SmartAllergy

1. SmartAllergy

2. What is SmartAllergy? • A simplebloodtest to identify IgE-mediated allergies • Diagnosis based on the CML test results and patienthistory • Treatment by sublingual immuno-therapy (SLIT)

3. Why identify the allergic triggers? • Optimize avoidance relief • Provide a treatment option that will cure rather than mask symptoms • Identify allergic rhinitis from non-allergic rhinitis since both present with similar symptoms • Minimize costs to the patient and healthcare system by treating the underlying cause of the disease

4. Candidates for testing are those with: • Seasonal or perennial allergic rhinitis • Recurrent bronchitis/sinusitis • Asthma • Chronic cough • Recurrent otitis media • Headaches/migraines • Acid Reflux

5. Allergic vs Non-allergic Rhinitis • Symptoms of both are the same • Antihistamines are not effective in treating non-allergic rhinitis • A study conducted at Ohio State revealed that 65% of patients taking antihistamines did not have an IgE-mediated allergy

6. Should the local allergist treat AR? • Currently there are only 17,000 trained allergists worldwide to treat the 400M people with allergic disease • Allergy is an ideal adjunct to the Primary Care or ENT practice since 25% or more of your patients have AR • Complex patients may still be referred to an allergist

7. What the allergists say….. • The professional allergy community supports the utility of the in vitro tests in allowing Primary Care practitioners to diagnose and manage uncomplicated cases within their practices.1 1 American Academy of Allergy, Asthma & Immunology: The Allergy & Asthma Report 2000

8. Step 1 – The Allergy History • An accurate patient history is critical for interpreting your test results • CML’s combination history/test order form simplifies this process • Consider having your patient complete the history form prior to their office visit

9. Can a history alone diagnose allergy? • A recent study of PC physicians in the UK revealed that history alone v s history + testing misdiagnosed dust mite allergy 75% of the time; trees 54%; grass 48%; cat 32% and dog 27%. Patients who self-reported allergy without any history had even higher percentages.

10. Patient Rhinitis History Form

11. Step 2 – Test for Allergies • Check the allergens to be tested on the CML requisition form or check your pre-printed custom panel • Draw an SST, spin down, pour off serum into transport tube and place into the pre-paid shipping box provided • Ship specimen to CML

12. Is a Total IgE an effective screen? • A Total IgE is not recommended as a screening tool for allergic rhinitis • A seasonal variation of two to four fold can occur with Total IgE • CML’s patient internal lab data reveal that Total IgE levels of <10 (very low) may still result in IgE-specific allergen results of Class I to Class V

13. How will I know what to test? • A preliminary regional panel based on the pollen in your geographic area is the best place to start • Additional allergens may be added based on the patient’s history i.e., unusual pets, occupation, hobbies, etc. • CML retains remaining serum samples, frozen, for sixmonths to facilitate add-on testing without the need for a re-draw

14. The Allergic Threshold • Allergen avoidance is not a 100% reduction of exposure but a reduction of the threshold dose that initiates symptoms.

15. Is RAST as effective as skin tests? • RAST is sensitive, specific and reproducible • Provocation testing correlates to a high degree (95%) with RAST results compared to 60% agreement with skin tests • Quantitative results facilitate determin-ing initial immunotherapy dosing

16. Patient Benefits of RAST • Patient comfort – A simplebloodtest versus many skin pricks • There are no contraindications with prescription and OTC drugs • Not dependant on skin conditions • Usually LESS expensive for the patient • Safe for asthmatics or those who have experienced anaphylaxis

17. Practice Benefits of RAST/SLIT • Extended patient visits not required • Physician does not need to be present for a venipuncture. • No need for additional office space, personnel or equipment • SLIT vials are shipped directly to the patient’s home (after initial vial) and billed to your office or the patient.

18. Interpreting CML RAST Results

19. Step 3 – Treatment Options • Allergen Avoidance – CML provides patient tip sheets and diets • Pharmacotherapy – Prescribe with confidence that IgE-mediated allergies are the culprit • Immunotherapy – CML has vendor agreements for SLIT therapies

20. What is sublingual IT (SLIT)? • The same FDA-approved allergen extracts that are used to treat subcutaneously are used in the preparation of sublingual drops. The current ongoing studies here and abroad are to gain FDA-approval for the alternative route of administration via the dendritic cells.

21. Economics of SLIT • Patient’s monthly SLIT expense ranges from $40-$60/month • Drug co-pays and co-pays for injection therapy may equal or exceed that amount • Pharmacistprepareddrops may be ordered by the physician at a wholesale price

22. Additional CML Services • IgG-specific testing to determine late phase allergic reactions • One of the largest test menus in the U.S. for food allergens • Yearly allergy training co-sponsored by the University of Louisville for AMA Category 1™ CMEs for physicians, nursing credits and AAFP credits

23. The CML Difference • An allergy-only laboratory servicing medical professionals nationwide • 24 years of experience • Multiple allergy testing methodologies • Licensed by CLIA and various states, including NY, plus participation with CAP Proficiency

24. The CML Difference • Customized requisition forms and allergen panels to facilitate ordering • No voice mail or teleprompter to deal with when you call us • An allergy nurse and laboratory personnel readily available to assist you

25. Final Thoughts…. • With the appropriate interest, training and support, most mild to moderate allergic disease can be managed in the ENT or Primary Care office.