House Dust Mite Allergy

Part
01
of two
Part
01

House Dust Mite Perceptions

The general understanding of house dust mite allergies among US allergists include the following: Allergy reactions in people are caused by an allergen present in dust mites feces. Dust mites like to reproduce in warm and high humidity places, especially in the bedroom. The main symptoms of house dust mite allergy are allergic rhinitis, sneezing, runny nose and it is associated with asthma. The best option to treat a dust mite allergy is to go to an allergist or immunologist.

A General Overview of House Dust Mites

  • According to Allergist Jeffrey M. Wilson; there's been more than 50 years since the first house dust allergen was recognized as such. The discovery came from microscopic observation of mites in a sample of the dust of damp houses.
  • When this mite allergen was isolated to scientific studies it was first called F4P1 and subsequently Der p 1; after these studies were focused exclusively to the mites' feces it was found that the allergen on these feces is the main cause of the allergenic effect of dust mites.
  • Dust mites' ideal temperature to reproduce is between 68-77 °F and the ideal humidity is between 70-80%. Currently there are at least 13 different species of dust mites identified and they are very well adapted to live indoors at home.

Causes of House Dust Mite Allergy

  • According to The American College of Allergists, dust mites are one of the most common indoor allergens. This is because dust mites are invisible to the naked eye, so they reproduce freely and in high quantities.
  • According to allergist Wilson; the mite's fecal particles measure between 20 to 30 micrometers in diameter and are encased in a peritrophic membrane that prevents them from breaking up.
  • These large fecal particles enter the bronchi by inhalation. This can cause progressive inflammation of the lungs and provoke the creation of IgE (Immunoglobulin E) which induce the allergic response.

Symptoms of Dust Mite Allergy

  • The most common symptoms of dust mite allergy are; allergic rhinitis, sneezing, runny nose, irritated eyes, scratchy throat, coughing, wheezing, and shortness of breath. This allergen could cause asthma as well.
  • The symptoms of this allergy could be present year-round. Due to this characteristic, some allergists classify this allergy as "perennial".

How to Reduce Dust Mites in House

  • According to the Asthma and Allergy Foundation of America, which has Jennifer LeBovidge PhD as its allergist-scientist leader; to completely avoid allergies by mite feces is almost impossible in most cases, but some measures can be taken to reduce the mite population to the minimum.
  • Allergist Wilson states that the bedroom is the primary focus of dust mites. To reduce dust mites to a minimum a coordinated plan is crucial. These factors must be taken into account: the materials used for covering pillows and mattresses, humidity control, room air-cleaners, carpets, and lastly, vacuum cleaners.
  • An important measure to kill dust mites is to use water with temperatures up to 130°F when doing laundry. It is important to carefully wash sheets, blankets, bedspreads, duvet covers, and comforters every week and at high temperature.

Ways to Treat Dust Mite Allergy

  • When a dust mite allergy affects a family member, even when the numbers of dust mites and their feces are reduced to the minimum; it is important to go see a physician. If the allergy symptoms are not under control after 3-6 months it is necessary to visit a specialist.
  • Going to an allergist or immunologist is the most effective way to reduce and in some cases eliminate the allergic reaction to mites and their waste. An expert can formulate "allergy shots" to help manage the immune system’s response specifically to dust mite allergens.

Research Strategy

Your research team began research on trusted websites such as the official website of The Journal of Allergy and Clinical Immunology where we found an interesting article about research led by MD, PhD Jeffrey M. Wilson, allergist and immunologist who cares for patients at UVA Asthma, Allergy and Immunology. Also, The American College of Allergy, Asthma and Immunology website, this organization is formed by professionals of health who focus on allergies. Lastly, the Asthma and Allergy Foundation of America, led by Allergist Jennifer LeBovidge PhD, an allergist in charge of the Allergy and Asthma programs in the Boston Children's Hospital. All the information is highly reliable and gives an overall understanding of US allergists about dust mites allergies. It is important to mention that most of the sources don't have a specific year of publication, the reason is that they are the official website of the organizations and the information contained is updated when is needed.

Part
02
of two
Part
02

Prescribing Decisions

Some of the most important factors a physician considers when considering prescribing new medication include payments and rewards and continued medical education influences from pharmaceutical companies.

Payments/Kickbacks/Rewards From Drug Companies

  • A recent study, posted on the International Journal of Scientific & Technology Research, found out that pharmaceutical sales representatives and rewards have a significant influence on how physicians prescribe medication.
  • According to the research, pharmaceutical sales representatives normally have face-to-face interactions with doctors and most of the time, these interactions are aimed at getting into an agreement such that the physician prescribes, use, and recommend the products and services from a particular pharmaceutical company.
  • The research further stated that some pharmaceutical companies usually provide sponsorship support to physicians in the form of research assistance and tangible rewards which influence their prescription loyalty.
  • Although a little outdated, another study by ProPublica found that doctors who receive payments from the medical industry prescribe drugs differently compared to their colleagues who don't. Moreover, the more money they get, the more they prescribe certain brand-name medications.
  • To back this up, research led by Taeho Greg Rhee, PhD., of the University of Connecticut, Farmington, analyzed "Centers for Medicare & Medicaid Services Part D data and Open Payments data for general payments from industry to physicians associated with gabapentinoids". They found out that brand-name gabapentinoids made approximately 510,000 payments worth $11.5 million to 51,005 physicians and according to Dr. Rhee those doctors represented 14% of physicians who prescribed any gabapentinoid product under Part D during the same time period.
  • A second study led by Rishad Khan, MD, of the University of Toronto also examined the association between industry payments to physicians and Medicare spending on adalimumab and certolizumab drugs. The study discovered that pharmaceutical companies made more than $10 million in payments to gastroenterologists prescribing adalimumab or certolizumab. They also found out that for every $1 in physician payments, there was a $3.16 increase in spending for adalimumab and a $4.72 increase for certolizumab.
  • Providing physicians with certain forms of support such as research assistance is permitted as long as it is conducted within certain guidelines. Parties such as the government and medical organizations monitor these activities so that their results are beneficial to consumers or patients. Therefore, using sales representatives to interact with doctors and offering them sponsored support can be used as tools for marketing and influencing.

Medical Education Influences Prescribing Choices

  • 87 medical schools were surveyed in regards to ethics and prescribing practices and it was found that there were 39 different content areas and 8 different modes of teaching. Moreover, each school was incorporating an average of 4 teaching methods and 13 content areas. This proved that there is a lack of standardized ethics and prescribing curriculum. What this information translates to is that different physicians prescribe differently based on the curriculum they went through and therefore, measures should be taken in order to properly equip physicians.
  • Therefore, pharmaceutical companies can use Continuing Medical Education (CME) as an indirect marketing tool to increase the market for their products.
  • According to HealthCareDive, pharmaceutical and medical device companies contributed approximately $740 million (28%) of continuing medical education (CME) funding in 2017.
  • Although it is regulated by the Accreditation Council for Continuing Medical Education to prevent it from acting as hidden marketing, the Senate Finance Committee report found that drug companies have been using educational grants as one of the methods to increase the market size for their products in recent years.
  • Moreover, Adriane Fugh-Berman, director of PharmedOut, mentioned in an interview that CME is one of the most important marketing tools pharmaceutical companies have.

Additional Factors Considered In Prescribing

The following are some of the other important factors that physicians consider when prescribing new medication but they cannot necessarily be influenced via marketing.

Comorbidities

  • When a person has more than one medical condition, it becomes very important for a physician to take that into consideration to avoid potential complications.
  • For instance, if a patient has liver disease or renal impairment then it can get dangerous when these factors are not taken into consideration before a new medication is prescribed. This is because some drug levels in the body can get toxic if they are not eliminated by the liver or if the kidneys do not excrete them from the body.
  • Additionally, some drugs may worsen how the liver functions. Fluid overload and reduced clotting are also some of the issues a patient can face if the doctor did not consider his/her liver impairment.

Age

  • As people age, the changes occurring in their bodies can affect how new medication and all medications, in general, are absorbed and utilized. Moreover, children cannot be prescribed medicine like adults because their bodies are not only small but also react differently to certain medications
  • According to SingleCare, factors such as metabolism, body fluids, body fat, and how the body functions, in general, should be considered by physicians before prescribing new medication to both children and the elderly because they can affect how well they can handle a specific prescription.
  • On the other hand, older people have a higher prevalence of chronic and multiple illnesses and some of the physiological changes associated with aging can also be mistaken for illness. Therefore, physicians need to consider these issues when considering prescribing new medication so as to reduce their risk of suffering adverse drug reactions (ADRs).

Allergies and Side-Effects

  • Some individuals are sensitive to certain medications and physicians should consider if the new medication they want to prescribe might cause adverse effects to a patient.
  • Some new medications can also have hostile side-effects such as congenital abnormalities. Therefore, although drugs are rarely associated with congenital malformations, it is important for physicians to ask if a woman is pregnant or breastfeeding.
  • This is because some medications can affect the growth of the fetus, functional development, or have a toxic effect on fetal tissue during the second and third trimesters. Some drugs can even affect the labor delivery process or the baby after delivery.

Cost

  • Although physicians are mostly taught to think about safety and effectiveness when prescribing treatments, Jules Lipoff who is a doctor feels that they should also be realistic and consider the cost of medication.
  • Mr. Lipoff gave an example of a patient who had been prescribed a new acne cream and when he went to the pharmacy, he found out that it was too expensive for him to afford and he left angry and without the cream.
  • Mr. Lipoff further says that physicians need to understand that sometimes patients buy medications from their pockets and thus, they should consider prescribing a cheaper drug that works first unless there is an urgency to justify the expensive one.

Research Strategy

Our search to find the most important factors a physician considers when considering prescribing a new medication/treatment that can be influenced by marketing materials or medication information from drug manufacturers proved to be very difficult because of limited information on the public domain. This made us extend our usual time scope of two years to five and when that also proved to be insufficient we were forced to use some sources from as far as 2013.
However, after an exhaustive search, we were able to find useful information in articles and journals from credible sources such as NPR, Patient, PEW, HealthCareDive, and Medscape among others. We leveraged that information to compile the above findings.
Sources
Sources