Bustos Giseth, Sanchez-Gonzalez Marcos A, Grogan Troy, Bonansea-Frances Adriana, Wright Camysha, Lichtenberger Frank, Rizvi Syed A A, Kaplan Alan
Universidad El Bosque, Medicine, Bogota, Colombia.
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA.
NPJ Prim Care Respir Med. 2024 Aug 1;34(1):22. doi: 10.1038/s41533-024-00380-z.
Allergic rhinitis (AR), a condition characterized by sensitivity to allergens leading to poor quality of life, including disrupted sleep, reduced vitality, lowered mood, changes in blood pressure limited frustration tolerance, impaired focus, decreased performance in academic and professional settings, and millions of missed work and school days every year. Approximately 20–40% of individuals in the United States are affected by AR, which carries notable clinical and financial burdens. Interestingly, there is a strong link between AR and asthma to the extent that countries with a high prevalence of rhinitis have asthma rates ranging from 10% to 25%. Research has indicated that Allergen Immunotherapy (AIT) is associated with improved AR symptoms, a potential to resolve the AR over time, a decreased likelihood of asthma exacerbations and incidence of pneumonia in individuals with concurrent asthma, which are advantages that persist for years even after the cessation of treatment. Although patients presenting with allergies are first seen and treated in the primary care setting, gaps in training and the lack of available guidance for primary care practitioners have significantly impacted the quality of care for these patients with persistent AR symptoms, resulting in inefficient use of healthcare resources. To complicate matters, there is an insufficiency of allergists and immunologists, impacting the capacity to provide next-level care to the number of AR patients who could benefit from AIT. Hence, there is a critical need to equip primary care providers with educational experiences on essential concepts related to immune responses in allergies and asthma, recognizing the significance of the common airway in treating these entities and familiarization with the scientific evidence supporting various options for AIT. The development and implementation of medical education and algorithms designed to assess diverse patients’ symptoms, pharmacotherapy approaches, and situations where AIT can be initiated or sustained are warranted. The present commentary proposes a workflow model of the critical steps for managing and treating mild to moderate respiratory allergies via AIT in primary care settings. In addition, the initial development of medical education programs to minimize the burden on allergy-specialized care while, importantly, actively improving patient outcomes will be discussed.
过敏性鼻炎（AR）是一种对过敏原敏感的病症，会导致生活质量下降，包括睡眠中断、活力降低、情绪低落、血压变化、挫折耐受力有限、注意力受损、在学术和职业环境中的表现下降，以及每年数百万个工作日和学习日的缺勤。在美国，约20%-40%的人受AR影响，这带来了显著的临床和经济负担。有趣的是，AR与哮喘之间存在紧密联系，鼻炎高发国家的哮喘发病率在10%至25%之间。研究表明，变应原免疫疗法（AIT）与AR症状改善相关，有可能随着时间推移解决AR问题，同时降低合并哮喘患者哮喘发作和肺炎发病的可能性，这些益处即使在治疗停止后仍可持续数年。尽管出现过敏症状的患者首先在初级保健机构就诊和接受治疗，但培训差距以及初级保健从业者缺乏可用指导，显著影响了这些持续有AR症状患者的护理质量，导致医疗资源利用效率低下。更复杂的是，过敏症专科医生和免疫学家不足，影响了为可从AIT中受益的AR患者提供更高级护理的能力。因此，迫切需要为初级保健提供者提供与过敏和哮喘免疫反应相关基本概念的教育体验，认识到共同气道在治疗这些疾病中的重要性，并熟悉支持AIT各种选择的科学证据。开展和实施旨在评估不同患者症状、药物治疗方法以及可启动或维持AIT情况的医学教育和算法是必要的。本评论提出了在初级保健环境中通过AIT管理和治疗轻度至中度呼吸道过敏关键步骤的工作流程模型。此外，还将讨论医学教育项目的初步开发，以尽量减轻过敏专科护理的负担，同时重要的是积极改善患者结局。
