The Nectar Solution for Your Patients
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The Seen (and Unseen) Impact of Allergy Suffering
The prevalence of allergic disease continues to grow. For example, 26.5 million Americans (8.3% of the population) suffer from asthma today, compared to 20 million in 2001.¹⁵
Allergy sufferers report losing 15.1 productive work days each year.¹⁴
Direct annual medical costs for asthma and allergic rhinitis amount to more than $245 billion.²¹
Worldwide, 400 million people suffer from allergic rhinitis.²¹
300 million people around the world suffer from asthma.²¹
Globally, 250 million people suffer from food allergies.²¹
90.6 million American adults report purchasing allergy medications at least once in the past 12 months.
What is nectar?
Nectar Allergy is a comprehensive care solution for patients that suffer from allergic rhinitis and allergic asthma. We work in parallel with primary care providers in the long-term management of these allergic conditions through the evidence-based practice of allergen immunotherapy.
Our goal is to enhance the medical care experience for your patients by providing them with a convenient, safe, and effective form of immunotherapy with the goal of long-term hyposensitization or desensitization of environmental allergies. We are able to achieve this through a thorough history and an in vitro specific-IgE test to develop a personalized solution for their allergies which was developed by our Board-Certified Allergists/Immunologists. This is not a quick solution, as you may know, and we are available to your patient through the entirety of their journey and always available for any questions or concerns.
Let Us Help: You Don’t Have to Do It Alone
Allergen immunotherapy is a proven, evidence-based treatment for allergies (which is a top-ten reason for primary care visits). But in the US, patient compliance is less than 50% because of the inconveniences (such as regular dosing in a specialist clinic) that subcutaneous shots (the predominant immunotherapy route in the US) require.
To combat the inconveniences of subcutaneous immunotherapy, the predominant immunotherapy route in the US, Nectar Allergy offers Sublingual Allergen Immunotherapy (SLIT), the preferred allergy immunotherapy route in Europe and recommended by the World Allergy Organization (WAO).
SLIT is a safe, evidence-based, disease-modifying, and convenient option that can help substantially reduce or even eliminate your patient's allergies. Our goal is to partner with you on this patient journey, not replace you. Nectar is here to help.
The Nectar Solution
An Evidence-Based Survey to Establish a Clinical Diagnosis
Nothing can substitute a detailed history when diagnosing allergies. Yet, as discussed, most patients do not get enough time with their healthcare providers to go in-depth about their environmental allergies. A combination of history and objective allergy testing can provide the most comprehensive and accurate method of diagnosing allergies.
A detailed evidence-based survey (questionnaire)
Patients can fill out our evidence-based questionnaire from the comfort of their homes. The questionnaire details everything needed to establish an allergy diagnosis (without time constraints).
In addition, our questionnaire is not a one-and-done snapshot of time. Instead, we track patients over time to determine how their allergies are evolving while on immunotherapy.
The Atopic March
Atopy refers to the sensitization and familial predisposition to develop an immunologic response to various allergens and the overproduction of IgE antibodies.¹³ The physical manifestations of this can change with time, depending on disease severity and genetic factors.¹¹ This phenomenon called the atopic march, typically begins as atopic dermatitis and can progress to food allergies, asthma, and allergic rhinitis.⁴
Studies have shown that atopic dermatitis is primarily due to epidermal barrier dysfunction, which leads to local and systemic release of Th2 cytokines. Repeated exposure to environmental allergies in this inflammatory environment increases the patient’s risk of systemic sensitization and the development of allergic rhinitis and allergic asthma.¹
With this in mind, we regularly follow up with the patient to monitor their allergy symptoms and response to therapy, thus creating a comprehensive (yet convenient) diagnostic tool.
Supplementing a Clinical Diagnosis – The Nectar Lab (CLIA-Certified)
Allergists use both skin prick testing and blood allergy testing to detect allergen-specific IgE. Both types of tests are well-validated and used clinically on a regular basis. A one-size-fits-all allergy test does not exist. This is because, as detailed in the table below, all tests have inherent strengths and weaknesses. At times, allergists may even order both forms of testing if the diagnosis remains unclear. At Nectar, we provide blood allergy testing through a convenient, at-home testing kit which is processed by our Clinical Laboratory Improvement Amendments (CLIA)-approved lab.
Why Does the CLIA Certification Matter?
Laboratories require CLIA certification to accept human samples for diagnostic testing. The certification aims to ensure the accuracy, reliability, and timeliness of patient test results regardless of the test setting.
To ensure such high standards (and quality control), the CDC oversees the Clinical Laboratory Improvement Advisory Committee (CLIAC). This team of laboratory specialists, medical professionals, administrators, and consumer representatives supplies the Department of Health and Human Services (DHHS) with suggestions to improve the quality and practice standards of CLIA-certified labs.
The Nectar Testing Process
Through a simple finger prick, our test is able to detect allergen-specific IgE antibodies with high sensitivity and specificity through a well-established assay from PerkinElmer. This assay has been used by hundreds of thousands of Americans to detect allergen sensitization. While testing alone cannot diagnose allergies, it is a vital component, along with a detailed history, to make the correct diagnosis.
The benefits of this device include²⁸:
- Low error risk as the ELISA processing is fully automated
- Reliability, convenience, and traceability due to automatic identification of patient barcodes
- Can run multiple allergens simultaneously
What Do We Test For?
Here’s a (continuously growing) list of allergens we presently test for:
- Alternaria Alternata
- Ash (White)
- Aspergillus Fumigatus
- Bermuda Grass
- Cladosporium Herbarum
- Cockroach (German)
- Common Ragweed
- Common Sagebrush
- Dust Mite (D. Farinae)
- Dust Mite (D. Pteronyssinus and D. Ferinae)
- English Plantain
- Johnson Grass
- Mouse Urine
- Mulberry Tree
- Olive Tree
- Orchard Grass
- Penicillium Notatum
- Plane Tree
- Rough Pigweed
- Russian Thistle
- Sweet Vernal
- Timothy Grass
- Walnut Tree
- White Pine
How Does At-Home IgE Blood Spot Testing Compare?
|Nectar at-home IgE blood spot testing||Whole blood IgE testing||Skin prick testing (SPT)|
At-home sample collection, no appointment needed
Requires visiting laboratory testing centers or scheduling an in-person appointment
Requires visiting Allergy/ENT specialist clinic
Can be challenging (since the results are observer-dependent and need to be manually verified before sharing)
Risk of false positives because elevated IgE levels don’t always reflect true allergies.²
Some state regulations restrict the availability of at-home testing.
Risk of false positives because elevated IgE levels don’t always reflect true allergies.²
Lab availability may be difficult in rural areas.
Decreased accuracy in patients taking certain medications such as antihistamines and select antidepressants.³
Highly reactive skin or those with chronic urticaria can increase the risk of false positives.¹²
Accuracy depends on the individual clinician’s observation and interpretation.
Needs to be done at a specialist’s (Allergist/ENT) office which often has limited availability.
Minimal to none
Minimal to none
Discomfort associated with multiple positive tests. Small risk of anaphylaxis.
Allergy Laboratory Testing: The Verdict
A one-size-fits-all allergy test does not exist. This is because, as detailed in the table above, all tests have inherent strengths and weaknesses.
For instance, serum IgE testing is helpful for patients who:
- Need to take antihistamines
- Cannot tolerate skin prick testing
- Suffer from skin diseases that can interfere with skin prick testing
- Have an increased risk of anaphylactic reactions
- Don’t have easy access to an Allergy specialist due to long wait times or geographic proximity
Other times, skin prick testing may be the more practical or affordable option for patients.²²
In other words, an allergy diagnosis requires both a relevant clinical history and a confirmatory diagnostic test, whether it be serum allergen-specific IgE testing or skin prick testing.
Disease Modifying Treatment – Sublingual Allergen Immunotherapy
Sublingual immunotherapy (SLIT) is a convenient, evidence-based, disease-modifying treatment that can help improve (and potentially eliminate) your patients’ allergies. In the US, subcutaneous immunotherapy (SCIT), also known as allergy shots, are the predominant form of allergen immunotherapy, mainly due to convention and influence from the health insurance industry. Most of Europe, Canada and other parts of the world have transitioned away from SCIT and towards SLIT due to the similar efficacy, improved safety profile, and notable convenience for patients, which helps with compliance.
The Nectar Journey — Help Your Patients Get Started Right Now!
A simple four-step process can help your patients overcome their allergies and take back control of their lives.
- STEP 01
Patients fill out our evidence-based survey
- STEP 02
Take the at-home allergy test and send us the samples
- STEP 03
Patients meet with an allergy expert virtually to review their survey and test results. If appropriate, a prescription for sublingual immunotherapy will be written.
- STEP 04
Receive a personalized sublingual drop extract delivered directly to their doorstep with easy-to-follow instructions.
It really is that easy! Click here to get started right now.
¹ Akei, H. S., et al. “Epicutaneous Aeroallergen Exposure Induces Systemic TH2 Immunity That Predisposes to Allergic Nasal Responses.” The Journal of Allergy and Clinical Immunology, vol. 118, no. 1, July 2006, https://doi.org/10.1016/j.jaci.2006.04.046.
² Alvela-Suarez, L., et al. “False-Positive Results of Serological Tests for Allergy in Alcoholic Patients.” Journal of Investigational Allergology & Clinical Immunology: Official Organ of the International Association of Asthmology and Sociedad Latinoamericana de Alergia E Inmunologia, vol. 29, no. 3, 2019, https://doi.org/10.18176/jiaci.0309.
³ Ansotegui, Ignacio J., et al. “IgE Allergy Diagnostics and Other Relevant Tests in Allergy, a World Allergy Organization Position Paper.” The World Allergy Organization Journal, vol. 13, no. 2, Feb. 2020, p. 100080. (http://paperpile.com/b/m4baNI/dZeX)
⁴ Bantz, Selene K., et al. “The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma.” Journal of Clinical & Cellular Immunology, vol. 5, no. 2, Apr. 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/WsKT)10.4172/2155-9899.1000202 (http://dx.doi.org/10.4172/2155-9899.1000202). (http://paperpile.com/b/m4baNI/WsKT)
⁵ Bergmann, K. C., et al. “Efficacy and Safety of Sublingual Tablets of House Dust Mite Allergen Extracts in Adults with Allergic Rhinitis.” The Journal of Allergy and Clinical Immunology, vol. 133, no. 6, June 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/5GzD)10.1016/j.jaci.2013.11.012 (http://dx.doi.org/10.1016/j.jaci.2013.11.012). (http://paperpile.com/b/m4baNI/5GzD)
⁶ Caffarelli, Carlo, et al. “Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma.” Journal of Clinical Medicine Research, vol. 9, no. 10, Oct. 2020, https://doi.org/ (http://paperpile.com/b/m4baNI/dFvz)10.3390/jcm9103381 (http://dx.doi.org/10.3390/jcm9103381). (http://paperpile.com/b/m4baNI/dFvz)
⁷ Calderón, M. A., et al. “Sublingual Allergen Immunotherapy: Mode of Action and Its Relationship with the Safety Profile.” Allergy, vol. 67, no. 3, Mar. 2012, https://doi.org/ (http://paperpile.com/b/m4baNI/PZvp)10.1111/j.1398-9995.2011.02761.x (http://dx.doi.org/10.1111/j.1398-9995.2011.02761.x). (http://paperpile.com/b/m4baNI/PZvp)
⁸ Calderon, M. A., et al. “Sublingual Immunotherapy for Treating Allergic Conjunctivitis.” Cochrane Database of Systematic Reviews , no. 7, July 2011, https://doi.org/ (http://paperpile.com/b/m4baNI/pp0z)10.1002/14651858.CD007685.pub2 (http://dx.doi.org/10.1002/14651858.CD007685.pub2). (http://paperpile.com/b/m4baNI/pp0z)
⁹ Ciprandi, G. “Clinical Bystander Effect Exerted by Allergen Immunotherapy: A Hypothesis.” European Annals of Allergy and Clinical Immunology, vol. 47, no. 2, Mar. 2015, (http://paperpile.com/b/m4baNI/BIkz)https://pubmed.ncbi.nlm.nih.gov/25781197/ (https://pubmed.ncbi.nlm.nih.gov/25781197/). (http://paperpile.com/b/m4baNI/BIkz)
¹⁰ “Polysensitization as a Challenge for the Allergist: The Suggestions Provided by the Polysensitization Impact on Allergen Immunotherapy Studies.” Expert Opinion on Biological Therapy, vol. 11, no. 6, June 2011, https://doi.org/ (http://paperpile.com/b/m4baNI/5lR7)10.1517/14712598.2011.576246 (http://dx.doi.org/10.1517/14712598.2011.576246). (http://paperpile.com/b/m4baNI/5lR7)
¹¹ Filipiak-Pittroff, B., et al. “Predictive Value of Food Sensitization and Filaggrin Mutations in Children with Eczema.” The Journal of Allergy and Clinical Immunology, vol. 128, no. 6, Dec. 2011, https://doi.org/ (http://paperpile.com/b/m4baNI/fXGn)10.1016/j.jaci.2011.09.014 (http://dx.doi.org/10.1016/j.jaci.2011.09.014). (http://paperpile.com/b/m4baNI/fXGn)
¹² Heinzerling, Lucie, et al. “The Skin Prick Test - European Standards.” Clinical and Translational Allergy, vol. 3, no. 1, Feb. 2013, p. 3. (http://paperpile.com/b/m4baNI/2LXg)
¹³ Johansson, S. G., et al. “Revised Nomenclature for Allergy for Global Use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003.” The Journal of Allergy and Clinical Immunology, vol. 113, no. 5, May 2004, https://doi.org/ (http://paperpile.com/b/m4baNI/4HXq)10.1016/j.jaci.2003.12.591 (http://dx.doi.org/10.1016/j.jaci.2003.12.591). (http://paperpile.com/b/m4baNI/4HXq)
¹⁴ Lamb, C. E., et al. “Economic Impact of Workplace Productivity Losses due to Allergic Rhinitis Compared with Select Medical Conditions in the United States from an Employer Perspective.” Current Medical Research and Opinion, vol. 22, no. 6, June 2006, https://doi.org/ (http://paperpile.com/b/m4baNI/qD4o)10.1185/030079906X112552 (http://dx.doi.org/10.1185/030079906X112552). (http://paperpile.com/b/m4baNI/qD4o)
¹⁵ Liang, S. Y., and J. Marschall. “Update on Emerging Infections: News from the Centers for Disease Control and Prevention. Vital Signs: Central Line-Associated Blood Stream Infections--United States, 2001, 2008, and 2009.” Annals of Emergency Medicine, vol. 58, no. 5, Nov. 2011, https://doi.org/ (http://paperpile.com/b/m4baNI/6v4c)10.1016/j.annemergmed.2011.07.035 (http://dx.doi.org/10.1016/j.annemergmed.2011.07.035). (http://paperpile.com/b/m4baNI/6v4c)
¹⁶ Maloney, J., et al. “Efficacy and Safety of Grass Sublingual Immunotherapy Tablet, MK-7243: A Large Randomized Controlled Trial.” Annals of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 112, no. 2, Feb. 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/gEzE)10.1016/j.anai.2013.11.018 (http://dx.doi.org/10.1016/j.anai.2013.11.018). (http://paperpile.com/b/m4baNI/gEzE)
¹⁷ Masuyama, K., et al. “Efficacy and Safety of SQ House Dust Mite Sublingual Immunotherapy-Tablet in Japanese Children.” Allergy, vol. 73, no. 12, Dec. 2018, https://doi.org/ (http://paperpile.com/b/m4baNI/lDVt)10.1111/all.13544 (http://dx.doi.org/10.1111/all.13544). (http://paperpile.com/b/m4baNI/lDVt)
¹⁸ Navarro, Séverine, et al. “Bystander Immunotherapy as a Strategy to Control Allergen-Driven Airway Inflammation.” Mucosal Immunology, vol. 8, no. 4, July 2015, p. 841. (http://paperpile.com/b/m4baNI/sfmm)
¹⁹ Nevis, Immaculate F., et al. “Diagnostic Accuracy of Skin-Prick Testing for Allergic Rhinitis: A Systematic Review and Meta-Analysis.” Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, vol. 12, no. 1, Apr. 2016, p. 20. (http://paperpile.com/b/m4baNI/ELwo)
²⁰ Passalacqua, G., et al. “The Safety of Allergen Specific Sublingual Immunotherapy.” Current Drug Safety, vol. 2, no. 2, May 2007, https://doi.org/ (http://paperpile.com/b/m4baNI/wyGG)10.2174/157488607780598340 (http://dx.doi.org/10.2174/157488607780598340). (http://paperpile.com/b/m4baNI/wyGG)
²¹ Pawankar, Ruby. “Allergic Diseases and Asthma: A Global Public Health Concern and a Call to Action.” The World Allergy Organization Journal, vol. 7, Jan. 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/Wxre)10.1186/1939-4551-7-12 (http://dx.doi.org/10.1186/1939-4551-7-12). (http://paperpile.com/b/m4baNI/Wxre)
²² Portnoy, Jay M. “Appropriate Allergy Testing and Interpretation.” Missouri Medicine, vol. 108, no. 5, 2011, p. 339. (http://paperpile.com/b/m4baNI/s6jA)
²³ Qin, Y. E., et al. “Clinical Efficacy and Compliance of Sublingual Immunotherapy with Dermatophagoides Farinae Drops in Patients with Atopic Dermatitis.” International Journal of Dermatology, vol. 53, no. 5, May 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/ahbD)10.1111/ijd.12302 (http://dx.doi.org/10.1111/ijd.12302). (http://paperpile.com/b/m4baNI/ahbD)
²⁴ Radulovic, Suzana, et al. “Sublingual Immunotherapy for Allergic Rhinitis.” Cochrane Database of Systematic Reviews , vol. 2010, no. 12, Dec. 2010, https://doi.org/ (http://paperpile.com/b/m4baNI/Dmq0)10.1002/14651858.CD002893.pub2 (http://dx.doi.org/10.1002/14651858.CD002893.pub2). (http://paperpile.com/b/m4baNI/Dmq0)
²⁵ Shao, J., et al. “Efficacy and Safety of Sublingual Immunotherapy in Children Aged 3-13 Years with Allergic Rhinitis.” American Journal of Rhinology & Allergy, vol. 28, no. 2, Mar. 2014, https://doi.org/ (http://paperpile.com/b/m4baNI/S2r1)10.2500/ajra.2014.28.4006 (http://dx.doi.org/10.2500/ajra.2014.28.4006). (http://paperpile.com/b/m4baNI/S2r1)
²⁶ Siles, Roxana I., and Fred H. Hsieh. “Allergy Blood Testing: A Practical Guide for Clinicians.” Cleveland Clinic Journal of Medicine, vol. 78, no. 9, Sept. 2011, pp. 585–92. (http://paperpile.com/b/m4baNI/opJP)
²⁷ Yang, J., et al. “Clinical Efficacy and Safety of Artesimia Annua-Sublingual Immunotherapy in Seasonal Allergic Rhinitis Patients Based on Different Intervention Time.” International Archives of Allergy and Immunology, vol. 183, no. 8, 2022, https://doi.org/ (http://paperpile.com/b/m4baNI/VPs7)10.1159/000524108 (http://dx.doi.org/10.1159/000524108). (http://paperpile.com/b/m4baNI/VPs7)
²⁸ Ziegler, K., et al. “Comparative Analysis of the Euroimmun CXCL13 Enzyme-Linked Immunosorbent Assay and the ReaScan Lateral Flow Immunoassay for Diagnosis of Lyme Neuroborreliosis.” Journal of Clinical Microbiology, vol. 58, no. 9, Aug. 2020, https://doi.org/ (http://paperpile.com/b/m4baNI/Wii6)10.1128/JCM.00207-20 (http://dx.doi.org/10.1128/JCM.00207-20). (http://paperpile.com/b/m4baNI/Wii6)