Degree of fear of needles and preferred allergy immunotherapy treatment among children with allergic rhinitis: caregiver survey results.

Introduction: A child's fear of needles may impact the preferred route of allergy immunotherapy (AIT) when choosing between subcutaneous immunotherapy (allergy shots) or sublingual immunotherapy (SLIT). A survey was conducted to understand caregiver health-seeking behavior for children with allergic rhinitis with or without conjunctivitis (AR/C) and explore if fear of needles impacted AIT decisions. Methods: Caregivers of children ages 5-17 years with AR/C were recruited from the Dynata US research panel to participate in an online survey from May-June 2023. The survey received institutional review board exemption status. SLIT-tablets were described as "under-the-tongue tablets". Results: About a third (34%) of surveyed caregivers (n = 437) reported their child had a severe fear of needles and 47% reported moderate fear. Of surveyed caregivers, 53% and 43% reported they had discussed allergy shots and SLIT-tablets, respectively, with their child's physician. SLIT-tablets were preferred by 84% of caregivers; 6% preferred injections and 10% had no preference. Caregivers of children with a severe fear of needles had the highest preference for SLIT-tablets (95%) vs. injections (2%); 85% and 60% of caregivers of children with moderate and low fear, respectively, preferred SLIT-tablets. Among caregivers of children with a severe fear of needles, a higher percentage agreed that their child would welcome taking SLIT-tablets than that their child would accept taking an ongoing series of allergy shots (93% vs. 43%, respectively). Conclusions: Most caregivers preferred SLIT-tablets over allergy shots for their child with AR/C. Preference for SLIT-tablets corresponded with the child's degree of fear of needles. Fear of needles should be included in AIT shared decision-making conversations.

Social Media and the Allergist.

PURPOSE OF REVIEW: With this brief review, we summarize our findings of how allergists, professional organizations and patients within the allergy space are using social media to date. RECENT FINDINGS: Millions of Americans suffer from allergic conditions and it has been well established that there aren't enough allergists to help treat and reach each of these people. With a noticeable absence from social media platforms of board certified allergists with knowledge based in evidence and science, the vacuum has been filled by others - some of whom advocate for the exact things we discourage because they are not helpful, and can even be harmful, for our allergic patients. While there are drawbacks to using social media platforms, as a specialty we need to acknowledge and perhaps even embrace the idea that the use of social media can have a positive effect - as a means to not only introduce, engage and educate our patients and other HCPs, but also to reduce misinformation. Social media is a powerful tool that can be responsibly used by our allergy community to amplify our collective voice to share important health information with our patients and other healthcare professionals and we believe that more training and education needs to be done so that our speciality can join others in becoming a larger voice in the space.

Podcasting in Clinical Allergy and Immunology: Our Experience and a Review of the Current Landscape.

PURPOSE OF REVIEW: This review aims to improve our understanding of podcasts in the field of Allergy and Immunology and to share our experience in creating and hosting The Itch Podcast. To our knowledge, this is the first review providing an overview of podcasting in the field. RECENT FINDINGS: We found forty-seven podcasts in our search. Ten of these podcasts were specifically focused on Immunology and the other thirty seven covered allergy topics in general. Of the allergy podcasts, the majority, sixteen out of thirty-seven, were produced and hosted by patients and caregivers of patients living with allergies.  Our extensive research on podcasts and our own experience in podcast development has led us to recognize the crucial role that Allergy and Immunology podcasts can play in disseminating medical knowledge and clinical information to the public, while also enhancing the exposure of trainees to this specialty and supporting the professional growth and practice of Allergists and Immunologists.

Tropical Milky White Mushroom, Calocybe indica (Agaricomycetes): An Effective Antimicrobial Agent Working in Synergism with Standard Antibiotics.

Synergistic effect of mushroom extracts with standard antibiotics against pathogenic bacteria is beneficial for treating infectious diseases. The present investigation tested the antibacterial activity and synergistic effect from an edible mushroom, Calocybe indica, with standard antibiotics. The minimum inhibitory concentration (MIC) of different extracts from C. indica was checked against pathogenic and opportunistic pathogenic bacteria such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, S. epidermidis, and Bacillus subtilis using the broth dilution and agar well diffusion method. The agar disc diffusion method, checkerboard study, and growth curve analysis were used to test synergism. The preliminary mechanism of action regarding cellular morphology, membrane permeability, and damage to protein and DNA were evaluated. Maximum antimicrobial activity was found in the methanolic crude extract (MCE) from C. indica, with a MIC value ranging from 5 to 10 mg/mL. It showed a significant increase in the efficiency of ciprofloxacin (CIP) acting synergistically. The fractional inhibitory concentration index (FICI) of MCE was significant for E. coli and S. aureus with values of 0.46 and 0.45 respectively. Results showed an increase in the loss of cell viability, damage to cell membrane permeability, and damage to bacterial protein and DNA as the probable synergistic mechanism of action for the MCE and the antibiotic. HR-LCMS analysis of the MCE showed the presence of phenolic acid, terpenoids, fatty acid ester, and carboxylic acid, which, in combination, increased the bacterial susceptibility. The present study is significant because it considered the methanolic crude extract from C. indica as complementary medicine for infectious diseases.

Allergen immunotherapy practice patterns: a worldwide survey.

BACKGROUND: Allergists around the world have different practice styles when administering subcutaneous aeroallergen immunotherapy (IT) in peak pollen seasons, especially when changing doses or frequency of IT. The Immunotherapy practice parameters do not specifically address this issue. OBJECTIVE: Given the paucity of good data about adjustment of allergen immunotherapy during the pollen seasons, we examined whether a significant difference is present in the way allergists administer immunotherapy during allergy seasons. METHODS: To quantify the practice styles of allergists who are members of the American Academy of Allergy, Asthma and Immunology (AAAAI), a self-reported electronic survey was disseminated in September 2010 with the help of the AAAAI Needs Assessment Committee. The responses were tallied and analyzed according to demographic information. RESULTS: A total of 1,201 allergists in the AAAAI responded to the survey. Most responders practice in an urban or suburban nonacademic practice in the United States and have been in practice for more than 10 years. The size of their practice was variable. Those in practice for more than 10 years were more likely to adjust the dose and frequency of immunotherapy in pollen seasons. CONCLUSION: This survey highlights the differences in the practice styles of AAAAI member allergists, and these differences may be associated with their demographic characteristics. Given the wide variability in how allergists adjust dose and frequency of immunotherapy during pollen seasons, establishing guidelines regarding this routine dilemma might help standardize the delivery of treatment to patients.

Survey on immunotherapy practice patterns: dose, dose adjustments, and duration.

BACKGROUND: Practical issues dealing with the administration of allergen immunotherapy (AIT) by European and US allergists are not well known. Several concerns are only partially covered by guidelines. OBJECTIVE: To survey AIT practice patterns among worldwide members of the American Academy of Allergy, Asthma and Immunology (AAAAI). METHODS: A web-based survey was conducted among AAAAI members on dosing, dose adjustment after missed doses, and duration of AIT. RESULTS: A total of 1,201 replies (24.7% response rate of which 10% of responses were from non-US and non-Canada members). A total of 57% to 65% of the US-Canadian dosing falls within the recommended Practice Parameter ranges (9.4%-19% too low). Dose adjustment after missed doses is based on time elapsed since the last administered dose by 77% of US-Canadian and 58% of non-US-Canadian allergists. Doses are reduced when a patient comes in more than 14 days for 5 weeks after the last administration and initial dosing restarted after more than 30 days for 12 weeks since last administration during the build-up or maintenance stage. After missing 1 to 3 doses, the dosing schedules were mostly followed (build-up phase: repeat last dose, reduce by 1 dose, reduce by 2doses; maintenance phase: reduce by 1 dose, reduce by 2 doses, reduce by 3 doses). AIT is prescribed for a median of 3 years by non-US-Canadian allergists but for a median of 5 years by 75% of US-Canadian allergists. Main reasons for continuing beyond 5 years were "after stopping, symptoms reappeared" or "patient afraid to relapse." CONCLUSION: Many patients receive less than recommended doses. Two areas in which to plan further research are establishment of an optimal dose-adjustment plan for missed applications and exploration of the maximum appropriate duration of immunotherapy.