Blog

Hay Fever: Fact or Fiction

You can almost set your clock to it – winter ticks over into spring, plants start to bloom, and people’s noses start to act up – runny nose, stuffy nose, or even post-nasal drainage. The condition commonly called “seasonal allergies” or “hay fever,” which goes by the medical name of “Allergic Rhinitis,” affects up to 60 million people in the United States and can make life a snotty mess. Read below to learn more about this condition, including some common misconceptions.

Fact or Fiction: Seasonal allergies are called that because they only occur in the spring and the fall

FICTION. “Seasonal allergies” can be a bit of a misnomer. While it is certainly common to have flares of symptoms in the spring and fall, many people suffer from perennial (year-round) symptoms. This can occur because of allergies to indoor allergens like dogs, cats, cockroaches, and dust mites. Allergy testing can evaluate for the commonly known allergens like trees, grasses, weeds, and molds and tests for indoor allergens. Unfortunately, many people can’t count on the time of the year to provide relief.

Fact or Fiction: Eating local honey helps prevent or treat nasal allergy symptoms.

FICTION. This commonly suggested remedy offers to provide allergy relief with a tasty treat. Sadly, it is not effective. The thought process is that local honey contains pollen, and eating the honey will allow for exposure to the pollen – similar to an allergy shot. While there can be small amounts of pollen in local (unprocessed) honey, this tends to be from flowering plants, which are less likely to cause allergy symptoms. Pollen allergy is most commonly caused by wind spread pollens like those from grasses, trees, and weeds. 

Fact or Fiction: Allergies aren’t the only cause of this type of nasal symptom.

FACT. Though ⅓ of patients with persistent nasal symptoms have allergic triggers, another ⅓ have non-allergic triggers. These triggers can include perfumes/fragrances, smoke, or even temperature/humidity changes; the latter two can mimic the seasonal pattern seen in seasonal allergies. Thus, the final ⅓ of patients with nasal symptoms have a combination of allergic and non-allergic triggers, which we call “mixed rhinitis.”

Fact or Fiction: Allergic (or non-allergic) nasal symptoms are just a normal part of life that has to be dealt with – there’s nothing to be done about them.

FICTION. Thorough evaluation of symptoms, combined with allergy testing, helps guide specific treatment for your nose symptoms. At Allergy, Asthma & Food Allergy Centers, we are experts in diagnosing and treating allergic, non-allergic, and mixed nasal symptoms. A combination of environmental control measures (to reduce exposure to allergens), treatment with oral or nasal medications, and possibly the addition of allergen immunotherapy (allergy shots) can provide lasting symptom relief.

Allergists are uniquely qualified to help you get the relief you need when it comes to this troublesome condition. You can learn more about this condition in our blog, or by making an appointment to be seen by one of our providers.


Welcome Dr. Waterhouse

We are also excited to welcome Dr. Waterhouse to our AAFAC team! After graduating from medical school at UMKC, Dr. Waterhouse returned to St. Louis and did a pediatric residency at Cardinal Glennon Children’s Hospital.

She completed her allergy and immunology fellowship at SLU, and after finishing her fellowship, she started the allergy department at SSM Medical Group, where she has worked for the past 10 years. Dr. Borts and Dr. Warrier were Dr. Waterhouse’s mentors during her fellowship, and she is honored to practice and work with them again. She’s also excited to offer her patients OIT for those suffering from food allergies. Dr. Waterhouse will mainly be seeing patients in west county in the Chesterfield office at Clarkson and Baxter.


Welcome Dr. Dixit

We are pleased to welcome Dr. Dixit to our team of providers! 

He grew up on the Mississippi Gulf Coast and went to Millsaps College in Jackson, MS. Dr. Dixit stayed in Jackson for medical school at the University of Mississippi School of Medicine and completed his internal medicine training at the University of Mississippi Medical Center. He decided to pursue allergy and immunology and completed his fellowship at Saint Louis University.

Dr. Dixit is excited to be joining the team, and will mainly be seeing patients in the Swansea, Illinois office.


Q & A with Laura Kahle, PA-C

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.

 


Welcome Patients of Dr. Kim Waterhouse to Allergy, Asthma & Food Allergy Centers

Dear Dr. Waterhouse Patients,

We are delighted to welcome you to our practice! We aim to make your transition as smooth as possible. 

If you are on allergy injections, we should have your vials by July. Please download the new patient paperwork from this page and allergy shot treatment consent and financial consent. We do ask that you please email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aafacenters.com. Please include in the subject line “transferring Dr. Waterhouse patient”. Please also schedule an in person office visit at your earliest convenience in order to become further established in our practice. You will need to have that visit before we can refill medications and answer medical questions. The first visit will likely be with Lauren Davis, PA-C in the Chesterfield office, but Dr. Waterhouse will resume her role as your primary Allergist after she starts with the practice in late August. 

  • Allergy injections administered in our Chesterfield office (16216 Baxter Rd., Suite 299, Chesterfield, MO 63017):
    •  8:30AM – 4:30PM Mon-Thur
    •  8:30AM – 2:30PM Fri
    • We plan to add late office hours starting Tuesday, August 31, 2021.
  • We follow the guidelines from our professional allergy societies  that all allergy injection patients will need to wait in the office for 30 minutes after their injections.

If you are on a biologic for asthma or hives (ex. Xolair, Fasenra, Nucala, Cinqair, or Dupixent), please call at your earliest convenience to schedule a telemedicine or in person office visit by June 2021. If this is a telemedicine visit, it will be with one of our Advanced Practice Providers (Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus FNP-BC) so we can get you established as soon as possible. You can read more about telemedicine visits here. This will allow us to get you registered in the practice and enable us to go through the necessary prior authorization process to obtain your medications. When you are due for your injection(s), and we have verified that we have your medication, we will schedule an in person visit in the office. Please note that our policy is that you will need an office visit for each biologic injection administered in the office. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms (if needed), copies of the front and back of your insurance card, and driver’s license to info@aafacenters.com. Please include in the subject line “transferring Dr. Waterhouse patient”.

For all other patients, we request that you please schedule a telemedicine or in person office visit at your earliest convenience to become established in our practice. We will need to see you to get you established in our system so we can refill medications and answer any medical questions. This is also an excellent time to do an annual visit. We can provide updated food allergy and asthma action plans at the time of the visit if needed. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aafacenters.com. Please include in the subject line “transferring Dr. Waterhouse patient”.

We recommend that you follow us on Facebook, where we post practice updates.

It is our pleasure to play a role in keeping you well. We look forward to meeting you!


Telemedicine Still Available in 2021

Allergy, Asthma & Food Allergy Centers has been using the doxy.me platform for telemedicine visits since Thursday, March 19, 2020, and this has worked very well for patients unable to come to one of our physical locations (Swansea, Illinois; Bloomsdale/Ste. Genevieve, Missouri; South County/Sunset Hills, MO; and West County/Chesterfield, MO). 

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. What if my primary allergist is not available for a telemedicine visit?
    1. Do not worry! Our fantastic advanced practice providers, Lauren Davis, PA-CLaura Kahle, PA-C, or Dani Loftus, FNP-BC can see you if your primary allergist is not available.

Biologic Treatments for Asthma

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

 


What are USP 797 Guidelines?

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 & A with Lauren Davis PA-C

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.


Personalized & Caring Approach to Phlebotomy

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.