Reflections & Insights from AAAAI 2024!
- Michelle Kwok
- Apr 30, 2024
- 7 min read
Updated: Jul 28, 2024
Stepping into the Walter E. Washington Convention Center for American Academy of Allergy, Asthma, and Immunology (AAAAI) 2024 Annual Meeting was an eye-opening experience. For a first-timer like me, the sheer size was exciting and overwhelming all at once. It was like wandering into Costco without a shopping list. The options seemed endless, but there was something for everyone, regardless of their area of expertise or interest.
One late-breaking session was particularly memorable – an injectable biologic therapy for multiple food allergies that not only made international headlines but also drew such a massive crowd that attendees, whether they were physicians, nurses, allied health, or researchers, found themselves sitting on the floor trying to grasp every word.
However, what resonated with me most of all was the emphasis on volunteerism and social responsibility. As allergists, we have a unique opportunity to go beyond the confines of the clinic or lab and address the pressing issues that impact the lives of our patients on a broader scale.
Severe asthma
This year, I focused my attention on severe asthma, a debilitating disease where a patient can take high doses of multiple inhalers and pills but still end up in the hospital frequently. It is costly not just for the patient, but for their communities and for the healthcare system. I explored sessions on biologic treatments, aggravating factors like climate change and disparities, access to biologics, and how technology can narrow the gap in access to care.
Climate change and allergy
The Paris Agreement, a significant global treaty, aimed to combat climate change by setting a goal to keep the temperature increase well below 2.0°C below pre-industrial levels. However, for a whole year between 2023 and 2024, the world experienced +1.52°C of warming, emphasizing the escalating climate crisis and its associated impacts, including floods, droughts, heatwaves, and wildfires worldwide. Climate change has worsened allergies directly and indirectly.
Extreme heat worsens allergy symptoms by reducing lung function, disrupting protective barriers in the airways, and increasing allergic inflammation. As temperatures rise, humidity levels create ideal conditions for mold growth, releasing more allergenic spores. Studies have found more asthma attacks during extreme weather, as people tend to stay indoors where allergens accumulate. Vulnerable communities, lacking resources for adaptation and evacuation, suffer the most severe health impacts, including increased mortality and morbidity during extreme events.
Longer and worse allergy seasons
Climate change is also causing pollen seasons to be longer. One study showed the ragweed season extended by 27 days in Saskatoon and 22 days in Winnipeg. Trees are also pollinating earlier and have higher annual and daily peak pollen concentrations. Plants are also spreading to entirely new geographic areas, such as ragweed growing in more northern parts of North America and Europe. This can mean more than just a stuffy nose and runny eyes especially for those that have severe allergic diseases.
As clinicians we need to adapt our treatment approaches with the climate changes. As well we need to work with healthcare professionals, environmental scientists, and policymakers to address the growing burden of climate change on allergies and public health. Only then can we develop effective strategies to mitigate the impact of these changes and ensure better outcomes for allergy sufferers everywhere.
Addressing disparity in allergy care
As evident from the blog content, tackling disparities in allergy care is a topic that I am passionate about. This past year, our efforts have been particularly focused on reaching out to remote communities in northern Quebec, and a pilot trip in Rwanda.
Health disparities are defined as avoidable discrepancies in health outcomes that unfairly impact certain groups. These populations often face worse health outcomes compared to the general population. The overarching goal remains achieving health equity by eradicating these unjust disparities and ensuring equal access to quality healthcare and opportunities for well-being for all.
In asthma care, minority populations often experience higher prevalence rates and more severe, poorly controlled symptoms, leading to increased exacerbations. Shockingly, this can even exist within the same city! Some are often linked to housing code violations, such as mold, poor ventilation, and pest infestations, compounded by psychosocial stressors. Historically, discriminatory practices like redlining have exacerbated these issues, leaving a lasting impact even after being banned in USA in 1968.
Addressing these disparities requires a collaborative effort, involving urban planning, improved housing policies, and the creation of green spaces to promote respiratory health and well-being for all communities.
Pharmaco-equity
Currently there are six biologic medications for managing severe asthma which target the underlying immunological mechanisms causing the symptoms. Their recent arrival on the market have been life-changing for many patients who have otherwise exhausted conventional treatment. However, despite their effectiveness, these biologics come with a hefty price tag, leading to disparities in access among patients. Factors such as access to specialists, specific indications for the biologics, socio-economic status, age, and prior authorization can all impact who gets access to these critical medications.
Ensuring equal access to these transformative treatments is just as vital as the ground-breaking research that led to their development. Every patient should have the chance to experience the advancements in asthma care, regardless of their background or situation. Achieving optimal outcomes requires a collaborative approach between patients and providers. Patients bring invaluable insights into their own circumstances, along with their personal values and preferences. Meanwhile, providers offer their clinical expertise and scientific knowledge. By working together in shared decision-making, we can deliver the best care.
Enhancing access for First Nations and Indigenous peoples
In Canada, First Nations and Indigenous individuals aged 6 years and older with severe asthma have access to biologic treatments (dupilumab, tezepelumab-ekko, mepolizumab) covered by the Non-Insured Health Benefits (NIHB) program. Recently, I spoke with a medical science liaison at a pharmaceutical company who mentioned that most private payers also offer coverage for these treatments. Local pharmacies or nursing stations can assist in ordering these medications, with distributors handling shipping logistics. The company then covers shipping costs to ensure safe delivery to remote locations. This collaboration between government assistance, private insurance, and the pharmaceutical industry holds promising potential for improving healthcare accessibility in underserved communities.
Technology as a tool for equity
I also learned how technology can play a crucial role in bridging healthcare disparities—an issue we're actively tackling in our northern project. With the pandemic reshaping our healthcare landscape, technology has become essential for medical consultations and communication.
Despite the widespread adoption of tools like patient portals, medical apps, remote monitoring, and telehealth, it's important to recognize that not everyone is comfortable or proficient in using them, especially when language barriers come into play. This limitation can further widen disparities in healthcare access, ultimately impacting health outcomes negatively.
Nevertheless, technology presents a remarkable opportunity to overcome barriers related to accessibility, distance, and cost. The key lies in providing proactive support to individuals in utilizing these tools effectively. This includes offering navigators who can assist with language accessibility and guide patients through the complexities of the healthcare system. In some cases, a simple interpreter may not suffice, highlighting the need for specialized technological interpreters to ensure equitable access for all.
My key takeaways
My first AAAAI conference was truly eye-opening, giving me fresh insights into the latest treatments and the challenges facing allergy care. Moreover, it's clear that we need to address healthcare disparities, ensure fair access to treatments, and use technology to make care more inclusive. By working together across different fields and communities, we can create a future where everyone, regardless of their background, can access quality healthcare and thrive.
Sessions attended
1805 Climate Change and Health: Allergy and Asthma
Allison J. Burbank, MD: Introduction and Drivers of Climate Change
William J. Sheehan: Changes in Aerobiology and Impacts on Health
John C. Carlson, MD PhD FAAAAI: Climate Change and Public Health: Strategies for Public Policy
Torie L. Grant, MD, MHS : Introduction / closing remarks
2501: How to Develop, Implement, and Evaluate Patient-facing Mobile Health (mHealth) Applications for Asthma and Allergic Diseases
Sunit Jariwala MD
Thanai Pongdee, MD, FAAAAI
3304: The Integration of Diversity and Equity in Emerging Health Innovation Strategies
Marcus Shaker, MD, MS, FAAAAI: Pharmacoequity in Eligibility for Biologics in Patients with Allergic Disease
Jorge A. Rodriguez, MD: The Digital Divide: The Role of Digital Health Equity in Patient Care
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