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Provided by: Andrew J. Tompkins, MD MBA (ENT)

Many of us have recently completed the familiar period of open enrollment, where we select health insurance plans for the upcoming calendar year.  These exercises typically involve an attempt to project costs in order to reduce our out-of-pocket spend and decrease the downside risk of large, out-of-pocket payments.  These projections would be easier if our healthcare landscape didn’t have such cost opacity, making such attempts frustrating and near futile.  Healthcare costs and cost shifting have forced us to take these exercises much more seriously.

According to the Kaiser Family Foundation1, the average annual family premium for employer-based coverage has grown 4.5% annually over the last 10 years, now standing at $21,342.  These premiums, and worker contributions to them, have easily surpassed wage growth and inflation over that time period.  In order to reign in employer premium growth, costs are increasingly being shifted to employees not just through premiums but deductibles as well since high deductible plans are cheaper.  Employer plans now involve some level of deductible for 83% of workers, up 30% from 2006.  The average deductible has also risen 6% annually for the last 10 years and currently stands at $1,644 for single coverage.  Further, we have seen a marked shift toward high deductible health plan (HDHP) enrollment, rising from 4% in 2007 to 31% in 2020.  The trends are undeniable - healthcare is getting more expensive, and as more of that cost burden is being shifted to employees discretionary income is getting squeezed.

Provided by: Roger Friedman, MD and Philip Rancitelli, MD (Allergist / Immunologist)

The recent FDA emergency use authorization of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) has increased optimism that an end to the pandemic is within reach.  However, reports of anaphylactic reactions following vaccine administration have caused concern, especially among allergy sufferers.

Significant reactions to vaccines in general are very rare.  The incidence of anaphylaxis, the most severe type of allergic reaction, is estimated to occur in 1.31 per 1 million doses.  Thus far, there have only been a handful of apparent severe allergic reactions reported following COVID vaccination among the millions of doses already administered.

Provided by: Michael Goodman, MD (Allergist/Immunologist)

A frequent question that we receive from our patients with asthma is: Am I at increased risk from COVID due to my asthma? The CDC states that “having moderate-to-severe asthma might increase your risk for severe illness from COVID-19.” Intuitively one would think that since both COVID and asthma are respiratory disorders that people with asthma would be at increased risk for a more severe course should they become infected. We also know that asthmatic patients often have a more severe course when infected with influenza, also a respiratory virus.

Provided by Megan Goebel, MD (Allergist/Immunologist)

Eczema, sometimes referred to as atopic dermatitis, is a bothersome and chronic skin condition characterized by dry and itchy patches that can be exacerbated by exposure to allergens and irritants. Eczema typically appears in infants and young children but can persist into adulthood. The face, neck, arms and legs are most commonly involved.

Uncontrolled eczema can significantly decrease the quality of life of patients and is associated with depression, anxiety and trouble sleeping. Environmental allergy testing can be helpful to identify pollens, dust mites, pet dander, and/or molds that may be triggering eczema. In some patients food allergens can also play a role in eczema.

Provided by: Roger Friedman, MD (Allergist/Immunologist)

Oral Immunotherapy, also called OIT, has been a life-changing therapy for patients, parents and physicians. Food allergies have been dramatically increasing over the last 25 years and affect 8% of the population. Most concerning has been the severe food allergies, especially to peanuts and tree nuts.
 
One year ago, we began a program at Ohio ENT and Allergy Physicians for OIT.  Since that time, we have enrolled 50 patients, and seven of them are now graduates of the program.

Provided by: David Hauswirth, MD (Allergist / Immunologist)

Often we are asked to evaluate someone with ear problems and asked, “do allergies cause ear problems?” The simple answer is yes. The Eustachian tube drains the middle ear into the back of the nose. In someone suffering from allergies, the Eustachian tube can swell or not work correctly. This lack of function and drainage will cause fluid to build in the middle ear, leading to temporary hearing loss and sometimes ear infections.

Patients with allergies will often have ear symptoms. Sometimes the ears will itch, feel full, pop or have pressure. Manytimes clear fluid is found in the middle ear when someone has allergies. This fluid will often drain as allergies are treated. However, if allergies are not treated, this fluid can stay in the middle ear and become infected. Once someone develops an ear infection, the cause and the infection must both be treated.

Provided by: Michael Goodman, MD (Allergist/Immunologist)

Sinusitis is a common problem seen in both ENT and allergy offices. Sinusitis is inflammation of the sinuses, air-filled cavities located in facial bones around the nose. Sinusitis is often due to an infection in these cavities. It can feel like a bad cold with facial pain, runny nose (rhinorrhea), headache, nasal congestion, and a sore throat. While the common cold is a viral infection, sinus infections are often bacterial and treated with antibiotics (antibiotics are not of help in the treatment of viruses).

Many conditions can contribute to the onset of a sinus infection. Many of them involve blockage of the natural drainage of the sinuses and the nose. When this drainage is blocked, bacteria present in the nose have an easier time replicating and increasing their numbers to the point that a sinus infection occurs. Inflammation that starts as a cold can increase the chances of a sinus infection starting. Allergic rhinitis (allergic inflammation of the nose) can also create inflammation that results in blockage and increase the likelihood that a bacterial infection will take hold and cause sinusitis.

Provided by: Roger Friedman, MD (Allergist/Immunologist)

This is a unique and challenging time for all of us! A question I often hear is, “Could this be COVID-19 or is it my allergies?” First of all, allergies, asthma and COVID-19 do have some similar symptoms, including a runny nose, sneezing and cough. Allergies will often also cause itchy nose, eyes and throat; COVID-19 does not. In addition, most allergy sufferers know they are allergic to the tree pollen that is currently out, so their symptoms will be worse after being outside.

With COVID-19, patients will often have a fever which doesn’t occur with allergies. The sudden loss of the senses of smell and taste is a newly discovered symptom of COVID-19.

Provided By: Evan Tobin, MD

Everyone deals with a sensation of a stuffy or blocked nose from time to time. Usually we know why this is happening—we may have a cold, springtime allergies are here, etc. We are designed to breathe through the nose.  It is uncomfortable to us to feel a sensation of congestion. This can also affect our sense of smell and our ability to appreciate flavors. Chronic mouth breathing over a long period of time can lead to dental problems. And for children it can lead to misalignment of the teeth and they can develop bite problems. Nasal congestion can contribute to snoring and sleep apnea as well.

Sometimes nasal blockage or congestion becomes more recurrent or chronic or its cause is unknown. This will be a brief discussion of a variety of things that can cause nasal congestion, how they are diagnosed and treated and which may be serious enough to require a trip to your PCP or even a specialist.

Provided by: Roger Friedman, MD (Allergist)

Hay Fever Season is Here – What Can You Do?

Ragweed pollen is the cause of allergic rhinitis that begins in early August and lasts until it frosts a few times, which kills the weed. Ragweed pollen is everywhere – especially in the woods, fields and in the center strip of highways. The pollen counts can be over a thousand, especially during the heavy pollination times (early in the morning and late afternoons).

The first strategy is avoidance of the pollen. You can do this by keeping the windows in the house closed and using the AC. When you exercise try to avoid early am and dusk.

We use a variety of medications to treat hay fever, including antihistamines, nasal steroids, nasal antihistamines and Singulair®. Each patient responds to these differently, so if one fails another may succeed. If these work then no further evaluation may be needed, but if patients continue to suffer it’s time to see your Allergist.

Provided by Mehmet Basaran, MD (Allergist)

Western medicine that we practice in the United States is currently based on observation, testing, diagnosis and treatment. Observation includes physical examination and a thorough history. Testing is selected based on the patient’s history and suspected causes of the patient’s problems. At Ohio ENT and Allergy Physicians, the board certified Allergist uses testing techniques and laboratory techniques that are proven to be safe and relevant, based on scientific study and published in peer-reviewed journals. Then the results, correlated with observations and physical examination, and plans of therapy are discussed with the patient.

Allergy prick skin testing is still the most physiologic form of testing for allergy. Blood tests such as RAST and Immunocap testing are helpful in that they determine if there is sensitization to a particular allergen. It must be correlated with physical and clinical symptoms. Another proven method of testing for allergies is a challenge. This can be an environmental challenge and done in research settings where patients are exposed to known allergens by breathing it in, or a food challenge when patients ingest a small increasing amounts of the food in question.

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