The new year has arrived and it’s often a time to reflect on trends and highlights from the previous year. Below is my list of the highlights in the world of allergy in 2014. Enjoy and may you have a healthy and happy 2015!
- Allergy Partners of Louisville Opens: On January 2, 2014, I opened my own solo allergy practice with a wonderful staff and team. The office moved to its permanent location next to Wild Eggs in the Landis Lakes Shopping Center in June. The new office is even more patient-friendly with large HD monitors in every exam room with multiple viewing options, fewer “pokes” with allergy testing and shorter conventional allergy shot build-up schedules without having to pre-medicate with steroids.
- Nasal steroids moved to become available over-the-counter (OTC): Nasacort was approved for the switch from prescription to OTC and became available as such in February 2014. Steroid nasal sprays are considered first line treatment for moderate to severe allergic rhinitis. Look for others to follow suit in 2015. Flonase is expected to be on retail shelves in early 2015.
- Asthma inhalers continue to shift toward emphasizing smaller particle sizes: Aerospan became available in the US after Meda Pharmaceuticals bought Acton in late 2013. Better, deeper lung deposition is thought to be the benefit of inhalers with smaller particle size. Look for specialists to increase their use of Aerospan, Alvesco and Qvar, the three inhalers with the smallest particle sizes in 2015.
- FDA-approved sublingual immunotherapy (SLIT) becomes available in the US: Look for the products Grastek, Ragwitek and Oralair to be marketed heavily in 2015 and directly to consumers. You too have probably seen Grastek’s countdown to grass season whole page ads in the Courier-Journal and other publications. The main benefit is home administration. Barriers include cost, potential side effects, need for an injectable epinephrine device and the requirements of receiving the 1st dose in the physician’s office. Better discount programs should improve usage in 2015.
- The end of Maxair: Under the Montreal Protocol, all CFC-containing, ozone-depleting inhalers were phased out by the FDA as of December 31, 2013. Maxair could not be made or sold after December 31, 2013. This means any Maxair still in your drawers or purses should be properly disposed of, as they are expired and no longer compliant. If you’re still carrying Maxair or the old CFC version of Combivent, see your doctor to discuss alternatives. If you are still carrying an old white generic albuterol inhaler made by Wallace or Warrick, you may need to go through your medications more often!
- Xolair receives indication for Chronic Idiopathic Urticaria (CIU): Omalizumab or Xolair is a biologic antibody that has been available since 2003 for the treatment of allergic asthma. Xolair was approved for CIU in 2014 and will provide another step in the treatment options for hives sufferers before having to consider medications with more significant side effect profiles.
- Affordable Care Act to further drive consumer awareness of the cost of health care: As my family compared health insurance options for 2015, the changes brought on by the ACA were noticeable. Look for premiums and deductibles to rise. Shorter build-up shot schedules and smaller test panels without sacrificing quality will position Allergy Partners of Louisville as one of the most cost-conscious allergy choices in the Louisville market.
- Component Food Allergy Testing: More and more allergists are using component resolved diagnostic testing to aid in clinical decision making for food allergy sufferers. Component food allergy testing uses allergy specific blood testing to look at the components of specific foods like peanut, egg and milk. Knowing if a patient is allergic to casein or ovomucoid in milk and egg, respectively, can help a family know if they will tolerate cooked milk and egg in products. Knowing a patient’s Ara h2 level for peanut allergy is much more precise in knowing whether a patient will tolerate an oral peanut challenge. Look for component resolved diagnostics to become standard of care in making decisions for reintroduction of known food allergens.
That summarizes my year-end reflections on the ever-changing world of allergy. Thanks to each of you for a rewarding 2014 and going with me on this amazing journey in relationships and providing better health to patients. Best wishes and God bless in the New Year!
Derek Damin, MD