Choosing Wisely Australia® is a new, health profession led initiative facilitated by National Prescribing Service (PBS) that aims to stimulate informed conversations about healthcare services, with the ultimate goal to ensure delivery of high quality healthcare for Australians by reducing inappropriate care.
In a first for Australia, medical societies and colleges have united to take the lead on identifying tests, treatments and practices that are of proven low value, are still in the research phase or carry an unnecessary risk.
The Australasian Society and Clinical Immunology and Allergy (ASCIA) is one of the first medical societies and colleges that released recommendations at the launch of Choosing Wisely Australia on 29 April 2015.
The ASCIA list of 5 things that clinicians and consumers should question is available at www.choosingwisely.org.au/recommendations/ascia
Australian experts say the nation has given allergies too low a priority, and as a result people are suffering and at risk.
World Allergy Week, 13-19 April 2015
“The figures are of great concern,” says leading clinical immunology/allergy specialist Associate Professor Richard Loh, who chairs the National Allergy Strategy committee. “Allergic diseases are among our fastest growing chronic conditions. More than 4 million Australians have one or more allergic diseasesand this is increasing. Hospital admissions for anaphylaxis (severe life threatening allergic reactions) have quadrupled over the last 20 years, food anaphylaxis has doubled in the last 10 years and 10% of infants now have an immediate food allergy.”
“Even something that many people feel is trivial – allergic rhinitis (hay fever) - causes significant illness,” claims Maria Said, deputy Chair of the National Allergy Strategy committee and President of Allergy & Anaphylaxis Australia. “An astounding 80% of people who have persistent asthma also have allergic rhinitis, which if treated helps their asthma. Many in the community, even some health professionals don’t appreciate that treating hay fever can actually prevent asthma developing if it’s done early enough. We also know that having asthma and severe food allergy increases the risk of fatal anaphylaxis. And most Australians face a wait of many months to see a specialist with expertise in allergy, if they can access care at all ”
“You might think my story is unusual, but it isn’t,” says Kate Neville, a 24 year old communications professional who suffers from chronic allergies. “My hay fever, when it's bad, is like walking around in a fog. You go from feeling totally fine and within a few minutes you're experiencing the day 2 symptoms of a cold. I also have potentially life threatening food allergies, which are the biggest grind on my social, emotional and financial wellbeing.”
“And it’s not as if we don’t have some of the answers, We know that early diagnosis, prevention and effective treatment of allergic diseases is vital to halting the rapid increase in allergic diseases in Australia” says Associate Professor Loh who is also immediate past President of the Australasian Society of Clinical Immunology and Allergy (ASCIA). “Governments need to recognise allergic diseases as a significant chronic disease group in Australia. If this is acknowledged, then we can mobilise resources for prompt diagnosis, prevention, effective treatments and models of care that give people access to timely and affordable care. It’s about leadership and recognition.”
“The cost of allergies to the Australian economy is more than $7 billion per year, and significant cost savings could be made by Governments supporting the implementation of the first National Allergy Strategy for Australia” argues Maria Said. “
“There's not even consistency when it comes to education or support,” says Kate. “There’s too much reliance on individual doctors or passionate parents. It’s well-meaning but not enough.”
ASCIA, as a member organisation of the World Allergy Organisation (WAO), is involved in the 4th annual World Allergy Week from 13 to 19 April 2015, with the theme of: Airway Allergies – The Human and Economic Burden.
A new foundation, which is redressing underinvestment in allergy and immunology research in Australia and New Zealand has announced its first two grants.
Until now there has not been any organisation to specifically fund research into allergy, immunodeficiencies and other immune diseases in Australia and New Zealand. Despite having world class researchers in these fields, funding is very limited. The Allergy and Immunology Foundation of Australasia (AIFA), an initiative of the Australasian Society of Clinical Immunology and Allergy (ASCIA), is trying to fill this gap.
"Allergic rhinitis (commonly known as hay fever) is one of the most common allergic conditions in Australia. It can make asthma worse and is generally under recognised and under treated," says award recipient Dr Janet Davies, Deputy Director of the Lung and Allergy Research Centre at The University of Queensland. "Pollens in the air are what trigger attacks of hay fever and, in many pollen allergic people, asthma. So being able to avoid pollen exposure is important. But while pollen forecasts are seemingly available on a number of websites, they're not based on real data and are inaccurate, in comparison to actual pollen counts produced by our team in Melbourne, Canberra and Sydney.
"Using the grant from AIFA, the Australian Pollen Allergen Partnership (APAP) will work towards establishing the first national standardised pollen monitoring program, spanning all Australian state and territory capital cities and offer readily accessible and reliable local and current pollen count information to patients and doctors through its website. It will also provide patient education material and evidence-based guidelines on pollen allergen exposure risks in different locations.
"Reliable pollen measurements and short term forecasts of allergenic grass pollen counts will be sent to the public via websites, apps and media outlets," says Dr Davies. "We're already publishing pollen forecasts via melbournepollen.com.au and canberrapollen.com.au and an app for Melbourne has generated over 20,000 downloads since the spring of 2013. To do this well, we need a standardized national pollen monitoring network to accurately forecast exposure to grass pollens that cause allergies."
The second AIFA grant is for predicting shellfish allergy in children who are already allergic to the house dust mite. This mite is the allergy culprit in most people with asthma in Australia. The Chief Investigator is Dr Sandip Kamath based at James Cook University in Townsville.
"It might surprise you to know that there are similarities between the bits of the house dust mite that cause allergies and those in shellfish, which means that you can get what we call cross reactivity. This is when the immune system reacts to house dust mite and may rebel against shellfish as well. This can evolve into severe allergic reactions," explains Dr Kamath.
"I aim to develop a way of detecting this immunological cross-reactivity using antibodies called IgE with the hope that this may help to prevent accidental exposure and unexpected allergic reactions to seafood among house dust mite sensitised children and young people."
"One in four people are affected by allergy, immunodeficiencies and other immune diseases in Australia and New Zealand. We're delighted that the Allergy and Immunology Foundation of Australasia (AIFA) has been able to support such important projects, with the potential to positively affect so many people," says Dr Raymond Mullins, Chair of the AIFA Board. "Research into allergy has been under-resourced in Australia and New Zealand and this is the beginning of us redressing the balance."
Experts agree that allergies are major public health issue in Australia and national action is needed.
The world's first Allergy Summit took place in Sydney on August 8th. There were 60 invited participants including consumers and a wide range of medical specialists and key organisations from across Australia. This Summit was convened in partnership by the Australasian Society of Clinical Immunology Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA).
The scope of discussions included the impact of allergic diseases, their cost, the need for improved access to care, standards of care, education and training, research and policy, with a focus on possible solutions.
"The Allergy Summit was a great step forward, bringing together key representatives from a large number of backgrounds to work together to identify goals and strategies to address a major chronic disease affecting a large proportion of the Australian population." says Dr Melanie Wong, a leading specialist Allergy and Immunology physician and President-Elect of ASCIA.
"The Allergy Summit was the beginning of a new phase in the management of allergic diseases in Australia," said Dr Wong.
"The aim of the National Allergy Strategy will be to improve access to appropriate healthcare services and improve the quality of life of people with allergic diseases and those who care for them," says Associate Professor Richard Loh, President of ASCIA.
"We all agreed on the need for a National Allergy Strategy," says Maria Said, President of A&AA.
The National Allergy Strategy will be developed over the next six months and further funding will be sought to hold an implementation meeting in April 2015.
Allergy experts claim allergies are a much bigger and more serious problem than governments realise and national action is needed. A national Allergy Summit is taking place in Sydney on Friday, August 8, 2014.
“Allergic diseases have a significant impact on daily life including hospital admissions, lost work days, missed school and poorer quality of life - estimated at $30 billion a year.” says Dr Richard Loh, a leading specialist Allergy and Immunology physician and President of the Australasian Society of Clinical Immunology and Allergy (ASCIA), convenors of the forthcoming national Allergy Summit in Sydney on August 8th. “A collaborative approach between state and federal governments and key stakeholder organisations can greatly improve care and quality of life for patients” said Dr Loh.
“We urgently need a National Allergy Strategy,” says Maria Said, President of Allergy & Anaphylaxis Australia, who are working in partnership with ASCIA to convene the Allergy Summit. “Allergic diseases are commonly perceived as trivial. But they’re not. Conditions like allergic rhinitis (also commonly known as hay fever), asthma, eczema, allergies to foods, insects or drugs and occupational allergies cause a huge burden to individuals and the economy and people do die from anaphylaxis (severe allergic reactions) to insects, drugs and foods.”
“The fact is that many patients with allergic diseases are not receiving optimal treatment and progression of some allergic diseases can be prevented,” says Prof Loh. “For instance if allergic rhinitis (hay fever) is recognised and treated, expensive conditions like asthma, chronic rhinosinusitis and sleep apnoea can be significantly helped and even prevented. Allergic conditions also disproportionately affect children, which can significantly impact on their education and sometimes because of severity, threaten their lives.
In line with ASCIA's commitment to optimise continuing professional development (CPD) points that health professionals earn by completing ASCIA e-training courses, in 2014 the following 4 courses have been approved by the Royal Australasian College of General Practitioners (RACGP) QI & CPD Program as a single 6 hour Active Learning Module (ALM) titled ASCIA Allergy and Anaphylaxis e-training for Health Professionals ALM:
1. ASCIA anaphylaxis e-training for health professionals
2. ASCIA food allergy e-training for health professionals
3. ASCIA allergic rhinitis e-training for health professionals
4. ASCIA allergen immunotherapy e-training for health professionals
This Active Learning Module has been approved by the RACGP QI&CPD Program. Total points: 40 (Category 1). Therefore, we expect that this ALM will be popular, particularly as it has the flexibility to be completed in multiple sessions.
As of May 2014, the ASCIA allergy and anaphylaxis e-training for health professionals will be available at no charge from the ASCIA website: https://alm.ascia.org.au
ASCIA e-training courses provide a standardised and consistent approach to recognition, management and referral of appropriate patients with allergic disease. The courses are easily accessible, available at no charge and allow for flexible completion.
ASCIA is supporting World Allergy Week with the release of three new resources for patients at risk of anaphylaxis. World Allergy Week is 7-13 April 2014.
Anaphylaxis is a potentially life-threatening allergic reaction that requires urgent medical treatment. It is therefore essential to know how to recognise and respond to an anaphylaxis emergency as well as implement appropriate risk minimisation strategies to prevent exposure to known allergens.
Recent Australian data indicates that 1 in 10 children will have food allergy by the age of one year (1).
While the cause of the growing epidemic remains unknown, food allergy related anaphylaxis is more common than ever.
Whilst it is essential for health professionals to know how to treat anaphylaxis in an emergency and also provide appropriate ongoing management of patients at risk of anaphylaxis, it is also vital that patients are educated about how to manage their severe allergy.
Food allergy is common in early childhood. Avoidance of known allergic triggers is the mainstay of management, as potential future treatments such as food allergen immunotherapy remains in the realm of ongoing research at this time.
Since accidental exposure can occur despite best efforts, management of children with severe allergies, who are at risk of anaphylaxis, requires development of a broad management plan in schools and childcare including:
- age appropriate education of allergic individuals and their peers
- staff training in the recognition and management of allergic reactions
- development of strategies to reduce the risk of accidental exposure including individual health care plans
- an emergency response plan for when exposure does occur.
ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools and childcare were recently published in the Journal of Paediatrics and Child Health and are available from the ASCIA website: www.allergy.org.au/health-professionals/papers/prevent-anaphylaxis-in-schools-childcare
Blanket food bans are not recommended by ASCIA, although restricting some important food allergens (such as nuts) may have a place in reducing the risk of accidental exposure in very young children who are too young to be relied upon to avoid contact with potential allergic triggers themselves, either by ingestion or cross contamination of equipment like toys or play services.
Including new asthma and anaphylaxis information
Many individuals with severe allergies, who are at risk of anaphylaxis, also have asthma and sometimes it can be difficult to differentiate between anaphylaxis and asthma symptoms.
To help address this issue the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak medical society for immunology and allergy in Australia and New Zealand, has recently included a new “Asthma and Anaphylaxis” module into its updated versions of ASCIA anaphylaxis e-training for schools, childcare services and the community.
ASCIA anaphylaxis e-training courses for schools, childcare services and community have been developed to provide ready access to high quality, consistent, reliable and evidence based anaphylaxis education throughout Australia and New Zealand.
The updated ASCIA anaphylaxis e-training courses include the following important changes:
- New asthma and anaphylaxis module – which provides clear guidance on how to respond in an emergency situation regarding anaphylaxis and asthma, as it is sometimes difficult to differentiate between the two conditions.
- Updated ASCIA Action Plans – which provide guidance on how to manage mild or moderate allergic reactions and anaphylaxis, including when and how to give the adrenaline autoinjector. For these reasons, ASCIA Action Plans should always be kept with the adrenaline autoinjector.
- Updated information about adrenaline autoinjectors.
- Amendments to terminology to ensure consistency with revised ASCIA Action plans and other ASCIA education resources.
The updated ASCIA Action Plans include the following important changes:
- Revised wording regarding CPR – by stating “Commence CPR at any time if person is unresponsive and not breathing normally”, which is consistent with the Australian Resuscitation Council (ARC) wording.
- Revised wording regarding asthma – by stating “If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector first, then asthma reliever medication.” and inclusion of a tick box in the personal (red and green) versions to indicate if the person has asthma.
- Space to include a larger photo of the individual in the personal (red and green) versions.
The updated ASCIA Action Plans can be freely downloaded from the ASCIA website by doctors, patients or their care-givers from:
It is important to note that:
- ASCIA Action Plans are medical documents and therefore must be completed and signed by the individual’s medical practitioner (GP or specialist).
- Parents of children with food allergy/anaphylaxis are encouraged to visit their GP yearly to renew ASCIA Action Plans for the new school year, to be re-trained in the use of their adrenaline autoinjector device (if prescribed), and check if any new problems have arisen that might suggest the need for availability of an adrenaline autoinjector (e.g. new regular asthma, new or more serious allergic reaction).
Allergy and other immune diseases are amongst the fastest growing chronic and complex health conditions in Australasia – affecting one in four children and adults in Australia and New Zealand.
The Australasian Society of Clinical Immunology and Allergy (ASCIA) said the rapid rise has resulted in an urgent need for new research to understand the reasons for the increasing prevalence and to help find potential new treatments and cures.
Today in Perth, ASCIA will launch the Allergy and Immunology Foundation of Australasia (AIFA) to fund high quality education and research projects into disorders of the human immune system in Australia and New Zealand.
- May 23 2013 - New anaphylaxis resources for schools, childcare services and parents of children at risk of anaphylaxis
- July 10 2013 - ASCIA Allergy and Immune Diseases in Australia (AIDA) Report
- Apr 10 2013 - World Allergy Week (8-14 April 2013)
- Jan 23 2013 - ASCIA anaphylaxis e-training for first aid (community) is now available