Allergists discuss the differing opinions of allergies and optimizing patient care during the COVID-19 pandemic.
Whether or not most Americans are aware amid current health crises, the reality is the burden of allergies—from symptomatic irritations and general inconveniences, to even the risk of death—are on an unrelenting climb in the US.
In fact, the overwhelming issues in public health that would inhibit such knowledge may also be driving the growth of allergy. With the ongoing COVID-19 pandemic surging at several instances throughout the year, most people have taken precautionary measures that include shelter-in-place and limited interactions with the public, which in turn affected exposure to allergens and the rate of allergic reactions.
As with everything related to COVID-19, the implications this pandemic has had on the public perception of allergies are complicated.
“Based on the demographics, the rate of asthma and allergic diseases continues to climb, and will continue to climb,” J. Allen Meadows, MD, AllerVie Health and past President of the American College of Allergy Asthma & Immunology, told HCPLive.
“There's great debate about why that's climbing, I think the most prominent theories, the healthy Western living theory, is that we're not getting enough exposure to the right types of pathogens when we're young, and so our immune system defaults to fighting parasites and allergens, and only with exposure to certain infections, particularly in our toxins when you're young.”
Several prominent theories exist regarding the reason for this spike in allergies, though most allergists agree that it is multifactorial.
Similarly, it’s been difficult to gauge the public’s general understanding and interest in allergy trends during 2021, even if these trends may affect them directly.
For this entry into This Year in Medicine, Meadows, along with Rebecca Rosenberger, MMSc, PA-C, Allergy Diagnostic & Treatment Center, and Associate Director, Clinical Affairs & Education at Thermo Fisher Scientific, aid HCPLive in detailing the public perception of allergies, as well as how that perception has been influenced by recent global events such as the COVID-19 pandemic.
“Outside of a specialist office, allergies tend to be both over reported and under reported, at exactly the same time,” Rosenberger said. “I have seen many patients where they believe they have an allergy and that is often not the case, but they may have other allergic triggers. So, it can be presumed that they think they have some sort of allergy, but maybe they're guessing to the wrong thing.”
Though some patients are fully aware of their allergies and to what extent those allergies dictate their lives, many Americans are still uncertain of what they may or may not be affected by.
For instance, a new allergy patient might suspect they are allergic to pollen and will avoid exposure of certain outdoor environments, when they may actually be allergic to indoor allergens such as mold or dust mites.
Unless they are treated by an allergist and receive the appropriate diagnosis, patients might be inadvertently putting themselves in harm’s way.
Even chronic conditions, such as rhinitis, can dramatically affect a patient’s quality of life when gone unchecked.
“Unfortunately, there are a lot of people that suffer through that chronically, and they don't realize how bad it is until they have a chance to feel a little bit better,” Rosenberger said. “And so that being one of those chronic conditions, allergic rhinitis, or rhinitis in general, is one of those (conditions) that affects so many people, and they just settle for it because they don't understand that it could be better.”
Concerningly, there has been an increase in skepticism across all kinds of care due to recent developments with the COVID-19 virus, with allergies being an affected area of study.
Combative patients are by no means a new concept, as allergists have always dealt with patients who rely on outside sources that inform their opinions about allergies.
However, there now exists a subset of patients who are concerned with the spread of COVID-19 virus to seek help with their allergies, as well as those who simply choose not to prioritize their allergies during this tumultuous time in healthcare.
“I have seen this personally, I have definitely seen this professionally, and I do think it's been exacerbated over the past almost 2 years now,” Rosenberger said. “For a variety of reasons, access to care, fear, those are all playing a factor, and it does lead people towards maybe not seeking the care that they need and then guessing.”
Despite these frustrations, both Rosenberger and Meadows urged allergists to continue to recommend routine allergy tests for all patients, regardless of how skeptical or uncertain they may be.
“For those who are truly uncertain (about potential allergies) it's easier to have that conversation – it takes a little bit longer, but you can have the conversation and convince them, ‘You really do need to come in for your well visit, so that we can make sure that you are well, and so when you do get sick, you know that it's something that you either need to pay attention to that could be something potentially serious’,” Meadows said.
“The most important thing is, don't guess,” Rosenberger said. “There are tools that are at everyone's disposal that we don't have to guess, so if you suspect something it's a great situation to seek more care and get a get a test to start leading you down the right path of ruling in or ruling out an allergy."
The fallout from the COVID-19 pandemic is undoubtedly linked to public opinion of allergies. Is allergy care feasible during a global pandemic? Is it even necessary?
For Meadows and Rosenberger, the answer is "yes."
As is consistent with other forms of medical care, tele-health has been utilized to great effect in the management of allergies throughout the pandemic. According to Meadows, this form of treatment has been quite common in the allergy field.
“Historically, people who have flares of allergies, we give them the option of being treated on the phone or treated in person, and certainly if somebody had failed a phone treatment, we'd see all those people in person,” Meadows said. “But a lot of allergy and asthma practices want to keep the lobby a safe place for people coming in for well visits, in the case of allergists for people coming in for allergy shots, and so many allergy and asthma offices really aren't seeing sick patients in person.”
For patients who require in-person care, spirometry has remained prevalent, though Meadows added that it presents another “incredible challenge” during the pandemic.
“How do we handle the whole issue of spirometry?” Meadows said. “There is no agreement on it, and there aren’t any standards, and I’d like to be quoted on this, because there's no 1 size fits all solution to the problems we face.”
Despite this, Meadows and Rosenberger both stressed that they have made extensive efforts to make the office and lobby of their specialist offices safe for their patients.
In rural Montgomery, AL where Meadows lives, doctors and nurse practitioners have gone as far as to work in makeshift, outdoor tents to curb the spread of any potential diseases such as COVID-19 without limiting care.
The dedication medical professionals have to their patients and the challenges they are willing to endure to properly treat them speaks to the seriousness of allergies, especially uncontrolled allergies.
Meadows noted that in recent studies related to COVID-19, patients with allergies have been among the least represented groups in what he calls the “Big Bad 3”: hospitalization, intensive care, and mortality.
What is known, however, is that uncontrolled asthma and allergies put patients at an increased risk of COVID-19. Outside of that context, patients with asthma and allergies are still at an increased risk of comorbidities and other complications that can impact their quality of life.
“Really, the onus is on us as allergy and asthma providers to really get our patients’ symptoms well controlled, and that's really a new part of the conversation we're having with patients, because some of our patients who had it been poorly adherent in the past and unfortunately been willing to put up with symptoms that they really didn't need to put up with…some of that can land them in the hospital,” Meadows said. “But have that conversation with them.”