ABSTRACT
Telemedicine is a disruptive innovation in the health care marketplace that holds the potential for transforming medicine by improving access to medical care and providing a more affordable way of delivering care. On the basis of consumer demand, ongoing technologic advances, desire for greater practice efficiency, and behavioral and demographic trends, it is likely that more frequent use of telemedicine will be maintained post-pandemic and into the future. Looming areas for growth include the following: chronic disease management, care for patients in remote (eg, rural) areas, and expansion beyond direct-to-consumer models. On the basis of the multiple influences that will drive ongoing use of telemedicine, the future of allergy and immunology practice will likely entail traditional medicine in addition to telemedicine.
Subject(s)
Hypersensitivity , Telemedicine , Delivery of Health Care , Humans , Hypersensitivity/therapy , PandemicsABSTRACT
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
Subject(s)
Rhinitis/diagnosis , Rhinitis/therapy , Combined Modality Therapy , Disease Management , Disease Susceptibility , Humans , Phenotype , Practice Guidelines as Topic , Prevalence , Prognosis , Quality of Life , Rhinitis/epidemiology , Rhinitis/etiology , Risk Factors , Severity of Illness Index , Symptom Assessment , Treatment OutcomeABSTRACT
BACKGROUND: Food allergy affects an estimated 8% of children and 3% of adults in the United States. Food-allergic individuals increasingly use the web for medical information. We sought to determine the educational quality of food allergy YouTube videos. METHODS: We performed a YouTube search using keywords "food allergy" and "food allergies". The 300 most viewed videos were included and analyzed for characteristics, source, and content. Source was further classified as healthcare provider, alternative medicine provider, patient, company, media, and professional society. A scoring system (FA-DQS) was created to evaluate quality (-10 to +34 points). Negative points were assigned for misleading information. Eight reviewers scored each video independently. RESULTS: Three hundred videos were analyzed, with a median of 6351.50 views, 19 likes, and 1 dislike. More video presenters were female (54.3%). The most common type of video source was alternative medicine provider (26.3%). Alternative treatments included the following: water fast, juicing, Ayurveda, apple cider, yoga, visualization, and sea moss. Controversial diagnostics included kinesiology, IgG testing, and pulse test. Almost half of the videos depicted a non-IgE-mediated reaction (49.0%).Videos by professional societies had the highest FA-DQS (7.27). Scores for videos by professional societies were significantly different from other sources (P < .001). There was a high degree of agreement among reviewers (ICC = 0.820; P < .001). CONCLUSION: YouTube videos on food allergy frequently recommend controversial diagnostics and commonly depict non-IgE-mediated reactions. There is a need for high-quality, evidence-based, educational videos on food allergy.
Subject(s)
Consumer Health Information/methods , Consumer Health Information/standards , Food Hypersensitivity , Internet , Video Recording , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Food Hypersensitivity/therapy , Humans , United StatesSubject(s)
Adrenal Cortex Hormones/therapeutic use , Allergy and Immunology , Histamine Antagonists/therapeutic use , Rhinitis, Allergic, Seasonal/drug therapy , Allergens/immunology , Antigens, Plant/immunology , Evidence-Based Medicine , Humans , Poaceae , Pollen/immunology , Practice Guidelines as Topic , TreesABSTRACT
Understanding of the immunologic pathways involved in the pathogenesis of skin-related diseases is constantly advancing. Several biologic agents play important therapeutic roles for management of patients with chronic urticaria, atopic dermatitis, and psoriasis, particularly omalizumab for antihistamine-resistant chronic urticaria, interleukin (IL)-1 inhibitors for cryopyrin-associated periodic syndrome and Schnitzler syndrome, dupilumab for recalcitrant atopic dermatitis, and IL-17 inhibitors for psoriasis. The therapeutic utility of biologic agents for patients with immune-related dermatologic disorders is likely to expand in the future. This article reviews the data regarding biologic agents and their utility in the management of specific skin-related disorders.
Subject(s)
Biological Therapy , Skin Diseases/therapy , Anti-Allergic Agents/administration & dosage , Anti-Allergic Agents/adverse effects , Anti-Allergic Agents/therapeutic use , Biological Products/administration & dosage , Biological Products/adverse effects , Biological Products/therapeutic use , Biological Therapy/adverse effects , Biological Therapy/methods , Chronic Disease , Clinical Trials as Topic , Humans , Immunologic Factors/administration & dosage , Immunologic Factors/adverse effects , Immunologic Factors/therapeutic use , Molecular Targeted Therapy , Omalizumab/administration & dosage , Omalizumab/adverse effects , Omalizumab/therapeutic use , Skin Diseases/diagnosis , Skin Diseases/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Asthma affects >300 million people globally, including 25 million in the United States. Patients with asthma frequently use the Internet as a source of information. YouTube is one of the three most popular Web sites. OBJECTIVE: To determine the educational quality of YouTube videos for asthma. METHODS: We performed a YouTube search by using the keyword "asthma." The 200 most frequently viewed relevant videos were included in the study. Asthma videos were analyzed for characteristics, source, and content. Source was further classified as asthma health care provider, other health care provider, patient, pharmaceutical company, and professional society and/or media. A scoring system was created to evaluate quality (-10 to 30 points). Negative points were assigned for misleading information. RESULTS: Two hundred videos were analyzed, with a median of 18,073.5 views, 31.5 likes, and 2 dislikes, which spanned a median of 172 seconds. More video presenters were male (60.5%). The most common type of video source was other health care providers (34.5%). The most common video content was alternative treatments (38.0%), including live-fish ingestion; reflexology; acupressure and/or acupuncture; Ayurveda; yoga; raw food, vegan, gluten-free diets; marijuana; Buteyko breathing; and salt therapy. Scores for videos supplied by asthma health care providers were statistically significantly different from other sources (p < 0.001) and had the highest average score (9.91). CONCLUSION: YouTube videos of asthma were frequently viewed but were a poor source of accurate health care information. Videos by asthma health care providers were rated highest in quality. The allergy/immunology community has a clear opportunity to enhance the value of educational material on YouTube.