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Celebrating Over 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."

AAOA Member Benefits

  • Up to 60% discount for CME programs and free Annual Meeting. All AAOA’s CME programs meet ABOTOHNS Continuing Certification.
  • AAOA US ENT Affinity program, where AAOA members can gain savings on antigen, allergy supplies, and any of the other 5 service lines US ENT offers. For more email info@usentpartners.com.
  • Tools and resources to comply with US General Chapter 797 and practice management tools.
  • Advocacy support.
  • And much more! Learn More

PRACTICE MANAGEMENT CORNER

As part of our on-going member support, we are introducing a new website feature to help with common practice management challenges. We welcome your input with questions or challenges you would like to address. Read More

ADVOCACY UPDATES

Latest on Federal Issues

This blog will feature weekly updates from our Socioeconomic Committee and Health Policy team to…

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Physicians Urge MedPAC To Recommend Inflation-Based Medicare Payment Update To Replace Current Law

From the AMA Advocacy Update Newsletter, May 17, 2024 In a letter (PDF) to the Medicare Payment…

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CMS Updates Conversion Factor for Physician Services

In early March, Congress adopted legislation that updated the Medicare Physician Fee Schedule (MPFS) conversion factor for…

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Upcoming Dates

04/01/24: Fellow Exam Application Deadline
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06/01/24: Research Grant Cycle
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08/02/24: Scientific Abstract Submission Deadline
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12/01/24: Research Grant Cycle
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EDUCATION

AAOA Basic Course

Join us from July 25-27 at the hybrid 2024 AAOA Basic Course. As a hybrid course, we are excited to offer both live in-person and virtual participation. The course content will be accessible for over 90 days to help you maximize value. Register Today 

RESIDENTS

For information about Resident membership, opportunities, DosedDaily, research grants, and other resources. Learn More

IFAR

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IFAR Impact Factor: 2.454

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

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

2024 AAOA Basic Course in Allergy & Immunology - Hybrid
July 25-27, 2024
The Diplomat, Hollywood, Florida
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2024 AAOA Annual Meeting - Hybrid
November 8-10, 2024
Four Seasons Hotel Las Vegas
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2025 AAOA Advanced Course in Allergy & Immunology - Hybrid
March 27-29, 2025
The Hythe, Vail, CO
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USP 797 Online Module
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AAOA Educational Stacks
Next Release October 1, 2024

News and Updates

CEO Update, June 2024

Does it seem like everything old is new again? The 70s seem to be back…

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CEO Update, May 2024

Can you believe we just celebrated Memorial Day and are heading into summer? I am…

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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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PARTNER RESOURCE CENTER

AAOA has launched a Partner Resource Center to bring you partner resources that can assist your practice and patient care.

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PATIENT CORNER

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Practice Management Corner

Practice Resources

FAQs

As part of our on-going member support, we are introducing a new website feature to help with common practice management challenges.  We welcome your input with questions or challenges you would like to address.  Please send them to advocacy@aaoallergy.org.

For this blog we are addressing questions around transition immunotherapy due to supply chain challenges, pricing, and more.

FAQS and Myths Around Transitioning Immunotherapy

  1. Do I need to re-test my all my patients?
  • This is not necessary, but certainly an option and physician discretion. The AAOA does, however, recommend vial testing prior to introducing any new vial, as with a new lot from the same manufacturer.
  1. Do I need to keep two vendors as I transition to a new source as I enroll new immunotherapy patients?
  • As with question #1, a vial test will help you determine safe dosing.
    You could opt to keep existing patients or those close to completion of immunotherapy on your existing vendor while you switch new immunotherapy patients to the new product.
  1. Do I need to keep existing patients on their current antigen vendor and batch?
  • You can certainly keep your existing patients on the current antigen product, but you do not have to.
  1. Is there a dose adjustment during manufacturer transition, if so, how is this achieved?
  • Due to potency fluctuations between manufacturers, reducing the patient’s last injection by at least 50% should strongly be considered. For example, if the patient’s last injection was 0.5mL, the patient would receive 0.25mL (from same dilution if applicable), with new vial formulation. The AAOA also strongly recommends vial testing during manufacturer transition, similar as when switching lot to lot using same manufacturer.
  1. My current w/v is different than what my new antigen vendor is offering, how do I adjust my dosing?
  • 1:40w/v versus a 1:20w/v = cutting the formulary dose in half. For example, you were placing 1.0mL 1:40w/v concentration in formulary, you would insert 0.5mL 1:20w/v concentration.
  • 1:20w/v versus a 1:10w/v = cutting the formulary dose in half. For example, you were placing 1.0mL 1:20w/v concentration in formulary, you would insert 0.5mL 1:10w/v concentration.
  • 1:10w/v versus 1:20w/v= double the mL in formulary dose. For example, you were using 0.5mL 1:10w/v concentration in formulary, you would insert 1.0mL 1:20w/v concentration.
  • You may also consider diluting the w/v extract to previous concentration (if applicable), to avoid adjusting the vial mix and further manipulating the allergen components of the mix.

This can be achieved by taking the desired vial size and dividing by 2.

  • Example- You would like to dilute 1:20w/v extract to 1:40w/v using 50mL sterile empty vial. 50/2= 25mL
  • Insert 25mL 1:20w/v and 25mL 50% Glycerin= 50mL 1:40w/v extract.
  1. Species identification among manufacturers.
  • All manufacturers formulate extracts using the same species. There are a few exceptions, however, if the species nomenclature is not exact, the cross-reactive alternative is offered as substitute. With dose-reduction considerations already in place and new vial testing with transition, this accommodates potency differences when using a cross-reactive substitution. Climate has a huge impact on production, so it is not atypical for a species to backorder due raw material shortages. Often, physicians will look to purchase a cross-reactive alternative at that time. The safest protocol is to perform skin testing with the substitute species or, at minimum, perform a vial test with the new vial containing the new cross-reactive species.
  • What should we be logging? (Can pull in the USP details for answer here, if question appropriate)

7. What is the best approach to restarting subcutaneous immunotherapy (SCIT) after a prolonged absence?

  • Re-starting immunotherapy after a prolonged absence without dose adjustment can increase the risk of a serious systemic adverse event. It is important to consider the patient’s phase of immunotherapy — maintenance versus escalation.  Any changes in immunotherapy due to changes in the constituents of immunotherapy, including changes in production lot, manufacturer, or extract type (aqueous, glycerinated, standardized, non-standardized) also put the patient at increased risk of an adverse event.  Safety is paramount when re-starting immunotherapy injections.
    • Retesting to determine the safe starting dose is the most conservative approach.
    • Reducing the dose of the new antigen is another approach to allow for gradual and potentially safer introduction of the newly sourced antigen.
    • The use of vial testing for the first injection provides an additional level of safety and is recommended.

When determining an appropriate dose for restarting or making antigen adjustments during immunotherapy, the clinical features of each individual patient are essential, including the severity of allergic disease, prior systemic reaction, time of year for pollen allergies, health status including medications, and asthma presence, severity and control. If the patient is at increased risk of adverse reaction due to any of the above factors, decrease in dosing is recommended at the first injection.  The escalation schedule will similarly depend on individual factors and tolerance of prior injections.  Patients who are in the Maintenance Phase of SCIT may be able to tolerate higher initial dosing and more rapid new antigen escalation schedules than those patients in the Escalation Phase of all allergens during SCIT.

Below is a sample dosing schedule.

Download the pdf of the QA Focus Tips for Transitioning Immunotherapy here.

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References: Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter, third update. Journal of Allergy and Clinical Immunology, January 2011; Volume 127 (1), Supplement, page S1-S55.

Become a Member-Join Now

As a member, you will be eligible for registration fee discounts on all AAOA CME functions and all of our patient education and practice management resources. These savings alone can offset most or all of your dues. Join Today!

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