Frequently asked questions in allergy practice

BACKGROUND: Over the last 10-20 years, international guidelines and consensus statements for the management of common allergic diseases (e.g. allergic rhinitis and asthma) have been developed and disseminated worldwide. However, their impact on knowledge and standard of clinical practice among primary care physicians and specialists is unknown. OBJECTIVE: To investigate need for an improvement in the dissemination of international guidelines for the diagnosis and management of allergic rhinitis. METHODS: Seven medical students who attended 3-day 1st International Basic Allergy Course (2010) took down all questions raised during the entire course. A systemic analysis of these questions was performed to identify areas for improvement in diagnosis and management of allergic diseases mainly in the Association of Southeast Asian Nations (ASEAN) region. RESULTS: 268 participants, 143 males and 125 females, comprising Ear, Nose and Throat (ENT) specialists (n = 106) and trainees (n = 34), general practitioners (n = 87), and other healthcare professionals (n = 41) attended the course. Of the 103 questions recorded, 59 were regarding treatment modalities in allergy practice such as immunotherapy (n = 38), pharmacologics (n = 15), nasal surgery (n = 2), and others (n = 4). 41 questions (39.8%) have answers based in the Allergic Rhinitis and its Impact on Asthma guidelines (2001 and 2008). Certain questions were selected for further analysis because they appeared to be (a) more commonly asked (e.g. immunotherapy) or (b) were deemed to be challenging or, even controversial (e.g. food allergy and differential diagnosis between vasovagal and anaphylaxis reaction), as the recommendations in current international guidelines were less well-defined. CONCLUSION: Our study identified several problems that, if tackled, could help minimize confusion and provide better care for patients suffering from allergic diseases especially in the ASEAN region.

Discrepancies in Guidelines for Allergy Management in Asia-Pacific.

Objectives: We have conducted this study to assess (1) the existence of prevention programmes for AR as developed by professional and health care organizations in Asia- Pacific countries; (2) any discrepancies in local guidelines in comparison to ARIA, or within and across these countries. Study design: Web search study. Methodology: We have conducted a study using Web search in accordance with the perspective of physicians or patients for the relevant prevention and pharmacotherapy guidelines in the management of AR as developed by professional and health care organizations in Asia-Pacific countries/regions. Results: National allergy (AR and/or asthma) preventive programs are found in only 6 out of 17 (22.2%) countries (excluding Japan and South Korea). There exist several aspects of discrepancies in existing educational programs such as in (1) allergic disease (asthma or AR) that the guidelines focus on; (2) targeted age groups (children or adults); and (3) breadth and depth of coverage, such as for particular inhalant allergens or food allergies only. Based on the information provided by MIMS website (updated in 2011 by UBM Medica, London, United Kingdom) and the MIMS proven by the country’s local health authority, controversies exist in recommended minimum age, doses and potential side-effects of many commonly used 2nd-generation antihistamines and intranasal corticosteroids. Conclusion: This is the first study that demonstrates discrepancies and a lack of public education programmes for AR prevention and management in Asia-Pacific countries/regions.

An update on research ethics in Asia / Journal of the ASEAN Federation of Endocrine Societies

There are many international guidelines that have been developed to ensure that the conduct of researches by countries, institutions and individuals are ethical. There are, however, unique opportunities as well as challenges in research in the ASEAN region which mandate not only adherence to these guidelines but which necessitate regional as well as individual country efforts to ensure that biomedical researches uphold the dignity, ensure safety and protect the rights of participants. Some of the challenges are: the widespread poverty or uneven distribution of resources in developing countries which cause patients to participate in clinical trials to avail of services that otherwise are inaccessible, lack of a research infrastructure that makes ethics review of protocols inadequate or slow, and lack of post-trial access to medications which have been tested in precisely the populations that need these drugs. The aim of this paper is to review the ethical challenges in health research encountered in Asia and to describe the regional efforts being undertaken to address them.