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Welcome

Celebrating 80 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.

"Advance the comprehensive management of allergy and inflammatory disease in Otolaryngology-Head and Neck Surgery through training, education, and advocacy."

ADVOCACY UPDATES

Changes To E/M Codes Beginning On January 1st

Effective January 1, 2021, the Centers for Medicare & Medicaid (CMS) finalized significant changes to…

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Additional COVID-19 Relief Up in the Air

House Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin appeared to be moving closer…

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CY 2021 Physician Fee Schedule Proposed Rule Summary

On August 3, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician…

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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

02/01/20: 2021 Annual Meeting Crowdsourcing
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01/15/2021: Call for Proposals
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04/01/21: Fellow Exam Application Deadline
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06/01/21: Research Grant Cycle
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06/26/21: Membership Application Deadline to be eligible for AAOA Member rate for the 2021 Basic Course

07/15/21: Call for Scientific Papers

09/01/21: Membership Application Deadline to be voted in at the 2021 Annual Meeting

12/01/21: Research Grant Cycle
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EDUCATION

Don't miss the opportunity to curate content you need now conveniently in your own office or home! The content will only be available until March 25th!

NEW YEAR, SAME PANDEMIC

Looking for insights as you focus on 2021 and practice growth? Still struggling with some of the reboot challenges from COVID? AAOA is re-releasing core content from its summer Pandemic course to help give you access to content you need now. Register now for the great way to gain insights, earn up to 13 hrs CME, and help meet your maintenance of certification (MOC) requirements.

JUST THE BASICS

Do you have new staff and need help training them on the core concepts of allergy diagnosis and management in ENT? In your practice reboot, are you reconsidering your practice set up or considering adding allergy to your practice? Are you looking for great review tools for you and your staff?

To help you we are offering time-limited access to our core allergy education library to give you and your staff the tools you need to get up to speed or refresh on the key concepts in allergy diagnosis and management. Register today and earn up to 8.75 hrs of CME (MOC eligible).

IFAR

IFAR Impact Factor: 2.454

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IFAR Featured Content: COVID-19 - Free Access
Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategies . Read More

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

New Year, Same Pandemic
January 25-March 25 | On-Demand
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Just the Basics
January 25-March 25 | On-Demand
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2021 Basic Course in Allergy & Immunology
On-demand Mid-June Live Stream Targeted For July 8-11 | Virtual
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USP 797 Online Module
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2021 AAOA Annual Meeting
Pre-launch Mid-September
Live Stream Starting on Oct 16 | Virtual
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News and Updates

CMS Coding 2021 – AAOA Zoomcast

A brief summary of the CMS Coding 2021 – AAOA Zoomcast Series: Just In Time…

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Re-Engaging Patients During and Post COVID-19 Pandemic – AAOA Zoomcast

A brief summary of the Re-Engaging Patients 2021 - AAOA Zoomcast Series: Just In Time…

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College Allergy Symptoms Treatment Back to Shcool

PRACTICE RESOURCES

AAOA Practice Resource Tool Kit

The American Academy of Otolaryngic Allergy (AAOA) Practice Resource Tool Kit is intended as a guide to help AAOA members integrate allergy into their otolaryngology practice and to continually improve on this integration as new information, regulations, and resources become available.

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PATIENT CORNER

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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