SURVEY SHOWS THAT 30 PER CENT HAVE NEVER SPOKEN TO A HEALTHCARE PROFESSIONAL ABOUT THEIR ALLERGIES DESPITE EXPERIENCING FREQUENT SYMPTOMS

The Asthma Society of Ireland has shared the findings of a patient and carer survey, which highlighted that despite experiencing multiple hay fever symptoms, 30 per cent of respondents had not sought advice from their healthcare provider on managing their allergies.

Of those who have been diagnosed with allergies, the most common allergies were pollen (63 per cent) or house dust mites (56 per cent). Over 33 per cent of respondents reported a diagnosis of allergy to pet or animal hair whilst over a fifth had confirmed allergies to certain foods.

Some 304,000 people in Ireland have both asthma and hay fever, which can significantly affect quality-of-life.

Sneezing, stuffy nose, and runny nose were commonly experienced amongst the 655 patients surveyed. Of the symptoms most frequently experienced, 92 per cent cited urge to sneeze or sneezing fits, 91 per cent runny nose/rhinitis, 88 per cent stuffy or itchy nose, and 74 per cent of respondents reported itchy burning eyes.

Some 79 per cent of respondents also report experiencing fatigue associated with allergies; for some patients, tiredness can be caused by certain antihistamines and not the condition itself.

Dr Marcus Butler, Respiratory Consultant at St Vincent's University Hospital, Dublin, and Medical Director at the Asthma Society of Ireland, said: “The findings are concerning for the asthma population in Ireland as while all of those surveyed reported experiencing asthma symptoms, 30 per cent had not sought advice from their healthcare practitioner in managing their symptoms.

“While the symptoms are frustrating for many, unmanaged hay fever or allergies can cause asthma symptoms to heighten and escalate into an asthma attack. An asthma attack is a respiratory emergency that should be taken seriously by patients and carers. Allergies and hay fever with asthma can be fatal. At least one person dies every week as a result of asthma.

“Our research showed that 50 per cent of those surveyed had had an asthma attack in the past year – 14 per cent had experienced an attack in the past four weeks alone, 19 per cent in the past six months and a further 16 per cent in the past 12 months. So good hay fever management is crucial in preventing an asthma emergency.

“We really encourage patients to kickstart an improvement of their hay fever symptoms and better asthma control by flagging these symptoms with their

GP. The results of this survey indicate that there would be a real value to all GPs routinely asking the following question with an asthma patient – 'and, what about the nose'. If patients and GPs don’t discuss these symptoms, then they can’t create a plan for managing them."

Ruth Morrow, Respiratory Nurse Specialist at the Asthma Society of Ireland said: “Spring and Summer are the peak times for people with hay fever with 51 per cent reporting increased symptoms at this high pollen time, that can really impact on quality-of-life and asthma management. Lying in bed at night and being close to meadows, fields or trees can further aggravate symptoms.

“The ALK supported pollen tracker on www.asthma.ie helps us to highlight when periods of high pollen or bad weather are coming up so people with hay fever can better manage their symptoms. We have also put together a number of practical tips for management of hay fever symptoms.”

Ibs Patients Do Not Have Increased Mortality Risk

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Having irritable bowel syndrome (IBS) does not put one at increased risk of premature mortality, the recent Irish Society of Gastroenterology (ISG) 2021 Summer Meeting heard.

Dr Kyle Staller, Gastroenterologist/ Neurogastroenterologist Director, Gastrointestinal (GI) Motility Laboratory, Massachusetts General Hospital, Boston, US, gave an update on the latest approaches in IBS.

IBS affects an estimated 10-15 per cent of the population with substantial impacts on quality-of-life and work productivity and is one of the most common presentations to gastroenterologists, he noted.

Fear about the potential serious nature of bowel symptoms may underlie much of the explanation for seeking care for IBS, and the literature suggests that more than half of IBS patients fear that their illness will shorten their lifespan.

Despite clear diagnostic criteria, such as the Rome IV definition, which Dr Staller feels can be too strict, most clinicians consider IBS a diagnosis of exclusion, and over 50 per cent of patients with IBS will undergo colonoscopy at some point in their diagnostic workup given fears over missing something more serious like cancer.

To address this issue, Dr Staller and colleagues used a nationwide Swedish histopathology register to conduct a matched population-based cohort study to examine the overall risk of death in individuals with IBS (over 45,000 people) undergoing colorectal biopsy compared to matched reference individuals. In a secondary cohort, they examined mortality in IBS patients without biopsy.

After adjustment for confounders, IBS was not linked to mortality (HR=0.96; 95% CI=0.92-1.00). Risk estimates were neutral when IBS patients were compared to their siblings. Underlying mucosal appearance on biopsy had only a marginal impact on mortality, and IBS patients without colorectal biopsy were at no increased risk of death (HR=1.02; 95% CI=0.99-1.06). There was no link to increased cancerrelated death either.

“Now this is not scientifically groundbreaking, but what I think it tells us is that we need to spend more time focusing on what is the diagnosis, rather than what is it not, and what treatment options can we offer these long-suffering patients,” Dr Staller commented.

In that regards, the recommended diagnostic approach in IBS should include faecal calprotectin testing in those with diarrhoea symptoms, Coeliac testing, for those due a colonoscopy; random colon biopsies to assess for microscopic colitis, and malabsorption bile acid testing, he said. Small intestinal bacterial overgrowth (SIBO) testing should be retired he said, based on the latest data, while routine colonoscopy is unnecessary for those with standard IBS symptoms.

Alarm symptoms for further testing include iron-deficiency anaemia, blood in the stools, older age, unintentional weight loss, palpable abdominal mass, and family history of organic GI disease.

Dr Staller shared interesting data showing the association between psychological conditions and symptoms (anxiety, early life trauma, etc), and the development of IBS and disease severity; and he reminded delegates of the biopsychosocial model (and brain/gut axis) of GI disease.

Regarding treatment, beyond motility agents, he cited data for gluten-free and FODMAP diets, which showed that FODMAP diets have good results in addressing symptoms, while probiotics are likely to provide some benefit with, on the whole, products containing Bifidobacterium (either alone or in a combination) showing good efficacy. Though he noted that the quality of data on probiotics remains inadequate and contradictory.

While there is a lot of interest in faecal microbiota transplantation (FMT), it has shown mixed results to date “and it is not necessarily benign either”, so the jury is still out, Dr Staller reported, adding that there is a lot more to learn about the role of the microbiome in relation to IBS.

Neuromodulators (“so off-label use of antidepressants like SSRIs”) can have a role in some patients.

Looking at non-pharmacological approaches for the treatment of IBS symptoms, Dr Staller said that cognitive behavioural therapy (CBT) and hypnotherapy have been shown to be effective in studies. “Of course, the problem in Ireland and the US is a lack of available therapists who are skilled in managing IBS.” That said, he noted that there are new apps that provide CBT support for IBS symptoms with more in development.

For those with severe IBS symptoms, Dr Staller said “a multidisciplinary approach really targeting the brain/gut axis” is necessary, and commented that he is seeing a lot of younger females recently with significant symptoms and disability.

Good Uptake Of New Haemochromatosis Venesection Service In General Practice

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The long-awaited roll-out of the HSE general practice venesection service for haemochromatosis patients has been very successful to date, with high up-take especially in more rural and peripheral areas, according to Prof Suzanne Norris, Consultant Hepatologist, St James’s Hospital, Dublin.

Prof Norris gave an update on the condition at the virtual Irish Society of Gastroenterology (ISG) 2021 Summer Meeting, where she presented data on the GP therapeutic phlebotomy service for eligible haemochromatosis patients, which only formally launched in 2020, following its approval in the HSE’s 2017 Model of Care for hereditary haemochromatosis (HH), and the necessary GP contract negotiations in 2018.

Despite the impact of the pandemic, a total of 5,887 HH phlebotomy claims were made by 720 GPs for 2,175 patients in 2020.

“This is a fantastic first year of the primary care programme for venesection services being provided by our GP colleagues. This is hugely beneficial for patients. It means venesection is being provided close to where you live. When you look at the geographical spread of where these GPs are located and providing the services, there is a huge number of patients accessing the services in CHO 2, which is

Mayo, Galway, and Roscommon, and also CHO 4, which is Kerry and Cork…,” as well as other more rural and peripheral areas outside the Dublin north-east region.

Prof Norris presented an overview of various studies on the impact of HH, and the arguments for screening to enable earlier detection and morbidity risk reduction. Ireland has a very high prevalence of HH compared to most countries, at 1.5 per cent (1:83) for HH c282Y mutation.

The Hemochromatosis and Iron Overload Screening (HEIRS) study, which evaluated the prevalence, genetic and environmental determinants, and potential clinical, personal, and societal effects of iron overload and haemochromatosis in a multicentre, multi-ethnic sample of 101,168 primary care adults (25 years+) in the US and Canada, showed that women with ferritin >1,000 were three times more likely to have significant liver disease, while men with ferritin >1,000 were six times more likely to have significant liver disease. Further research from the same group showed that patients with HH had a much higher risk of diabetes, liver disease, and liver cancer, but no increased risk of stroke and heart disease, she reported.

Arguments in favour of screening for haemochromatosis, Prof Norris said, include “the fact that Ireland has the highest prevalence of any country, the consequences of late diagnosis can be very severe, it is such a simple and easy disease to diagnose with cheap, widely available tests, and the treatment is very simple”.

On the other hand, arguments against screening include that “despite its prevalence in Ireland very few people will develop life-threatening disease”, she noted.

“Many patients with haemochromatosis may never need venesection, probably about 50 per cent. And there is an argument that the health system has higher priorities, and there is the argument about genetic discrimination against those who are diagnosed as having homozygosity who will never develop iron overload, but could experience discrimination in terms of life insurance, mortgage approval, and so on.”

However, there is good evidence for targeted screening in higher at-risk populations, including those with type 2 diabetes or cardiac disease (atypical arthropathy) or male sexual dysfunction, close relatives of HH patients, those with abnormal LFTs with raised iron markers, etc, though Prof Norris pointed out that elevations in ferritin levels are common, and in type 2 diabetics can be due to liver fat.

Women In Healthcare Urged To Apply For Mcginty Scholarship For Nui Galway Mba

Female health professionals are being encouraged to apply for a women-only scholarship for NUI Galway’s MBA programme.

The McGinty Scholarships were established by alumna Dr Geraldine McGinty, a physician executive and radiologist, to empower a new cohort of women who will lead improved and impactful outcomes for patients and healthcare staff.

The McGinty Scholarships are available each year to support two women – one physician and one allied healthcare professional in the MBA programme at NUI Galway.

Established in 2020, the scholarships were introduced to encourage and enable female physicians and allied healthcare professionals to engage in the MBA programme, to support them on a career path to leadership in the healthcare sector.

Speaking about the value of women in healthcare leadership, Dr McGinty said: “Despite women making up the majority of

Dr Geraldine McGinty the healthcare workforce they are typically underrepresented in the highest levels of leadership. We know diverse teams drive better results and outcomes so making sure women are prepared to assume senior leadership roles is a key goal.”

Emergency Medicine physician Dr

Odharna Ní Dhomhnalláin received the inaugural McGinty scholarship. She said: “Healthcare practitioners bring a unique insight, particularly with regard to patient care and healthcare problems that we encounter in our day-to-day practice. The MBA has been very helpful in broadening my thinking and exposing me to the business knowledge that I need in order to pursue leadership and management positions in the future.”

Ann Cosgrove, Chief Operations Officer at Saolta University Healthcare Group, said: “The hospital services operate with a predominantly female workforce, with women delivering and managing clinical services across our health service. Ensuring more women reach leadership roles will strengthen our teams. I am delighted that this scholarship has been made available to further develop key leadership pathways for women in the healthcare sector.”

Full details can be found at www. nuigalway.ie/mba.