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Celebrating Over 75 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."

ADVOCACY UPDATES

CARES Act and Public Health Emergency Funds Allocation

The Department of Health and Human Services (HHS) announced how it plans to allocate the…

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CARES Act Provider Relief Fund Additional Information

AMA Updates on CARES Act Today the Department of Health and Human Services (HHS) provided…

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Interim Package and Resuming Non-COVID Care

Sharing the latest on the interim package and the news from CMS about resuming non-COVID…

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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

04/15/20: Fellow Exam Application Deadline
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06/01/20: Research Grant Cycle
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06/26/20: Membership Application Deadline to be eligible for AAOA Member rate for the 2020 Basic Course Learn more

07/15/20: Call for Scientific Papers
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09/11/20: Membership Application Deadline to be voted in at the 2020 Annual Meeting and to be eligible for AAOA Member Rate (FREE) for the 2020 Annual Meeting Learn more

12/01/20: Research Grant Cycle
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EDUCATION

New Virtual Course!

Register now as we build out Part 2 Core Allergy & Part 3 Core Rhinology.   Both promise to deliver clinical content you need.  Core Allergy will offer what you need to help refresh or add allergy to your practice — everything from the clinical science to the basics of allergy from a better understanding of testing techniques, vial prep, and dose calculations to other practical implications.  Core Rhinology encompassed the highly sought after rhinology content from our former IAR program.  Part 1 will launch soon with on demand content to help you balance all your time demands.  Part 2 & 3 will feature live-stream content to give you opportunities to interact with the faculty.  Post live session, this content will also be available on demand. Stay tuned for more details as we finish our program build. Read More

IFAR

IFAR Impact Factor: 2.454

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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

Now Available

Changes in Managing Practices

Mission

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

NEW VIRTUAL COURSE! Core Allergy and Rhinology Concepts: Age of Pandemics and Beyond
Learn How to Reboot Your Practice and Freshen Up on Core Allergy and Rhinology Components
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2020 Basic Course in Allergy & Immunology
July 9-11 | Orlando, FL
COVID-19 has made it impossible to convene our 2020 Basic Course. We hope you will consider another AAOA CME opportunity

2020 AAOA Annual Meeting
October 23-25| Scottsdale, AZ
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2020 Advanced Course in Allergy & Immunology
December 9-12 | Vail, CO
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AAOA Clinical Insights
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USP 797 Online Module
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2021 Basic Course in Allergy & Immunology
July 15-17 | Seattle, WA

News and Updates

Resuming SCIT During COVID-19 Pandemic

This summary is intended to provide practicing Otolaryngologists a guide to resuming safe allergy care…

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Small Business Paycheck Protection Program

by Dole Baker, MD, FAAOA, AAOA Socioeconomic Committee Member  Small Business Paycheck Protection Program is…

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College Allergy Symptoms Treatment Back to Shcool

PRACTICE RESOURCES

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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PATIENT CORNER

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Practice Resources: Compounding Allergenic Extracts

Compounding Allergenic Extracts Guidance

In late November 2013, Congress passed the Compounding Bill. This legislation enforces regulation of compounding pharmacies, as a result of injections of contaminated compounded drugs – which caused 64 deaths and many more nonfatal injuries.

PLEASE NOTE: The preparation of allergenic extract vials is considered compounding. The AAOA is pleased that the new legislation does not restrict or limit the ability of Allergists to compound allergy vaccines. AAOA members may have to adopt additional measures to ensure sterility, based on USP guidelines, but fortunately the ability to continue compounding extracts remains.

The statute contains two provisions that may impact allergy immunotherapy. Since the law is effective, it is recommend that you implement these changes as soon as possible. The AAOA expects practices will be subject to inspections to monitor compliance.

The first requirement is that all compounded sterile preparations have a prescription. This should not cause much of a problem since most AAOA members already have an order sheet of some sort, which is used to instruct staff to make a new or renewal vial for a patient. These order sheets can be labeled at the top as a prescription for a specific patient, and they can have a line at the bottom for the physician’s (or other appropriately licensed provider’s) signature. Again, you are already signing off on this process, as well as the shots, so this should not be a huge practice change.

In addition, it appears that physicians will be required to comply with all of the USP 797 sterile compounding rules. Fortunately, because of work by the AAOA in conjunction with JCAAI back in 2006, USP 797 contains specific rules for allergy vaccine compounding that are much less stringent than the rules applicable to other compounded sterile products. While the USP rules are not draconian (no filtered air or laminar flow hoods required), they do increase the standard for sterility.You can read the relevant Allergy Section of USP 797 by clicking here or read the rules below.

“Allergen extracts, as compounded sterile preparations (CSPs), are single-dose and multiple dose intradermal or subcutaneous injections that are prepared by specially trained physicians and personnel under their direct supervision. Allergen extract, as CSPs, is not subject to the personnel environmental and storage requirements for all CSP microbial contamination risk levels in this chapter, BUT only if all of the following criteria are met:

  1. The compounding process involves simple transfer via sterile needles and syringes of commercial sterile allergen products and appropriate sterile added substances (e.g., Glycerin, phenol in sodium chloride injection).
  2. All allergen extract as CSPs shall contain appropriate substances in effective concentrations to prevent the growth of microorganisms. Non-preserved allergen extracts shall comply with the appropriate CSP risk level requirements in the chapter.
  3. Before beginning compounding activities, personnel perform a thorough hand cleansing procedure by removing debris from under fingernails using a nail cleaner under running warm water followed by vigorous hand and arm washing to the elbows for at least 30 seconds – with either non-antimicrobial or antimicrobial soap and water.
  4. Compounding personnel don hair covers, facial hair covers, gowns and face masks.
  5. Compounding personnel perform antiseptic hand cleansing with an alcohol – based surgical hand scrub with persistent activity.
  6. Compounding personnel don powder – free sterile gloves that are compatible with sterile 70% isopropyl alcohol (IPA) before beginning compounding manipulations.
  7. Compounding personnel disinfect their gloves intermittently with sterile 70% IPA when preparing multiple allergen extracts as CSPs.
  8. Ampule necks and vial stoppers on packages of manufactured sterile ingredients are disinfected by careful wiping with sterile 70% IPA swabs to ensure that the critical sites are wet for at least 10 seconds and allowed to dry before they are used to compound allergen extracts as CSPs.
  9. The aseptic compounding manipulations minimize direct contact contamination (e.g., from glove, fingertips, blood, nasal and oral secretions, shed skin and cosmetics, other non-sterile materials) of critical sites (e.g., needles, open ampules, vial stoppers).
  10. The label of each multiple-dose vial (MDV) of allergen extracts (as CSPs) lists the name of one specific patient, a “by use date” (BUD) and storage temperature range that is assigned based on manufacturers recommendations or peer-reviewed publications.
  11. Single-dose allergen extracts as CSPs shall not be stored for subsequent additional use.

Personnel who compound allergen extracts as CSPs, must be aware of greater potential risk of microbial and foreign material contamination when allergen extracts are compounded in compliance with the foregoing criteria instead of the more rigorous standards in the USP chapter for CSP microbial contamination risk levels. Although contaminated allergen extracts as CSPs can pose health risks to patients when they are injected intradermally or subcutaneously, these risks are substantially greater if the extract is inadvertently injected intravenously.”

References

1. Lay PC, Bass R, Lin SY. Allergen vial mixing and immunotherapy:  risks of infection and vial contamination.  Otolaryngol Head Neck Surg. 2007 Aug;137(2):243-5

2. Lin SY, Lay PC, Hughes LF, Bass R. The safety of multi-dose vials in allergy immunotherapy.  Otolaryngol Head Neck Surg. 2008 Aug;139(2):195-7

3. Lay PC, Bass R, Hughes LF, Lin SY. Risks of allergy vial contamination: Comparison of mixing in-office versus under ventilation hood. Otolaryngol Head Neck Surg. 2008 Sep;139(3):364-6.

4. Gilbert KC, Sundareshan V, Bass RM, Lin SY.  Antibacterial Properties of Additives Used in Injection Immunotherapy. Int Forum Allergy Rhinol.  2011 Dec 7. doi: 10.1002/alr.20105. [Epub ahead of print].

Allergy and Rhinology Journal (IFAR)

A Member Benefit

A Member Benefit

The International Forum of Allergy & Rhinology (IFAR) is the official journal of the AAOA and the American Rhinologic Society (ARS). Published monthly by John Wiley & Sons, Inc., IFAR provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions.