The 10 Worst Cities For Spring 2014 Allergies

Despite the lingering chilly temperatures and persistent threats of snowfall, millions of Americans have started heading to their doctors with itchy, watery eyes, runny noses, headaches, difficulty breathing and more of the classic symptoms of seasonal allergies.

For the nearly 45 million Americans who suffer from seasonal allergies, the joy of springtime can be significantly dampened. But to help them plan ahead, the Asthma and Allergy Foundation of America (AAFA) has once again compiled a list of the most challenging places to live for people with allergies this spring -- should it ever arrive.

In fact, because of the sporadic warm days followed by snowfall, mold may be a bigger issue this year in addition to pollen, according to the AAFA. "No matter what time of the year it is, and no matter what Mother Nature sends our way, people with allergies need to be prepared,” Dr. Clifford W. Bassett, M.D., medical director of Allergy and Asthma Care of NY and an ambassador for the AAFA said in a statement.

Being prepared can include medications, but people with allergies can also cope with a handful of simple lifestyle strategies such as leaving shoes and jackets outside, keeping windows closed, washing hair before bed and staying inside when pollen counts peak.

To calculate the Allergy Capitals report, the AAFA tallied local pollen levels, use of over-the-counter and prescription allergy medication and number of board-certified allergists in each area. Then, each city is assigned a score out of a total of 100 points. Virginia Beach made the biggest jump from last year's rankings, up to 20 from 66. And Los Angeles dropped the most, from 38 to 77.

Below, you'll find the 10 worst U.S. cities for spring allergies. Head over to the AAFA site for the full list of 100.

  • 10
    McAllen, Texas
    Rank last year: #4
    Total score: 87.61
  • 9
    Birmingham, Alabama
     Flickr:Max Wolfe
    Rank last year: #14
    Total score: 87.71
  • 8
    Richmond, Virginia
    Rank last year: #22
    Total score: 88.68
  • 7
    Dallas, Texas
    Rank last year: #23
    Total score: 88.82
  • 6
    Chattanooga, Tennessee
     Flickr: Space Ritual
    Rank last year: #3
    Total score: 90.18
  • 5
    Jackson, Mississippi
     Flickr / Ken Lund
    Rank last year: #1
    Total score: 90.61
  • 4
    Oklahoma City, Oklahoma
    Rank last year: #9
    Total score: 91.19
  • 3
    Baton Rouge, Louisiana
    Rank last year: #10
    Total score: 91.93
  • 2
    Memphis, Tennessee
    Rank last year: #8
    Total score: 97.10
  • 1
    Louisville, Kentucky
    Rank last year: #5. This is Louisville's third #1 ranking in 12 years.
    Total score: 100.00


March 31, 2014

Common Cold Meds May Pose Health Threats: Interaction of two ingredients could cause serious side effects, researchers say

WEDNESDAY, March 19, 2014 (HealthDay News) -- Over-the-counter sinus and pain remedies that combine two common ingredients -- phenylephrine and acetaminophen -- might cause serious side effects such as high blood pressure, dizziness and tremors, New Zealand researchers warn.

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United Allergy Services launches mobile healthcare app to encourage patient medication adherence.

‘myAllergyPal’ Allows Patients Undergoing Immunotherapy Treatment to Track Symptoms, Medication and Medical Appointments

SAN ANTONIO, March 6, 2014 – United Allergy Services (UAS), a leading healthcare services company that enables family physicians, pediatricians and health systems to deliver safe and effective allergy testing and customized immunotherapy services, today announced myAllergyPal, an innovative mobile application that enables patients to track home-based immunotherapy treatment progress.

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Immunotherapy Best for Chronic Rhinitis

SAN DIEGO -- Treating allergic rhinitis with immunotherapy appeared to reduce the risk of chronic upper respiratory conditions, a Medicaid study showed.

Treatment for those conditions was three-fold more likely to decline in the 18 months after immunotherapy than in matched patients treated for rhinitis pharmacologically or otherwise (down 6% versus 2%, P<0.0001), Cheryl Hankin, PhD, of the health research company BioMedEcon in Moss Beach, Calif., and colleagues found.

The difference was significant in chronic sinusitis, pharyngitis, tonsil or adenoid disease as well as nasal polyps and influenza, they reported here at the American Academy of Allergy, Asthma, and Immunology meeting.

The results weren't unexpected but should help in counseling patients considering immunotherapy for allergic rhinitis, Theodore M. Freeman, MD, an allergist in private practice in San Antonio, Texas, told MedPage Today.

"This is absolutely confirming what I hear from my patients," he said."Now with this data, I can say it's documented that you're going to reduce the number of infections you're going to get and things like that."

Another implication is validating immunotherapy as important for allergic rhinitis, Hankin told reporters at a press conference.

"The public health and public policy message is that allergic rhinitis is not just a nuisance disease but is a precursor for the development of serious and extremely expensive respiratory disease," she said, noting that it also adds impetus to fast referral from primary care.

Her group had previously shown cost-effectiveness of allergy immunotherapy for hay fever using the same Florida Medicaid databases from 1997 through 2009.

The new analysis included 4,967 patients who had immunotherapy (likely almost all subcutaneous, given that the oral form isn't reimbursed) for newly diagnosed allergic rhinitis, and an equal group of matched allergic rhinitis patients who didn't get that treatment.

The likelihood of a decline in use of outpatient services over 18 months after immunotherapy versus controls was:

  • 35-fold higher for nasal polyps (down 0.34% versus up 0.14%, P=0.0131)
  • Two-fold more likely for chronic sinusitis (down 3.81% versus 2.15%, P<0.0001)
  • 35-fold higher for "other" upper respiratory tract disease (down 0.30% versus up 0.06%, P=0.0131)
  • Eight-fold more likely for chronic pharyngitis and nasopharyngitis (down 4.57% versus 0.62%, P<0.0001)
  • Four-fold more likely for chronic tonsil and adenoid disease (down 1.39% versus 0.34%, P<0.0001)

The same pattern with generally even greater magnitude of difference was seen at 6 and 12 months.

Immunotherapy was also associated with a three-fold higher likelihood of decrease in flu-related treatments (down 1.05% versus 0.34%, P<0.0001), but Harkin said this was not likely causal.

Rather, it suggested "that by getting specialty treatment, they're also getting preventive treatment," she said. "Their specialists are looking out for them."

The results should generalize from the Florida Medicaid population to other settings, Freeman suggested.

The study was supported by AAAAI; the Joint Council of Allergy, Asthma, and Immunology; and the American College of Allergy, Asthma, and Immunology.

Hankin reported relevant financial relationships with Teva and Greer Labs.

Freeman reported relevant financial relationships with McKesson and UpToDate.

Primary source: American Academy of Allergy, Asthma, and Immunology
Source reference: Hankin CS, et al "Allergy immunotherapy significantly reduces outpatient services use for chronic respiratory conditions in patients with newly-diagnosed allergic rhinitis" AAAAI 2014; Abstract 579.


By Crystal Phend
March 4, 2014

Pollen Allergies Rise During Spring in South Florida

For many South Florida children, March brings pollen allergy symptoms.  As trees and grass blossom, they release pollens that can trigger a reaction in your child's immune system, leading to sneezes, coughs, itchy eyes or more serious allergic reactions.

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Is It a Cold or Winter Allergies?

If you’re sniffling and sneezing this winter, you might think it’s a winter cold or flu — but it could be allergies.

“In the winter, most of the allergies that you’re going to suffer from are going to be indoor allergies — mold, cockroaches, dust mites and animal dander,” Joan Lehach, M.D., an allergist and clinical immunologist with a focus on integrative medicine at Montefiore Medical Center in New York, told

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UAS WAO Abstract Published Online

Congratulations to Frederick M. Schaffer, M.D., CMO; Larry Garner, allergy consultant; and Andrew Naples, clinical research coordinator; on the recent publication of The Safety of the United Allergy Services Immunotherapy Protocol. The abstract was published online in a supplement to the World Allergy Organization (WAO) Journal on February 3, 2014.

Click the link to access the publication:

The data was presented at the WAO Annual Symposium on Immunotherapy and Biologics in Chicago. The team earned Top Abstract Award by the WAO and was honored at the symposium in December.

Something To Sneeze At: National Survey Reveals That Majority Of Seasonal/Perennial Allergy Sufferers Want To Be Treated By A Primary Care Physician--Not An Allergist

SAN ANTONIO, Jan. 14, 2014 /PRNewswire/ -- According to the results of a recent United Allergy Services survey, two-thirds (68 percent) of U.S. seasonal/perennial allergy sufferers would rather seek treatment for their allergy symptoms from a primary care physician (PCP) than an allergist. Allergies are the fifth leading chronic disease in the U.S. among all agesi, and, with repeated exposure to allergens, many patients can develop allergic asthma. The Centers for Disease Control and Prevention (CDC) estimates that today, approximately 50 million Americans suffer from allergies and allergic asthma, and the prevalence is increasing.

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Allergists Accused Of Shutting Out Competition

The Academy of Allergy & Asthma in Primary Care and United Allergy Services hit several coalitions of board-certified allergists, including the American Academy of Allergy, Asthma & Immunology, with a lawsuit in Texas federal court Monday, alleging anti-competitive practices.

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Less Variety in Babies’ Gut Bacteria May Lead to Asthma Risk

Swedish study followed 47 infants for 7 years.

FRIDAY, Jan. 10, 2014 (HealthDay News) -- Infants with fewer types of intestinal bacteria are at increased risk for developing asthma, a small new study suggests.

Researchers assessed the varieties of gut bacteria in 47 infants and then followed them until they were 7 years old. At that age, 17 percent had chronic asthma, 28 percent had hay fever, 26 percent had the skin condition eczema, and 34 percent reacted to the allergens in a skin prick test.

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Data presented at World Allergy Organization Annual Symposium demonstrates safety of self-administered allergy shots

SAN ANTONIO– December 13, 2013 United Allergy Services (UAS)®, a leading healthcare services company assisting family physicians and health systems to deliver safe and effective allergy testing and customized immunotherapy services, today announced that data from a recent retrospective study citing the safety of UAS’ protocols for seasonal and perennial allergy treatment in the primary care setting will be presented at the World Allergy Organization’s (WAO) Annual Symposium on Immunotherapy and Biologics in Chicago. The abstract was also recognized with a Top Abstract Award by the WAO.

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Your Month-by-Month Guide to Allergies

You may feel as though you have year-round allergies, and you may be right. See what's most likely to be causing you to sneeze and wheeze as the months go by.

If you suffer from allergies for even part of the year, you may wonder when you'll get a reprieve. People with spring allergies, fall allergies, or winter allergies might feel relief during their off seasons, but for those who experience allergy symptoms year-round — it's a constant battle with allergens in the air. Here's a look at which allergies plague people most — and when.


During the winter, there's less pollen (if any) floating around, but cranking up the heat indoors can kick up house dust, a winter allergy trigger. If you're allergic to dust, winter allergies can be just as bad as in the spring and fall. To reduce dust exposure, it helps to keep your home's humidity below 55 percent, use a vacuum with a HEPA filter regularly, and encase pillows and mattresses with dust-mite-proof covers.


Mold and dust can cause year-round allergy symptoms, but even if dust and mold don't bring on the sniffles for you, trees can cause your allergies to flare at this time of year, depending on where you live. "We can see tree pollen as early as February, even in the Northeast," says Marjorie L. Slankard, MD, an associate attending physician and director of the Allergy Clinic at New York-Presbyterian/Columbia University Medical Center. In the United States, trees that commonly cause allergies include catalpa, elm, hickory, olive, pecan, sycamore, and walnut. Tree pollen can cause the same symptoms as most spring allergies — watery eyes, sneezing, and nasal congestion


Tree pollen remains high on the list of allergens for March, which marks the beginning of spring. "If the trees, grasses, and pollens start coming out early, March can be rough going for people with spring allergies," Dr. Slankard says. Though nice spring weather beckons you outside, if you have spring allergies, keep your eye on the pollen count. The higher the count, the worse the allergies will be. A good place to check pollen counts is at the National Allergy Bureau of the American Academy of Allergy Asthma & Immunology.


April showers can bring … spring allergies. All that rain can make for blooming flowers, but as beautiful as they are, flowers and their pollen means discomfort for people with spring allergies. In some areas of the country, grass pollen emerges in April, too. Between the pollen from the flowers and the pollen from the grass, spring allergies may make you feel especially miserable.


Allergic to tree pollen? Although tree pollination can begin as early as February, it can last through May. That means you might need to slog through spring allergies for four long months. Grass pollen can also emerge this time of year in some parts of the country.


June is a key grass pollen month in many areas, and it's likely that grass pollen will start to trigger your spring allergies by this time of year if it hasn't already. As the days get longer and the temperature gets higher, you'll probably want to spend more time outdoors. If you suffer from spring allergies, you may have good days and bad days — the temperature, the rainfall amount, and even the time of day will affect grass pollen levels, and you'll need to adjust accordingly.


The good news is that by July, grass pollen should subside and you might feel like your spring allergies are finally becoming manageable again. The bad news is that July marks the start of fungus spores and seeds, so if you're allergic to molds and spores, too, you may feel like your allergies never end. Mold can grow on fallen leaves, compost piles, grasses, and grains.


August is a prime month for people with summer allergies to mold spores, which peak during hot, humid weather. You might want to stay inside on days when the mold spore count is particularly high. The best way to keep away from these allergens is to run the air conditioning with a HEPA filter — this cool comfort indoors should help you feel better during the dog days of August.


Late summer/early fall ragweed is the most common cause of fall allergies. Depending on where you live, ragweed-fueled fall allergies can start in August or September and continue through October and possibly November. Pollen grains are lightweight and spread easily, especially on windy days. The more wet and windy autumn is in your area, the more easily the pollen spreads, and the worse your symptoms will feel


Chances that fall allergies will ease by October get better the farther north you go in the United States. But in warmer climates, fall allergies can linger well into this month. Seasonal rain and wind can also ramp up mold spores — if your fall allergies include mold or fungi spores, your symptoms may linger.


The ragweed pollen season usually ends by mid-November in most areas of the country. If you have fall allergies and react to fungi and molds, you probably face your worst symptoms in late summer and early fall. Although you might feel miserable from the end of March until November, making it seem like you have year-round allergies, you should get a break now. November may be one of the best months for people with outdoor allergies, which allows for enjoying the crisp weather. Then, just in time, indoor allergies to pet dander and indoor molds pick up.


As pretty as they are, real Christmas trees can make you wheeze and sneeze. It's likely not the tree itself that triggers allergies but the microscopic mold spores that can harbor in its branches. If you can't resist buying a live tree despite winter allergies, take it home a week before you plan to decorate it and leave it in a garage or an enclosed porch. Then give it a good shake to try to get rid of any spores.


By Beth W. Orenstein
Medically reviewed by Pat F. Bass III, MD, MPH

Study: Hay Fever More Commonly Found In Southern U.S. Kids

Children in the southern United States are more likely to suffer from hay fever, according to research conducted by the American College of Allergy, Asthma, and Immunology (ACAAI).

Researchers looked at data from over 91,000 kids, finding that over 18 percent suffered from the disorder. Hay fever rates were highest in the southern and southeastern U.S., while the lowest rates occurred in Alaska, Montana and Vermont.

"According to the study, wetter regions with average humidity were associated with a decreased number of children with hay fever," said Dr. Micheal Foggs, president elect of the ACAAI. "The study also found areas of the south with warm temperatures and elevated UV indexes seem to harbor more hay fever sufferers."

Over the counter hay fever remedies include nasal corticosteroid sprays, antihistamines, decongestants, montelukast (Singulair), allergy shots and sinus rinses.


by RTT Staff Writer
November 15, 2013

American College of Allergy, Asthma & Immunology, Nov. 7-11

The annual meeting of the American College of Allergy, Asthma & Immunology was held from Nov. 7 to 11 in Baltimore and attracted approximately 3,500 participants from around the world, including allergy and immunology specialists as well as other health care professionals. The conference featured presentations focusing on the latest advances in the prevention and treatment of asthma, food and medication allergies, immune dysfunction, and sleep apnea.

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When Allergies Trigger Asthma: Allergic asthma is the most common form of asthma. Proper diagnosis and treatment are key to preventing attacks.

More than 26 million Americans have asthma, and the number of people with it continues to rise. A chronic and potentially dangerous disease in which the airways of the lungs become inflamed, asthma is closely intertwined with allergies. “Anything that can cause allergies can also cause asthma symptoms,” said David Rosenstreich, MD, director of the Allergy and Immunology Division at Montefiore Medical Center in New York City.

As many as three out of four adults with asthma have at least one allergy. In fact, the most common form of asthma is allergic asthma, which accounts for 60 percent of all cases. Allergic asthma, also known as extrinsic asthma, is set off by inhaled allergens such as dust mites, mold, pollen, and pet dander. “When some people breathe in allergens, the tubes in their lungs become inflamed,” said Dr. Rosenstreich.

“People think of seasonal allergies as a runny nose, but your airway starts at your nose,” said Boyd Hehn, MD, a pulmonologist at Thomas Jefferson University and Hospitals in Philadelphia. “So it’s a chain reaction where that runny nose will cause the asthma to act up and the airway to become inflamed.”

Non-allergic, or intrinsic asthma, can be triggered by other factors such as anxiety, stress, exercise, cold air, and viruses. But many of the symptoms are the same for both kinds of asthma, including coughing, wheezing, tightness in the chest, and shortness of breath.

Rachel Lewis has been dealing with allergic asthma since she was a child, and she suffered her first asthma attack at age 7. “The doctors told me I would grow out of my allergies, but they’ve only gotten worse,” said Lewis, 30.

For people like Lewis, it’s critical to manage their exposure to allergens that may trigger attacks.

Doctors who suspect a patient has allergic asthma perform tests to see what they’re specifically allergic to. This can be done with a skin test, where a small amount of allergen is placed on top or slightly below the skin with a needle. Doctors then look for an immediate reaction, usually a rash resembling a mosquito bite. A blood test can also be done to look for allergen-specific antibodies in the bloodstream.

Fall allergy season is here, and people sensitive to common autumn allergens such as ragweed and mold are starting to feel its effects.

“Once the ragweed comes out, a lot of asthma patients are coming into the office,” said Dr. Hehn. “Controlling the allergies can only help in limiting asthma symptoms.”

Lewis lives in Texas, where fall can be a windy season with a lot of allergens blowing around. She’s looking forward to winter, “when I can go outside and actually breathe.”

Experts recommend those sensitive to seasonal allergies limit their time outdoors on days when there are high allergen counts. These daily counts can be found online through the National Allergy Bureau, part of the American Academy of Allergy, Asthma & Immunology.

There are several simple steps that someone with allergic asthma can take to control their symptoms. Here are a few suggestions:

  • Keep home and car windows shut during peak allergy times.
  • Use an in-home air filtration system.
  • Protective bedding covers can keep dust mites out of pillows and mattresses.
  • Limit cats and dogs to certain rooms in the home, and keep them out of the bedroom.
  • Bathing pets regularly reduces allergen counts, and frequent vacuuming can help control dander.

Lewis has her own strategies to manage her allergic asthma:

  • She takes hot showers after she’s been outside and exposed to pollen.
  • She only uses fragrance-free laundry detergents.
  • When she cleans, she wears a mask.
  • She keeps a lint roller with her to get pet dander off her clothing.

“It’s a constant effort to keep all my symptoms balanced and controlled,” said Lewis. “Some people think I’m overreacting and making my allergic asthma a bigger deal than it is. But until you go through that experience of not being able to breathe, then you don’t really know what it’s like and how scary it can be.”


By Dr. Sanjay Gupta
October 29, 2013

Allergy Testing and Treatment in Your Medical Practice

In this week's installment of revenue sources for your medical practice, I want to introduce to you different ways of thinking about testing and treating your patients for their seasonal allergies. The results for your patients and bottom line are nothing to sneeze at.

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Experts: High pollen count increases medical dangers

Borger resident Edwin Scott said his allergies have been so bad this season he’s been chasing his Zyrtec with Allegra. “Usually, I use Benadryl or something (to supplement Zyrtec), not one of the name-brand medicines,” Scott said.
Allergens may be something to sneeze at, but area residents should not underestimate them as higher moisture levels and higher temperatures have caused higher pollen levels, local allergy experts said.

“People should not take allergies as something mild,” Dr. Constantine K. Saadeh said. “(Allergies) can have serious ramifications.”

Serious allergy suffers face sinus infections that can lead to meningitis, he said.

People who suffer from asthma caused by allergies can suffer irreparable lung damage if their asthma goes untreated, Saadeh said.

West Texas A&M University Purchasing Director Bryan Glenn said he couldn’t make it to work Friday because of his seasonal allergy symptoms. He said he’s been taking allergy shots to no avail.

“My face is swollen and eyes are runny … ready for the first freeze,” Glenn said.

WT biology professor Arun Ghosh cited research by Rutgers University environmentalist Leonard Bielory to explain heightened pollen levels worldwide. Global climate change is prompting many plant species into a sort of species-
survival mode in which they release more pollen, Ghosh said.

“(Plants) cannot move themselves, so it’s kind of a gene-controlled phenomenon,” Ghosh said. “They are producing more reproductive units.”

Ghosh said West Texas residents face the worst allergy conditions in the state. He said he assumed allergens wouldn’t be prevalent in the area when he first moved to the Texas Panhandle due to the region’s limited plant life.

“Just the opposite thing is true,” Ghosh said. “Pollen grains, they can fly 300 to 400 miles. We receive pollen grains from Oklahoma, we receive pollen grains from Colorado, New Mexico — all of our neighboring states.”

This summer, a team of of WT researchers measured heightened levels of ragweed in Palo Duro Canyon State Park, Ghosh said. Nine years ago, researchers found scattered patches of ragweed in the canyon, but due to recent rains, a “continuous trail” of ragweed littered the landscape this summer, Ghosh said.

“Ragweed is the most important culprit that is causing allergies to 90 percent of people who are suffering from allergies in the world,” he said.

Another area culprit is the fungus alternaria, which forms on wheat plants and agitates residents with mold allergies, Ghosh said.

Saadeh said allergy sufferers can can take preventative measures to head off their symptoms, such as avoiding going outside between 4 and 8 p.m., as well as avoiding the outdoors when wind speeds range from 20 to 30 mph.

Over-the-counter antihistamine medicine can help mild allergy sufferers, but people experiencing more serious symptoms should talk to a doctor, he said. It’s also a good idea to wash clothes in hot water to deal with pollens that stick to clothing, Saadeh said.

Ghosh said allergy sufferers also should consider wearing a face mask when working outdoors. Parents can help their children tolerate allergies by letting them play outside at an early age, he said, and residents suffering from allergies should consider having their homes inspected for mold growing inside walls or air ducts.

To many, allergies are a minor annoyance, but they can be dangerous for others, Ghosh said. After all, pollens might be responsible for killing off the dinosaurs.

“You laugh at that, but it’s a very plausible theory, and many archaeologists and scientists … believe that the dinosaurs became extinct because of allergies,” Ghosh said.


By Russell Anglin
October 12, 2013

2013 Fall Allergy Capitals

This fall could be a perfect storm for allergy sufferers, as global weather conditions boost ragweed levels, and fall storms and tornadoes disperse allergens and outdoor mold, according to the Asthma and Allergy Foundation of America (AAFA).

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Ragweed Pollen and Mold will be the Key Allergens this Fall: AAFA

Ragweed pollen will be the key allergy causing source this season’s fall in the U.S. which would make more the season tougher for people with fall allergies.

The Allergy Foundation of America (AAFA), a not-for-profit organization, warns that this season's fall will be comparatively more difficult for people with allergies; ragweed pollen and mold will be the key allergy causing sources.

The global weather is likely to increase ragweed growth. Tornadoes and fall storms will disperse outdoor mold and allergens in the atmosphere, according to a report by AAFA.

The AAFA also created a list of challenging U.S. cities to live in for people with fall allergies. The list has been created on the basis of the usage of over-the-counter and prescription allergy medication, pollen levels and the number of Board Certified allergists present in each city.

The growing carbon dioxide levels and temperatures could boost the ragweed season by about a month or more, according to recent studies. The warmer weather now lasts for longer periods in the northern states of U.S. due to climatic changes.

Pollen from weeds is more problematic during fall compared to spring.

Though the season now commences later than its normal time, there is a fear of increased pollen distribution, which can trigger the allergy symptoms. These estimations are made on the basis of the forecast about the above-average tornadoes expected in the Midwest and the hurricane season predicted in the East.

Outdoor mold grow and spread more because of the wind patterns and the fall weather.

The allergic reactions to pollen and outdoor mold are often mistaken to be flu or cold, particularly during this season, which sometimes leads to delayed treatment.

Approximately 40 million Americans suffering from seasonal allergies are advised by the AAFA to learn more and seek advice from specialists for proper diagnosis and treatment of seasonal allergy symptoms.


By Nupur Jha
September 19, 2013

Caring for Chronic Conditions in Primary Care

With the Patient Protec­tion and Affordable Care Act now underway, more attention is being focused on patient-centered and coordinated care. As a result, primary care physicians (PCPs) are seeking new ways to organize care around patients. This includes providing in-office services that meet all of patients’ healthcare needs and/or taking responsibility for appropriate referrals.

Within MaxHeath Family Medicine, the focus is on increasing our ability to address all patient health concerns by adding a diverse array of services. In addition to a patient clinic, our practice houses centers for allergy, physical medicine and rehabilitation, cosmetic medicine, and weight loss. It also offers centers for sports medicine, brain health, and mental health. By offering more services, we have successfully improved patient outcomes, as well as financial benefits for the practice.

A Focus on Allergic Rhinitis & Asthma

Efficient treatment of chronic conditions is important to cultivating patient-centered primary care. Nearly half of all Americans have a chronic condition, and the prevalence of such conditions continues to increase. For example, approximately 60 million Americans suffer from allergic rhinitis (AR), which often precedes the onset of chronic allergic asthma. To enhance care of chronic conditions, we must shift from simple chronic disease-state management toward prevention-focused care.

In an effort to address AR, my colleagues and I implemented additional AR treatment protocols by establishing an allergy center. We work with United Allergy Services to supply allergy testing and immunotherapy to patients. For those who view their symptoms as a minor inconvenience, it is important that they avoid specific allergens. However, this avoidance approach can only work if the offending allergens have been identified. Allergy testing allows us to arm patients with information on what they’re allergic to and what to avoid. For those needing more substantial treatment, allergen immunotherapy addresses the underlying causes, helping reduce symptoms in about 85% of patients. Allergen immunotherapy has also been shown to prevent the development of new allergies and halt the progression of diseases, such as allergic asthma.

Allergy Care: Appropriate Resource Allocation

Increasing access to allergy care within primary care ultimately aligns with healthcare reform goals to deliver higher quality, affordable care to more patients. There are not many board-certified allergists and other allergy specialists, but demand for their services is projected to rise rapidly. By increasing the scope of care within our practice, we can help more patients fight chronic conditions like AR and allergic asthma. Given these benefits, the extent of care provided by PCPs will continue to expand as the healthcare industry evolves.

To learn more about Atrial Fibrillation Awareness Month, go to The Heart Rhythm Society also offers guides several helpful pocket guides for clinicians managing patients with atrial fibrillation. Two of these guides—“Managing the Patient With Atrial Fibrillation” and “Practical Rate and Rhythm Management of Atrial Fibrillation”—are available as free downloads.


By Jeffrey Bullar, MD
September 5, 2013

ADHD more likely in children with asthma or allergies

Children with a history of asthma and various allergies may be at higher risk of developing ADHD (attention deficit hyperactivity disorder), according to a study published in the journal Annals of Allergy, Asthma and Immunology.

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NPs offer a bright spot as primary care practices combat rising costs

According to a recent MGMA-ACMPE study (reported in the journal AAFP) over the last 11 years, the cost of running a medical practice in the United States has increased twice as quickly as the consumer price index. This surprising and dramatic gap underscores the significant financial challenges facing many primary care providers, including revenue streams that may fail to counter the rising costs of keeping a practice afloat.

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Allergy symptoms arrive in Charlotte early this year

"I have been sneezing a lot more lately when I am out running or exercising," said Regina Harrison.

As fall approaches, a lot of people suffer from allergies because of the change in weather, but people are noticing the symptoms: itchy and watery eyes, nasal congestion, coughing and sneezing much earlier this year.

Dr. Gray Norris said there has been a recent spike because of all of the rain we have had this summer.

"I think the weeds are a little bit early. I think they have gotten a little bit of a head start with all of the water we have had for them to grow," said Norris.

So far this year, Charlotte has seen more than 35 inches of rain. Normally by this time Charlotte has an average of 28 inches.

All of that wet weather has caused an early rise in ragweed and mold.

Norris said do not expect conditions to change any time soon.

"We are going to have fairly high levels until we get some really cold weather. Once we get a really good freeze that will knock the levels down," said Norris.

Charlotte has already seen a burst of cooler temperatures, but meteorologists don't expect the cold weather to arrive until late October.


By Vicki Graf
September 2, 2013

Fall allergy season arrives, approaching early September peak

Ragweed season is upon us, pollen counts show, and is expected to peak over the next couple of weeks.

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Heavy Traffic Pollution, Wood Fire Smoke May Worsen Asthma Symptoms

A word of caution to asthma-sufferers: Living by busy streets could make your symptoms worse, according to a new study.

Researchers from the University of Melbourne found that heavy traffic pollution seemed to increase asthma symptoms by 80 percent and smoke from wood fires seemed to increase symptoms by 11 percent among people with the condition.

"These findings may have particular importance in developing countries where wood smoke exposure is likely to be high in rural communities due to the use of wood for heating and cooking, and the intensity of air pollution from vehicular traffic in larger cities is significant," study researcher Dr. John Burgess, of the School of Population Health at the University of Melbourne, said in a statement.

Interestingly, researchers did not find an association between asthma onset and exposure to heavy traffic pollution or smoke from wood fires.

The study, published in the journal Respirology, included 1,383 adults, age 44, who were part of the Tasmanian Longitudinal Health Study. The study participants rated their exposure to wood fire smoke and traffic pollution. They were also asked to provide information on frequency of exposure to heavy traffic near their homes, as well as their exposure to wood smoke in the environment during the wintertime. Researchers tracked the participants' asthma symptoms and flare-ups over a year-long period.

Everyday Health previously reported that for traffic pollution in particular, particulate matter and atmospheric ozone are likely the biggest asthma culprits.

"Both pollutants can strain airways in asthma by increasing inflammation and susceptibilities to allergies and infections," Sumita B. Khatri, M.D., who is the co-director of the Cleveland Clinic Respiratory's Institute's Asthma Center, told Everyday Health.


August 21, 2012

Obese Kids More Likely to Have Asthma, With Worse Symptoms

WEDNESDAY, Aug. 7 (HealthDay News) -- Overweight and obese kids are more likely to struggle with asthma than kids of normal weight, according to a new review of more than 623,000 children.

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New Report Shows Most States Fall Behind on Asthma and Allergy School Policies

With millions of children heading back to classrooms in the coming weeks, asthma and food allergies at school present serious concerns, but some states are better than others when it comes to supporting students with these chronic diseases.  A new report by the Asthma and Allergy Foundation of America (AAFA) shows that most states still don't have core policies in place to protect kids and adults in schools nationwide. In fact only 7 states and the District of Columbia currently meet the Foundation's criteria to be listed on the "State Honor Roll™ of Asthma and Allergy Policies for Schools." The report, at, is an annual look at how states compare on 18 core policy issues that affect kids and adults with asthma and allergies while they spend the day learning or working in America's schools.

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How to best prepare and adapt for shared risk and value-based payment: Tips for practice managers

UAS president and CEO, Nick Hollis, was quoted in the most recent Medical Group Management Association (MGMA) members magazine. The article was an industry roundtable on valuable tips for practice managers. Please see the page in the magazine below where Nick is quoted.

MGMA Connexion pg 57

When Allergies Attack! Asthma and Allergies in America (Infographic)

Seeing how combating unhealthy air quality and allergies are the main factors Oransi builds our high quality HEPA air purifiers, we have compiled the most recent statistics on allergies and asthma in the U.S. to show you how important fresh, clean air is to millions of Americans. Some of the facts in this infographic may surprise you. For instance, most Americans believe the air in their home is clean. In reality, indoor air can be up to 100 times more polluted than outdoor air, which is why having air purifiers for allergies can be a huge benefit to your health. Click the infographic to learn more about common triggers, risk factors, and the costs of asthma, allergies and poor indoor air quality in the United States.

Feature Our Asthma & Allergy Infographic on Your Site
You are free to display this infographic on your own website or blog. All you have to do is copy and paste our embed code below to attribute the graphic back to Oransi with a link. It’s really that simple!

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Case Report: Allergic Rhinitis (AR)

Learning Objectives:

1. ) Better understand the seasonal and perennial allergies that Louisianans face, particularly in the summer.
2. ) Learn more about allergy treatment options in the family practice setting.
3. ) Understand the need for primary care providers to provide allergy care.Draft Article:

Allergic Rhinitis (AR) is the fifth leading cause of chronic disease among all Americans1 and a major concern for Louisianans year round. As many as 30 percent of all adults and 40 percent of children suffer from AR nationwide.2 In Louisiana in particular, the humid weather often causes patients to experience more severe symptoms than in other parts of the country. While in other areas summertime is often associated with reduced pollen counts and allergy symptoms, Louisiana’s hot humid, summers foster spikes in mold, grasses and other airborne allergens.

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Providers Prep for New Models of Care

Like it or not, a new healthcare landscape is taking shape that runs counter to just about every convention the industry has ever known.

Instead of furnishing services and automatically getting paid, providers must demonstrate their value through outcomes. Rather than being hospital-centric, healthcare must be shared by a network of post-acute care providers. It is a different mindset that the industry is trying to come to grips with, experts say.

"It is about providers understanding their market, their strengths and their capabilities," says Gary Anthony, head of technology business development and sales operations for Hartford, Conn.-based Aetna Accountable Care. "The market seems to be embracing it, but the pace with which they accept that change is different for different reasons."

Whether the new business model is called an accountable care organization, value-based purchasing or medical home, the goal is the same: to provide cost-effective health services that meet a high standard of quality. And while that may cause some executives to freeze in anticipation of a complex, convoluted transformation, the process is actually simpler than it appears, says Brenda Radke, CEO of the Brevard Physicians Care Network, a group of 270 independent physicians on Florida's Space Coast.

"It is really pretty basic stuff," said Radke, who also serves as executive director at Medical Practitioners of Care ACO, an organization with 150 physicians. "I wish I could say it was a stroke of genius, but it really isn't."

In the months following the organization's launch of an electronic medical record last October, Radke says the physicians are realizing that "they belong to each other" and that "all the focus is on why the patient is there."

Critical to the success of this ACO model is communication, Radke says, because that connection through the EMR enables all physicians to share the same patient data so that they know symptoms, test results and diagnosis before the face-to-face encounter.

"There was a disconnect about the appointments between primary care and specialists - maybe a piece of paper from the primary care that said the patient has an abnormal EKG," she said. "The specialists would then perform the same lab work and diagnostics that the patient already had. There was also a lot of faxing going on back and forth, which was very inefficient."

'Volume to value'

Katherine Schneider, MD, executive vice president and chief medical officer for Wayne, Pa.-based Medecision, characterizes the new healthcare landscape as "the journey from volume to value." In other words, it is shifting from basing revenues on the number of patients treated to becoming invested in how patients are cared for.

The transformation has been slow and gradual for the industry so far, but Schneider says that is a natural part of the evolution.

"The lights don't come on all at once," she said. "It's building blocks. But once you gain momentum, it is hard to put the brakes on. The business model and care model should progress at the same pace, not letting them get ahead of each other. At some point, however, it will have to accelerate so that the revenue part takes over."

As a consultant to providers on ACO formation, Schneider says she wants to instill trust and confidence in her clients by getting them to envision their own futures.

"All our conversations are around 'how are you doing things now, how will you be doing them next year, what will things look like in 2016 and how we can be their partner," she said.

Maximizing health

Physician Jeff Bullard's healthcare philosophy is summed up in the name of his Colleyville, Texas, practice - MaxHealth Family Medicine. As a primary care practitioner, Bullard serves as the anchor for a litany of services provided in his 10,000 square-foot complex, including allergy treatment, mental health and wellness services, physical medicine and rehabilitation, sports medicine, weight loss and cosmetic medicine.

Realizing that the healthcare model was ripe for change, Bullard and his associates set up a "medical home" model five years ago that laid out a roadmap of service extensions.

"When we examined the medical home idea for us, it amounted to a documentation of processes that are already in place," he said. "As a primary care physician, it is quite intimidating to be involved in an ACO where you give up responsibility depending on what measures you are trying to achieve. Our hope is that we can demonstrate cost effectiveness by focusing on prevention. We are in contact with employers on the importance of workplace wellness and our role in addressing it."

Finding a balance

Providers need to study the impact on their service levels as they move away from fee-for-service to a value-based system, added Frank Flosman, vice president and West regional leader for Aetna Consulting.

"They need to look at improving utilization patterns and finding a balance," he said. "As an organization you may see your top line revenue decrease, so what investments can you make in infrastructure for care management capabilities? Some organizations can manage within four walls, but that isn't the real challenge - it is to coordinate and deliver care across the continuum."

Providers must also take greater interest in the population outside the realm of service delivery, Flosman said, such as population health.

"This gives them information about the appropriate level of services," he said. "They need to utilize the data and use it for provision of services. It is a critical shift."


By John Andrews
June 1, 2013

Healthy Memphis: Know difference between seasonal allergies and cold symptoms

What you should know

Spring and summer open up the enjoyment of outdoor activities and scenery. Yet a runny nose, stuffiness, and itchy eyes can ruin the experience. Relief methods depend on whether you have an allergy or a cold.

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Half of nasal allergy sufferers have sleep issues

More than half of U.S. nasal allergy sufferers report sleep issues as a result of their allergy symptoms, but 35 percent treat their symptoms, a survey says.

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Respiratory Symptoms And Exacerbations In COPD Worsened By Allergic Disease

Patients with chronic obstructive pulmonary disease (COPD) who also have allergic disease have higher levels of respiratory symptoms and are at higher risk for COPD exacerbations, according to a new study from researchers at Johns Hopkins University in Baltimore.

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Blurry vision and allergic shiners? How to treat eye allergies

Up to 40 percent of the U.S. population suffers from itchy and watery eyes. Seasonal allergy symptoms experienced in the eye area can result in practical problems such as extreme sensitivity to bright light, blurry vision and an annoying desire to rub your eyes.

Many allergy patients also experience darkness and/or swelling underneath one or both eyes. This is known as “allergic shiners,” and is simply the result of congestion in the sinuses that slightly affect ones blood flow. Some of the smaller blood vessels beneath the skin may enlarge and show up as darkness (often purplish) right under the eyes.

My female patients try to remedy this situation by using facial cosmetics, such as concealers and foundation, as a cover-up to the puffiness and dark circles.

But, upon medical examinations, we often find that our patients’ have allergic sensitivities to the very eye make-up they are using to try and look better. Mascara and eyeliner in particular make the allergic shiner worse, rather than fixing the problem.

Other hygienic products that may worsen one’s allergic shiner include hair care products, facial moisturizers and products containing fragrances.

In-office allergy patch tests can easily identify if contact dermatitis, or skin allergies, are present, and may explain the puffiness, redness and irritated eyelids.

The next step, after removing irritant eye make-ups and creams, is to look for specific solutions to treat the allergy or sinus disease. Of course, dehydration, lack of sleep and familial facial characteristics may contribute to ones unfavorable physical appearance. Many of us tend to have more puffiness around the eyes upon wakening, as a result of the horizontal or recumbent sleeping position in which fluid has accumulated, and will subsequently diminish during the day.

Another indicator may be one’s amount of salt intake, which can contribute to the retention of fluid within and around your lids. Low-tech treatments such as “cool” compresses around your eyelids will help reduce swelling and residual daytime puffiness.

Bottom-line: Visit your doctor to have a diagnosis confirmed. A simple in-office allergy test can help pinpoint whether you have seasonal or indoor allergies. Second, many allergy patients benefit from prescription antihistamine eye drops as well as oral antihistamines. Last, a sinus evaluation can also detect inflamed or blocked sinus passages that require appropriate remedies.

After you complete these steps you will be on your way to feeling better and having younger-looking eyes.


By Dr. Clifford Bassett
Published April 29, 2013

Spring Flowers Bring Itchy Eyes, Runny Noses to Millions of Americans

Spring has arrived and warm weather is on its way. While many of us are eager for the change, nearly 50 million Americans now face the start of spring allergy season. Those who suffer from allergies are familiar with the nasal congestion, sneezing and itchy and watery eyes that accompany change in seasons. While it's impossible to avoid all allergens, Northwestern Medicine(R) experts urge preparation and recognizing allergy triggers to minimize symptoms this spring.

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FDA warns on adverse effects of over-the-counter allergy medications for kids

The US Food and Drug Administration (FDA) has warned parents to be aware of the active ingredients in over-the-counter (OTC ) allergy medications for kids.

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Ranking Top 25 Worst Spring Allergy U.S. Cities in 2013

Do you feel sneezy? Don't be upset if you won't hear 'Bless you" response when you sneeze more often this days, as you might blame it to allergies as the culprit. According to report there is no place safe from allergies in United States cities especially this year's spring-time, and some cities are more troublesome than others.

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The Allergy Season Is Upon Us Part One

It was earlier predicted, and may have already occurred by the time this article is published, that allergy season is going to start sooner this year. In 2012, the allergy season started in February.

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Top 100 Spring Allergy Cities

As spring arrives, flowers bloom and airborne pollen molecules bring allergy sufferers misery. To kick off the spring season, the Asthma and Allergy Foundation of America released a list of the top 100 U.S. allergy capitals.

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Surviving, Thriving, as an Independent Physician

Many physicians today are faced with the difficult decision of remaining in an independent practice or accepting an offer to be bought out (swallowed up?) by a hospital or large medical group. It would seem physicians are caught between the proverbial rock and a hard place.

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Spring-Clean Allergens Away: Reduce seasonal allergy symptoms by targeting your home's hot spots

Allergy sufferers know that the arrival of spring also means the start of sneezing, wheezing and other seasonal symptoms; according to the American Academy of Allergy, Asthma, & Immunology, more than 35 million people are affected by seasonal allergies. Aside from reaching for meds, you can also find some relief through your annual spring-cleaning routine. “A thorough once-over of your home helps control both indoor and seasonal allergens,” says Sakina Bajowala, MD, Board-Certified Allergist & Immunologist with DuKane Allergy Asthma Associates in St. Charles, Illinois. “You won’t completely eliminate allergens, but there are many ways to reduce exposure for you and your family.” Here, a few tips to help you tidy your way to an allergen-reduced home.

1. Avoid bringing the outdoors in.

“Know your triggers and, to keep offending allergens outside, don't open windows on days when the pollen count is elevated,” recommends Andy Nish, MD, an allergist with the Allergy and Asthma Care Center in Gainesville, Georgia. (Go to to find out the current pollen and mold levels in your area.) If you’ve spent time outdoors, launder your clothes and shampoo your hair to avoid carrying around allergens or transferring them to indoor surfaces such as sofas and bedding. According to Dr. Nish, allergens that are tracked indoors can stay potent enough to cause symptoms for a few days. Photo: Shutterstock

2. Use a vacuum with a high-efficiency particulate air (HEPA) filter.

Though taking your vacuum to the rug seems like an efficient way to zap allergens, irritants like dust mites and pet dander can easily be released back into the room while you clean. To prevent this, use a vacuum with a HEPA filter, which traps allergens, at least once a week (this handheld version will do the trick if you're not ready to replace your full-size model). And “if you’re the allergy sufferer, wear a dust mask when vacuuming so you’re not inhaling allergens,” advises Dr. Nish.

3. Wash bedding every week.

Dust mites are the most common trigger of indoor allergy and asthma symptoms, and they thrive on soft surfaces, which means your greatest exposure to them is through your mattress. To help decrease susceptibility, wash bedding weekly in hot (130°F) water and dry on a hot cycle. If your comforters can’t be laundered, cover them with a washable duvet cover to keep them out of allergens' reach. Encase mattresses, box springs and pillows in allergen-proof covers. Luna's mattress protectors are waterproof, but still allow for air circulation, and are completely noiseless so you won't hear any rustling while you sleep. Photo: Shutterstock

4. Clean drapes and upholstery.

Because allergens cling to soft surfaces, it's essential to wash, dry-clean or vacuum drapes, as well as vacuum sofas and chairs to remove lingering allergens, and wash or dry-clean throw rugs. “Vertical blinds or roller shades are less likely to accumulate dust than drapes, so use them whenever possible,” says Dr. Bajowala. When renovating rooms in the future, skip wall-to-wall carpeting and opt for hard floors such as hardwood, tile or sheet vinyl, which are easier to clean and don’t harbor allergens. Photo: Shutterstock

5. Dust forgotten surfaces.

Because dust can cause symptoms in some people, it's important to remember to clean out-of-the-way areas. Use a damp microfiber cloth to trap dust as you wipe down flat surfaces that rarely get cleaned, such as baseboards, door jambs, air duct vents, ceiling fan blades and Venetian blinds. Vacuum underneath the stove and fridge to suck up crumbs that attract insects, which in turn produce allergens like cockroach droppings. And whenever possible, ditch clutter—it’s much easier to clean if you don’t have to dust around piles of paperwork and oodles of knickknacks. Photo: Shutterstock

6. Keep tabs on humidity levels.

To keep allergens that grow in damp areas, such as mold, under control, maintain proper household humidity, says Dr. Nish. A humidistat, a gauge that measures humidity and that can be found at most local home improvement stores, helps you monitor how much moisture is in the air. Indoor humidity levels should be kept below 50 percent. Use dehumidifiers in damp areas such as basements, and empty and clean the holding tank regularly. Run the air conditioning in humid weather to remove moisture from the air, and replace the air filter monthly (it helps trap some allergens). Repair leaking roofs or drippy pipes, as chronic leaks give mold a foothold.

7. Avoid harsh chemicals.

“Many patients with allergies are sensitive to chemicals and strong fragrances,” says Dr. Bajowala. “Whenever possible, use cleaning products that are unscented or contain only natural ingredients.” Or make your own all-purpose cleaning solution by combining one half cup distilled vinegar and two teaspoons of borax powder in half a gallon of water. Use this eco-friendly solution to wipe down surfaces and then let air-dry. Photo: Ian Batchelor / Getty Images

8. Clean up after pets.

Pet dander may be elevated in certain parts of your home after a long winter spent indoors. If you have pet allergies, vacuum your pet’s sleeping quarters well, wash your pet and pet’s bedding frequently, and speak to your vet about a well-balanced diet for your animal, because a healthy pet may shed less dander. Photo: Shutterstock


By Arricca Elin SanSone
March 8, 2013

What you Don’t Know About Spring Allergies can Cause You Misery

Chirping birds won’t be the only thing heard in the coming spring months. More than 40 million Americans will be sneezing and wheezing thanks to seasonal allergies. And according to the American College of Allergy, Asthma and Immunology (ACAAI), if spring comes early again this year, allergy symptoms will be intense and last longer than average.

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Allergy Season To Be Intense & Early This Year

If you have allergies, the worst season could be on our doorstep.

While it's chilly outside, doctors are expecting seasonal allergies to arrive early this year, and much more intense.

Experts said you can blame the weather and the temperature roller coaster.

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7 Tips to Transform Your Patient Base: Effective methods for tweaking your roster

There are many reasons why a medical practice might want to transform its patient base. Maybe you want to increase the profitability of your practice by attracting a different demographic or you want to enhance your offerings and expand your reach into the community. Perhaps you’ve become intrigued by a complementary specialty that appeals to a different audience than the one you’re currently serving.

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Alternative Business Models Keep Doctors in Business and Thriving

As doctors weigh whether to stay in their practices or become employed in a group practice or at a hospital, they’re increasingly looking to alternative business models in order to remain – and thrive.

“Especially as the industry evolves, physicians and practice staff may be looking at alternative business models,” said Todd Evenson, data solutions director for the Medical Group Management Association.

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Reduced Physician Compensation and Other Trends in Primary Care

Primary care forms the backbone of the nation’s healthcare system, providing patients with information about preventive and self-care strategies and ideally coordinating care with specialists and other providers. Yet as 32 million more Americans prepare to join the ranks of the insured, the country not only lacks sufficient numbers of primary-care physicians, but medical students increasingly are choosing to specialize.

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The opportunity for in-office allergy testing and treatment

In an age when many physician practices face tightening business margins, some are exploring new services they may be able to offer patients. One such area is the in-office treatment of patients who suffer from allergic rhinitis.

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Partnering with an Outside Specialist

Some days, even Andrew Minigutti, MD, forgets that his practice’s allergy specialist isn’t one of his actual employees. Instead, she is an outside employee working out of Minigutti’s Plano, Texas practice to the benefit of not only the patients, but the doctors as well.

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United Allergy Services Teams Up with the Patient-Centered Primary Care Collaborative As an Executive Committee Member

San Antonio, Texas — October 3, 2012 United Allergy Services (UAS)™, the leading healthcare services company empowering physicians and health systems to deliver safe and effective allergy testing and customized immunotherapy services, today announced it has joined the Patient-Centered Primary Care Collaborative (PCPCC) as an Executive Committee member. The Executive Committee guides the efforts of the PCPCC, which aims to advance an effective health system built on a strong foundation of primary care and the Patient-Centered Medical Home (PCMH). Through this collaboration, UAS will become a profound contributor to the PCMH movement and will help to shape the organization’s advocacy efforts. UAS will also be further empowered to promote awareness of allergy conditions and the need for coordinated allergy care across the healthcare continuum.

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