Check Your Work: Understanding Allergy and Asthma Clinical Guidelines


Dive in and learn more about the answers to yesterday’s quiz.

Before you read further, take the quiz: Quiz: Understanding Allergy and Asthma Clinical Guidelines.

Each week during Allergy and Asthma Awareness Month, Drug Topics will be publishing a weekly quiz focused on a different aspect of allergy and asthma management. Our first weekly quiz, published on Thursday, May 9, focused on clinical guidelines in allergy and asthma management. Below, we break down the answers.

Question 1

According to the latest guidelines, which of the following is the preferred initial medication for patients with mild intermittent asthma?

Answer: Short-acting beta2-agonist (SABA), as needed

In 2020, the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group published Focused Updates—the first revision of these guidelines in over a decade.1 Importantly, the guidelines in this report differ from the Global Initiative for Asthma (GINA) recommendations.

For patients with mild intermittent asthma, GINA guidelines recommend treating patients with as-needed inhaled corticosteroids and short-acting beta2 agonists (SABAs) for children aged 6 to 11 years, and inhaled corticosteroids and formoterol in adults. Although there are limitations, update authors doubled down on their previous recommendation for as-needed SABA medication as step 1 therapy in adults and adolescents aged 12 years and older.2

Question 2

When managing a patient with allergic rhinitis, which of the following medication classes is not typically recommended as first-line therapy?

Answer: Decongestants (used alone)

Although some patients with allergic rhinitis would do almost anything to stop their sneezing, runny nose, and itchy eyes, the American Academy of Allergy, Asthma, and Immunology suggests that nasal decongestant use should be for a short-term duration, and should only be used for intermittent or episodic nasal congestion therapy.3

These medications—alpha-adrenergic agonists including oxymetazoline (Afrin) and xylometazoline (Otrivin)—typically work quickly and can improve nasal congestion for up to 10 hours. However, continuous use of these medications can lead to the development of rhinitis medicamentosa or rebound congestion.

Question 3

In the assessment of childhood asthma, which of the following tools is most highly recommended by current guidelines?

Answer: Peak flow monitoring

Effective asthma management is crucial in preventing disease exacerbations and other unwanted outcomes. A peak flow meter is a useful tool to measure airflow, and comes in 2 versions: a low range peak flow meter for pediatric patients, and a standard range peak flow meter for older children, adolescents, and adults.4

According to the American Lung Association, a peak flow meter may be particularly helpful for young children, who may have difficulty communicating their symptoms to caregivers.4

Question 4

Which of the following statements is most consistent with current recommendations for food allergy management?

Answer: Early peanut introduction can help prevent peanut allergies in high-risk infants

The complete Guidelines for the Diagnosis and Management of Food Allergy in the United States, a report by the National Institute of Allergy and Infectious Disease-sponsored panel, were initially published in 2010.5 Since then, continued research in the food allergy space has lead to the publication of several addendums.

In 2015, results of the landmark Learning Early About Peanut Allergy (LEAP) study were published. In these results, researchers found that the early introduction of peanut-containing foods to infants at high risk of developing a peanut allergy was safe—and, crucially, led to an 81% relative reduction in the subsequent development of peanut allergies.6

Question 5

When developing an asthma action plan for a patient, which of the following elements should be included?

Answer: All of the above

An asthma action plan is a crucial piece of the treatment puzzle for all patients living with asthma. These individualized worksheets include important details like physician and emergency contact phone numbers, asthma triggers to avoid, treatment plans for green-, yellow-, and red-level asthma symptoms, and indicate when a patient should call their physician or other health care provider.7

The Asthma and Allergy Foundation of America, the American Lung Association, and the CDC all have free asthma action plan templates that can be printed and shared with patients.

How did you do? Check back next Thursday and Friday for the next quiz in our Allergy and Asthma Awareness Month series.

1. Cloutier MM, Baptist AP, Blake KV, et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270. Doi:10.1016/j.jaci.2020.10.003
2. Elward KS. Asthma management guidelines: Focused updates for 2020. Am Fam Physician. 2021;104(5):446-447.
3. Dykewicz MS, Wallace DV, Amrol DJ. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-767. doi:10.1016/j.jaci.2020.07.007
4. Measuring your peak flow rate. American Lung Association. Updated April 18, 2024. Accessed May 9, 2024.
5. Boyce JA, Assa’ad A, Burks AW, et al; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-S58. Doi:10.1016/j.jaci.2010.10.007
6. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States. JAAPA. 2017;30(3):1-5. Doi:10.1097/01.JAA.0000512231.15808.66
7. Asthma action plan. Asthma and Allergy Foundation of America. Accessed May 9, 2024.
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