Celebrating Over 75 Years Of Service

The American Academy of Otolaryngic Allergy (AAOA) represents over 2,700 Board-certified otolaryngologists and health care providers. Otolaryngology, frequently referred to as Ear, Nose, and Throat (ENT), uniquely combines medical and surgical expertise to care for patients with a variety of conditions affecting the ears, nose, and throat, as well as commonly related conditions. AAOA members devote part of their practice to the diagnosis and treatment of allergic disease. The AAOA actively supports its membership through education, research, and advocacy in the care of allergic patients.

"Dedicated to enhancing knowledge and skill in the care of the allergic patient."


USP Update

Final Standards for Allergen Extract Compounding under USP Chapter 797 The long-awaited new USP Chapter…

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Impact OF 2019 Physician Fee Schedule on Allergy and Sinus Services

Specialty Impact The conversion factor for 2019 will be $36.0391 and remains essentially flat.  The changes…

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Your AAOA at the AMA

I want to urge you to consider membership in the AMA because your membership in…

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Changes in MACRA

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Before the close of 2017, all physicians must take action to avoid the 4 percent cut that will be assessed in 2019 for not participating in the new Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).  Read More

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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Upcoming Dates

07/31/19: Membership Application Deadline to be voted in at the 2019 Annual Meeting and to be eligible for AAOA Member Rate (FREE) for the 2019 Annual Meeting
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12/01/19: Research Grant Cycle
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04/01/20: Fellow Exam Application Deadline
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06/01/20: Research Grant Cycle
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06/01/20: Call For Scientific Abstracts Deadline
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06/7/20: Membership Application Deadline to be eligible for AAOA Member rate for the 2020 Basic Course


New Orleans: Should I Stay or Should I Go?

Much like the Clash song lyrics, many of you will flip through this AAOA Today issue trying to assess whether it is worth the cost to get on a plane to participate in the AAOA’s Annual Meeting. We recognize you have lots of CME options, some are even competing with our meeting in New Orleans. Read More


IFAR Impact Factor: 2.454


Now Available

Changes in Managing Practices


Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices.

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Live and Online CME

2019 AAOA Annual Meeting
September 13-15 | New Orleans, LA
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2019 Advanced Course in Allergy & Immunology
December 12-14 | Austin, TX
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2020 Basic Course in Allergy & Immunology
July 9-11 | Orlando, FL
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AAOA Clinical Insights
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History of Allergy Treatment

The history of modern allergy treatment dates back to the early decades of the twentieth century with the demonstration of decreased response to grass pollens following conjunctival challenge done by Noon and Freeman.

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News and Updates

New Orleans: Should I Stay or Should I Go?

Much like the Clash song lyrics, many of you will flip through this AAOA Today…

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International Forum of Allergy & Rhinology Top Articles 2018-2019

Read top articles published in the International Forum of Allergy & Rhinology 2018-2019. Most Cited International Consensus…

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CEO Update – Re·im·ag·ine

re·im·ag·ineverb reinterpret (an event, work of art, etc) imaginatively; rethink Reimagined, Reinvented, Reinvigorated….these are all…

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Gluten-Free or Not Gluten-Free?  That is the Question…

I never heard anything about gluten before 5 years ago, now you can’t swing a baguette without hearing about gluten. What gives?

Gluten is a naturally-occurring protein present in several cereal grains.  Wheat , Barley, and Rye are the principal gluten-containing grains.  The gluten molecule is made up of Glutenin and Gliadin.   Gliadin is rich in prolene and poorly degraded in the gut.

Coeliac Disease is the best-known  gluten sensitivity.  It is an auto-immune response to this protein that causes acute discomfort as well as long-term damage to the intestinal lining.  There does appear to be an increase in Coeliac Disease over the last several decades, though not to the degree proportionate with the media hype.

Also, better awareness and ability to establish diagnosis have increased numbers of identified case.

That said, much of the ado about gluten parallels the interest in low-carb/paleo diets touted as healthier and helpful for weight loss.

It seems like everyone I know is going gluten-free. Should I be gluten-free too?

This answer comes from the tautology department- Gluten is only a problem if it’s a problem…  The percentage of the population thought to have Coeliac Disease is thought to be slightly more than 1%. Meaning that about 99% of the population ain’t got it.

That said, there are 2 other reported problems with consumption of wheat and/or other gluten-containing grains.  The first is Wheat Allergy.  In true Wheat Allergy, patients have a true allergic (often anaphylactic!) response to Albumins and Globulins contained in wheat.  It is worth noting that these are not the proteins that constitute gluten.

While wheat allergy represents a true hypersensitivity to wheat, it does not represent a reaction to gluten itself in most cases.  There is another condition called Non-Coeliac Gluten Sensitivity in which patients suffer a variety of non-specific, but often quite serious symptoms surrounding the consumption of gluten-containing foods.

This condition is what is known as a “diagnosis of exclusion”, meaning that Coeliac Disease and Wheat Allergy must be ruled out first before arriving at this diagnosis.  There are no specific test that can be performed to establish this diagnosis.

How do I know if this is a thing (for me)?

One easy thing to do is to eliminate gluten-containing foods from the diet and see what happens.  Whatever the cause, it eliminating these foods is easy for a person to do and makes them feel better (for whatever reason!), it’s worth consideration.  That said, modern food is a majestic product of modern engineering that includes all sorts of additives that may affect digestion.  There also may be some risks to this strategy (see below).

If a person wants to investigate whether they have Coeliac Disease, this should be done under the direction of their physician.

There are blood tests that can be performed.  IgA Tissue Transglutaminase (tTG) is the best initial test for Coeliac Disease.  Small intestine biopsy is considered the “gold standard” confirmatory test.

Genetic testing may also be useful.  HLA-DQ2 is present in approximately 90% of patients with Coeliac Disease.  HLA-DQ8 is present in roughly 5% of Coeliac patients.

For Wheat Allergy, skin prick testing would be the initial screening method of choice.

While Skin prick testing is very specific for wheat allergy, some question the sensitivity of this test.  Because of this, it is often necessary to initiate confirmatory testing.  Food challenge is a valuable confirmatory test for wheat allergy.

Given the potential danger of wheat exposure in a sensitized individual, this should only be performed under strict guidance of a physician.

As mentioned above, NCGS is a diagnosis of exclusion. Once Wheat Allergy and Coeliac Disease have been ruled out, a formal food challenge would be the next appropriate step.  For this, the patient has already undertaken a strict gluten-free “washout” period.  The next step would be to re-introduce gluten and document reported symptoms.

The strongest support for this diagnosis would be provided by a double blind food challenge, although the logistics of this are complicated.  An open gluten challenge is also considered acceptable for diagnostic purposes.

Couldn’t hurt, might help, right?

Well, except that it can…  In the USA, wheat flour is enriched with several B vitamins (folic acid, niacin, riboflavin, and thiamine) and, in some cases, calcium.  There is some suggestion that elimination of enriched wheat from the diet may predispose towards deficiency of these vitamins.

While some fiber and protein is present in whole wheat flour, adherence to the other components of the food pyramid should provide adequate intake of these nutrients.  Daily supplementation with a multivitamin would adequately replace these and most other vitamin and trace mineral deficiencies.  Consultation with a dietician may be indicated to verify that all of an individual’s nutritional needs are being met.

With the many claims made about gluten, it is important to be able to separate the wheat from the chaff (so to speak…).

If concerned about these issues or other food related sensitivities, it may be worth consultation with your physician.

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