Welcome

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."

ADVOCACY UPDATES

Your AAOA at the AMA

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

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Fall Advocacy Update: USP 797, E/M Documentation and Payment

Revisions to USP Chapter 797 Open for Comment Since the United States Pharmacopeia (USP) released…

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Brief Update on the Final CY 2019 Physician Fee Schedule

On November 1, the Centers for Medicare and Medicaid Services released the final Physician Fee…

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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

12/01/2018: Research Grant Cycle
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04/01/2019: 2019 Fellow Exam Application Deadline
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06/01/2019: Research Grant Cycle

06/7/19: Membership Application Deadline to be eligible for AAOA Member rate for the 2019 Basic Course

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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EDUCATION

Codes/Guidelines

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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IFAR

IFAR Impact Factor: 2.135

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Now Available

Changes in Managing Practices

Mission

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 Interactive Allergy & Rhinology Course
February 8-10, 2019 | Dallas, TX
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2019 Basic Course in Allergy & Immunology
June 27-29 | Minneapolis, MN
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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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AAOA Clinical Insights
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PATIENT CORNER

OTC Allergy Medications

There seem to be more and more medications available for allergy treatment that  you can now purchase over the counter.
The FDA is allowing previously prescription only drugs to be made available directly to the consumer without a prescription — adding more to the over-the-counter options in the healthcare aisles.

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News and Updates

From the AAOA President, Matthew Ryan, MD

...the AAOA continues to be the organization that Otolaryngologists look to for up-to-date education and information on the…

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FDA Approves First Generic Version of EpiPen

The Food and Drug Administration approves the first generic version of EpiPen and EpiPen Jr.…

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Social and Networking Events at the 2018 AAOA Annual Meeting

This year’s Annual Meeting assures to be not only educational, interactive, and practice-centered, but also…

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Risk Factors for Testing & Immunotherapy

Sampled from the AAOA Clinical Care Guidelines

vials of allergens

The American Academy of Otolaryngic Allergy (AAOA) recognizes the importance of allergy skin testing and immunotherapy in the clinical practice of allergy.

Although felt to be a safe practice in most patients, certain populations need to be given special consideration as they have been identified as being at a higher risk for compli- cations during skin testing and treatment of allergies with immunotherapy. This is not intended to be an all-inclusive list.

Pregnancy

Allergy immunotherapy can be continued during pregnancy. Escalation and skin testing should be avoided.

The most recent update on allergen immunotherapy states that allergen immunotherapy can be continued but is usually not initiated in the pregnant patient. Allergen immunotherapy is usually not initiated during pregnancy because of concerns about the potential for systemic reactions and the resultant adverse effects on the mother and fetus. For this reason, if the patient becomes pregnant during escalation and the dose is unlikely to be therapeutic, discontinuation of immunotherapy should be considered.

Asthma

Asthma patients should be under good asthma control prior to undergoing skin testing or before the initiation or continu- ation of immunotherapy. In asthma patients, consider evaluat- ing lung function prior to administration of immunotherapy.

Immunotherapy is effective in the management of allergic asthma; however, uncontrolled asthma has been repeatedly identified as a high-risk factor for systemic reactions during skin testing and allergen immunotherapy.

The most recent update on allergen immunotherapy states that allergen immunotherapy in asthmatic patients should not be initiated unless the patient’s asthma is stable with phar- macotherapy. It is also recommended that allergy injections should be withheld if the patient presents with an acute asthma exacerbation. Before the administration of an allergy injection, the asthmatic patient should be evaluated for the presence of asthma symptoms. One might consider an objective measure of airway function (peak flow).1, 2

Beta Blockers

The AAOA recognizes that exposure to a beta-adrenergic blocking agents is a risk factor for more serious and treat- ment resistant anaphylaxis. Therefore it is preferable to not perform inhalant skin testing and immunotherapy on patients taking beta blockers.

The balance of possible risks and benefits is not the same for patients with the potential for life-threatening stinging insect reactions who are also taking a beta– blocker. In these patients, the benefits of venom immunotherapy may outweigh any risk associated with concomitant beta-adrenergic blocker admin- istration. The individualized risk/benefits of immunotherapy should be carefully considered in these patients.

Beta blockade can enhance mediator release in the setting of IgE-mediated anaphylactic reactions. Therefore, concom- itant treatment with beta-adrenergic blockers may result in more protracted and difficult to treat anaphylaxis. Studies looking at patients taking ophthalmic and cardio-selective

beta-blockers have found unusually severe anaphylactic reac- tions and for this reason, the absence of increased risk in this population cannot be assumed.3, 4, 5, 6, 7

Other Risk Factors

Other predictors of future allergic reactions include, prior allergic reactions, immunotherapy escalation, first treatment vial and technical (dosing/wrong vial) error.8, 9

Review AAOA’s Clinical Care Statements

References:

  1. Cox L, Nelson H, Lockey, R. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 2011; 127(suppl): S1-55

  2. Lockey RF, et al. Systemic Reactions and fatalities associated with allergen immu- notherapy. Ann Allergy Asthma Immunol 2001; 87:47-55.

  3. Hepner MJ, et al. Risk of systemic reactions in patients taking beta-blocker drugs receiving allergen immunotherapy injections. J Allergy Cl in Immunol 1990;86:407

  4. Lang DM. Do beta-blockers really enhance the risk of anaphylaxis during immuno- therapy? Curr Allerg Asthma Rep 2008; 8:37

  5. Odeh M, Oliven A, Bassan H. Timolol eyedrop-induced fatal bronchospasm in an asthmatic patient. J Fam Pract 1991;32:97-8, NR

  6. Cox L, Nelson H, Lockey, R. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 2011;127(suppl):S1-55

  7. Lieberman P, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 Update. J Allergy Clin Immunol 2010;126(3): 477-523

  8. Roy SR. et al. Increased frequency of large local reactions among systemic reac- tors during subcutaneous allergen immunotherapy. Ann Allergy Asthma Immunol 2007; 99:82.

  9. Bernstein DI, et al. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001. J Allergy Clin Immunol 2004;113:1129

Member Benefits

Aaoaf Ifar

International Forum of Allergy & Rhinology (IFAR)

is the official journal of the AAOA and the American Rhinologic Society (ARS). Published monthly by John Wiley & Sons, Inc., IFAR provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions.

Medical therapy for Chronic Rhino-sinusitis

The indications for surgical management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) are poorly defined..
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Safety of long-term Intranasal Budesonide

The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).. Read More

News from AAOA Leaders

Allergies, not just for summer anymore.
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How to treat allergies at home.
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