to allergen extract compounding for individual patients.  Under the new standards, to continue in-office compounding of individual treatment for allergen immunotherapy, allergy practices need to comply with personnel qualifications, facilities requirements, and documentation.  

How has Allergy Asthma & Food Allergy Centers addressed and met these requirements? 

• Our allergen extract mixing is overseen by Dr. Michael Borts who has over 30 years of experience in allergen extract compounding.  
• Our Clinical Staff, Ashley Crowden, RN and Jessica Tharp, RN have completed training and standardized testing on principles and procedures for sterile compounding, garbing, hygiene, gloved fingertip, and thumb sampling and media fill tests.

• Our compounding occurs in a dedicated Allergenic Extracts Compounding Area located in our South County office location. 

• Our allergen extracts are labeled with patient name, type, and fractional dilution with corresponding vial number, beyond use date, and required storage conditions.
• Training, assessment results, evaluations, and qualification records for all compounding personnel, including any corrective actions following assessments and evaluations are kept on file. 

In addition, we use Rosch Immunotherapy in order to provide additional efficiency and safety with rapid patient check-in (to reduce pre-injection waiting times), bar-coding of vials (to promote patient safety with the right extract for the right patient), and efficient documentation of injections.  

While the lack of any reported cases of an infectious adverse event might make these guidelines seem unnecessary, our practice is willing to comply with the USP Expert Compounding Committee’s guidelines to reflect our dedication to patient safety.

Q: What inspired you to become a Physician Assistant in the field of allergies, asthma, and immunodeficiencies?

A: Actually, I came across this specialty by accident. My physician assistant program provided a general education across a variety of specialties. I knew I wanted a career where I had an opportunity to work with children. I got really lucky to find this specialty (and this office). Not only do I get to treat children, but I get to treat families. I really enjoy getting to see patients frequently, and I feel that our work makes a difference in allowing kids and adults to live more normal lives.

Q: What do you love most about your job?

A: I love the opportunity to see people over and over again. It allows me to form relationships with the families and to get insight into how they are truly doing. I really like being there for milestones for families. Whether that is watching them eat their first peanut, or getting them through a winter without terrible asthma exacerbations, I like being there for these families and doing things to improve their quality of life.

Q: What are your hobbies outside of work?

A: Anything outside! I love playing tennis, skiing, and hiking. I can’t wait for the nicer weather.

To identify what airborne allergens or food substances you are allergic to, we generally perform a prick skin test. Allergy testing can be done by a blood test, or phlebotomy, as well. While in some cases, skin testing can identify an allergy that is missed by blood testing, the latter can be useful for evaluating and managing food allergies. Skin testing allows us to obtain results and to develop a treatment plan at the time of your visit, but sometimes it may be helpful to prepare children for blood testing as well, especially if food allergy is a concern. Our phlebotomist, Emily Alexander, is wonderful and takes a personalized and caring approach to her patients.

Emily shares her story below:

I started my lab career at the age of 18 as a lab assistant, learning all the ins and outs of how a laboratory works. My mom had previously worked in that same lab, so it was easy for me to get started on the right foot from coworkers that knew of me. My interest was piqued at a young age, I got to ask a lot of questions about why and how a lab works. Microscopes, tubes, beakers, needles, and the importance to remember that behind each tube being a person.  

My next step was learning phlebotomy from a team of people that instilled the motto of “lab work is the gateway of going home.” Treating each child as if they were our own and the importance of collecting lab tests properly. That journey started in 2007 at a high-ranking local pediatric hospital where the patients and co-workers treated each other as family. The understanding that patients could be scared and apprehensive when I walk into the room was not to be taken lightly. The parents are often nervous and children can sense it and feed off of it. Taking a caring and gentle approach to each baby, toddler, child, and teenager means as much to the patient and parents as it does to me.   

After years of building trust and confidence with families and their physicians (and getting their sometimes complex laboratory orders completed) is how I met the providers, Dr. Warrier, Dr. Borts, and Dr. Vitale. 

I switched gears to private practice in 2016 at Allergy Asthma & Food Allergy Centers, and I continue to take pride in comforting a wide range of ages from babies to adults. I listen to their concerns and their previous experiences. Children like to hear that everyone gets their blood collected at one point in their life and that they’ll be okay before/after the labs are collected.

Whether the families have driven for hours or minutes to get lab work done, I like for them to feel at ease with me. When it comes down to the actual process of blood collection, it’s always best and helpful for the patient to be hydrated and to try to keep from drinking sodas or anything with caffeine. I use a comforting tone while I speak to the children while making eye contact. I like to give the children my honest step-by-step instructions of how it’ll be done and with a few countdowns of 1-2-3’s so there aren’t any surprises. 

One thing I make sure to do is always put the tourniquet on top of the sleeve and not too tight to cause much discomfort or possible pinching. With that being done at the beginning, I believe that it sets the stage for a more peaceful collection. I always ask how they’re doing and love having conversations about their favorite things, like activities, games, shows, or whatever is on their mind. These hidden gems are the best part of my day. Keeping their minds off of whatever is happening has a great calming effect. 

As parents, we don’t ever want to feel like we’re putting our kids in scary situations. Blood draws can be hard on parents, so be mindful of that. Your little ones feel your energy. For them, manage your fear, anxiety, or apprehension as best you can. I would refrain from telling your child too far ahead of time that it will hurt or making a big deal of it. For some families, it may be helpful that the less nervous parent or caregiver is with the child during this appointment. When the patients and families leave with a smile on their faces and the peace of mind of having accurate results, I’ve done my job.

We are pleased to introduce you to Dani Loftus! She is a Certified Family Nurse Practitioner (FNP-BC) & Certified Pediatric Nurse (CPN) who treats people of all ages at the Allergy, Asthma & Food Allergy Centers (AAFAC). Learn more about her in the Q&A below:

Q: How long have you worked at AAFA centers?

A: I joined AAFAC in November 2019. This is my first position after graduating with my Doctor of Nursing Practice (DNP) Degree in May 2019. Prior to joining AAFAC, I worked at St. Louis Children’s Hospital, Shriners Hospitals for Children, and Southern Illinois University Edwardsville.

Q: What inspired you to be a nurse practitioner? 

A: I was inspired to become a nurse from growing up taking care of my grandmother who had diabetes. She was an inspiration and I miss her dearly. 

I wanted to become a nurse practitioner after experiencing the health care system from the perspective of the patient. In 2014 I had two tumors removed from my tongue, and I was hospitalized twice. I had to relearn to eat and how to talk. It was through that experience that I wanted to become a nurse practitioner. I chose to pursue my education through SIUE as I had excellent experiences attending the school for both my bachelor’s and master’s degrees.

Q: What do you love most about your job?

A: I love that I am in an environment where I can continue to learn something new every day. I enjoy working with a physician team that is passionate about teaching!

Q: What are your hobbies outside of work?

A: Outside of work, I spend a lot of time with my family and our rescue pets. I enjoy playing board games and exploring new places. Travel is a passion of mine, and I have been fortunate to see many beautiful places including the Eiffel Tower and the Great Wall of China!