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
15.1
Allergy sufferers report losing 15.1 productive work days each year.¹⁴
$245B
Direct annual medical costs for asthma and allergic rhinitis amount to more than $245 billion.²¹
400M
Worldwide, 400 million people suffer from allergic rhinitis.²¹
300M
300 million people around the world suffer from asthma.²¹
250M
Globally, 250 million people suffer from food allergies.²¹
90.6M
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.
The Nectar Solution
STEP 01
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.
OUR SOLUTION:
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.
STEP 02
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:
- Acacia Tree Allergy
- Alternaria Alternata Allergy
- Aspergillus Fumigatus
- Beech Tree Allergy
- Bermuda Grass Allergy
- Birch Tree Allergy
- Boxelder Allergy
- Cat Dander Allergy
- Cladosporium Herbarum Allergy
- Cockroach (German) Allergy
- Common Ragweed Allergy
- Common Sagebrush Allergy
- Dog Allergy
- Dust Mite (D. Farinae) Allergy
- Dust Mite (D. Pteronyssinus and D. Ferinae) Allergy
- Elm Allergy
- English Plantain Allergy
- Goosefoot Allergy
- Johnson Grass Allergy
- Mouse Urine Allergy
- Mugwort Allergy
- Mulberry Tree Allergy
- Nettle Allergy
- Oak Tree Allergy
- Olive Tree Allergy
- Orchard Grass Allergy
- Penicillium Notatum Allergy
- Plane Tree Allergy
- Poplar Allergy
- Rough Pigweed Allergy
- Russian Thistle Allergy
- Ryegrass Allergy
- Sheep Sorrel
- Sweet Vernal Grass Allergy
- Timothy Grass Allergy
- Walnut Tree Allergy
- White Ash Tree Allergy
- White Pine Allergy
- Willow Tree Allergy
How Does At-Home IgE Blood Spot Testing Compare?
SWIPE
| Nectar at-home IgE blood spot testing | Whole blood IgE testing | Skin prick testing (SPT) | |
|---|---|---|---|
| Patient Convenience | At-home sample collection, no appointment needed | Requires visiting laboratory testing centers or scheduling an in-person appointment | Requires visiting Allergy/ENT specialist clinic |
| Result shareability | Very easy | Very easy | Can be challenging (since the results are observer-dependent and need to be manually verified before sharing) |
| Sensitivity | Comparable²⁶ | 43-100%²⁶ | 68-100%¹⁹ |
| Specificity | Comparable²⁶ | 35-100%²⁶ | 70-91%¹⁹ |
| Limitations | 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. |
| Risks | 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.
STEP 03
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.
