Spring is right around the corner and with it comes another season with patients allergic to pollen from trees, grasses, and weeds. According to the American College of Allergy, Asthma and Immunology, allergies are common for all age groups in the U.S., and may manifest in symptoms of the nasal passages such as rhinitis/conjunctivitis, of the airway (asthma), or of the gut and skin (eczema or hives). Over 50 million Americans suffer from allergies each year and over 26 million Americans have asthma, including 7 million children.
The demand to care for allergy and asthma patients is always heavy, but certain times of the year stress the ability of the system to deliver adequate care to all patients.
As a certified PA working in an allergy practice, I see many ways that PAs in primary care and other specialties can help alleviate the burden on physicians and bring relief to patients. Diagnosing allergic disease and empowering patients to be adherent with a treatment plan takes time and requires effective communication. PAs can help.
Certified PAs can help manage the influx of patients in your practice during allergy season by:
•Documenting patient history. Obtaining a thorough history takes time and is essential to making the proper diagnosis to alleviate symptoms. PAs are adept at digging into the details. It is not always obvious that the triggers for nasal/sinus, dermatitis or airway related symptoms may extend beyond allergen exposure. To nail the diagnosis, PAs can broaden the history to include details from the patient's lifestyle such as eating habits, exercise routine, exposure to irritants, NSAID use and understanding the climate in which they live. For example, if a child has a chronic cough and congestion, it is important to understand if the child drinks milk from a sippy cup before bedtime. Lying in a horizontal position allows acid to inflame the sinuses and bronchial tubes and could be the cause of the cough. It is best to eliminate these influences before prescribing medication.
•Diagnosing the illness. Allergies are often disguised as a cold that never goes away. If you have a patient that has a cold every March and April, you probably suspect allergies from seasonal exposure to tree pollen. PAs can make the correct diagnosis based on details obtained in the patient history and form a treatment plan that works. The time to refer to an allergy specialist is when the patient is not getting the level of control they would like or not tolerating OTC medications. A specialist can employ special tests to aid in diagnosis of unusually difficult to treat or severe cases.
•Educating patients. PA programs also focus on the importance of educating patients and their families. Patients need to understand how important it is to take charge of their own health. This is especially true in the treatment of allergies, not only for symptom control, but for safety, as in the case of a food allergy. Managing food allergies is very time consuming and treatment plans are individualized. Because exposure to even trace amounts of a food allergen has the potential to cause anaphylaxis, patients and their caregivers need to understand the importance and nuances of strict avoidance.
In the case of patients experiencing symptoms involving the nasal/sinus passages, the airways or skin, we educate them on triggers such as changes in barometric pressure or exposure to fumes which may compound the effects of allergy season. For those with asthma, we can suggest gradual transitions with exercise, which is better tolerated than a quick change from rest to high intensity activity.
•Reviewing how and when to use medication. Everyone knows how to swallow a pill, but some medication delivery systems used to treat allergic disease are not self-explanatory. For example, it is common to prescribe inhalers for those with asthma. Yet studies show the majority of patients do not know the proper inhaler technique or that a spacer can maximize delivery into the airways. Those at risk for anaphylaxis may be prescribed epinephrine auto-injectors. PAs can help patients learn the proper technique for using their medication thus ensuring that patients are confident in managing their health.
As we enter another allergy season, PAs can help busy practices see patients sooner, allowing them to achieve symptom control more quickly which limits missed days of school and work.
Angela Oest, MPH, PA-C, has worked for Dr. Lisa Sullivan, allergist and immunologist, for almost five years. Prior to earning her MS in PA Practice from Rosalind Franklin University, Oest did research in environmental interventions for children with asthma and was a research coordinator on food allergy studies. She also worked as a certified PA in family medicine.