Health Tips from Dr. Moghissi
Spring 2003

Spring Allergies
What is HIPAA
New Cosmetic Services
Next Issue

This year promises to be especially bad for spring allergies. What to do? There are ads everywhere for many different drugs, what should you use?

There are several different approaches you can take. The most common medications people will use are the antihistamines. Many of the allergy symptoms are caused by the release of histamine, and antihistamines block that release. The most common over the counter versions would be Benadryl, Tavist, and Chlor-Trimeton (and their various house brand versions). These all have properties of sedation, which make people tired and also slows reaction time (especially important when driving). A new class of non-sedating antihistamines was developed several years ago. Claritin, Clarinex, and Allegra are in this class. Another prescription antihistamine, Zyrtec, is sort of in between. It is generally considered mildly sedating. Claritin recently went “over the counter”, meaning you no longer need a prescription to buy it.

Claritin going over the counter has had several effects. Although it is less expensive than it was as a prescription, it costs more than other antihistamines, and more than most people were paying in copays from their insurance company. The insurance company would rather you pay for an over the counter medication, so many are requiring preauthorization before paying for the prescription antihistamines. In addition, some are requiring you try over the counter Claritin for a month and fail (not do well) before they pay for the prescription antihistamine. Finally, most have made the prescription antihistamines a higher tier, meaning a higher copay. So did we really win on this one?

There are other options, of course. If your primary symptom is nasal congestion, the antihistamines don’t work so well anyway. You can add a decongestant to the antihistamine (currently only pseudoephedrine is available), but many people have trouble sleeping while on this, and it can raise your blood pressure. Another option is the nasal sprays. The most common type would be the steroid nasal sprays. They work by decreasing inflammation in the nasal and surrounding area. This will decrease swelling. They are topical, not systemic, meaning they act locally in the nose without going into the blood stream and affecting the entire body. They can also be combined with antihistamines for additive effects. Some common ones would be Flonase, Nasonex, Nasacort and Rhinocort. Their major side effect would be nose bleeds in some people, especially when using this for a long time, although they are generally considered safe to use indefinitely. The nasal steroids also have the advantage of helping with some of the eye and sneezing symptoms.

There is an antihistamine nasal spray called Astelin, which also works well for nasal stuffiness. It is based on one of the older antihistamines though, and can cause drowsiness. Finally, NasalCrom is available over the counter which works by a totally different mechanism. It works really well in some people, not well at all in others.

Singulair, which was previously only used for asthma, has recently also been approved for use in allergies. I have not personally prescribed it much for this purpose, so I can only go by what the manufacturer says. It is supposed to help with nasal congestion and also general allergy symptoms. It very safe, and has few side effects. It turns out asthma and allergies are closely related, and this medication takes advantage of that.

When do you need to see an allergist? Allergy testing would be a major reason. If you want to know what you are allergic to so you can practice avoidance, or if you are interested in allergy shots, you should consider allergy testing.

In general, most allergy medication works best when started 2 weeks prior to exposure to the allergen, and when used regularly, as directed. By the way, much of the above goes for any type of allergy (with the possible exception of food allergies).

I hope this overview will be helpful in helping you decide how to approach this spring’s allergy season!

On April 14th 2003, the first set of HIPAA regulations will take effect. Most people will barely notice, but in the medical field this is a really big deal. HIPAA stand for Health Insurance Portability and Accountability Act, and was originally drafted to standardize billing in the medical industry. Somewhere along the way, privacy regulations were added in, and that is where the biggest impact will be.

You may see several changes the next time you go into a doctor's office. We are required to post the rules in a conspicuous space; mine are posted in each exam room. You will be receiving a copy of the rules to take home with you, and will be asked to sign that you have received them. You may refuse to sign, but we have to document that we gave you a copy of the rules and you refused to sign. You have the right to ask for and receive a copy of your medical records, unless we have a compelling reason not to allow you to see them. You have a right to amend your record. You will need to sign a special form to have your records released to anyone but another medical entity (generally a doctor). This will usually come up when you try to get life insurance and they want a copy of your medical records.

If you think your privacy has been breached, there is a form for filling out a grievance. Marketers cannot use your private health information (PHI) without your specific consent. Each medical practice has a privacy officer (ours is Donna) who is supposed to be up on the rules, and take in, file, and act on all these forms (although not necessarily in that order). If you want any private information, including lab test results, mailed to your home, you will need to complete another consent form. My patients have been completing email consent forms since I have been at this office in anticipation of this.

Those who have been to my office recently know I have moved all my patient records to the computer, and am using an electronic medical records (EMR) system. This is recommended under HIPAA, as it is harder for casual observers to see PHI when it is all on computer. (There will be no charts and random pieces of paper with people's private health information lying around.) Any business associate who has access to PHI will need to sign an agreement with me certifying that they will not release any information they receive to anyone else. My primary agreements will be with the computer vendor who maintains the system and does my electronic billing (same company), and the company that handles my email newsletter. Other offices will need to make agreements with transcription services, billing services, document destruction services, etc.

There are many more nuances that go along with HIPAA (the regulations are reportedly 500 pages long, but I can't confirm that), but this should give you an idea what we are up against. In addition, there are hefty fines and even jail terms for non-compliance. Pretty scary. Please be patient with your health care providers as we all try to comply with HIPAA!

I will being expanding into cosmetic procedures, so please let me know if you are interested in discussing medically-supervised options. I am in the process of getting prescription cosmetic creams and supplies for doing facial peels. I am very excited about these great creams (I can't wait to try them myself!) and a great peel system. Depending on interest and demand, I will also consider doing Botox injections. Let me know if you are interested. I'll include more information on this in the next newsletter.

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