The Principles of
Environmental Medicine and
The Diagnosis and
Treatment of Inhalant Allergies/Sensitivities
February 28
March 1, 2008
PURPOSE:
v
To enhance understanding of the multiple impacts of
environmental exposures on health.
v
To provide an initial overview of the field of
Environmental Medicine, within which Inhalant Allergies/Sensitivities is an
important component
v
To provide the practitioner with a comprehensive
program with which to assess and treat complex inhalant allergies and
sensitivities in the office setting.
v
To provide insights and techniques that can be used
in the office tomorrow, without making any major changes in the office, as well
as more advanced techniques for enhanced management.
OBJECTIVES:
Upon the completion of this course, the participant
should be able to:
v
Discuss the model of environmental medicine and how
it integrates with, and enhances the classic allopathic model of medicine.
v
Understand the multiple impacts of foods,
aeroallergens and chemical inhalants on health.
v
Take a detailed environmentally focused history.
v
On physical examination, recognize signs of
allergies and sensitivities in various body systems.
v
Prescribe practical strategies to help patients in
controlling environmental exposures.
v
Articulate an understanding of the basic immunology
involved in inhalant immunotherapy.
v
Understand the pros and cons of the pharmacotherapeutic options for allergic disease.
v
Articulate how to prevent, recognize and treat an
adverse or anaphylactic reaction.
v
Describe how to confirm clinical suspicions and
determine the levels of sensitivity with quantitative intradermal
testing for specific allergens.
v
Set up an allergy treatment plan and demonstrate
how to prepare a patients antigen vial(s) for immunotherapy.
v
Discuss how to manage common difficulties in the
administration of immunotherapy;
February 28, 2008
8:00 8:30 a.m. Introduction to Environmental Medicine
James W. Willoughby, II, D.O.,
Course Director
1. Discuss the
purpose and objectives of the course.
2. Articulate
the history of the American
8:30 9:15 a.m. The Model of Environmental Medicine: A New
and Effective
Approach to Complex Chronic Diseases
Gary R. Oberg, M.D., FAAEM
1. Discuss how
Environmental Medicine concepts are different than, and additive to classic
medical concepts.
2. Describe how to
use the basic concepts of Environmental Medicine in the diagnosis and treatment
of complex chronic disease.
9:15 10:00 a.m. The Complex Role of the Diet in Chronic
Diseases: Avoiding
Nutritional
Potholes in the Road to Optimal Health
Gary R. Oberg, M.D., FAAEM
1. Describe the
complex role of foods and nutrition in health and disease.
2. Explain how to
diagnose and correct adverse impacts of foods in chronic disease.
10:00-10:15 a.m. Questions & Answers.
10:15 10:45
a.m. Beverage Break
10:45 11:30 a.m. Man Made Chemical Exposures: Do These Contribute to
Chronic
Disease?
Lynn M. Marshall, M.D., FAAEM
1. Describe changes
in exposures over the last 60 years.
2. Review changes in
human health over the same time frame.
3. Examine the
evidence linking increased chemical exposures with adverse health outcomes.
4. Discuss why it is
important to take a detailed clinical and environmentally focused history.
11:30
12:30 p.m. Environmentally Focused
History: How to Identify Your Patients
Harmful or Potentially Harmful
Exposures
Lynn M. Marshall, M.D.,
FAAEM
1.
Determine when it is appropriate to take an
exposure history.
2.
Describe in detail how to take a proper
environmental exposure history.
3.
Explain how to interpret the results of this
history.
4.
Practice taking an exposure history with a partner.
12:30 2:00 p.m. Luncheon Sponsored by The Great Plains Laboratory, Inc. featuring keynote speaker William Shaw, Ph.D. speaking on "Deficient Cholesterol: A Common New Factor in Autism"
2:00 2:45 p.m. Documentation for Environmental Medicine:
A Higher Standard
James W. Willoughby, II,
D.O.
1. Describe the key
principles in integrating environmental medicine records with classical medical
records.
2. Demonstrate how
to keep medical records that will pass the test.
2:45 3:30 p.m. Aeroallergens: Natural History /
Distribution / Health Impacts
James W. Willoughby, II,
D.O.
1. Describe airborne
allergen types.
2. Explain
Thomens postulate.
3. Discuss dispersal
of inhalant antigens and effects on allergic symptoms.
4. Describe seasonal
versus perennial occurrence patterns.
5. Describe
how antigens are identified, standardized and manufactured.
3:30 4:15 p.m. Diagnosis of Allergic Disease- Sign and
Symptom Patterns
Diego Saporta, M.D.
1. Delineate
subjective allergic symptoms and how the patient presents these.
2. Explain how to
elicit unstated symptoms from the allergic patient.
3. Articulate how a
review of system-by-system physical findings reveals signs that help elucidate
the nature and current status of the patients allergic disease.
4.
4:15 4:45 p.m. Beverage Break
4:45 5:30 p.m. Environmental Modification Techniques
Diego Saporta, M.D.
1.
Discuss how reduction of natural aeroallergens and chemical
burdens on the body is of prime importance to effective therapy for
environment-associated conditions.
2.
Describe practical strategies for reduction of
exposure to harmful inhalant allergens and synthetic chemical inhalants.
5:30 6:00 p.m. Questions and Answers
February 29, 2008
8:00 9:00 a.m. Immunology of Inhalant Allergy:
How Immunotherapy and
Pharmacotherapy Work
A.L. Barrier, M.D., FAAO-HNS,
FAAOA
1.
Describe how our immune system works to protect us
against allergies.
2.
Discuss the nature of the allergic response.
3.
Explain the humoral
immune response.
4.
Recognize the immune mechanisms that suppress the
allergic response when immunotherapy is used.
5.
Outline pharmacotherapeutic
options indications, contraindications, advantages and disadvantages.
9:00
9:30 a.m. Adverse and Anaphylactic
Reactions:
How to Prevent, Identify and
Treat
A.L. Barrier, M.D.,
FAAO-HNS, FAAOA
1.
Define anaphylaxis.
2.
Articulate the biochemistry of adverse reactions
and anaphylaxis.
3.
Describe the treatment of adverse reactions and
anaphylaxis.
4.
How to prepare a kit for adverse reactions and emergencies.
9:30 - 9:45 a.m. Questions and Answers.
9:45 10:30 a.m. Serial Dilution Endpoint Titration
Principles and Whealing Responses
James W.
Willoughby, II, D.O.
1.
Describe the physiological principles of SDET.
2.
Describe preparation of allergenic extracts for
diagnostic testing and immunotherapy.
3.
Recognize normal and abnormal whealing responses.
4.
Discuss factors that affect whealing
response.
10:30 11:00 a.m. Beverage Break
11:00 11:45 a.m. Vertical Safety Screen and Linear Testing
James W.
Willoughby, II, D.O,
1.
Define the safety screen and linear titration.
2.
Discuss safety controls.
11:45 12:00 p.m. Questions and Answers.
12:00 1:30
p.m. Lunch
1:30 3:30 p.m. Testing Demonstration:
Serial Dilution Endpoint
Titration
Betsy Willoughby, R.N.
1.
Describe testing and treatment boards - how to
prepare extracts and controls.
2.
Express how to apply safety screen and controls,
and interpret skin wheals.
3.
Demonstrate serial dilution titration.
3:30 4:15 p.m. Beverage Break in Exhibit Hall
4:15 4:45 p.m. Serial Dilution Endpoint Titration
Practicum
Betsy Willoughby, R.N. & Faculty
1.
Explanation and group participation making testing
board 5 fold dilutions.
2.
Practice wheal induction technique and response
interpretation with a partner.
4:45 5:15 p.m. Questions and Answers.
March 1, 2008
8:00 9:30 a.m. Serial Dilution Endpoint Titration Dose
Calculations and Escalation
Betsy Willoughby, R.N.
1.
Describe how to calculate and escalate dosage for a
single allergen
2.
Articulate how to calculate and escalate multiple
allergen multi dose treatment vials
3.
Discuss dose incompatibilities
4.
Explain dose administration.
9:30 10:30 a.m. Practical Troubleshooting -- What To Do
If Treatment Does Not Succeed
James W. Willoughby, II, D.O,
1. Describe
realistic/unrealistic expectations of immunotherapy.
2. Discuss potential
technical obstacles to successful immunotherapy.
3. Recognize
local/systemic reactions with immunotherapy.
4. Illustrate
reactions at maintenance dose and when to re-assess the endpoint.
5. Identify
treatment failures.
10:30 11:15 a.m. Beverage Break in Exhibit Hall
11:15 12:00 p.m. Wrapping It All Up Questions and Answers
Panel Discussion
Faculty:
Lynn
M. Marshall, M.D., FAAEM
Room
1001
Gary
R. Oberg, M.D., FAAEM
Diego
Saporta, M.D.
Betsy
Willoughby
James
W. Willoughby, II, D.O.
Intended Audience:
Practicing MDs and DOs,
and other health professionals interested in enhancing the outcomes of common
complex illnesses contributed to by inhalant sensitivities, using
state-of-the-art, cause-oriented, patient-centered concepts and
modalities. This CME activity will be especially helpful for allergists,
occupational medicine physicians, toxicologists, and primary care physicians
who must triage or treat patients with inhalant sensitivities.
Educational Formats:
v
Plenary Sessions
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Roundtables
v
Case Presentations
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Question and Answer Sessions
v
Hands-On Practicum
v
Comprehensive Syllabus