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 patient’s 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 Academy of Environmental Medicine

 

            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 Thomen’s 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 patient’s 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:

 

A.L. Barrier, M.D., FAAO-HNS, FAAOA

One Hospital Drive Room MA 314         

Columbia,  MO  65212

 

Lynn M. Marshall, M.D., FAAEM

76 Grenville St.

Room 1001

Toronto, Ontario  M5S 1B2

CANADA

 

Gary R. Oberg, M.D., FAAEM

31 North Virginia St.

Crystal Lake, IL  60014

 

Diego Saporta, M.D.

470 North Avenue

Elizabeth, NJ  07208

 

Betsy Willoughby

24 South Main St.

Liberty, MO  64068

 

James W. Willoughby, II, D.O.

24 South Main St.

Liberty, MO  64068

 

Intended Audience:

 

Practicing MD’s and DO’s, 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

v     Roundtables

v     Case Presentations

v     Question and Answer Sessions

v     Hands-On Practicum

v     Comprehensive Syllabus