Computer-Assisted Clinical Diagnosis and Treatment.

PURPOSE OF REVIEW: Computer-assisted diagnosis and treatment (CAD/CAT) is a rapidly growing field of medicine that uses computer technology and telehealth to aid in the diagnosis and treatment of various diseases. The purpose of this paper is to provide a review on computer-assisted diagnosis and treatment. This technology gives providers access to diagnostic tools and treatment options so that they can make more informed decisions leading to improved patient outcomes. RECENT FINDINGS: CAD/CAT has expanded in allergy and immunology in the form of digital tools that enable remote patient monitoring such as digital inhalers, pulmonary function tests, and E-diaries. By incorporating this information into electronic medical records (EMRs), providers can use this information to make the best, evidence-based diagnosis and to recommend treatment that is likely to be most effective. A major benefit of CAD/CAT is that by analyzing large amounts of data, tailored recommendations can be made to improve patient outcomes and reduce the risk of adverse events. Machine learning can assist with medical data acquisition, feature extraction, interpretation, and decision support. It is important to note that this technology is not meant to replace human professionals. Instead, it is designed to assist healthcare professionals to better diagnose and treat patients.

Pediatric subcutaneous allergen immunotherapy.

Subcutaneous immunotherapy (SCIT) is a widely used therapy for allergic rhinitis and asthma. It is a useful adjunct to standard medical management of these conditions that can lead to long-term benefits and possible resolution of symptoms. The benefits of SCIT, particularly for children, include avoiding prolonged use and side effects from medications, preventing new aeroallergen sensitizations, and reducing the risk of developing asthma. The primary risks of SCIT include local and systemic reactions. Standard schedules for SCIT include advancing through multiple doses usually in four vials (diluted to 1:1000) on a weekly basis; however, there are benefits of using accelerated schedules, especially for children who need to coordinate school and parent work schedules. Special considerations for pediatric patients include fear of needles, avoiding discomfort with injections, consent, optimal injection scheduling, and difficulty communicating about symptoms during reactions in very young children. Overall, SCIT can be a safe and beneficial therapy for children.

The Regulatory Environment of Telemedicine After COVID-19.

The COVID-19 pandemic has created many barriers to providing health care, yet it also has created new opportunities. Although telemedicine was a nascent means of health care delivery before COVID-19, it now is one of the principal means for doing so today, and it is likely to remain so. Whether this will happen may depend in part on continued relaxation of regulations that hampered it before the pandemic. Whereas enforcement of compliance with Health Information Portability and Accountability Act will most likely resume, platform operators and providers have had an opportunity to prepare for this. State licensure requirements may also resume; however, the regulations were in the process of becoming more liberal before COVID-19 so that process might continue. There is no reason to anticipate that payment for telemedicine services including check-ins, remote physiologic and therapeutic monitoring, and relaxation of location and service requirements will end. For these reasons, telemedicine therefore is likely to continue as an important part of medical practice.

Patient and Clinician Attitudes Toward Telemedicine for Allergy and Immunology.

The use of telemedicine has increased in allergy/immunology, with rapid uptake of its use during the coronavirus disease 2019 pandemic. Existing data indicate an overall positive view of telemedicine by patients, particularly during the coronavirus disease 2019 pandemic. However, patients and clinicians prefer in-person visits for specific types of allergy/immunology encounters, such as those requiring a physical examination or diagnostic testing. The most data for telemedicine exist with asthma, and provide a model for treatment technique, therapeutic monitoring, and education in other allergic and immunologic conditions. Clinician satisfaction is also necessary for telemedicine to be an enduring option for patient/clinician interactions, and this is influenced by a multitude of factors, including technology quality, reimbursement, and maintenance of patient/clinician relationships. Areas of future research should include the need for more outcome data in additional disease states, which will likely help facilitate improved logistical policies around telemedicine that would facilitate its adoption.

Digital Health Technology in Asthma: A Comprehensive Scoping Review.

BACKGROUND: A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE: To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS: We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS: Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS: Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.

Continuous and Daily Oral Immunotherapy for Peanut Allergy: Results from a 2-Year Open-Label Follow-On Study.

BACKGROUND: The randomized, controlled PALISADE trial demonstrated the benefit of daily oral immunotherapy with Peanut (Arachis Hypogaea) allergen powder-dnfp (PTAH, formerly AR101) in peanut-allergic children and adolescents. OBJECTIVE: ARC004, the open-label follow-on study to PALISADE, used 5 dosing cohorts to explore PTAH treatment beyond 1 year and alternative dosing regimens in peanut-allergic individuals. METHODS: Active arm (PTAH-continuing) PALISADE participants who tolerated 300-mg peanut protein at the exit double-blind placebo-controlled food challenge and placebo arm (PTAH-naive) participants could enter ARC004. PTAH-continuing participants were assigned to receive daily (cohorts 1 and 3A) or non-daily (cohorts 2, 3B, and 3C) dosing regimens; PTAH-naive participants were built up to 300 mg/d PTAH, followed by maintenance dosing. At study completion, participants underwent an exit double-blind placebo-controlled food challenge with doses up to 2000 mg peanut protein. Data were assessed using descriptive statistics. RESULTS: Overall, 358 (87.5%) eligible participants (4-17 years) entered ARC004 (PTAH-continuing, n = 256; PTAH-naive, n = 102). Among PTAH-continuing participants, exposure-adjusted adverse event rates were 12.94 to 17.54/participant-year and 25.95 to 42.49/participant-year in daily and non-daily dosing cohorts, respectively; most participants (83%) experienced mild or moderate adverse events. Daily dosing cohorts appeared to have higher desensitization rates than non-daily dosing cohorts. Of all PTAH-continuing cohorts, cohort 3A had the longest daily dosing duration and the highest desensitization rates. Changes in immune markers with PTAH continuation demonstrated ongoing immunomodulation. Outcomes in PTAH-naive participants mirrored those of the PALISADE active arm. CONCLUSIONS: Continued daily PTAH treatment beyond 1 year showed sustained safety and efficacy. Ongoing immunomodulation was observed during the second year of treatment.

Ten Rules for Implementation of a Telemedicine Program to Care for Patients with Asthma.

During the coronavirus disease 2019 (COVID-19) pandemic, the use of telemedicine changed from being an optional way to see patients to becoming a necessity. It has transformed primary, specialty, and mental health services by becoming incorporating into everyday practice. Because allergists have adapted to patient care using telemedicine, use of this technology is likely to continue after COVID-19. In the process of using telemedicine, lessons have been learned. We now offer 10 rules for creating a successful telemedicine practice while also ensuring that quality asthma care is provided.

Peanut allergy diagnosis: A 2020 practice parameter update, systematic review, and GRADE analysis.

Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a "positive" test) is not always associated with clinical reactivity. This practice parameter addresses the diagnosis of IgE-mediated peanut allergy, both in children and adults, as pertaining to 3 fundamental questions, and based on the systematic reviews and meta-analyses, makes recommendations for the clinician who is evaluating a patient for peanut allergy. These questions relate to when diagnostic tests should be completed, which diagnostic tests to utilize, and the utility (or lack thereof) of diagnostic testing to predict the severity of a future allergic reaction to peanut.

Immunologic Strategies for Prevention of Asthma.

A new understanding of factors leading to the development of asthma has pointed to potential primary, secondary, and tertiary prevention strategies. Some, such as genetic makeup, are not yet modifiable. Interventions targeting other factors such as maternal intake of vitamin D or environmental control can be used to decrease the risk of asthma development (primary prevention). The benefits of a diversified microbiome could be considered when recommending allergen avoidance and pet ownership. In addition to reducing symptoms, allergen immunotherapy is also worth considering for prevention of new sensitivities (secondary prevention) in addition to the development of asthma. Ongoing studies involving the use of bacterial vaccines and biologics may provide additional strategies for primary prevention of asthma and for reducing symptoms once it has developed (tertiary prevention). As the relative benefits of these strategies are defined, they should have an increasingly important place in the prevention and management of asthma.

Benefits and risks of incorporating virtual visits into an allergy/immunology practice.

Telemedicine (TM) involves the use of technology to overcome the patient care barriers of distance and time. Asynchronous TM can be used to monitor patients remotely and for providers and patients to communicate with each other without needing to be online at the same time. Synchronous TM can include direct-to-consumer visits in which patients use their own equipment to communicate with a provider or facilitated visits in which a patient travels to a clinic to use the clinic's equipment with a facilitator. The advantage of the latter is that a physical examination can be performed. Although some patients and providers may prefer in-person visits, patients who are seen by TM report satisfaction that it is as good as or better than that of an in-person visit. TM can be used in the outpatient setting, in the hospital to perform consults, or in the school. The convenience of TM makes it likely that more patients will adopt TM as their preferred mode of obtaining health care. It is important for allergists to become familiar with this new technology because patients will demand it.

Telemedicine and emerging technologies for health care in allergy/immunology.

Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic face-to-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference.

Desensitization to pegaspargase in children with acute lymphoblastic leukemia and lymphoblastic lymphoma.

Hypersensitivity to pegaspargase is associated with inferior survival in pediatric patients with acute lymphoblastic leukemia and lymphoblastic lymphoma. In the past year, drug-supply shortages have led to the lack of an available alternative to pegaspargase. Rather than omit asparaginase from the treatment of acute lymphoblastic leukemia or lymphoblastic lymphoma patients with hypersensitivity to pegaspargase, we continued pegaspargase treatments for nine pediatric patients, utilizing a rapid desensitization protocol. There were no adverse events related to the pegaspargase during desensitization, and all patients who were checked had asparaginase serum levels above the threshold of 0.1 IU/mL at 7 to 14 days after pegaspargase therapy.

Telemedicine for General Pediatrics.

The use of telemedicine (TM) to deliver health care has been growing throughout the United States and internationally through asynchronous and synchronous technology. It has proven to be an effective way of delivering health care at a distance. There are multiple ways that a practice can offer these services, from direct-to-consumer to consultations in ambulatory or inpatient services. TM can be used to deliver care in homes, schools, and virtually anywhere that a patient and provider can access technology. For rural communities, emergency departments and inpatient specialty consults that were not available previously are now routine. TM also has been proven to be effective in decreasing costs to patients and increasing access in pediatrics while providing high degrees of satisfaction among patients and providers. [Pediatr Ann. 2019;48(12):e479-e484.].

COLA (Conferences On-Line Allergy) at 10 Years - Evolution of an Online Fellowship Curriculum.

Online learning has been present since the early days of the Internet. As with any new technology, users look to make their life easier and to save time. Experts in medical education are no different than other users. They want to adapt new technologies to their fullest. Medical educators have been challenged with keeping education interesting and up to date, while maximizing their resources. The challenges with any online educational program include being able to reach large numbers of learners, having content that is relevant and timely, and having it available thorough many different formats to suit the user. There are many examples of online learning programs in all fields of medicine and many specific to Allergy/Immunology. In this review, we describe a form of real-time videoconferencing referred to as Conferences On-Line Allergy (COLA), which was developed at Children's Mercy Hospital and Clinics. This program, which started as a once a month webinar, has transformed into a well-known curriculum used by many Allergy/Immunology training programs across the United States. It provides not only live interactive conferences but also a library of recorded lectures and workshops that can be used at the learner's convenience. Taking advantage of the generosity of many volunteer presenters, it allows sharing of resources and provides benefits to the Allergy/Immunology community.

Telemedicine for Allergy Services to Rural Communities.

Telemedicine (TM) involves the use of technology to provide medical services to patients who live at a distance. It can be used asynchronously for interpretation of test results (spirometry, skin tests imaging studies), and for communication of information when the simultaneous presence of provider and patient is unnecessary. Synchronous encounters can either be unscheduled and initiated on demand by patients or be facilitated substitutes for in-person visits. The latter results in asthma outcomes that are as good as those for in-person visits while reducing the cost and inconvenience of travel from rural communities to urban centers. Facilitated visits can be done in the ambulatory and emergency department settings, and they can be used for inpatient consults when allergy specialists are not readily available. Both patients and providers experience high degrees of satisfaction with this type of visit. In addition, virtual visits performed using TM are cost-effective. TM offers a solution to the shortage of specialty care that is present in rural communities.