List of allergy care ‘don’ts’ expanded

SAN DIEGO – Allergists added to their list of "don’ts" in the Choosing Wisely campaign by releasing a second set of five things that physicians should stop doing, bringing their number of recommendations to 10.

The American Academy of Allergy, Asthma, and Immunology was part of the first wave of groups in 2012 to compile lists of tests and procedures that are overused in diagnosis and treatment, as part of the ABIM Foundation’s Choosing Wisely campaign. Academy leaders released the new list at the annual meeting.

The second round of recommendations includes admonitions related to antihistamine use, food IgE testing, radiocontrast media, vaccinations, and penicillin allergy, with supporting statements and references to the evidence behind them. The five new recommendations are:

• Don’t rely on antihistamines as first-line treatment in severe allergic reactions. Data show that antihistamines are overused as first-line treatment for anaphylaxis, and they have been associated with delay of proper treatment and death. The first-line treatment of anaphylaxis is epinephrine, the statement said.

• Don’t perform food IgE testing without a history consistent with potential IgE-mediated food allergy. From 50% to 90% of patients with presumed food allergies have food intolerance or symptoms produced by non-food-related causes, not IgE-mediated reactions. Ordering panels of food tests in those patients wastes resources and leads to misdiagnoses and unnecessary food avoidance.

• Don’t routinely order low- or iso-osmolar radiocontrast media or pretreat with corticosteroids and antihistamines for patients with a history of seafood allergy who require radiocontrast media. Some patients do react to contrast media, but the reactions aren’t related to seafood allergy, data in the medical literature show. Don’t deny imaging to patients with seafood allergies or pretreat them with antihistamines or corticosteroids, and don’t tell patients who have had an anaphylactic reaction to contrast media that they are allergic to seafood. Patients with a history of anaphylaxis to contrast media are at risk for another reaction if exposed again, and the risk of serious anaphylaxis from radiographic contrast media is increased in patients with asthma or cardiovascular disease or who are taking beta-blockers.

• Don’t routinely avoid influenza vaccination in egg-allergic patients. These patients can be given egg-free influenza vaccine or egg-based influenza vaccine if they are observed for 30 minutes afterward. Give the vaccine and observe the patient in an allergist/immunologist’s office if the patient has a history of a reaction stronger than hives from eating eggs.

• Don’t overuse non–beta-lactam antibiotics in patients with a history of penicillin allergy without an appropriate evaluation. Although 10% of people say they are allergic to penicillin, data show that only 1% truly have a penicillin allergy. That suggests that 99% of the population can take these antibiotics safely and can avoid the higher cost and greater complications associated with alternative antibiotics.

The statement emphasizes that these are not hard and fast rules, but rather words of advice that should spark conversations between patients and physicians if management choices diverge from these recommendations.

The academy’s list is preceded by the five items it released earlier in the Choosing Wisely campaign: Do not perform unproven diagnostic tests such as IgG testing or an indiscriminate battery of IgE tests in the evaluation of allergy. Do not order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. Do not routinely do diagnostic testing in patients with chronic urticaria, or recommend replacement immunoglobulin therapy for recurrent infections unless there’s demonstration of impaired antibody responses to vaccines. And lastly, don’t diagnose or manage asthma without spirometry.

Lists created by medical groups in the Choosing Wisely campaign can be found here.

sboschert@frontlinemedcom.com

On twitter @sherryboschert

SAN DIEGO – Allergists added to their list of "don’ts" in the Choosing Wisely campaign by releasing a second set of five things that physicians should stop doing, bringing their number of recommendations to 10.

The American Academy of Allergy, Asthma, and Immunology was part of the first wave of groups in 2012 to compile lists of tests and procedures that are overused in diagnosis and treatment, as part of the ABIM Foundation’s Choosing Wisely campaign. Academy leaders released the new list at the annual meeting.

The second round of recommendations includes admonitions related to antihistamine use, food IgE testing, radiocontrast media, vaccinations, and penicillin allergy, with supporting statements and references to the evidence behind them. The five new recommendations are:

• Don’t rely on antihistamines as first-line treatment in severe allergic reactions. Data show that antihistamines are overused as first-line treatment for anaphylaxis, and they have been associated with delay of proper treatment and death. The first-line treatment of anaphylaxis is epinephrine, the statement said.

• Don’t perform food IgE testing without a history consistent with potential IgE-mediated food allergy. From 50% to 90% of patients with presumed food allergies have food intolerance or symptoms produced by non-food-related causes, not IgE-mediated reactions. Ordering panels of food tests in those patients wastes resources and leads to misdiagnoses and unnecessary food avoidance.

• Don’t routinely order low- or iso-osmolar radiocontrast media or pretreat with corticosteroids and antihistamines for patients with a history of seafood allergy who require radiocontrast media. Some patients do react to contrast media, but the reactions aren’t related to seafood allergy, data in the medical literature show. Don’t deny imaging to patients with seafood allergies or pretreat them with antihistamines or corticosteroids, and don’t tell patients who have had an anaphylactic reaction to contrast media that they are allergic to seafood. Patients with a history of anaphylaxis to contrast media are at risk for another reaction if exposed again, and the risk of serious anaphylaxis from radiographic contrast media is increased in patients with asthma or cardiovascular disease or who are taking beta-blockers.

• Don’t routinely avoid influenza vaccination in egg-allergic patients. These patients can be given egg-free influenza vaccine or egg-based influenza vaccine if they are observed for 30 minutes afterward. Give the vaccine and observe the patient in an allergist/immunologist’s office if the patient has a history of a reaction stronger than hives from eating eggs.

• Don’t overuse non–beta-lactam antibiotics in patients with a history of penicillin allergy without an appropriate evaluation. Although 10% of people say they are allergic to penicillin, data show that only 1% truly have a penicillin allergy. That suggests that 99% of the population can take these antibiotics safely and can avoid the higher cost and greater complications associated with alternative antibiotics.

The statement emphasizes that these are not hard and fast rules, but rather words of advice that should spark conversations between patients and physicians if management choices diverge from these recommendations.

The academy’s list is preceded by the five items it released earlier in the Choosing Wisely campaign: Do not perform unproven diagnostic tests such as IgG testing or an indiscriminate battery of IgE tests in the evaluation of allergy. Do not order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. Do not routinely do diagnostic testing in patients with chronic urticaria, or recommend replacement immunoglobulin therapy for recurrent infections unless there’s demonstration of impaired antibody responses to vaccines. And lastly, don’t diagnose or manage asthma without spirometry.

Lists created by medical groups in the Choosing Wisely campaign can be found here.

sboschert@frontlinemedcom.com

On twitter @sherryboschert

SAN DIEGO – Allergists added to their list of "don’ts" in the Choosing Wisely campaign by releasing a second set of five things that physicians should stop doing, bringing their number of recommendations to 10.

The American Academy of Allergy, Asthma, and Immunology was part of the first wave of groups in 2012 to compile lists of tests and procedures that are overused in diagnosis and treatment, as part of the ABIM Foundation’s Choosing Wisely campaign. Academy leaders released the new list at the annual meeting.

The second round of recommendations includes admonitions related to antihistamine use, food IgE testing, radiocontrast media, vaccinations, and penicillin allergy, with supporting statements and references to the evidence behind them. The five new recommendations are:

• Don’t rely on antihistamines as first-line treatment in severe allergic reactions. Data show that antihistamines are overused as first-line treatment for anaphylaxis, and they have been associated with delay of proper treatment and death. The first-line treatment of anaphylaxis is epinephrine, the statement said.

• Don’t perform food IgE testing without a history consistent with potential IgE-mediated food allergy. From 50% to 90% of patients with presumed food allergies have food intolerance or symptoms produced by non-food-related causes, not IgE-mediated reactions. Ordering panels of food tests in those patients wastes resources and leads to misdiagnoses and unnecessary food avoidance.

• Don’t routinely order low- or iso-osmolar radiocontrast media or pretreat with corticosteroids and antihistamines for patients with a history of seafood allergy who require radiocontrast media. Some patients do react to contrast media, but the reactions aren’t related to seafood allergy, data in the medical literature show. Don’t deny imaging to patients with seafood allergies or pretreat them with antihistamines or corticosteroids, and don’t tell patients who have had an anaphylactic reaction to contrast media that they are allergic to seafood. Patients with a history of anaphylaxis to contrast media are at risk for another reaction if exposed again, and the risk of serious anaphylaxis from radiographic contrast media is increased in patients with asthma or cardiovascular disease or who are taking beta-blockers.

• Don’t routinely avoid influenza vaccination in egg-allergic patients. These patients can be given egg-free influenza vaccine or egg-based influenza vaccine if they are observed for 30 minutes afterward. Give the vaccine and observe the patient in an allergist/immunologist’s office if the patient has a history of a reaction stronger than hives from eating eggs.

• Don’t overuse non–beta-lactam antibiotics in patients with a history of penicillin allergy without an appropriate evaluation. Although 10% of people say they are allergic to penicillin, data show that only 1% truly have a penicillin allergy. That suggests that 99% of the population can take these antibiotics safely and can avoid the higher cost and greater complications associated with alternative antibiotics.

The statement emphasizes that these are not hard and fast rules, but rather words of advice that should spark conversations between patients and physicians if management choices diverge from these recommendations.

The academy’s list is preceded by the five items it released earlier in the Choosing Wisely campaign: Do not perform unproven diagnostic tests such as IgG testing or an indiscriminate battery of IgE tests in the evaluation of allergy. Do not order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. Do not routinely do diagnostic testing in patients with chronic urticaria, or recommend replacement immunoglobulin therapy for recurrent infections unless there’s demonstration of impaired antibody responses to vaccines. And lastly, don’t diagnose or manage asthma without spirometry.

Lists created by medical groups in the Choosing Wisely campaign can be found here.

sboschert@frontlinemedcom.com

On twitter @sherryboschert