Telemedicine Services Available!

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, 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 a few days before your appointment to give you the option of a telemedicine visit or to reschedule. 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 7 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 during this allergy season.

Telemedicine Frequently Asked Questions:

  1. How does telemedicine work?
    1. A staff member will call you 15-20 minutes before your scheduled appointment time to collect insurance information, review the telemedicine consent, and collect copays.
    2. You will receive a text in most cases (an email if you cannot receive texts) with a link from doxy.me.
    3. Open the link through your phone or use Chrome browser when on a computer/laptop. You will need a strong internet connection.
    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 information in your medical record. 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 may 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, and the guidelines are not clear. 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.

Singulair (montelukast) Black Box Warning

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.


Keeping Asthma In Check

 

The best way to keep your asthma in check is to avoid what triggers your asthma. Common asthma triggers include:
• Allergens such as pollen, mold, dust mites, and pet danders
• Irritants in the air such as tobacco smoke and air pollution
• Extreme weather conditions of heat, humidity and cold air.
• Exercise
• Emotions–not only sadness and stress, but also sometimes laughter.
• Respiratory infections

Some other health problems can make asthma symptoms worse, such as obesity, acid reflux, sleep apnea, stress and depression.  If you have one of these other problems, let your allergist know so that they can be addressed as a part of your overall treatment.

Treating your asthma includes identifying and avoiding asthma triggers when possible.  Nearly everyone needs some medication in addition to avoidance measures.  In addition, some people benefit from monitoring their lung function with a portable device like Wing or a peak flow meter.  This type of device allows you to measure your airflow, and then to follow the Asthma Action Plan that you and your allergist create.

There are many effective medicines to treat asthma.  In simple terms there are two kinds:  quick relief medicines (short acting bronchodilators like albuterol) and long-term control medications (like inhaled corticosteroids, long-acting bronchodilators, and other oral and inhaled medications) that control airway inflammation.  The right medications depend on your triggers, asthma severity and your your control.  The goal is to make you feel your best with the least amount of medication.

There are health risk concerns with corticosteroids.  They are powerful medications that can be dangerous if taken in excessive amounts.  Medical research over the past 30 years shows that when taken as directed, inhaled corticosteroids are safe and well tolerated, and one of the most effective treatments for asthma.

In recent years new medications for severe asthma have become available that fall into the category of biologic medications.  These typically block a specific antibody or other chemical that the body makes in excess that has made the asthma worse.  Currently these biologic medications for asthma are given in the form of an injection or intravenous treatment in the office.  If you have severe asthma that is not controlled with other medications, your allergist will discuss these medications with you.

When allergies play a role in asthma, then you should consider allergy shots.  These are very effective in relieving allergy symptoms and in some cases cure your allergy.  The treatment typically occurs over several years involving injecting small amounts of the allergen in gradually increasing amounts over time.  Allergy shots are generally given for three to five years, and sometimes longer.

Most of all, remember that your allergist is an asthma specialist.  You allergist can help you learn more about your asthma and develop a treatment plan that works for you.   You should see an allergist if:
• Your asthma symptoms interfere with your daily activities or your sleep.
• You’ve had a life-threatening asthma attack.
• Your doctor believes that you are not responding to your current treatment.
• Your symptoms are not usual.
• You’ve taken oral corticosteroids for asthma more than twice in one year.
• You have been hospitalized for your asthma.
• You need help to identify your asthma triggers.

Although asthma can be treated and symptoms can be controlled, there is not yet a cure for asthma.  Preventive treatment should allow you to lead a normal, active lifestyle.

If you would like to see if your asthma and allergies are not under control, take the asthma and allergy symptom test from the American College of Allergy, Asthma & Immunology.