Auvi-Q recall

October 29th, 2015

Sanofi US has issued a recall of all Auvi-Q devices.

AAC dose not prescribe epinephrine “Dispense As Written”, so pharmacies can switch to a different self-injectable epinephrine device based on patient preference (or, as in this case, due to a recall). Information regarding reimbursement for out of pocket cost to replace Auvi-Q devices is available on the Sanofi US site (see above).

May 2014 update on sub-lingual immunotherapy (SLIT)

May 16th, 2014

The FDA has recently approved 3 products for use as SLIT in the US market. 2 products treat grass pollen allergy: Oralair (Stallergenes/Greer) and Grastek (ALK/Merck). 1 product treats ragweed allergy: Ragwitek (Merck). As mentioned in the last AAC blog post, SLIT for grass is relevant in the Rogue Valley whereas SLIT for ragweed is not (based on our local aerobiology).
Treatment for grass pollen allergy with SLIT is best accomplished by beginning treatment at least 3 months prior to the onset of grass season. We typically see grass pollen on the Rotorod sampler at our Medford office in early May each spring. 2014 has been an atypical year with less rain in the valley and less snow in the surrounding Cascades/Siskiyous–and we observed an earlier onset of grass pollinosis beginning the second week of April. We anticipate further escalation of grass pollen counts as we progress through May and June, with resolution in July. Future grass SLIT treatments will be most effective by starting therapy in January for individuals who are primarily sensitized to grass.
We recommend evaluation by an allergist for testing and to discuss all treatment options, including SLIT. The FDA has recommended (and the package inserts specify) that the first SLIT dose should be delivered in an office with trained immunotherapy personnel (i.e. an allergist’s office).
We are excited about this new development in allergy and immunology!
Kevin Parks MD

FDA Advisory Committee Sublingual Immunotherapy Recommendations

February 4th, 2014

Subcutaneous immuntherapy (SCIT or “allergy shots”) has been utilized for decades as a safe and effective treatment for allergic asthma, allergic rhinitis, hymenoptera hypersensitivity, and allergic conjunctivitis. Multiple well designed trials have demonstrated that SCIT is a disease-modifying treatment for allergies and asthma with reduction in medication use, lower symptom frequency and severity, reduction in exacerbation rates, less development of new allergies, and improvement in lung function and quality of life. Financial analyses have documented cost effectiveness, with reduction in overall healthcare utilization for appropriately diagnosed and treated SCIT patients; which has led to widespread coverage by all major payers including Medicare and Oregon Health Plan.

Sublingual immunotherapy (SLIT, allergen delivered orally) has been shown to be safe and effective WHEN DOSED APPROPRIATELY using standardized allergen preparations. This treatment has been available in Europe for several years for select allergens such as house dust mite, parietaria (a weed pollen) and northern pasture grass. Most studies evaluating safety and efficacy of SLIT involve only one or few allergens delivered to monosensitized or oligosensitized (without multiple allergies) individuals. These studies have delivered a strong safety signal, with very few anaphylactic events even when dosing was performed at home by the patient. Oral itching and gastrointestinal problems were frequent but generally mild adverse events which generally waned with time.

Our research site in Medford has been involved in sublingual immunotherapy studies for grass and house dust mite. Though we are blinded to the treatment allocation for each of our patients, we have reviewed the overall data and agree that this form of immunotherapy is likely beneficial for appropriate patients.
In December 2013, an FDA advisory committee recommended approval of a grass pollen tablet which will be marketed jointly by 2 US companies, likely beginning spring of 2014. In January 2014, the same committee recommended approval of a ragweed allergen tablet which will also be marketed by a US pharmaceutical company if approved. Although the FDA is not obligated to follow the recommendations of its advisory committees, we usually observe that the agency does.

One of these 2 products will be very relevant in the Rogue Valley. We are a “node” of high density northern grass pollen during late spring/early summer. Very few geographic areas of the US experience grass pollen as intense and predictable as the Rogue Valley. The Willamette Valley may be a bit worse, but we have a huge grass season! Patients who are PRIMARILY SENSITIZED to grass pollen will be good candidates for grass SLIT if other criteria support this treatment option. Because treatment with SLIT for grass will not alter other allergies, we recommend that skin testing to inhalant allergens be performed prior to beginning SLIT to identify the optimal treatment program for each individual. Because we have experience with this product in the context of the US clinical trials, we will be prepared to use these new modalities when they become available (likely soon). Board-certified allergists are trained allergy specialists who are equipped to help you evaluate all treatment options. We caution against testing to only grass pollen prior to making this treatment decision; grass is certainly important, though we frequently find that grass allergic patients improve most if they avoid and treat additional relevant allergens based on their personal profile.

Ragweed is not relevant in the Rogue Valley. The distribution of giant and short ragweed in the US spares our region. We have performed pollen counts using a Rotorod sampler in our Medford office each spring and summer for many years. We’ve never seen a ragweed pollen grain. The ragweed product will be very relevant for patients from the Intermountain West to the East Coast, with greatest concentration in the Midwest.

House dust mite SLIT is still under evaluation by industry partners. The FDA will evaluate this product in the future.

We welcome questions about SLIT. At AAC, we adhere to evidence-based medicine and strive to personalize each treatment plan based on the individual’s goals and style. We are excited to broaden the treatment of allergies using SLIT where appropriate.

Kevin Parks MD

Beautiful aerobiology… This is what we are seeing under the microscope in Medford: tree pollen. Happy Spring!

March 27th, 2013

Summer Camp for children with food allergies

March 19th, 2013

Camp Blue Spruce announcement

Influenza vaccination and egg allergy

November 15th, 2012

Second blog post on this topic…
It seems that confusion still surrounds the topic of egg allergy and flu shots. New information sometimes needs time to diffuse across the medical landscape!
Data regarding administration of influenza vaccine to egg allergic individuals now consistently signal that testing or graded influenza vaccine challenge is not necessary. With rare exceptions, even patients with persistently positive skin and/or blood tests to egg CAN safely receive the flu shot. We recommend that you discuss this with your pediatrician or family doctor; as always, we are happy to help if needed. Most primary care physicians are now willing to vaccinate egg allergic individuals in their offices in light of the new data.
Kevin Parks MD

Fire Season

July 11th, 2012

As you will notice if you look out your window today, a haze has settled into the Rogue Valley as a result of fires–mostly east of the Cascades based on current reports.
Asthmatics should be particularly careful with outdoor exercise or vigorous work during the warmest hours of the day, especially when we have wildfire smoke. Pre-treatment with your rescue medication may help, but the best strategy is to do outdoor work and exercise early in the day; and listen to your body. Although pollen season is coming to a close, wildfire season is just getting started.
Kevin Parks MD

Pollen Counts 2012

February 24th, 2012

We’ve started counting pollen for the spring season. Although it feels like winter, we are seeing tree pollen above the symptom threshold. Yesterday’s tree count was 49 grains/m3 (grains per cubic meter). Generally speaking, a count above 20 will likely be noticeable to tree-allergic people. We expect counts to rise gradually as the weather warms up, greater on sunny days and less on rainy days. Follow counts on twitter or facebook for details throughout this pollen season (through July). Many thanks to our research coordinators who take time to look into the microscope every day!
Kevin Parks MD