Prevalence of Allergy in Patients with Primary Dysphonia.

Objective: The purpose of this investigation is to examine the prevalence of allergy in patients with primary dysphonia. Methods: The medical records of patients diagnosed with primary dysphonia and who underwent allergy testing during the period extending from June 2018-2020 were reviewed. Patients' demographics, laryngoscopic findings and allergy skin prick testing were analyzed. Results: A total of 22 patients were included. Eleven out of twenty-two patients (50%) tested positive to at least 2 allergens, and eight (36%) tested positive for at least 3 allergens. The most common allergens tested positive were D. Farinae for household inhalants, followed by Chenopodium, Russian thistle and weed mix for weeds. In patients with a positive allergy testing, the most common laryngeal findings included edema in 36%, followed by excess mucus and MTD in 18% of cases each. Conclusion: Allergy is common in patients presenting with primary dysphonia and non-specific laryngeal findings. Allergy testing should be part of the diagnostic work-up of affected patients.

Prevalence of Self-Reported Dysphonia and Dysphagia in Patients with Allergy.

OBJECTIVE: To investigate the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy test in comparison to patients with negative allergy tests. SUBJECTS AND METHODS: A total of 52 patients who presented to the allergy clinic of a tertiary medical referral center for skin testing between June 2019 and December 2019 were were recruited for this study. Demographic data included age, gender, history of smoking, family history for eczema, atopy, asthma, food and drug allergy. A control group of 20 subjects was matched according to age and gender. All subjects were asked to fill the voice handicap index -10 and the eating assessment tool (EAT-10) questionnaires. RESULTS: Thirty-six of 52 patients were positive for at least one allergen, and 23 tested positive for at least three allergens. On the other hand, there was no significant difference in the mean score of VHI-10 in patients with allergy to at least one allergen, in comparison to patients with no allergy (3.667 vs 3.066, respectively, P value 0.307). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.305 vs 0.00, respectively, P value 0.270). There was also no significant difference in the mean score of VHI-10 in patients with allergy to at least three allergens in comparison to patients with no allergy (3.304 vs 3.066, respectively, P-value 0.603). Similarly, there was no significant difference in the mean score of EAT-10 between the two groups (0.435 vs 0.00, respectively, P-value 0.667). There was a significant difference in mean VHI-10 scores between patients testing positive for at least one allergen and the control group (P = 0.0002). CONCLUSION: The results of this investigation did not show any significance in the prevalence of self-reported dysphonia and dysphagia in patients with positive allergy skin testing in comparison to those with negative allergy skin-testing. More clinical studies on the prevalence of self-reported phonatory complaints in patients with allergy are warranted.

Digital tools in allergy and respiratory care.

Patient care in the allergy and respiratory fields is advancing rapidly, offering the possibility of the inclusion of a variety of digital tools that aim to improve outcomes of care. Impaired access to several health care facilities during the COVID-19 pandemic has considerably increased the appetite and need for the inclusion of e-health tools amongst end-users. Consequently, a multitude of different e-health tools have been launched worldwide with various registration and access options, and with a wide range of offered benefits. From the perspective of both patients and healthcare providers (HCPs), as well as from a legal and device-related perspective, several features are important for the acceptance, effectiveness,and long-term use of e-health tools. Patients and physicians have different needs and expectations of how digital tools might be of help in the care pathway. There is a need for standardization by defining quality assurance criteria. Therefore, the Upper Airway Diseases Committee of the World Allergy Organization (WAO) has taken the initiative to define and propose criteria for quality, appeal, and applicability of e-health tools in the allergy and respiratory care fields from a patient, clinician, and academic perspective with the ultimate aim to improve patient health and outcomes of care.

Immunopathological features of air pollution and its impact on inflammatory airway diseases (IAD).

Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases (IAD) such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), asthma, and chronic obstructive pulmonary disease (COPD). Oxidative stress in patients with IAD can induce eosinophilic inflammation in the airways, augment atopic allergic sensitization, and increase susceptibility to infection. We reviewed emerging data depicting the involvement of oxidative stress in IAD patients. We evaluated biomarkers, outcome measures and immunopathological alterations across the airway mucosal barrier following exposure, particularly when accentuated by an infectious insult.

Allergen immunotherapy at university health services and allergist's reasons for guidelines nonadherence.

BACKGROUND: Our previous pilot study conducted at the University of Michigan Health Services showed that fewer than 25% of the non-university allergen immunotherapy (AIT) prescribers adhered to AIT labeling guidelines which impacted both patients and healthcare personnel involved in AIT administration. OBJECTIVES: We expand our study to characterize AIT labeling compliance and impact of practice variability at the "Big 10" University Health Services, and investigate prescribers motives for nonadherence to practice parameter guidelines. METHODS: Three online surveys were distributed: AIT Administrator and Manager surveys for healthcare personnel at the "Big 10"; University Health Services and Physician Survey for physician members of the AAAAI. Data were analyzed using frequency/bivariate analysis and logistic regression. RESULTS: 21 AIT administrators from 10 University Health Services responded. 90.4% (20/21) felt labels containing all recommended practice parameter guidelines, components would decrease error; and standardization of labels, buildup and missed dose schedules would increase workflow efficiency (76%; 16/21). 90% (17/19) felt standardized protocols for treatment of systemic reactions would increase patient safety, workflow efficiency and comfort level of administrators. Only 28.6% of AIT extract vial labels at University Health Services were in accordance with practice parameter guidelines. Despite familiarity with the guidelines (91.5%; 697/762), only 64% (488/762) of surveyed physicians had practice parameter adherent AIT extracts labels with higher odds of a complete label when physicians were in group practice (odds ratio 1.51; [95% confidence interval, 1.06-2.15]; P=0.02). Reasons for nonadherence included having personalized labeling systems (55.4%, 174/314), unfamiliarity (14%, 44/314) and disagreement (9%, 29/314) with practice parameter guidelines. CONCLUSION: Poor adherence with AIT practice parameters labeling guidelines is an important concern in nonallergy offices. It is imperative that allergists comply with the highest recommended standards to provide the best clinical outcomes and ensure excellent and efficient care in both allergy and non-allergy offices.

A modified breathing exercise program for asthma is easy to perform and effective.

OBJECTIVES: Breathing exercises are used by some asthmatic patients, yet are often difficult to perform and time-consuming. This study evaluated a simple, modified breathing exercise program regarding ease to perform and effectiveness as an adjunctive therapy. METHODS: Subjects age 18 to 65 with a current diagnosis of persistent asthma were enrolled. A program that incorporated three different breathing exercises (yoga pranayama techniques, diaphragmatic breathing and pursed lip breathing) was taught to subjects. The program was designed to be completed in less than 10 minutes per day. Subjects completed the Asthma Control Test (ACT) and mini-Asthma Quality of Life Questionnaire (AQLQ) at baseline and at 1-month follow-up. They also completed a survey that asked them to rate the effectiveness and difficulty of the exercises, and whether they would recommend them in the future. RESULTS: A total of 74 subjects were enrolled in this study. The intervention improved breathing for 52.9% of the subjects, while 67.6% felt that their daily activity was improved and 66.1% noted that the exercises allowed decreased use of a rescue inhaler. Most subjects (80.9%) recommended breathing exercises as a complementary therapy for asthma and 79.4% of the subjects stated the exercises took less than 10 minutes per day total. Overall, ACT scores improved significantly (p = 0.002) with a statistically non-significant improvement in AQLQ scores. CONCLUSION: A simple program of breathing exercises was found to be effective and could be completed in less than 10 minutes per day. Furthermore, there was a statistically significant improvement in ACT scores post-exercise.

Adherence with allergen immunotherapy labeling guidelines.

BACKGROUND: Little is known about the adherence rate to allergen immunotherapy (AIT) labeling guidelines. OBJECTIVE: To assess adherence to labeling guidelines of AIT Practice Parameter 2011 at University of Michigan Health Service. METHODS: AIT vials of 320 patients who received their care at the University of Michigan Health Service were reviewed. Data collected looked at patient identifiers (PI), concentrations in volume/volume (v/v) format, color coding, allergen content, expiration date and instructions about AIT dosing, and systemic reaction treatment. Data were analyzed by using χ(2) test and the Fisher exact test and logistic regression. RESULTS: Of 238 non-university formulated labels, 65% had 2 PIs, 62% had a v/v concentration, 41% had color coding, 71% had the content listed, and 100% had a recorded expiration date. Only 21% had all 5 recommended components. All 82 University vials had 5 components. Labels with 2 PIs were more likely to have a v/v concentration with its corresponding color coding (odds ratio [OR] 3.84 [95% CI, 1.9-7.7]; P < .001). Labels that specified the extract's content were more likely to be color coded or to have a v/v concentration listed (OR 6.3 [95% CI, 3.4-11.8]; P < .001). For all AIT vials, complete labels were significantly more likely to have a clear buildup schedule (OR 9.6 [95% CI, 4.2-23.2]; P < .001), dosing adjustment after a missed dose (OR 8.2 [95% CI, 3.4-19.8]; P < .001) or after a reaction (OR 13.7 [95% CI, 7.8-2.1]; P < .001), and clear systemic reaction treatment instructions (OR 9.7 [95% CI, 7.8-24.1]; P < .001). CONCLUSION: Fewer than 25% of the nonuniversity prescribers adhered to AIT practice parameters 5 years after publication. Recording 2 PIs, the v/v concentration, or the color coding increased the likelihood of having a complete label. Complete label contents were associated with clear instructions about AIT dosing and reaction treatment and/or dose adjustments.