One of the more important and quite frankly interesting websites developed for patients is called www.chosinglywisely.org. This is a website sponsored by the American Board of Internal Medicine Foundation. The site has compiled a list of "Five Things Physicians and Patients Should Question". It was with the help of the various sub-specialities of medicine, such as the American Academy of Allergy, Asthma, and Immunology, that five important suggestions about things to question in the field of allergy and they even produced a helpful PDF to download.
- The use of Immunoglobulin G (IgG) testing to test for allergy is inappropriate and instead patients should be checked for specific Immunoglobulin E (IgE) either using skin tests or blood. The use of IgG4 really needs to be discouraged due to its lack of clinical relevance.
- The indiscriminate use of Computerized Tomography of the Sinuses (CT Scan) for acute sinusitis is generally not indicated. Nearly all acute sinus infections are caused by viral disease and generally cause some significant inflammation or thickening of the sinuses for 2-3 weeks. Often the thickening or swelling that occurs will resolve spontaneously without any specific treatment.
- Hives or Urticaria is quite common and typically no cause if ever found. Routine extensive testing, especially allergy testing, is usually not indicated unless an allergen is closely linked to the by history.
- Immunoglobulin replacement therapy (IVIG) is very expensive and should only be used for treatment of immunodeficiency when there is a documented poor antibody response to vaccines or clinical infections. If the total IgG level is just low but not profoundly low (perhaps < than 150-300 mg/dl), intravenous IgG is not indicated.
- If an adult patient is going to be diagnosed with asthma, please request spirometry. Often history and physical exams under-estimate or over-estimate the degree of impairment. Another way to state this is that Board-Certified Allergists are poor judges of pulmonary function and the degree of impairment is now crucial to the proper characterization of the severity of the disease.
What are some important questions in Asthma that patients and physicians alike tend to struggle with? These are things that I get asked everyday in my practice.
1. Does treating reflux help control asthma? Well this is clearly one of the questions that most doctors feel is important, but does it matter? If you look at this new data, using Nexium twice daily does not seem to make much difference at all.
2. What is the best test to measure allergies?
3. Can patients safely use intermittent therapy?