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Celebrating Over 80 Years Of Service!

The American Academy of Otolaryngic Allergy (AAOA) represents over 2,700 Board-certified otolaryngologists and health care providers. Otolaryngology, frequently referred to as Ear, Nose, and Throat (ENT), uniquely combines medical and surgical expertise to care for patients with a variety of conditions affecting the ears, nose, and throat, as well as commonly related conditions. AAOA members devote part of their practice to the diagnosis and treatment of allergic disease. The AAOA actively supports its membership through education, research, and advocacy in the care of allergic patients.

"Advance the comprehensive management of allergy and inflammatory disease in Otolaryngology-Head and Neck Surgery through training, education, and advocacy."


United Healthcare Home Immunotherapy Policy Change

United Healthcare has recently announced a policy change. Effective January 1, 2023, UHC will no longer…

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Medicare 2022 Conversion Factor Update

Thanks to lobbying efforts from the House of Medicine, Congress took action this month. The…

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CY 2022 Physician Fee Schedule Proposed Rule Summary

On July 13, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician…

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Changes in MACRA

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Before the close of 2017, all physicians must take action to avoid the 4 percent cut that will be assessed in 2019 for not participating in the new Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).  Read More

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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Upcoming Dates

06/01/23: Research Grant Cycle
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06/26/23: Membership Application Deadline to be eligible for AAOA Member rate for the 2023 Basic Course

07/01/23: Scientific Abstract Submission Deadline
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12/01/23: Research Grant Cycle
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04/01/24: Fellow Exam Application Deadline
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2023 AAOA Annual Meeting

Register Now to access over 19 hrs of CME | Continuing Certification through our 2023 Hybrid Annual Meeting. The meeting will take place in Nashville and virtually from September 29 - October 1, 2023. On-Demand post course access will be open until November 14, 2023. Learn More


For information about Resident opportunities, DosedDaily, research grants, and other resources. Learn More


Available Now


IFAR Impact Factor: 2.454

IFAR Featured Content: COVID-19 - Free Access
Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategies . Read More

Changes in Managing Practices

Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices.

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Live and Online CME

2023 AAOA Basic Course in Allergy & Immunology - Hybrid
September 1 - Access
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2023 AAOA Annual Meeting - Hybrid
September 29 – October 1, 2023
Embassy Suites by Hilton Nashville Downtown
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2024 AAOA Advanced Course in Allergy & Immunology - Hybrid
February 8 - 10, 2024
Hyatt Regency Tamaya
Santa Ana Pueblo, New Mexico
(outside Albuquerque)

2024 AAOA Basic Course in Allergy & Immunology - Hybrid
July 25-27, 2024
The Diplomat, Hollywood, Florida
Learn More and Get Hotel Room

2024 AAOA Annual Meeting - Hybrid
November 8-10, 2024
Four Seasons Hotel Las Vegas

USP 797 Online Module
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AAOA Educational Stacks
Next Availability - November 1, 2023

News and Updates

National Study to Document Changes in Physician Practice Expense

The American Medical Association (AMA) is undertaking a new national study, supported by 173 healthcare organizations,…

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American Elm Shortage

American Elm is dying from Dutch Elm Disease. This may explain the concentrate shortage many practices…

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College Allergy Symptoms Treatment Back to Shcool


AAOA Practice Resource Tool Kit

The American Academy of Otolaryngic Allergy (AAOA) Practice Resource Tool Kit is intended as a guide to help AAOA members integrate allergy into their otolaryngology practice and to continually improve on this integration as new information, regulations, and resources become available.

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AAOA has launched a Partner Resource Center to bring you partner resources that can assist your practice and patient care.

Visit the New Center>


Gluten-Free or Not Gluten-Free?  That is the Question…

I never heard anything about gluten before 5 years ago, now you can’t swing a baguette without hearing about gluten. What gives?

Gluten is a naturally-occurring protein present in several cereal grains.  Wheat , Barley, and Rye are the principal gluten-containing grains.  The gluten molecule is made up of Glutenin and Gliadin.   Gliadin is rich in prolene and poorly degraded in the gut.

Coeliac Disease is the best-known  gluten sensitivity.  It is an auto-immune response to this protein that causes acute discomfort as well as long-term damage to the intestinal lining.  There does appear to be an increase in Coeliac Disease over the last several decades, though not to the degree proportionate with the media hype.

Also, better awareness and ability to establish diagnosis have increased numbers of identified case.

That said, much of the ado about gluten parallels the interest in low-carb/paleo diets touted as healthier and helpful for weight loss.

It seems like everyone I know is going gluten-free. Should I be gluten-free too?

This answer comes from the tautology department- Gluten is only a problem if it’s a problem…  The percentage of the population thought to have Coeliac Disease is thought to be slightly more than 1%. Meaning that about 99% of the population ain’t got it.

That said, there are 2 other reported problems with consumption of wheat and/or other gluten-containing grains.  The first is Wheat Allergy.  In true Wheat Allergy, patients have a true allergic (often anaphylactic!) response to Albumins and Globulins contained in wheat.  It is worth noting that these are not the proteins that constitute gluten.

While wheat allergy represents a true hypersensitivity to wheat, it does not represent a reaction to gluten itself in most cases.  There is another condition called Non-Coeliac Gluten Sensitivity in which patients suffer a variety of non-specific, but often quite serious symptoms surrounding the consumption of gluten-containing foods.

This condition is what is known as a “diagnosis of exclusion”, meaning that Coeliac Disease and Wheat Allergy must be ruled out first before arriving at this diagnosis.  There are no specific test that can be performed to establish this diagnosis.

How do I know if this is a thing (for me)?

One easy thing to do is to eliminate gluten-containing foods from the diet and see what happens.  Whatever the cause, it eliminating these foods is easy for a person to do and makes them feel better (for whatever reason!), it’s worth consideration.  That said, modern food is a majestic product of modern engineering that includes all sorts of additives that may affect digestion.  There also may be some risks to this strategy (see below).

If a person wants to investigate whether they have Coeliac Disease, this should be done under the direction of their physician.

There are blood tests that can be performed.  IgA Tissue Transglutaminase (tTG) is the best initial test for Coeliac Disease.  Small intestine biopsy is considered the “gold standard” confirmatory test.

Genetic testing may also be useful.  HLA-DQ2 is present in approximately 90% of patients with Coeliac Disease.  HLA-DQ8 is present in roughly 5% of Coeliac patients.

For Wheat Allergy, skin prick testing would be the initial screening method of choice.

While Skin prick testing is very specific for wheat allergy, some question the sensitivity of this test.  Because of this, it is often necessary to initiate confirmatory testing.  Food challenge is a valuable confirmatory test for wheat allergy.

Given the potential danger of wheat exposure in a sensitized individual, this should only be performed under strict guidance of a physician.

As mentioned above, NCGS is a diagnosis of exclusion. Once Wheat Allergy and Coeliac Disease have been ruled out, a formal food challenge would be the next appropriate step.  For this, the patient has already undertaken a strict gluten-free “washout” period.  The next step would be to re-introduce gluten and document reported symptoms.

The strongest support for this diagnosis would be provided by a double blind food challenge, although the logistics of this are complicated.  An open gluten challenge is also considered acceptable for diagnostic purposes.

Couldn’t hurt, might help, right?

Well, except that it can…  In the USA, wheat flour is enriched with several B vitamins (folic acid, niacin, riboflavin, and thiamine) and, in some cases, calcium.  There is some suggestion that elimination of enriched wheat from the diet may predispose towards deficiency of these vitamins.

While some fiber and protein is present in whole wheat flour, adherence to the other components of the food pyramid should provide adequate intake of these nutrients.  Daily supplementation with a multivitamin would adequately replace these and most other vitamin and trace mineral deficiencies.  Consultation with a dietician may be indicated to verify that all of an individual’s nutritional needs are being met.

With the many claims made about gluten, it is important to be able to separate the wheat from the chaff (so to speak…).

If concerned about these issues or other food related sensitivities, it may be worth consultation with your physician.

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