Welcome to our November research update! Getting involved with research is an important way to impact asthma and allergy treatments, education, and awareness.

This month, we are highlighting clinical trials, surveys, and news on:

• Potential asthma treatments
• The impact of environment on asthma
• Moderate to severe eczema in children
• Differences in COVID-19 outcomes based on asthma type
• Study on tezepelumab for nasal polyps
• Impact of corticosteroid use in people with nasal polyps
  
  

Note: The links below will take you to external websites.

Surveys

Community Asthma Survey

If you are over 18 and have asthma, we want to hear about how the environment affects your breathing. By telling your story, you can help others understand and manage asthma better!

The Asthma and Allergy Foundation of America (AAFA) is a partner in this research and appreciates your support!

TAKE THE SURVEY

Participants Needed for Eczema Study

If you are a caregiver for a child under 18 with moderate to severe eczema, we would love to hear your opinions and perspectives. Your feedback can help impact guidelines for childhood eczema. Your child can take the survey too with your help.

Take a 15-minute online survey for a research study on using systemic (oral or injectable) medicines for eczema.

Your voice makes a difference! Each participant will be entered into a drawing for a reward.

Principal Investigator: Dr. Joy Wan (Johns Hopkins Medicine IRB00397225)

TAKE THE SURVEY

Chronic rhinosinusitis is a common medical condition that affects 5-12% of adults.¹ Around 20 to 30% of people with chronic rhinosinusitis have nasal polyps.^2,3 Nasal polyps associated with type 2 inflammation, which is also linked to asthma, allergic rhinitis (hay fever), atopic dermatitis (eczema), food allergies, eosinophilic esophagitis (EoE).⁴

Nasal polyps can have a major impact on quality of life. They can affect sleep, the ability to do daily activities, and cause anxiety and depression. They can also cause safety concerns because they can affect a person’s ability to smell.

The Asthma and Allergy Foundation of America (AAFA) studied the impacts of living with nasal polyps in a report titled, Life with Nasal Polyps: The Patient Experience and Opportunities to Improve Care in the U.S.

As part of our research, we interviewed people with nasal polyps to understand the patient experience. Below, you’ll hear from Tom, Norah, Teresa, Leo, Tamara, and Georgia* about how their experiences line up with some of the key findings of our report.

Diagnosis Can Take a Long Time

For many people, it can take months, or even years, to get a nasal polyps diagnosis. Tom, who was recently diagnosed with nasal polyps, described having symptoms for months before diagnosis.

“For some months I had some nasal congestion issues,” Tom said. “And I really wasn't too happy with the doctor's response. I ended up in the hospital [and] had an ENT say I had a head full of polyps.”

For some people, getting a formal diagnosis can take years. Georgia was diagnosed with nasal polyps after having symptoms and seeing multiple health care providers for years with no relief.

“Before my diagnosis I just had issues with allergies,” recalled Georgia. “Every season it started out with me having sinus infections real bad. So once I started getting sinus infections and I knew it was seasonal, I went to an allergist. From the allergist, I started taking allergy shots. I did that for about a year, and I felt like my allergies weren't getting any better. So then I started having issues with asthma … then it got to the point where I was going back and forth to the hospital, to the ER. Then I decided from there to go to an ENT [who diagnosed me with nasal polyps].”

Nasal Polyps Can Impact Quality of Life

Nasal polyps can have physical impacts like congestion, stuffy and runny nose, and loss of taste or smell. They can also impact mental, social, and emotional health. Teresa, who has had chronic sinus infections as a result of her nasal polyps, described the impact on social life and relationships.

“It impacts your life,” Teresa said. “You have to change plans with friends if you have a sinus infection, and they get worse and worse. You’re constantly altering your life, family events, [you] just lose your energy, and they get harder to fight.”

Leo, a college student, also detailed the impact on school and physical activities.

“I swam before,” Leo said. “I can't really do that anymore just because water goes up in [my nose] and doesn't come back out. It doesn't drain. And so I end up with a sinus infection … There have definitely been times where I’m at work or I’m in class, and I can feel a bad one coming on that I have to just buckle down and know that I’m going to go take a nap or something after.”

The impacts on smell and taste can also be dangerous in some cases. Georgia described times when she couldn’t smell spoiled food or burning in the kitchen.

“I would eat foods and not know if they were spoiled or not,” Georgia said. Like milk, you don't know it's not good, especially if you can't taste or smell it. I could even remember a point where I was in my room, I had put on dinner. And I was sitting on my bed and the alarms went off in the house, and all of a sudden I started seeing white smoke…and then I noticed my throat was feeling a little funny, because I was inhaling the smoke, but I couldn't even taste it or smell it.”

Access to Effective Treatments for Nasal Polyps Can Be Challenging

Nasal polyps can be treated with medicines and surgery. For many of the people we interviewed, getting access to these treatments was a challenge.

Norah, who has managed her nasal polyps well through budesonide nasal sprays, talked about the challenges of getting insurance to approve her prescription.

“The cost is going up,” said Norah. “I'm in the middle of a fight with Medicare. They denied me once, but you can appeal. So, I'm in the middle of an appeal process to get the tier lowered on that drug … And so now I have to ask [my asthma specialist’s] office to reapply. Otherwise, I’m looking at between $80 and $120 a month just for the budesonide because it's a tier 4 drug under Medicare. They denied it because the FDA doesn't see the need for using it that way.”

Tom, who qualified for a biologic treatment for nasal polyps, described the difficult process to get the treatment.

“Getting that prescription was an incredible odyssey all in itself,” said Tom. “Getting it approved or not approved and getting the specialty pharmacy to deliver it … And I'd have to call them every couple of weeks to go through this whole rigamarole all over again. It was not fun.”

Challenges with accessing treatments (especially newer, more expensive options) can be different for everyone. Factors like your insurance provider and plan can play a big role in accessing treatment.

Some people we interviewed also had trouble getting information about surgery.

“I wasn't offered surgery, surgery was never an option,” said Tamara. “I go to my ear nose and throat doctor, [and they say] 'Okay, you look good, you're doing okay.' Surgery was never on the table.”

For others who had surgery to remove their nasal polyps, they often had to try medicines first or do surgeries more than once. And for some people, recovery after surgery can be challenging.

Leo described his experience with surgery: “I got surgery because the drugs didn't work. And the surgery recovery, at least for a couple of [the surgeries], was a pain... two to three weeks of a lot of bleeding and junk coming out, just because of the large amount of stuff that was in there that they had to remove.”

Nasal Polyps Can Impact Quality of Life

Nasal polyps can have physical impacts like congestion, stuffy and runny nose, and loss of taste or smell. They can also impact mental, social, and emotional health. Teresa, who has had chronic sinus infections as a result of her nasal polyps, described the impact on social life and relationships.

“It impacts your life,” Teresa said. “You have to change plans with friends if you have a sinus infection, and they get worse and worse. You’re constantly altering your life, family events, [you] just lose your energy, and they get harder to fight.”

Leo, a college student, also detailed the impact on school and physical activities.

“I swam before,” Leo said. “I can't really do that anymore just because water goes up in [my nose] and doesn't come back out. It doesn't drain. And so I end up with a sinus infection … There have definitely been times where I’m at work or I’m in class, and I can feel a bad one coming on that I have to just buckle down and know that I’m going to go take a nap or something after.”

The Need for More Nasal Polyps Support and Resources

Our report highlighted a need for more support and resources for nasal polyps. Tamara, who was diagnosed at age 14, described frustrations in the education she received from her health care provider when she was first diagnosed.

“Especially when you're talking to a 14-year-old, the big thing is compliance,” said Tamara. “And if you don't explain why compliance is important, at some point, they’re going to get tired of doing things. [They] get tired of using nasal sprays and stop because they don’t understand what can happen if they don’t. And he never bothered to explain all of that. He just said, ‘You need to take it, and it may help your ear problems,’ but that was it. He never went into details.”

As such, she explained how doing her own research as a nurse practitioner helped her learn more about nasal polyps.

“Once I became a nurse, I researched it myself,” Tamara recalls. “Sometimes you have to do your own research and be your own advocate. So that’s pretty much what I did … I was able to understand things to the point where I was better able to ask questions and get the answers that I needed.”

Teresa also talked about how important it is to raise awareness about nasal polyps among health care providers.

“I just wish more local allergists were aware,” Tamara said. “For a time, I was just seeing an allergist and a pulmonologist to treat the allergy and asthma because I had dealt with other allergists, and no one was helping … So I wish there was more training in polyps and awareness of that. I don’t feel like every allergist and every ENT is aware.”

There is also a need for more education and awareness for people with nasal polyps. Norah spoke about the need for more information on day-to-day management.

“I would just love more information. Other than what I’m doing, is there anything I can do to keep these from growing back or keep them under control? I guess it would be just more ways of controlling and keeping them from coming back.”

Georgia also stressed the importance of raising awareness among caregivers and loved ones.

“They’re looking like, ‘Huh? Polyps? I’ve heard of cancerous polyps, but not nasal polyps.’ And then you got to go through the spiel and be the doctor and break down things and give people terminologies and stuff, and they’re still lost.”

The Life with Nasal Polyps report was developed independently by AAFA and made possible by support from Sanofi and Regeneron.

*Names have been changed for privacy.

References
1. Dietz de Loos, D., Lourijsen, E. S., Wildeman, M. A. M., Freling, N. J. M., Wolvers, M. D. J., Reitsma, S., & Fokkens, W. J. (2019). Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology. Journal of Allergy and Clinical Immunology, 143(3), 1207–1214. https://doi.org/10.1016/j.jaci.2018.12.986
2. Stevens, W. W., Schleimer, R. P., & Kern, R. C. (2016). Chronic Rhinosinusitis with Nasal Polyps. The Journal of Allergy and Clinical Immunology: In Practice, 4(4), 565–572. https://doi.org/10.1016/j.jaip.2016.04.012
3. Benjamin, M. R., Stevens, W. W., Li, N., Bose, S., Grammer, L. C., Kern, R. C., Tan, B. K., Conley, D. B., Smith, S. S., Welch, K. C., Schleimer, R. P., & Peters, A. T. (2019). Clinical Characteristics of Patients with Chronic Rhinosinusitis without Nasal Polyps in an Academic Setting. The Journal of Allergy and Clinical Immunology: In Practice, 7(3), 1010–1016. https://doi.org/10.1016/j.jaip.2018.10.014
4. Bachert, C., Hicks, A., Gane, S., Peters, A. T., Philippe Gevaert, Nash, S., Horowitz, J. E., Sacks, H., & Jacob-Nara, J. A. (2024). The interleukin-4/interleukin-13 pathway in type 2 inflammation in chronic rhinosinusitis with nasal polyps. Frontiers in Immunology, 15. https://doi.org/10.3389/fimmu.2024.1356298

If you’re on Medicare, a new program will be available in 2025 that might make it easier to pay for your medicines. It’s called the Medicare Prescription Payment Plan.

What Is the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan is a program that lets you spread out your estimated out-of-pocket drug costs throughout the year. If you have a Medicare Part D or Medicare Advantage plan, you have the option to sign up for the program starting on Jan. 1, 2025.

The Medicare Prescription Payment Plan is part of the Inflation Reduction Act that passed in 2022. It included several items, including this program, that would help people with asthma and allergies. The Asthma and Allergy Foundation of America (AAFA) supported the Inflation Reduction Act in 2022, and we are happy that this program is now available to help people with asthma who are on Medicare better manage the cost of their medicines.

The Inflation Reduction Act also caps Medicare out-of-pocket drug costs to $2,000 per year. This benefit is for everyone on Medicare, not just people who sign up for the Medicare Prescription Payment Plan.

How Can I Sign Up for the Medicare Prescription Payment Plan?

The program is optional, but it may help you if you pay high drug costs, especially at the beginning of the year.

To sign up, go to the website for your health or drug plan. Or call your plan to set it up:

If you want to participate in the Medicare Prescription Payment Plan in 2025, contact your prescription plan as soon as possible. The plan will start Jan. 1, 2025.

You can also sign up for the plan at any time during 2025. After Jan. 1, 2025, contact your prescription plan to sign up for the Medicare Prescription Payment Plan anytime.

Will the Medicare Prescription Payment Plan Reduce the Cost of My Medicines?

No, the program will not reduce your medicine costs. But it will spread out your costs over the year so you can manage your budget better. The new $2,000 out-of-pocket cap may help reduce your yearly costs if you normally spend more than that on your medicines.

How Can I Save Money on My Prescription Medicines?

Many pharmaceutical companies, state programs and nonprofits have drug assistance programs (PAPs) that offer free or low-cost medicines. AAFA has a list of several drug assistance programs.

Some programs may not offer help to people with Medicare, but you may be able to get help through these options:

• Extra Help from Medicare
• State Pharmaceutical Assistance Program
• Pharmaceutical assistance program for people in a Medicare Part D drug plan
  
  

Each year, usually in the fall, you have the chance to change or sign up for health insurance coverage. Here is a review of what you need to know in order to enroll in a plan, whether you are getting insured for the first time, or are switching plans.

What Are Open Enrollment Terms I Need to Know?

When you review your options for health insurance, there are some terms you need to know so you can make the best decision for you and your family.

A health care provider is a person who is trained and licensed to provide health care, such as a doctor or nurse.

Open enrollment refers to the time period when you can add or change your health insurance. Outside of that time frame, you can only make changes if you have a certain change in your circumstances.

A special enrollment period is a time outside the yearly open enrollment period when you can sign up for health insurance through the marketplace. Certain life events will qualify you for this enrollment period, like getting married, having a baby, adopting a child, moving, or losing health coverage.

Your monthly premium is what you pay each month for the cost of your health insurance plan.

There are also costs you pay each time you need care. These are called out-of-pocket costs.

Out-of-pocket pocket costs include the following:

• A deductible is what you pay each year for health care services or medicines before your insurance begins paying.
  
  
• Copayments are what you pay to see a health care provider. For example, it may cost $15 to see your primary care doctor and a visit to your asthma specialist might cost $30.
  
  
• Coinsurance is the percentage of your your medical expenses you must pay, including medicines, hospital stays, office visits, etc.
  
  
• Covered services means what your health plan will pay for. This includes medical treatments and prescription medicine.
  
  

Finally, know which doctors, specialists and other health care providers are in-network or out-of-network.

• In-network means that your health plan has an agreement with that a group of specific providers for your health care. Copayments and other costs  generally cost less if you use in-network providers.
  
  
• Out-of-network means there is no agreement between the health insurance company and the provider. Your costs will be higher to see a health care provider out of network.
  
  

For more insurance definitions, see this list of common terms.

Where Can I get Health Insurance?

Millions of people in the United States can get health insurance through their jobs. If your employer does not offer health insurance benefits, you have other options.

You can buy insurance through the Health Insurance Marketplace, created by the Affordable Care Act.

Open enrollment for these plans ends on Dec. 15, 2024, for coverage that starts on Jan. 1, 2025. You can apply until Jan. 15, 2025, for coverage that starts Feb. 1, 2025.

If you don’t act by Jan. 15, 2025, you can’t get coverage for 2025 unless you qualify for a special enrollment period. Some states may have a longer open enrollment period.

How Can I Get Help If I Have Questions?

HealthCare.gov has free tools, and many communities offer help to make sure you feel confident you’ve picked the right plan for you and your family. If you have questions about signing up or want to talk through your options with a trained professional, you can get free and confidential assistance:

• Online: Information is available at HealthCare.gov and CuidadoDeSalud.gov.
  
  
• By phone: Marketplace call center representatives are available to help all day, every day at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in many languages. The call is free.
  
  
• In person: Consumers can find free and confidential local help in their communities by visiting HealthCare.gov or you can make an appointment with the Get Covered America Connector.
  
  

When you apply for insurance, you'll find out if you qualify for financial help to pay your monthly premiums.

_{Updated October 2024}

If you have asthma or allergies, costs for medicines, lab tests, lung function tests, and visits to see a specialist all add up. Health insurance can help with some of these costs. What do you need to know about your insurance options during open enrollment this year?

Open enrollment refers to when you can add, change, or switch health insurance plans. For people who get health insurance through work, your employer and the insurance company set the dates for open enrollment periods.

The Affordable Care Act (ACA) makes health insurance more affordable and available to people without insurance benefits through their employer, Medicare, Medicaid, or another source. It includes other important provisions for people with allergic diseases. For example, if you buy a Marketplace plan, you cannot be denied because you have a pre-existing condition, such as asthma.

How Do I Enroll in a Health Insurance Plan?

If your job offers health insurance benefits, you will need to follow your employer's instructions on how to enroll.

If you do not have health insurance benefits from your employer, or if you are uninsured, you can apply through the Marketplace. You can preview and compare plans before you choose a plan.

Here is a checklist of what information to have on hand to help you make a decision:

• Your household size
• Home and/or mailing address for everyone needing coverage
• Information about everyone needing coverage, like birth dates and Social Security Numbers
• Information about any professional person who is helping you apply (for example, agent or broker)
• Information on how you plan to file your taxes in 2025
• Income information, such as pay stubs and W-2s for every member of your household
• Policy numbers from your current health care plans
• Estimated household income in 2025
• Completed "Employer Coverage Tool" if anyone in your household can get insurance through an employer
• Notices from your current Marketplace plan, if you had one for 2024
• Documents for legal immigrants and naturalized citizens in your household
  
  

HealthCare.gov also has a checklist to help you get ready to apply.

When looking at plans on the Marketplace, you can choose to “estimate total yearly costs.” To do so, you will be asked to select the level of care you expect to use this year. It's OK if you end up using more or less. This won't change your premiums or cost-sharing, or limit how many services you can use.

You might select "Low Use" if you expect:

• Few doctor visits
• Occasional prescription drugs
• No expected hospital visits
  
  

You might select "Medium Use" if you expect:

• Regular doctor visits
• Regular prescription drugs
• No expected hospital visits
  
  

You might select "High Use" if you expect:

• Frequent doctor visits
• Frequent prescription drugs
• At least 1 hospital visit
  
  

What Is Important to Consider If I Have Asthma or Allergies?

1. Are your current health care providers in-network, such as your primary care doctor and your specialists?
2. Does the plan include care from an asthma and allergy specialist?
3. What medicines are covered by the plan? Look for the drug list or formulary.
4. Does the health insurance plan require a referral required to see a specialist? Be aware that the number and type of plans will vary by state. Some states may have a wide choice of plans. Others may offer a health maintenance organization (HMO), which may require you to get a referral to see a specialist.
5. What kind of treatments for asthma or allergies are covered by the plan?
6. Will the plan pay for more advanced treatments, or will it limit the kind of treatment you can receive?
7. Does the plan cover diagnostic tests for diagnosing asthma or allergies, such as lung function tests and skin prick testing?
8. Will the plan cover medical devices such as spacers and nebulizers?
9. Does the plan offer an asthma management program? Under program “details,” you can see if the health insurance plan covers asthma management. Many plans do. Asthma management programs may include a nurse hotline, help identifying your asthma triggers, assistance understanding your medicine, or using equipment like nebulizers and spacers.
   
   

What Are the “Metal” Categories in the Health Insurance Marketplace?

ACA plans fall under the categories of Bronze, Silver, Gold, and Platinum. The levels have nothing to do with quality. They refer to how you and your insurance plan split costs, known as cost-sharing.

Consider Silver if you qualify for extra savings on out-of-pocket costs, or if you want more of your costs covered.

• If you qualify for extra savings (“cost-sharing reductions”), your deductible will be lower, and you’ll pay less each time you get care. These extra savings are only available through the Silver plan. This can save you hundreds or even thousands of dollars a year if you use a lot of care. Silver carries moderate premiums and deductibles.
• While a Silver plan may have a monthly premium that’s higher than a Bronze plan’s premium, be sure to consider the total cost of your medical care. Your total costs include not just monthly premiums but the payments you make when you get care.
• If you have a Silver plan and qualify for extra savings, the deductible can be thousands of dollars less than a typical Bronze plan’s deductible. So, you may end up spending less on health care overall if you enroll in a Silver plan.
  
  

Consider Gold or Platinum if you expect a lot of health care visits or need regular prescriptions.

These plans generally have higher monthly premiums but pay more of your costs when you need care.

What Are Advance Premium Tax Credits?

Advance premium tax credits (APTC) can help lower the cost of your monthly premium. Whether or not you qualify depends on your household size and household income.

When you apply for coverage through HealthCare.gov, you will find out instantly if you qualify for this credit or not. You can also quickly check if you might qualify on their website without an application.

The government may pay your tax credit directly to the insurance company, lowering the cost of the monthly premium that you pay out of pocket. Or you may choose to pay the full premium amount and get a refund at the end of the year.

What If I Have Low Income?

When you apply for coverage, you will also find out if you qualify for:

• Medicaid
• CHIP (the Children’s Health Insurance Program)
  
  

Both provide free or low-cost health coverage for some people, including low-income adults, children, pregnant women, seniors and people with disabilities. Medicaid provides insurance to more than 72 million people in the United States.

These programs may be known by different names in each state. Some states have expanded their Medicaid programs to cover all adults below a certain household income. Learn more about the expansion and what it means to you.

I Have Insurance Through My Job. Should I Look at the Marketplace?

You can, but the Marketplace is intended for people without health insurance. Since the ACA was passed, job-based health insurance must meet certain standards. You will pay full price for a Marketplace plan unless your coverage through work does not meet those standards.

Should I Buy “Catastrophic” Coverage, Short-Term Insurance or Hospital-Only Coverage?

The Catastrophic health plans may look like health insurance, but they do not meet the minimum standard for ACA plans or job-based health plans. For instance, they will not include prescription medicine or preventative care, both of which are important for people with asthma and allergies.

If you are under 30 years old, you can get a Catastrophic health plan without an exemption.

If you are 30 years old or older, you have to apply for a hardship exemption or affordability exemption.

Will I Pay a Penalty If I Don't Buy Health Insurance?

As of 2019, you no longer have to pay a tax penalty if you are uninsured. But you might still be subject to a state tax penalty.

How Can I Get More Help While Applying?

Enter your ZIP code or city and state and get connected to someone who can help you locally.

Where Can I Learn More?

AAFA’s advocacy resources have more details about health care coverage and insurance issues, including Medicaid, Medicare and CHIP.

Updated October 2024

Welcome to our October research update! Getting involved with research is an important way to impact asthma and allergy treatments, education, and awareness.

This month, we are highlighting clinical trials, surveys, and news on:

• New treatment options for eczema, chronic spontaneous urticaria (CSU), chronic obstructive pulmonary disease (COPD), eosinophilic granulomatosis with polyangiitis (EGPA), and nasal polyps
• The impact of climate change and environment on asthma and allergies
• Safety of direct penicillin challenges
  
  

Note: The links below will take you to external websites.

Surveys

Community Asthma Survey

If you are over 18 and have asthma, we want to hear about how the environment affects your breathing. By telling your story, you can help others understand and manage asthma better!

The Asthma and Allergy Foundation of America (AAFA) has a participating member on the survey steering committee and appreciates your support!

TAKE THE SURVEY

Participants Needed for Eczema Study

If you are a caregiver for a child under 18 with moderate to severe eczema, we would love to hear your opinions and perspectives. Your feedback can help impact guidelines for childhood eczema. Your child can take the survey too with your help.

Take a 15-minute online survey for a research study on using systemic (oral or injectable) medicines for eczema.

Your voice makes a difference! Each participant will be entered into a drawing for a reward.

Principal Investigator: Dr. Joy Wan (Johns Hopkins Medicine IRB00397225)

TAKE THE SURVEY

Latest Asthma and Allergy News

Anaphylaxis

neffy® Epinephrine Nasal Spray Now Available in the U.S.
In August 2024, the Food and Drug Administration (FDA) approved the epinephrine nasal spray, neffy®, for adults and children over 66 pounds for the treatment of severe allergic reactions, including anaphylaxis. The treatment is now available by prescription in the United States. Through the neffyConnect program, eligible people with commercial insurance can purchase 2 single-use devices for $25. Uninsured people can buy them for $199. Neffy is also available free to people who qualify for the ARS Patient Assistance Program. The nasal spray offers a needle-free alternative to epinephrine auto-injectors. Experts believe neffy will encourage more people to carry and use their epinephrine earlier during an allergic reaction. This can lead to treatment outcomes and fewer emergency room visits.

Allergy

How Climate Change Impacts Allergies
A recent article examined the impact of increased use of fossil fuels on the environment and allergic conditions. Increased use of fossil fuels has led to global warming, causing more extreme weather events like wildfires and storms. This results in higher levels of air pollutants, including particulate matter, greenhouse gases, and pollen. Together, these factors worsen allergic diseases.

Factors like droughts, floods, heat waves, pollution, and deforestation also add to the rise in allergies. As global warming and extreme weather continue to worsen, allergic diseases are expected to increase, which can put more strain on health care systems.

To improve health, the authors say we need to address climate change by reducing fossil fuel use and promoting biodiversity. Health care providers can also play a key role in educating patients about climate change's effects on health and advocating for policy changes to create a healthier, more sustainable future.

Safety of Direct Penicillin Challenges
In a direct penicillin challenge, a patient is given a small dose of penicillin and is monitored for signs of an allergic reaction. A recent study looked at how often people labeled as allergic to penicillin have allergic reactions during direct penicillin challenges.

The researchers analyzed data from 56 studies involving 9,225 participants. It found that only 3.5% of people experienced a reaction, most of which were mild. Children, outpatients, and people receiving graded or prolonged challenges had higher rates of reaction. Only 5 severe reactions were reported, including 3 cases of anaphylaxis, but none were fatal. These findings suggest that direct penicillin challenges are generally safe and could be widely used to evaluate penicillin allergies, helping reduce unnecessary allergy labels in both children and adults.

Asthma

Risk Factors for Missing Appointments Among Children with Asthma
Missing scheduled asthma appointments has been linked to more asthma flare-ups in children and higher health care costs. This study reviewed 17 studies involving 27,023 children to identify risk factors for missing appointments. It found that teenagers, non-White children, and children with less severe asthma were more likely to miss appointments. The analysis did not find significant differences based on insurance, allergies, gender, or rural living.

The study also showed that children who missed appointments had a higher risk of acute asthma events. These findings highlight the need to develop strategies to reduce missed appointments in children with asthma, which could lower the risk of severe asthma episodes.

A Look at Azithromycin as a Low-Cost Asthma Treatment
New treatments for severe asthma have greatly improved how the condition is managed, leading to better quality of life and fewer asthma attacks. Some treatments aim for “remission,” meaning patients experience no symptoms and do not need steroids. But defining remission is challenging, and it’s unclear what helps people reach this state.

One potential treatment is azithromycin, an antibiotic that may help reduce asthma attacks, especially for people with non-type 2 asthma. A study found that people with asthma taking azithromycin had higher rates of clinical remission compared to people who didn’t take the treatment. While azithromycin is affordable and widely available, it can have side effects and may lead to antibiotic resistance. More research is needed to fully understand its long-term effects and how it works with other asthma treatments.

Atopic Dermatitis (Eczema)     

FDA Approves EBGLYSS™ for People 12 Years and Older with Moderate-to-Severe Atopic Dermatitis
In September, the FDA approved EBGLYSS for moderate to severe atopic dermatitis (AD) in people aged 12 and older who weigh at least 88 pounds and have not found relief with creams. EBGLYSS is an injectable biologic that can be used alone or with topical steroids. EBGLYSS works by blocking a protein that causes excessive inflammation. Treatment begins with two injections at weeks 0 and 2, followed by one every 2 weeks until week 16, after which patients can switch to a monthly dose. In clinical trials with over 1,000 participants, 38% of those on EBGLYSS had clear or almost clear skin by week 16, compared to 12% who did not take the treatment. Also, 43% of participants had itch relief at week 16. Common side effects include redness, swelling, and skin irritation.

Chronic Spontaneous Urticaria (CSU)

Dupixent® Phase 3 Trial Shows Improvements in Itch and Hives for Patients with Chronic Spontaneous Urticaria (CSU)
Chronic spontaneous urticaria (CSU) is a condition that causes sudden hives and intense itching, affecting quality of life. Regeneron Pharmaceuticals and Sanofi have announced that their drug Dupixent® (dupilumab) has successfully completed a Phase 3 trial for treating uncontrolled chronic spontaneous urticaria (CSU) in patients who have not previously used biologics. The trial showed that Dupixent significantly reduced itch and hive activity compared to non-treatment.

In the study, 30% of patients treated with Dupixent reported no urticaria at 24 weeks, compared to 18% who did not take the treatment. The safety of Dupixent was consistent with its known profile, with similar rates of side effects for both groups. The results will be submitted to the U.S. Food and Drug Administration by the end of 2024 to seek approval for CSU treatment.

COPD

FDA Approves Dupixent as the First-Ever Biologic Medicine for Patients with COPD in the U.S.
The FDA has approved Dupixent (dupilumab) as a maintenance treatment for adults with chronic obstructive pulmonary disease (COPD) who have an eosinophilic phenotype. This makes Dupixent the first biologic medicine approved in the U.S. for these patients. COPD can cause severe symptoms like breathlessness, coughing, and fatigue, making daily activities difficult. The approval is based on 2 major studies showing Dupixent significantly reduces severe COPD flare-ups and improves lung function compared to non-treatment. Patients taking Dupixent experienced a 30% to 34% decrease in annual flare-ups and better quality of life scores. Common side effects included viral infections, headaches, and back pain. This approval offers new hope for better managing COPD symptoms and improving patients’ lives.

EGPA

FDA Approves FASENRA for Eosinophilic Granulomatosis with Polyangiitis (EGPA) in the U.S.
AstraZeneca’s FASENRA® (benralizumab) has been approved in the U.S. to treat adults with eosinophilic granulomatosis with polyangiitis (EGPA), a rare and serious condition that can harm multiple organs. The approval followed the MANDARA Phase III trial, which compared FASENRA with the only other approved EGPA treatment, mepolizumab. In this trial, nearly 60% of patients treated with FASENRA achieved remission, similar to those on mepolizumab. Also, 41% of FASENRA patients could stop using oral corticosteroids, compared to 26% of those taking mepolizumab. This new treatment offers a convenient monthly injection and may help patients reduce reliance on long-term steroids, which can have severe side effects. FASENRA is also approved for severe eosinophilic asthma in over 80 countries.

Nasal Polyps

FDA Approves Dupixent® as First and Only Treatment for Adolescents with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the U.S.
Approximately 9,000 adolescents in the U.S. have chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a long-term condition that blocks nasal passages, causing breathing issues and affecting the sense of smell and taste. Regeneron Pharmaceuticals and Sanofi recently announced that the U.S. FDA has approved Dupixent (dupilumab) as a treatment for adolescents aged 12 to 17 with CRSwNP that isn't well controlled. This approval expands Dupixent's use, which was initially approved in 2019 for adults with CRSwNP. The approval is based on two clinical trials that showed Dupixent significantly reduced nasal congestion and polyp size while decreasing the need for surgery or steroids. Dupixent has a proven safety record, with common side effects like injection site reactions and insomnia. This new approval provides adolescents with a treatment option beyond current standard therapies.

Eczema is a group of chronic skin conditions that cause your skin to become inflamed, dry, itchy, and irritated. The rash can be a different color than your normal skin tone. Atopic dermatitis (AD) is the most common type of eczema. If you or a family member has asthma and allergies, you have a higher chance of having AD. It affects nearly 10 million children and 17 million adults in the United States.

Living with AD can be challenging. Many people living with AD report symptoms like sore and painful skin, and poor sleep caused by itching. These physical symptoms can also impact mental health, social life, and overall well-being.

There is no cure for AD., but it can be managed through medical treatments like topical corticosteroids, non-steroidal topicals, and biologic treatments. AD can also be managed by avoiding known triggers and managing stress.

In 2024, the Food and Drug Administration (FDA) approved 2 new treatments for AD:

1. ZORYVE® (a non-steroidal treatment that you put on your skin)
2. EBGLYSS™ (a biologic)
   
   

Here is more information about these new treatments, how they work, and the research that supports their approval:

ZORYVE®

In July, the FDA approved ZORYVE cream for the treatment of AD in children and adults aged 6 and older. ZORYVE is a once-daily, steroid-free topical cream. It can be used on any location on the body affected by AD and can be used for as long as needed.

ZORYVE was previously approved for the treatment of seborrheic dermatitis and plaque psoriasis. ZORYVE works by blocking an enzyme called PDE4. Blocking this enzyme can help calm down the body’s nerves on the skin that cause you to itch and reduce inflammation caused by conditions like AD.  

The approval of ZORYVE cream is based on positive results from several studies. In these studies, people with mild to moderate AD used ZORYVE cream or a placebo cream for 4 weeks.

The studies showed that ZORYVE helped many patients improve their skin. About 40% of people had clear or almost clear skin by the end of the 4 weeks.

The cream also helped reduce itching quickly. Some people felt better within 24 hours. More than 30% of participants had major itch relief after 4 weeks. Long-term studies also showed that many participants continued to improve. More than 60% had significant relief up to 56 weeks.

Very few participants reported adverse reactions. Most of the people who did report  side effects said they had headaches, nausea, and minor skin irritation where they used treatment.

EBGLYSS™

In September, the FDA approved EBGLYSS for the treatment of moderate to severe AD in people aged 12 and older who weigh at least 88 pounds and who have AD that is not well-controlled with creams or ointments.

EBGLYSS is an injectable biologic treatment that can be used alone or with topical steroids. EBGLYSS works by blocking a protein in the body that causes too much inflammation.

Treatment starts with 2 injections at week 0 and week 2, followed by 1 injection every 2 weeks until week 16. After that, you can switch to a monthly maintenance dose.

The FDA approved EBGLYSS based on findings from 3 clinical trials that included more 1,000 people. In these studies, 38% of people who took EBGLYSS had clear or almost clear skin at week 16, compared to 12% of participants who did not receive treatment. One in 10 participants who took EBGLYSS saw these results in as early as 4 weeks. Of the people who experienced clear or almost-clear skin at week 16, most (77%) maintained those results at 1 year with monthly maintenance dosing.

Many participants also had itch relief with EBGLYSS. On average, 43% of people who took EBGLYSS felt itch relief at week 16, compared to 12% of participants who did not get the treatment. Of the people who felt itch relief at week 16, most (85%) still felt relief at 1 year of treatment with monthly maintenance dosing.

The most common side effects of EBGLYSS include redness, swelling, and inflammation of the eye and eyelid, minor skin irritation at the injection site, and shingles.

The recent FDA approvals of EBGLYSS and ZORYVE provide more treatment options for people living with eczema. Both treatments offer new ways to manage challenging symptoms like itching and irritation. With more treatment options available, people with AD are one step closer to getting relief and improving their quality of life. As always, talk with your health care provider to see if one of these treatments might be right for you.

After a natural disaster with flooding, people with asthma and allergies need to take extra precautions as they begin cleanup efforts. Long after waters have receded, flood waters can leave behind chemicals, bacteria, viruses and mold. These can create long-term health issues if you have asthma and allergies.

Mold is one of the biggest concerns after a flood. Mold, a fungus, can grow in any damp environment. It is different from plants or animals in how it reproduces and grows. The “seeds,” called spores, travel through the air. Mold spores get into your nose and cause allergy symptoms. They also can reach your lungs and trigger asthma.

If your home has been flooded or has water damage, mold may start growing in places you don’t expect. It does not go away as the water dries. Mold may grow inside furniture or under carpet that got wet, making it hard to find. If not replaced, it can make you and your family very sick. Items that have gotten wet from a flood have to be thoroughly cleaned and dried or discarded.

Use these tips to prevent long-term symptoms from mold:

• Wear an N95 mask to protect yourself when you return to your home.
• Consider hiring a professional to do the cleanup.
• Clean washable items in a washing machine with detergent and hot water.
• Clean hard surfaces with soap and water.
• Throw out furniture and other items that cannot be cleaned and disinfected immediately.
• Create ventilation in your home by opening windows and using a CERTIFIED asthma & allergy friendly® air cleaner.
• Remove and replace drywall/plaster that got wet to at least 4 inches above the water line.
• If possible, find another place to stay until the mold has been cleaned up.

There are many health concerns to think about when cleaning up mold after a flood. Read the Homeowner’s and Renter’s Guide to Mold Cleanup After Disasters from the Environmental Protection Agency for more tips and precautions.

Many factors can affect your child’s health and how well they perform in school. Did you know indoor air quality is one of them?¹ But most public schools in the U.S. have polluted indoor air, exposing children and staff to asthma triggers.

This may result in asthma that is hard to control, poor school performance, and missed school and workdays.

Why is indoor air quality such an issue in schools? There are a few reasons.

Why Many Schools Have Poor Indoor Air Quality

Several factors can affect a school’s indoor air quality. Some may be obvious. Other factors may seem harmless or minor. But they can all add up as a student is exposed to them throughout their day.

Aging buildings

Around 53% of public school buildings need repairs and updates just to be in good condition.² Schools in low-income areas and schools with higher numbers of Black, Hispanic, and Indigenous children usually have fewer resources and are in poorer condition. This is due to discriminatory funding and districting policies.

Most schools don’t have enough money to update their buildings. Funding to keep up school buildings falls short by about $38 billion each year.³

Allergens, asthma triggers, and irritants

Dust mites, animal dander, pests, and mold are common allergy and asthma triggers found in schools. Add irritants to the list, such as harsh or heavily scented cleaning chemicals, personal care products, pesticides, and fumes from buses idling outside school doors. Respiratory infections, which can trigger asthma symptoms, tend to spread more during school months.

Tobacco use is also a concern in schools. Vaping has become very popular among students. In 2024, more than 1.63 million high school and middle school students claimed to use e-cigarettes.⁴

Poor ventilation

Proper ventilation in schools can help reduce air pollution and the spread of viruses that cause respiratory illnesses, such as the flu and COVID-19. Many schools need to upgrade their HVAC, ventilation, and filtering systems.⁵

Many schools keep windows and doors closed due to safety and security concerns. This reduces air circulation and prevents indoor air from swapping with fresh outdoor air.

Transportation pollution

Air pollution can make asthma symptoms worse. Emissions from cars, buses, and semi-trailers contain tiny particles and gases that pollute the air. When those particles and gases are in the air, they can get into your lungs.

School children can be exposed to pollution while riding the bus to and from school. Most afternoons, buses and cars in the pickup line idle just outside schools. The polluted air also makes its way into the school. If a child attends a school near a major roadway, they are also exposed to vehicle-related pollution throughout the day.

How to Tell If Your Child Is Affected by Indoor Air Quality at School

According to the Environmental Protection Agency (EPA), watch for these signs that polluted indoor air is affecting your child’s health:⁵

• Your child complains about asthma or allergy symptoms during certain times of the day or week
• Other students in your child’s classroom or groups have similar issues
• Your child feels better when they leave the school but has symptoms again when they return
• The school has recently been renovated or refurnished
• Your child recently started working with new or different materials or equipment at school
• The school started using new cleaning or pesticide products or practices
• Smoking is allowed in or around the school
• The classroom adopts a new warm-blooded animal (such as a hamster or guinea pig)
  
  

When mold grows in school buildings, it can impact the health of students and staff – especially those with asthma and allergies.  

Watch for these signs of mold exposure:

• Irritation of the eyes, skin, nose, throat, and lungs (in people with or without allergies)
• Allergic reactions (in people with allergies)
  • Sneezing, runny nose, skin rash, red/itchy eyes
• Asthma attacks
  
  

How We Can Improve Indoor Air Quality in Schools

Lack of funding may prevent schools from making major upgrades to their buildings. But there are some steps school staff can make to help improve indoor air quality, such as:

• Don’t allow buses to idle on campus.
• Use unscented and low-VOC cleaning products and methods.
• Don’t use scented candles, scent or essential oil diffusers, or scented personal hygiene products (soaps and lotions).
• Don’t allow warm-blooded pets in classrooms.
• Fix leaks immediately before they have the chance to grow mold.
• Do not use air cleaners with ionizing features or that release ozone.
• Keep humidity between 30 to 50% to reduce dust mites and help prevent mold.
• Use integrated pest management as a way of controlling pests such as cockroaches and mice.
• Do maintenance on central heating and air systems regularly according to manufacturer’s instructions.
• Add fans and vents in areas with poor ventilation.
• Use portable air cleaners with HEPA filters in classrooms if the central HVAC is not sufficient.
  
  

The EPA also offers several resources for school staff who want to learn more about creating healthy indoor school environments.

Without funding, many schools are limited on the steps they can take. On a greater scale, we can all advocate for policies and practices that make schools healthier. In The Asthma and Allergy Foundation of America's (AAFA) 2024 Asthma Capitals™ report, we list steps that can help improve asthma outcomes in schools. Stakeholders, such as lawmakers, health care providers, health insurance and drug companies, and people managing asthma, can all work together to make these happen.

• Advocate for policies that support funding for school building improvements and electric school buses.
• Support programs that help prevent or stop teens and children from smoking and vaping.
• Ensure every school has a nurse.
• Encourage asthma management plans in schools.
• Continue efforts to stock quick-relief asthma medicine (such as albuterol) in schools.

References
1. Evidence from Scientific Literature About Improved Academic Performance. (2024, August 20). United States Environmental Protection Agency. https://www.epa.gov/iaq-school...academic-performance
2. K-12 Education: School Districts Frequently Identified Multiple Building Systems Needing Updates or Replacement Report to Congressional Addressees United States Government Accountability Office. (2020). United States Government Accountability Office. https://www.gao.gov/assets/gao-20-494.pdf
3. Schools. (2021). ASCE’s 2021 Infrastructure Report Card; American Society of Civil Engineers. https://infrastructurereportca...ools-infrastructure/
4. Results from the Annual National Youth Tobacco Survey. (2024, September 5). U.S. Food and Drug Administration. https://www.fda.gov/tobacco-pr...youth-tobacco-survey
5. Parents, Students, and Healthy Indoor School Environments. (2023, June 28). United States Environmental Protection Agency. https://www.epa.gov/iaq-school...-school-environments

Did you know people spend as much as 90% of their time inside their homes, offices, schools, and cars?¹ For people with allergies and asthma, air quality is important both indoors and out.

What Impacts Your Indoor Air Quality?

Air quality is a measure of gases and small particles in the air that can be harmful to your lungs. Air pollution is when particles or gases that are not normally part of the air affect the air quality. Air pollution can happen indoors when items in your home release gases and irritants into the air. Outdoor air pollution (traffic exhaust, wildfire smoke, smog, etc.) can make its way in and get trapped inside to worsen your indoor air quality.

Allergens (like dust mites and pet dander) also impact your air quality. Allergens are the most common asthma trigger. This is called allergic asthma.

Some sources of indoor allergens include:

• Dust mites
• Pets
• Cockroaches and mice
• Mold and damp areas
• Wall-to-wall carpet
• Soft furniture and stuffed toys
• Mattresses
• Pillows and bedding

Some sources of indoor air pollution include:

• Scented household cleaners and air-fresheners
• Fuel-burning heat sources (such as gas stoves, cooktops, and fireplaces)
• Smoke from cooking, candles, fireplaces or cigarettes, cigars, pipes, and e-cigarettes (vapes)
• Vehicles or lawnmowers stored inside garages
• Fumes from new furniture and carpet
• Building and paint products
• Pesticides
• Radon and ozone
• Cosmetics, perfumes, and hair sprays

What Can You Do to Improve Indoor Air Quality?

The best way to improve indoor air quality is to:

1. Remove sources of allergens and irritants.
2. Improve ventilation with outdoor air.
3. Filter your indoor air with good quality air filters on your central heating and air conditioning or portable air cleaners.
4. Control indoor humidity.
   
   

Use our interactive Healthier Home Checklist to help you improve air quality in different areas of your home.

Here are a few tips:

Establish regular cleaning routines using non-toxic and unscented cleaning products.  

RELATED: Spring Cleaning for an Asthma and Allergy Friendly Home

Remove fragranced products, candles, and air fresheners.

Keep the humidity (moisture levels) in your home between 30-50%.  Keeping humidity under 50% reduces growth of dust mites and mold. And keeping humidity above 30% prevents your skin, eyes, nose, and lips from drying out.

Replace carpets with solid surface flooring, if possible. Otherwise, vacuum carpets and rugs weekly.

Regularly clean and replace air filters according to instructions.

Quit smoking (including vaping) and don’t allow others to smoke in or around your home. If you live in a multi-family building like an apartment, close your windows if someone is smoking nearby. A portable air cleaner in your apartment may be helpful.

Many products promise to help control allergens but not all of them do. When you are shopping for products for your home, look for the CERTIFIED asthma & allergy friendly® mark. It indicates the product has passed our testing standards to help reduce allergens and irritants in your home.

Visit aafa.org/certified to search for CERTIFIED products such as vacuums, air cleaners, cleaning products, flooring, bedding, appliances and more.

References
1. Indoor Air Quality. (2024, July 8). U.S. Environmental Protection Agency. https://www.epa.gov/report-env...t/indoor-air-quality

Many skin conditions can look similar, so it can be hard to tell the difference. And some conditions, such as eczema, can appear and behave differently for each person. Getting the right diagnosis is important so you can manage it and feel better in your skin.

What Is Eczema?

Eczema is a group of chronic skin conditions that cause your skin to become inflamed, dry, itchy, red, and irritated. There are several types of eczema and most of them are connected to allergies. Atopic dermatitis is the most common type.

There are other skin conditions that can seem similar to eczema. How can you tell the difference? We’ll talk about other skin conditions and how they are different from eczema.

What’s the Difference Between Psoriasis and Eczema?

Psoriasis is a skin condition that causes itchy, scaly rashes. They appear mostly on your knees, elbows, torso, and scalp.

Psoriasis and eczema can both cause itchy, scaly rashes. If you have plaque psoriasis, you may have red, purple, or discolored raised thick areas called “plaques.” Eczema tends to be brown or red and less defined than psoriasis.

What’s the Difference Between Scabies and Eczema?

Scabies is caused by mites that live in your skin. They burrow into your skin, creating small, red, itchy bumps. It spreads from person to person very easily through skin contact.

Eczema is not contagious and is not caused by mites infecting your skin. Eczema is a chronic immune condition caused by a defect in your skin barrier.

What’s the Difference Between Ringworm and Eczema?

Ringworm is a skin infection caused by a fungus. It causes round patches on your skin with red edges that look like a ring. Like scabies, it is contagious.

Ringworm can be confused with a type of eczema called nummular eczema. With nummular eczema, you can have spots with red edges, but the spots are usually not as well-defined as ringworm. It can be caused by a skin injury like a bug bite or scratch, a skin infection, stress, and heat.

What’s the Difference Between a Staph Infection and Eczema?

A staph infection is caused by a bacteria called Staphylococcus aureus. Staph is found on the skin and in the nose of most people. It usually doesn’t cause issues. But when staph infects the skin, it can cause boils, cellulitis, folliculitis, or impetigo. Infected spots may be red and have pus, like a pimple. The area can be warm and painful.

While a staph infection and eczema are different, they can go together. When you have eczema, you are more likely to get staph infections. Staph infections can become serious, so it’s important to take care of your skin and contact your doctor as soon as you think you have a staph infection.

What Can I Do If I Have a Skin Condition?

Eczema can be easily confused with other skin conditions. That’s why it’s important to get a proper diagnosis. The only real way to know if you have eczema or another skin condition is to see an allergist or dermatologist. They can tell you what’s going on with your skin and help you develop a treatment plan.

Medical review: September 2024 by Matthew Greenhawt, MD

Navigating the world of biologics can be complicated. But it doesn't have to be! If you’ve tried treatments for your asthma, food allergies, eczema, eosinophilic esophagitis (EoE), or nasal polyps without success and wonder if biologics are right for you, watch our latest webinar on biologics.

Jessica Peck DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, and the Asthma and Allergy Foundation of America (AAFA) presented information on biologics for several allergic conditions.

Watch on YouTube

In the video, we talk about:

• What is a biologic?
• Administration/delivery methods
• Roadmap to getting a biologic treatment
• Navigating and coordinating biologics with your health care team
• The role of patient advocates and biologics coordinators
• Insurance coverage and prior authorization
• Financial assistance
• Biologics for asthma, food allergies, and related conditions
• What to do once you are prescribed a biologic
• Practical tips (reminders, storage, self-injections, travel)