Wallace DV, Dykewicz MS, Eds. Joint Task Force on Practice; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma, and Immunology; Joint Council of Allergy, Asthma, and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;172(2 Suppl):S1-S84.
Settipane RA, Schwindt C. Chapter 15: Allergic rhinitis. Am J Rhinol Allergy. 2013;27 Suppl 1: S52-S55. Abstract
Asthma and Allergy Foundation of America. Allergy facts and figures. http://www.aafa.org/display.cfm?id=9&sub=30 Accessed August 24, 2014.
American College of Allergy, Asthma & Immunology. Allergy facts. http://www.acaai.org/allergist/news/Pages/Allergy_Facts.aspx Accessed September 10, 2014.
Soni A. Allergic rhinitis: trends in use and expenditures, 2000 to 2005. Statistical brief No. 204. Bethesda, MD: Agency for Healthcare Research and Quality; 2008.
Centers for Disease Control and Prevention (CDC). Allergies and hay fever. http://www.cdc.gov/nchs/fastats/allergies.htm Accessed September 9, 2014.
Meltzer EO, Gross GN, Katial R, Storms WW. Allergic rhinitis substantially impacts patient quality of life: findings from the Nasal Allergy Survey Assessing Limitations. J Fam Pract. 2012;61(2 Suppl):S5-S10.
Canonica GW, Bousquet J, Mullol J, Scadding GK, Virchow JC. A survey of the burden of allergic rhinitis in Europe. Allergy. 2007;62 Suppl 85:17-25. Abstract
Schatz M. A survey of the burden of allergic rhinitis in the USA. Allergy. 2007;62 Suppl 85:9-16. Abstract
Léger D, Annesi-Maesano I, Carat F, et al. Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Arch Intern Med. 2006;166:1744-1448. Abstract
Kaliner MA, Farrar JR. Consensus review and definition of nonallergic rhinitis with a focus on vasomotor rhinitis, proposed to be known henceforth as nonallergic rhinopathy. Part 1. Introduction. World Allergy Organ J. 2009;2:97.
Carr TF, Saltoun CA. Chapter 2: Skin testing in allergy. Allergy Asthma Proc. 2012;33 Suppl 1:S6-S8. Abstract
Kolethekkat AA, Paul RR, Kurien M, Kumar S, Al Abri R, Thomas K. Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease? Oman Med J. 2013;28:427-431.
Seasonal allergic rhinitis: limited effectiveness of treatments. Prescrire Int. 2008;17:28-32. [no authors listed]
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Viswanathan RK, Busse WW. Allergen immunotherapy in allergic respiratory diseases: from mechanisms to meta-analyses. Chest. 2012;141:1303-1314. Abstract
Cox L, Jacobsen L. Comparison of allergen immunotherapy practice patterns in the United States and Europe. Ann Allergy Asthma Immunol. 2009;103:451-459; quiz 459-461, 495.
Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014;7:6.
Lin SY, Erekosima N, Kim JM, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013;309:1278-1288. Abstract
Calderón MA, Simons FE, Malling HJ, Lockey RF, Moingeon P, Demoly P. Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile. Allergy. 2012;67:302-311. Abstract
Radulovic S, Calderon MA, Wilson D, Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2010;Dec 8;(12):CD002893.
Khinchi MS, Poulsen LK, Carat F, André C, Hansen AB, Malling HJ. Clinical efficacy of sublingual and subcutaneous birch pollen allergen-specific immunotherapy: a randomized, placebo-controlled, double-blind, double-dummy study. Allergy. 2004;59:45-53.
Nelson HS, Nolte H, Creticos P, Maloney J, Wu J, Bernstein DI. Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults. J Allergy Clin Immunol. 2011;127:72-80. Abstract
Blaiss M, Maloney J, Nolte H, Gawchik S, Yao R, Skoner DP. Efficacy and safety of timothy grass allergy immunotherapy tablets in North American children and adolescents. J Allergy Clin Immunol. 2011;127:64-71. Abstract
Maloney J, Bernstein DI, Nelson H, et al. Efficacy and safety of grass sublingual immunotherapy tablet, MK-7243: a large randomized controlled trial. Ann Allergy Asthma Immunol. 2014;112:146-153. Abstract
Cox LS, Casale TB, Nayak AS, et al. Clinical efficacy of 300IR 5-grass pollen sublingual tablet in a US study: the importance of allergen-specific serum IgE. J Allergy Clin Immunol. 2012;130:1327-1334. Abstract
Creticos PS, Maloney J, Bernstein DI, et al. Randomized controlled trial of a ragweed allergy immunotherapy tablet in North American and European adults. J Allergy Clin Immunol. 2013;131:1342-1349. Abstract
Nolte H, Hébert J, Berman G, et al. Randomized controlled trial of ragweed allergy immunotherapy tablet efficacy and safety in North American adults. Ann Allergy Asthma Immunol. 2013;110:450-456. Abstract
Cox LS, Linneman DL, Nolte H, et al. Sublingual immunotherapy: A comprehensive review. J Allergy Clin Immunol. 2006;117:1021-1035. Abstract
Nolte H, Amar N, Bernstein DI, et al. Safety and tolerability of a short ragweed sublingual immunotherapy tablet. Ann Allergy Asthma Immunol. 2014;113:93-100.e3.
Blaiss MS, Dykewicz MS, Skoner DP, et al. Diagnosis and treatment of nasal and ocular allergies: the Allergies, Immunotherapy, and RhinoconjunctivitiS (AIRS) surveys. Ann Allergy Asthma Immunol. 2014;112:322-328. Abstract
Bender BG, Oppenheimer J. The special challenge of nonadherence with sublingual immunotherapy. J Allergy Clin Immunol Pract. 2014;2:152-155. Abstract
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Bender BG, Pedan A, Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. J Allergy Clin Immunol. 2006;118:899-904. Abstract
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Vita D, Caminiti L, Ruggeri P, Pajno GB. Sublingual immune therapy: adherence based on timing and monitoring control visits. Allergy. 2010;65:668-669. Abstract
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Brozek JL, Bousquet J, Baena-Cagnani CE, et al; Global Allergy and Asthma European Network; Grading of Recommendations Assessment, Development and Evaluation Working Group. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126:466-476. Available at: www.whiar.org/docs/ARIAReport_2010.pdf Accessed August 24, 2014.
Frew AJ, Powell RJ, Corrigan CJ, Durham SR; UK Immunotherapy Study Group. Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006;117:319-325. Abstract
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CME

Diagnosis to Treatment Optimization: A Case-Based Approach to Effective Management of Allergic Disease

Authors: Mark S. Dykewicz, MD
CME Released: 9/18/2014
THIS ACTIVITY HAS EXPIRED
Valid for credit through: 9/18/2015

Target Audience and Goal Statement

This activity is intended for allergists, primary care physicians, and other healthcare providers who treat patients who have allergic disease.

The goal of this activity is to provide education about the evaluation and management of allergic diseases.

Upon completion of this activity, participants will be able to:

Establish a stepwise approach to the management of allergic diseases, including an action plan that incorporates allergen avoidance, initial pharmacotherapy, and ongoing assessment of allergic disease severity and control
Identify patients with allergic disease who are likely to benefit from allergen immunotherapy
Differentiate between the benefits and limitations of different formulations of allergen immunotherapy

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author

Mark S. Dykewicz, MD

Raymond and Alberta Slavin Endowed Chair in Allergy & Immunology, Professor of Internal Medicine, Chief, Section of Allergy & Immunology, Saint Louis University School of Medicine, St. Louis, Missouri

Disclosures

Disclosure: Mark S. Dykewicz, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consult for: Merck & Co., Inc.
Received grants for clinical research from: Novartis Pharmaceuticals Corporation

Dr Dykewicz does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Dykewicz does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor

Sarah Williams, PhD

Senior Scientific Director, Medscape, LLC

Disclosures

Disclosure: Sarah Williams, PhD, has disclosed no relevant financial relationships.

Writer

Lynne Kolton Schneider, PhD

Freelance writer, Boca Raton, Florida

Disclosures

Disclosure: Lynne Kolton Schneider, PhD, has disclosed no relevant financial relationships.

Steering Committee

Linda S. Cox, MD

Associate Clinical Professor, Department of Medicine, Nova Southeastern University, Davie, Florida

Disclosures

Disclosure: Linda S. Cox, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Stallergenes

Tolly E.G. Epstein, MD, MS

Assistant Professor of Clinical Medicine, University of Cincinnati, Cincinnati, Ohio

Disclosures

Disclosure: Tolly E.G. Epstein, MD, MS, has disclosed the following relevant financial relationships:
Received grants for clinical research from: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI); Teva Pharmaceuticals, Inc.

Mark S. Dykewicz, MD

Disclosures

As listed above.

Peter S. Creticos, MD

Associate Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Asthma & Allergy Center, Baltimore, Maryland; Director of Clinical Research, Creticos Research Group, LLC, Crownsville, Maryland

Disclosures

Participation by Dr Creticos as a member of the Scientific Advisory Board does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.
Disclosure: Peter S. Creticos, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consult for: Circassia, Ltd; Greer
Received grants for clinical research from: Circassia, Ltd; Greer; Merck & Co., Inc.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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From Medscape Education Allergy & Clinical Immunology

CME

Diagnosis to Treatment Optimization: A Case-Based Approach to Effective Management of Allergic Disease

Authors: Mark S. Dykewicz, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED

CME Released: 9/18/2014

Valid for credit through: 9/18/2015

processing....

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you can see whether you answered correctly and read evidence-based information that supports the best answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short assessment based on the material covered.

Case 1: Patient History

Abel is a 15-year-old boy who presents with symptoms of sneezing; clear rhinorrhea; nasal itching; nasal congestion; eye/ear/throat itching; and red, watery eyes. He reports that in the past his symptoms appeared to worsen in May to June, become minimal during July, but worsen again with moderate to severe symptoms in the fall (usually mid-August and September). He also has a low degree of nasal congestion year round. This is not the first year he has had a major seasonal flare, but the symptoms in May-June are more severe than in previous years. It is now late May.

At this appointment with his primary care provider, he has already tried over-the-counter oral antihistamines but remains symptomatic. His physical examination findings are consistent with allergic rhinitis (AR)/rhinoconjunctivitis:

Eyes: signs of conjunctivitis (injection of the conjunctival vessels, edema of the eyelids)
Ears: normal
Nose: nasal crease, boggy turbinates
Throat: evidence of drainage, posterior cobblestoning
Chest: No signs of coexisting asthma/wheezing
Skin: Minimal atopic dermatitis

Page 1 of 13

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Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Author

Mark S. Dykewicz, MD

Editor

Sarah Williams, PhD

Writer

Lynne Kolton Schneider, PhD

Steering Committee

Linda S. Cox, MD

Tolly E.G. Epstein, MD, MS

Mark S. Dykewicz, MD

Peter S. Creticos, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Peer Reviewer

CME

Diagnosis to Treatment Optimization: A Case-Based Approach to Effective Management of Allergic Disease

Target Audience and Goal Statement

Disclosures

Author

Mark S. Dykewicz, MD

Editor

Sarah Williams, PhD

Writer

Lynne Kolton Schneider, PhD

Steering Committee

Linda S. Cox, MD

Tolly E.G. Epstein, MD, MS

Mark S. Dykewicz, MD

Peter S. Creticos, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Diagnosis to Treatment Optimization: A Case-Based Approach to Effective Management of Allergic Disease

Case 1: Patient History