2003 - Autumn by Arkansas Blue Cross and Blue Shield

~ responding to your “top four” needs — P. 20 ~

Autumn 2003

from the n e w s

s t o r i e s

HEALTH f r o m

Drug industry spent $2.7 billion on drug advertising in 2001 The pharmaceutical industry’s spending on direct-to-consumer (DTC) advertising has increased significantly in recent years, more than tripling from $800 million in 1996 to $2.7 billion in 2001, according to a news release from the Henry J. Kaiser Family Foundation. A new study by researchers at the Harvard School of Public Health, Massachusetts Institute of Technology, and Harvard Medical School for the Kaiser Family Foundation, found that increases in advertising have had a significant impact on drug-spending growth. In 2000, researchers estimated that 12 percent of drug-spending growth, or about $2.6 billion, was related to increased spending on DTC advertising, with each additional dollar in DTC advertising yielding an additional $4.20 in drug sales that year, the release noted.

Comprehensive health care cost data available The Blue Cross and Blue Shield Association (BCBSA) recently announced the publication of its second annual Medical Cost Reference Guide — one of the most comprehensive collections of health care cost information available. BCBSA developed this publication to help shed light on an important national issue — access for affordable health care. The report highlights the key drivers of health care costs including: • Hospital costs — Between 2000 and 2001, the fastest-growing components of private health care costs were outpatient services (15 percent), while inpatient hospitals grew about 6 percent. • Cost-shifting — Cost-shifting has significantly increased as private payers are forced to pay more than it costs for their members, while the Medicare and Medicaid programs are underpaying for hospital services. • Drug costs — Prescription drug costs continue to be one of the top drivers of health care costs, growing by 11 percent between 2000 and 2001. Rising pharmaceutical costs are being driven by the increased use of prescription drugs, price increases and switching to

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higher cost drugs. The guide is available to download through BCBSA’s newsroom at www.bcbs.com.

Blue Plans collaborating with FDA to improve patient safety Blue Plans across the country are working with the U.S. Food and Drug Administration (FDA) to improve patient safety and to promote more effective and efficient use of pharmaceuticals, Allan M. Korn, M.D., chief medical officer of the Blue Cross and Blue Shield Association, wrote in a letter to the editor published in the Chicago Tribune Magazine. The issues of patient safety and rising health care costs — two of the most important issues facing health care today — won’t resolve themselves, according to Korn. Because it also is unrealistic to believe that federal regulators and the pharmaceutical industry can resolve these issues alone, he noted, physician leaders from Blue Plans began collaborating with the FDA. Through a new, national drug safety communications infrastructure, the Blue System will be able to send FDA-endorsed warnings and other important information to many physicians and employers in the Blue network, wrote Korn.

Drug ads impact studied According to a spokesperson from the American Medical Association, many doctors feel pressured to write prescriptions for drugs because patients are seeking “instant gratification.” A recent study found that television advertising accounted for about 12 percent of the growth in spending on prescription drugs in 2000. Since the U.S. Food and Drug Administration (FDA) relaxed its rules on television advertising, an increasing number of doctors have had patients come to their offices and demand a drug they saw advertised on television. According to an FDA survey last year of 500 doctors, 75 percent believed television ads caused their patients to think a drug worked better than it really did. And, 25 percent felt pressure to prescribe a drug that a patient had seen advertised on television. Blue & You Autumn 2003

Customer Service Numbers Little Rock Toll-free Number (501) Number

Category

State/Public School Employees 378-2437 1-800-482-8416 e-mail: publicschoolemployees@arkbluecross.com stateemployees@arkbluecross.com Medi-Pak (Medicare supplement)

378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) Part B (physician benefits)

378-3151 1-877-356-2368 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products), BlueCare Dental 378-2010 1-800-238-8379 Group Services

378-2070

BlueCard®

378-2127 1-800-880-0918

Federal Employee Program (FEP)

312-7931 1-800-482-6655

Health Advantage

221-3733 1-800-843-1329

BlueAdvantage Administrators

378-3600 1-800-522-9878

Pharmacy Customer Service (AdvancePCS): Arkansas Blue Cross and Blue Shield Health Advantage BlueAdvantage Administrators Specialty Rx

1-800-421-1112

1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779

For information about obtaining coverage, call: Category

Little Rock Toll-free Number (501) Number

Medi-Pak (Medicare supplement)

378-2937 1-800-392-2583

BasicBlue®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583

Regional Office locations are: Central, Little Rock; Northeast, Jonesboro; Northwest, Fayetteville; South Central, Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana; and West Central, Fort Smith. Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone numbers above.

Web sites:

www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.

Blue & You Autumn 2003

INSIDE THIS ISSUE

~autumn 2003~

From the Health files ................................... 2 What is an allergy? ...................................... 4 Hay fever “no-nos” ...................................... 5 Coping with asthma ..................................... 6 Childhood asthma ........................................ 7 The skinny on skin allergies ..................... 8-9 Food … friend or foe? .......................... 10-11 Not a food allergy, then what? ................... 12 When blue eyes turn pink .......................... 13 Avoiding indoor allergens .......................... 14 Taking the sting out of an insect bite ........ 15 Anaphylaxis = extreme reaction ................ 16 Antihistamines information ....................... 18 The pharmacist is in .................................. 19 Claritin now available over the counter ..... 19 Top four customer needs addressed ..... 20-21 New Web-based group enrollment ............. 22 Race For The Cure … and watch ............... 22 My BlueLine: 24-hour-a-day IVR system ..... 23 Women’s Health and Cancer Rights Act ..... 23 Seeking clarification of law ...................... 23 Members give “thumbs up” to HEP ............ 24 New animated TV tunes ............................. 25 Sundae party winners ................................ 26 Blue & Your Community ............................. 27 Blue On-Line .............................................. 28 Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Tammi Bradley, Janice Drennan, Damona Fisher and Kathy Luzietti

What is an allergy? ou can run, but you can’t hide. They are Yallergies, and they can find you whether

sudden and affects the whole body (see article on page 17).

you are mowing your lawn, dusting your credenza or petting your cat. An allergy is basically an overreaction of the immune system. If you have allergies, you probably have a sensitive immune system that is always on the alert for substances in the environment called “allergens.” For most people, an allergen is a harmless substance. A good example is pollen, which is often in the air during the spring and fall seasons. It causes the immune system of those with allergies to react as if the substance was harmful. Allergies are a common problem, and they affect at least two out of every 10 Americans.

Tell me more

What is an allergic reaction? When you have a reaction to an allergen, your body begins to produce a specific type of antibody (called IgE) to fight the allergen. The antibodies then attach to a form of blood cell called a mast cell, which are in the airways and gastrointestinal tract. The mast cells explode, releasing chemicals, including histamine, which causes most of the symptoms of an allergy. If the allergen is in the air, the allergic reaction will occur in the eyes, nose and lungs. If the allergen is ingested, the reaction will occur in the mouth, stomach and intestines. If the allergen touches the skin, the reaction will be noticeable on the skin.

Allergies are inherited, which means they are passed on to children from their parents. Although people inherit a tendency to be allergic, they do not inherit an allergy to a specific allergen. When one parent is allergic, the child has a 50 percent chance of having allergies. When both parents are allergic, the risk jumps to 75 percent.

Allergies make me miserable. What can I do? • If you have a food allergy, you must limit your intake. When you dine out, be sure and ask how the meals will be prepared so you can avoid those foods that cause you to have an allergic reaction. Learn to read food labels and check for problem foods. • If you are allergic to pollen or other airborne substances, keep your windows closed and use air conditioning. There also are over-thecounter medications available such as Claritin, Benadryl, Chlor-Trimeton, Dimetapp and Tavist. Over-the-counter antihistamine eye drops can relieve red, itchy eyes, and nasal sprays can be used to treat seasonal or yearround allergies. Decongestants relieve nasal congestion and are available without a prescription at your local pharmacy. Over-thecounter decongestants include Actifed, NeoSynephrine, Sudafed, Afrin nasal spray and Visine eye drops. • Finally, speak to your physician about the most appropriate way to fight your allergies. — Sources: The American Academy of Allergy, Asthma & Immunology and www.WebMD.org

Symptoms Mild allergy symptoms include rash, hives, watery eyes and congestion. Moderate symptoms may spread to other parts of the body and include itchiness or difficulty breathing. A severe reaction, called anaphylaxis, is a rare, life-threatening emergency in which the body’s response is

An allergy is basically an overreaction of the immune system. Blue & You Autumn 2003

Hay fever sufferers may need to avoid pollen and pets

The yellow

dusting of pollen that cloaks your car in the springtime isn’t likely to evoke pleasant thoughts of flowers and fields if you suffer from hay fever. It’s more likely to conjure up images of being a prisoner in your own home with a box of tissues in one hand and nasal spray in the other. Hay fever (or allergic rhinitis) is an allergic response to pollen (the male component of the plant reproductive system), to mold (a type of fungus usually found in the outdoor environment or in the musty corner of your basement), or to other microscopic substances. Hay fever may be seasonal or year-round. In the spring, pollinating trees are responsible for causing hay fever. During the summer, grasses and weeds are the culprit. And, in the fall, ragweed is usually the cause. Agents present throughout the year such as dust, mold, animal dander and feathers cause year-round hay fever. It is common for those with hay fever to be allergic to more than one agent. The symptoms of hay fever are: • Prolonged, sometimes violent sneezing; • Itchy, painful nose, throat and roof of mouth; • Stuffy, runny nose; • Postnasal drip, resulting in coughing; • Watery, itchy eyes; • Head and nasal congestion; • Ear pressure or fullness; and • Fatigue. Your body’s immune system interprets the allergen as an “invader” and releases histamine into the bloodstream. Histamine causes inflammation of the sinuses, nose and mucus membranes of the eyes. The swelling reaction is designed to block the invader from entering the body, and the sneezing reaction is to expel the invader from the body. Although hay fever can occur at any stage of life, most people develop hay fever before age 30.

Can hay fever be prevented? Although a tendency to develop hay fever is possibly in your genes, you may be able to avoid symptoms by taking preventive steps and being alert to the signals. If Blue & You Autumn 2003

you have eczema or asthma, be aware that you may be more likely to develop hay fever. Consult your physician for specific recommendations that may help you. Also, strengthen your immune system with a healthy lifestyle including wholesome foods, exercise and plenty of rest. Cut down on environmental pollutants and toxins as much as possible by keeping your home clean and your yard neat. The best way to avoid allergy symptoms is to avoid the substance that you are allergic to — something that is often not easily done.

How can I treat my hay fever? The most effective course of treatment for allergies is avoidance, although that is not always possible. Air filters can help remove airborne pollen from your home, and facemasks (like those worn by surgeons) can reduce the amount of the allergen you inhale while you are outdoors. Treatment options include: • Antihistamines — Nonprescription antihistamines such as Claritin or Benadryl usually are effective in treating mild cases of hay fever. They don’t prevent the release of histamine, but they do prevent some of the chain reactions triggered by histamine, which reduces the symptoms. • Decongestants — Over-the-counter decongestants (pills, drops or sprays) such as NeoSynephrine or Sudafed, help clear nasal passages and improve breathing.

When should I call my doctor? If your condition becomes so severe that it interferes with your life and you’re unable to control it with overthe-counter medications, you should contact your physician. He or she may give you prescription-strength antihistamines or decongestants to help. Steroids, usually a nasal spray, also can be used but are only available by prescription. A secondary infection may develop in congested sinus cavities; signs are fever, pain, a yellow or green discharge, postnasal drip, and sinus or tooth tenderness. — Sources: American Academy of Allergy, Asthma & Immunology, the National Institutes of Health and www.WebMD.org

oughing, chest tightness, shortness of breath, wheezing — these are all symptoms of asthma, a chronic lung disease that affects more than 17 million Americans. If you have asthma, you can help control the symptoms by avoiding the triggers and working with your physician to create an asthma management and treatment plan. Asthma symptoms can be triggered by various factors including: allergens or irritants, viral or sinus infections, exercise, reflux disease (stomach acid flowing back up to the esophagus), medications or foods, and emotional anxiety. Approximately 78 percent of those with asthma also have allergic rhinitis, better known as “hay fever.” Symptoms of both may be triggered by seasonal or yearround allergens (allergens are any substance that triggers allergies), which can include airborne pollens and molds, animal dander (dead skin flakes), house dust, mite and cockroach droppings, and indoor molds. If your asthma is triggered by allergens, it is a good idea to avoid them as much as possible. Some substances do not trigger allergies but can irritate the nose and airways; thus are called “irritants.” Examples of irritants include air pollutants (such as tobacco smoke), strong odors, sprays (such as perfumes), household cleaners, airborne particles (such as chalk dust or talcum powder), and changing weather conditions. Viral conditions, such as colds or viral pneumonia, may trigger or aggravate asthma, especially in young children. These infections can irritate the airways, nose, throat, lungs and sinuses; and this added irritation often causes asthma flare-ups. Vigorous physical exercise also may trigger an asthma attack. Breathing through your mouth, exercising in cold, dry air, or engaging in prolonged activities such as distance running can increase the chances of exercise-induced asthma. Gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back up the esophagus, affects up to 89 percent of patients with asthma. Symptoms include severe or repeated heartburn, belching, night asthma, increased asthma symptoms after meals or exercise, or frequent coughing and hoarseness.

Coping

Taking certain medications may cause some adults to have an asthma attack. Medications that trigger asthma symptoms include aspirin or non-steroidal anti-inflammatory drugs such as ibuprofen, and beta-blockers (used to treat heart disease, high blood pressure or migraine headaches). Those with asthma should consult their physician before taking any over-thecounter medications. For approximately 6 to 8 percent of children with asthma, certain foods such as milk, eggs, peanuts, soy, wheat, fish and shellfish may trigger an asthma attack. Emotional anxiety by itself is not enough to trigger an asthma attack. However, anxiety and nervous symptoms can cause fatigue, which also may increase asthma symptoms and increase the possibility of an attack. As with any other chronic condition, proper rest, nutrition and exercise are important to overall well-being and can help in managing asthma.

with

asthma

Managing asthma According to the national Guidelines for the Diagnosis and Management of Asthma, there are six goals for the effective management of asthma: 1. Prevent chronic and troublesome symptoms. 2. Maintain (near) “normal” breathing. 3. Maintain normal activity levels, including exercise. 4. Prevent recurrent asthma flare-ups and minimize the need for emergency room visits or hospitalizations. 5. Provide optimal medication therapy with no or minimal adverse effects. 6. Meet patients’ and families’ expectations of satisfactory asthma care.

Medication treatment Medications used to manage and treat asthma include: anti-inflammatory agents, which prevent and stop inflammation of the lungs; corticosteroids, which are an effective medication used in an inhaled or oral form; bronchodilators, generally used as “rescue medications” to open up the bronchial tubes so that more air can flow through; and anti-leukotrienes, which fight potent chemicals responsible for airway inflammation within the body. As part of a treatment plan, those with asthma may use a peak flow meter to monitor how much air is pushed out of the lungs. With a peak flow meter, asthma patients receive a peak flow number to fit into a treatment plan. The Blue & You Autumn 2003

number lets you know what asthma “zone” you are in and then decide what treatment to pursue.

CHILDHOOD ASTHMA

The cost of asthma Severe asthma sufferers spend $12,813 per year caring for their asthma, according to a comprehensive study of the direct and indirect costs of asthma published in the June 2003 Journal of Allergy and Clinical Immunology (JACI). Patients with moderate asthma spend $4,531 per year while those with mild asthma spend $2,646 per year. Direct costs, such as medication and visits to the doctor account for 65 percent of the cost; while the indirect costs, such as loss of work productivity, account for 35 percent. Medical costs account for 85 percent of direct costs, with prescription medications accounting for 50 percent of all direct costs. The other medical costs include doctor’s office visits, outpatient procedures related to asthma, and hospital admissions. Approximately 98 percent of asthma sufferers take at least one asthma medication, and 75 percent of those with asthma report doctor visits other than those to the emergency room within the past year. If just 5 percent of severe asthma sufferers were able to reduce their asthma severity level to moderate, it would save $1.4 billion annually. One proven way to reduce asthma severity levels is to use appropriate management and treatment plans, such as those outlined in the National Asthma Education Prevention Program (NAEPP) guidelines. A recent update of the NAEPP guidelines can be found on the Web at www.nhibi.nih.gov/ guidelines/asthma/asthsumm.htm.

Just remember If you or someone in your family has asthma, it is important to work closely with your physician to develop an asthma management plan to treat and manage your asthma.

early five million children in the United States have asthma, the most common serious chronic disease of childhood. Asthma is the cause of almost three million visits to the doctor and 200,000 hospitalizations. In infants and children, asthma may appear as a cough, noisy breathing or chest congestion. For children, asthma may interfere with many school and extracurricular activities. Parents may notice that their child has less stamina during activities than his or her friends, or they may notice that their child avoids physical activities to prevent coughing or wheezing. More subtle signs of asthma, such as chest tightness, often are not identified by children because they are so used to living with it. Often, recurrent or constant coughing spells may be the only noticeable symptom in young children. Up to 80 percent of children with asthma develop symptoms before age 5. It is essential that children with asthma be protected from irritants such as tobacco smoke, which causes chronic irritation of the airways. Studies have shown that children born to a mother who smokes or who live with a smoker have a much higher incidence of asthma and respiratory infections. Based on a child’s history and symptoms, the physician must consider various conditions and the child’s environment when making a diagnosis of asthma. When asthma is diagnosed, the child’s physician and parents must work together on an effective management and treatment plan. If the child is very young, parents must assist by observing for possible asthma symptoms, helping the child use a peak flow meter to objectively measure the ease or difficulty of breathing, and ensuring the child receives appropriate medications when needed. Older children can follow a management and treatment plan with less supervision.

Frequently asked questions from parents What is the natural course of asthma? Will my child outgrow it? Will the symptoms improve? Because asthma is a disease that does not follow a set course, predicting symptoms and progress is not possible. Some children have asthma symptoms that improve during adolescence, while others worsen. Sometimes, symptoms in young children seem to resolve themselves but return later in life. For most children, asthma can be controlled with appropriate management and treatment. Although asthma is a chronic illness, it does not have to be debilitating. Children with asthma can have normal or near-normal lung function with appropriate treatment and medications. It also is possible for a child with asthma to have normal endurance; there are many professional and Olympic athletes who have asthma.

— Sources: American Academy of Allergy, Asthma & Immunology and the National Institutes of Health Blue & You Autumn 2003

Dermatitis

Dermatitis means inflammation of the skin. Types of dermatitis include: • Atopic dermatitis (eczema) • Nummular dermatitis (nummular eczema) • Hives (urticaria) • Contact dermatitis Dermatitis may be chronic or acute and is usually associated with allergies. Dermatitis produces rashes, itching, inflammation and sometimes infection. Those with chronic dermatitis suffer not only from the tormenting physical symptoms but also from emotional distress associated with their physical appearance and avoidance of allergens that aggravate the disease, which often dictates a change in lifestyle (i.e., finding a new home for the family pet).

Eczema Atopic dermatitis, commonly called eczema, is a chronic disease in people who have a genetic predisposition to develop the condition. They usually have asthma or hay fever or have a family history of these allergic conditions. When eczema breaks out, the skin becomes extremely itchy and inflamed and often exhibits redness, swelling, cracking, weeping, crusting and scaling. Scratching, the natural response of the person with this condition, often leads to infection. When in remission, those who have eczema have skin that is dry and easily irritated. Although eczema symptoms appear in 90 percent of patients before the age of 5, they can develop at any time of life. After age 30, onset is less common and often occurs after exposure of skin to harsh conditions. Eczema can be dormant for periods of time but can persist for years. More than 15 million people in the United States have symptoms of the disease. Like many allergies, the cause of eczema is unknown, but both genetic and environmental factors play a role in its development. Eczema is not an emotional disorder, but stress can trigger flare-ups and aggravate the disease. The most important clues to a diagnosis of eczema are:

Are your allergies • a personal or family history of atopic disorders (eczema, hay fever, asthma); • intense itching; • characteristic rash in locations typical of the disease (on babies, around the cheeks and chin and on knees and elbows when the baby starts crawling; in childhood, behind knees, inside elbows, on the sides of the neck, on wrists, ankles and hands; in adulthood, often on hands and limbs, but can appear anywhere on the body); and • chronic or repeatedly occurring symptoms. A physician may order a skin biopsy to be certain of the diagnosis. Patch testing of the skin may help the patient avoid allergens that trigger or worsen symptoms. A blood test to check the level of IgE (an antibody whose levels are often high in atopic dermatitis) or white blood cells also may help in diagnosis. People who have eczema should avoid: • Wool or synthetic fibers • Soaps and detergents • Perfumes and cosmetics • Chlorine, mineral oil and solvents • Dust or sand • Cigarette smoke • Dog or cat hair and dander Scientists and physicians disagree on whether food allergies play a role in eczema. Some recommend avoidance of eggs, peanuts, milk, fish, soy products and wheat. Breast feeding an infant may have a protective effect for the child. Treatment of eczema varies from proper skin care to use of steroidal and immunosuppresent medications. Some precautions are: • Keep baths or showers brief and not too hot. Lukewarm water is best. • Apply fragrance-free lotion or cream for sensitive skin immediately after bathing. • Wear soft cotton or other non-irritating clothing. • Take antihistamines at night to reduce scratching. • Stay cool and avoid temperature fluctuations and activities that cause sweating. Blue & You Autumn 2003

getting under your SKIN? • Don’t scratch or rub skin. • Protect skin from irritants, such as chemicals and detergents. • Limit exposure to cigarette smoke, pollens, dust mites and animal dander. • Recognize and limit emotional stress. Medications prescribed for eczema include: • Antihistamines to help control itching and the release of histamine; • Antibiotics if skin becomes infected; • Corticosteroid creams and ointments; • Systemic corticosteriods, such as prednisone; • Topical immunomodulators (TIMs) — tacrolimus (Protopic) and pimecrolimus (Elidel); and • Immunosupressive drugs, such as cyclosporine, in severe cases. All of these medications have side effects, which must be weighed against the severity of the symptoms. Systemic corticosteroids may cause skin damage, thinned or weakened bones, high blood pressure, high blood sugar, infections and cataracts. Topical corticosteroids may cause thinning of skin, infections, stretch marks and growth suppression (in children). Immunosuppressive drugs may cause high blood pressure, nausea, vomiting, kidney problems, headaches, tingling, numbness, increased risk of cancer and infections. Phototherapy is sometimes used to treat atopic dermatitis for children over 12 and adults. Ultraviolet A or B light or both can be used. Photochemotherapy combines ultraviolet light with a drug called psoralen. This therapy can cause premature aging of the skin and skin cancer. The Centers for Disease Control and Prevention recommends that people who have eczema should not take the smallpox vaccine unless they have been exposed to the smallpox virus. This includes anyone who has eczema even if the condition is not currently active, mild or was experienced as a child.

Nummular Dermatitis Nummular dermatitis or discoid eczema gets its name from its shape. Its round or oval scaly patches of skin may be extremely itchy. Its cause is unknown, but nummular eczema sometimes occurs after a minor skin injury, such as an insect bite; or it can result from hypersensitivity to bacteria on the skin. Nummular eczema is a chronic condition. Treatment is similar to that for atopic dermatitis. Blue & You Autumn 2003

Hives

Hives (urticaria) are red, itchy swollen areas of skin. A hive may resemble a mosquito bite. Hives may be acute or chronic; but they most often are acute and result from an identifiable substance, such as a medication, food, latex, or from a viral infection. In adults, hives are most commonly caused by reactions to medications. The most common culprits are aspirin and other nonsteroidal anti-inflammatory drugs. When a drug is the cause, the reaction occurs within minutes to an hour of taking the drug. In children, foods or viral infections, such as colds, may cause hives. Hives may result from an outside source, such as rubbing of the skin, cold, heat, physical exertion, pressure or direct exposure to sunlight. Hives usually disappear on their own. Those who suffer with chronic hives may have them for a period of as little as three months to as long as 20 years. Physicians may prescribe antihistamines or corticosteroids to treat hives.

Contact Dermatitis Contact dermatitis may be either allergic or irritant. Allergic contact dermatitis is an immune response caused by allergens that come in direct contact with skin. A good example is the rash caused by poison ivy. A chemical in the plant called urushiol causes the reaction. Other common allergens are nickel, perfumes and fragrances, dyes, rubber (latex) products, cosmetics, ingredients in medications (such as neomycin found in antibiotic ointments and creams), animal hair, saliva or dander, and adhesives. Treatment depends on severity of symptoms and may include cold soaks and compresses, corticosteroid creams or oral corticosteroids. Natural substances, such as balsam of Peru, a sticky aromatic liquid that (Skin, continued on Page 17)

10 PB&J

FOOD ...

FRIEND OR FOE? Food allergies can prove frustrating, even fatal

(peanut butter and jelly) and a glass of milk are standard fare for most kids, and most folks lose count when munching on popcorn shrimp. In fact, most people take eating for granted … open mouth, insert food. Yummmmmm, nutritious and delicious. But, for some people, these and other foods can lead to vomiting, gasping for breath, and scratching hives for hours or even days. For them, food is no picnic. While an estimated 40-50 million Americans have allergies, only 1 to 2 percent of all adults are allergic to foods or food additives. Food allergies or food intolerances affect nearly everyone at some point. One out of three people says that he or she has a food allergy or that they modify the family diet because a family member is suspected of having a food allergy. Although many people often have an unpleasant reaction to something they have eaten and wonder if they have a food allergy, only about 3 percent of children have clinically proven allergic reactions to foods. In adults, the prevalence of food allergy drops to about 1 percent of the total population. This difference between the clinically proven prevalence of food allergy and the public perception of the problem is in part due to reactions called “food intolerances” rather than food allergies. While many people develop gas, bloating or another unpleasant reaction to something they eat, it is usually not an allergic response. A food allergy — or hypersensitivity — is the result of your body’s immune system over-reacting to food proteins called allergens. Food allergies are an abnormal response to a food that is triggered by the immune system. The immune system is not responsible for the symptoms of a food intolerance, even though the symptoms can resemble those of a food allergy. It is extremely important for people who have true food allergies to identify them and prevent allergic reactions to food because these reactions can cause devastating illness and, in some cases, be fatal. An estimated 150 Americans die each year from severe allergic

reactions to food, according to Hugh A. Sampson, M.D., a food allergy expert and director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City.

Common food allergies In adults, the most common foods to cause allergic reactions include: shellfish (such as shrimp, crayfish, lobster, and crab); peanuts, a legume that is one of the chief foods to cause severe anaphylaxis (see article on page 16); tree nuts (such as walnuts); fish; and eggs. In children, the pattern is somewhat different. The most common food allergens that cause problems in children are eggs, milk and peanuts. Adults usually do not lose their allergies, but children can sometimes outgrow them. Children are more likely to outgrow allergies to milk or soy than allergies to peanuts, fish or shrimp. The foods that adults or children react to are those foods they eat often. In Japan, for example, rice allergy is more frequent. In Scandinavia, codfish allergy is more common. Anyone can have allergies to any kind of food — corn, wheat, strawberries, pineapple, beans or broccoli — but 90 percent of food allergies in children and adults are caused by the foods listed above.

Diagnosis To diagnose food allergy, a doctor must determine if the patient is having an adverse reaction to specific foods. This assessment is made with the help of a detailed patient history, the patient’s diet diary, or an elimination diet. Sometimes a diagnosis cannot be made solely on the basis of history. In that case, the doctor may ask the patient to go back and keep a record of the contents of each meal and whether he or she had a reaction. This gives more detail from which the doctor and the patient can determine if there is consistency in the reactions. The next step some doctors use is an elimination diet. Under the doctor’s direction, the patient does not eat a food suspected of causing the allergy, like eggs, and substitutes another food, in this case, another source of protein. If the patient removes the food and the symptoms go away, the doctor can almost always make a diagnosis. If the patient then eats the food (under the Blue & You Autumn 2003

doctor’s direction) and the symptoms reappear, then the diagnosis is confirmed. This technique can’t be used if the reactions are infrequent or severe (in which case the patient should not resume eating the food). If the patient’s history, diet diary or elimination diet suggests a specific food allergy is likely, the doctor will then use tests that can more objectively measure an allergic response to food. One of these is a scratch skin test, during which a diluted extract of the food is placed on the skin of the forearm or back. This portion of the skin is then scratched with a needle and observed for swelling or redness that would indicate a local allergic reaction. Skin tests are rapid, simple and relatively safe. But a patient can have a positive skin test to a food allergen without experiencing allergic reactions to that food. A doctor diagnoses a food allergy only when a patient has a positive skin test to a specific allergen and the history of these reactions suggests an allergy to the same food. In some extremely allergic patients who have severe anaphylactic reactions, skin testing cannot be used because it could evoke a dangerous reaction. Skin testing also cannot be done on patients with extensive eczema. For these patients, a doctor may use blood tests such as the RAST and the ELISA. These tests measure the presence of food-specific IgE in the blood of patients and may cost more than skin tests. (Results are not available immediately and, as with skin testing, a positive test does not necessarily confirm a diagnosis.)

shell) can prompt an allergic reaction. Other less sensitive people may be able to tolerate small amounts of a food to which they are allergic. People with severe food allergies must be prepared to treat an inadvertent exposure: • Wear medical alert bracelets or necklaces stating that they have a food allergy and that they are subject to severe reactions. • Always carry a syringe of adrenaline (epinephrine), obtained by prescription from their doctors, and be prepared to self-administer it if they think they are getting a food allergic reaction. • Immediately seek medical help by either calling the rescue squad or by having themselves transported to an emergency room. Anaphylactic allergic reactions can be fatal even when they start off with mild symptoms such as a tingling in the mouth and throat or gastrointestinal discomfort. A patient can take several medications to relieve food allergy symptoms that are not part of an anaphylactic reaction. These include: • Antihistamines to relieve gastrointestinal symptoms, hives, or sneezing and a runny nose. • Bronchodilators to relieve asthma symptoms. These medications are taken after people have inadvertently ingested a food to which they are allergic but are not effective in preventing an allergic reaction when taken prior to eating the food. No medication in any form can be taken before eating a certain food that will reliably prevent an allergic reaction to that food.

Treatment

Summary

Food allergies are treated by strict dietary avoidance. Once a patient and the patient’s doctor have identified the food to which the patient is sensitive, the food must be removed from the patient’s diet. To do this, patients must read lengthy, detailed ingredient lists on each food they are considering eating. Many allergy-producing foods, such as peanuts, eggs and milk, appear in foods one normally would not expect. Peanuts, for example, are often used as a protein source, and eggs are used in some salad dressings. The FDA requires ingredients in a food to appear on its label. People can avoid most of the things to which they are sensitive if they read food labels carefully and avoid restaurant-prepared foods that might have ingredients to which they are allergic. In highly allergic people, even minuscule amounts of a food allergen (for example, 1/44,000 of a peanut kernel — or exposure to dust from breaking open a peanut

The prevalence of food allergies is growing and probably will continue to grow along with allergic diseases, according to physicians and medical researchers. Currently, there are no medications that cure food allergies. Identifying food allergies, being vigilant to read food labels (although there are some gaps in allergen labeling still being addressed) and take precautions, and being prepared to respond to a severe reaction are all realities when dealing with food allergies.

Blue & You Autumn 2003

— Sources: National Institute of Allergy and Infectious Diseases/National Institutes of Health/ U.S. Department of Health and Human Services; WebMD; U.S. Food and Drug Administration; www.pediatrics.about.com; kidshealth.org; and American College of Allergy, Asthma and Immunology Web site

12 I

If not a food allergy, then what?

f a patient goes to the doctor’s office with a concern that he or she has a food allergy, the physician has to consider the list of other possibilities that may lead to symptoms that could be confused with food allergy. A differential diagnosis is needed, which means distinguishing food allergy from food intolerance or other illnesses. One possibility is the contamination of foods with microorganisms, such as bacteria, and their products, such as toxins. Sometimes, contaminated meat mimics a food reaction when it is really a type of food poisoning. There also are natural substances, such as histamine, that can occur in foods and stimulate a reaction similar to an allergic reaction. For example, histamine can reach high levels in cheese, some wines, and in certain kinds of fish, particularly tuna and mackerel. In fish, histamine is believed to stem from bacterial contamination, particularly in fish that hasn’t been refrigerated properly. If someone eats one of these foods with a high level of histamine, that person may have a reaction that strongly resembles an allergic reaction to food. This reaction is called histamine toxicity. A commonly reported food intolerance that is often confused with a food allergy is lactase deficiency. This food intolerance affects at least one in 10 people. Lactase is an enzyme that is in the lining of the gut and degrades lactose, which is in milk. If a person does not have enough lactase, the body cannot digest the lactose in most milk products. Instead, the lactose is used by bacteria, gas is formed, and the person experiences bloating, abdominal pain, and sometimes diarrhea. There are a couple of diagnostic tests in which the patient ingests a specific amount of lactose, and then the doctor measures the body’s response by analyzing a blood sample. Another type of food intolerance is an adverse reaction to certain additives or products that are added to food to enhance taste, provide color, or protect against the growth of microorganisms.

Compounds most frequently tied to adverse reactions that can be confused with food allergy are yellow dye number 5, monosodium glutamate (MSG) and sulfites. Yellow dye number 5 can cause hives, although rarely. MSG is a flavor enhancer, which when consumed in large amounts, can cause flushing, sensations of warmth, headache, facial pressure, chest pain, or feelings of detachment in some people. These transient reactions occur rapidly after eating large amounts of food to which MSG has been added. Sulfites can occur naturally in foods or are added to enhance crispness or prevent mold growth. High concentrations of sulfites sometimes create problems for people with severe asthma. Sulfites can produce a gas called sulfur dioxide, which an asthmatic inhales while eating the sulfited food. This irritates the lungs and can send an asthmatic into severe bronchospasm — a constriction of the lungs. The U.S. Food and Drug Administration (FDA) has banned sulfites as spray-on preservatives in fresh fruits and vegetables, but they still are used in some foods and are made naturally during the fermentation of wine. Ulcers and cancers of the gastrointestinal tract share symptoms with food allergies and can be associated with vomiting, diarrhea or cramping abdominal pain exacerbated by eating. Gluten intolerance is associated with the disease called gluten-sensitive enteropathy or celiac disease, which is caused by an abnormal immune response to gluten, a component of wheat and some other grains. Some people may have a food intolerance that has a psychological trigger. Often during childhood, an unpleasant event may be tied to eating a particular food, and eating that food — even years later, as an adult — is associated with a rush of unpleasant sensations that can resemble an allergic reaction to food. — Sources: National Institute of Allergy and Infectious Diseases/National Institutes of Health/U.S. Department of Health and Human Services; WebMD; U.S. Food and Drug Administration; www.pediatrics.about.com; kidshealth.org; and American College of Allergy, Asthma and Immunology Web site Blue & You Autumn 2003

When your blue eyes turn PINK

It’s the one thing that doesn’t look so “pretty in pink.” Pink eye (allergic conjunctivitis) is one of the most common and treatable eye conditions. It is an inflammation of the “conjunctiva,” which is the tissue that lines the inside of the eyelid and helps keep the eyelid and eyeball moist and can be caused by viruses, bacteria, irritating substances (shampoo, dirt, smoke, etc.), sexually transmitted diseases (STDs) or allergens. Pink eye caused by bacteria, viruses or STDs spreads easily from one person to another, but it

is not a serious health risk if diagnosed promptly. For this article, the focus is on allergic conjunctivitis, which is not contagious. Allergic conjunctivitis can appear in two forms: seasonal and perennial. The seasonal version is much more common and is related to exposure to specific airborne allergens, such as grass, tree and weed pollens and molds. The perennial form persists throughout the year and is usually triggered by dust mites, animal dander and feathers. The symptoms of pink eye (allergic conjunctivitis) include redness in the eye or inner eyelid, increased tears, itchy eyes, blurred vision and swelling of the eyelid. To relieve symptoms, it is recommended that you: • Remove contact lenses, if you wear them. • Place cold compresses on your eyes. • Try nonprescription “artificial tears,” a type of eye drop that may help relieve itching and burning. (Note: Other types of eye drops may irritate the eyes and should not be used.) Do not use the same bottle of drops in the other eye if it is not affected. Other tips: • Don’t touch or rub the affected eye(s). • Wash your hands often with soap and warm water. • Wash your bed linens, pillowcases and towels in hot water and detergent to reduce allergens. • Avoid wearing eye makeup. • Don’t share eye makeup with anyone else. • Never wear another person’s contact lens. Blue & You Autumn 2003

• Wear glasses instead of contact lenses to reduce irritation. • Wash your hands after applying the eye drops or ointment to your eye or your child’s eye.

Treatment options Allergic conjunctivitis may disappear completely, either when the allergy is treated with antihistamines or when the allergen is removed. The following medications may help relieve the symptoms:

• Decongestants: These medicines reduce redness by constricting small blood vessels in the eye. They are not recommended for long-term use. • Antihistamines: These medicines reduce redness, swelling and itching by blocking the actions of histamine, the chemical that causes these symptoms of allergy. They are available both over the counter and by prescription. • Steroids: When other medicines fail, your doctor may prescribe steroid eye drops to relieve the symptoms of conjunctivitis. These must be used with the supervision of your doctor since they can cause elevated pressure inside the eye, which can lead to vision damage. Your doctor also must check for viral eye infections, such as herpes, before optical steroids are used. These drops also can increase the risk of cataracts (a clouding of the lens of the eye that can impair vision). The best defense against allergic conjunctivitis is a good offense: try to avoid substances that trigger your allergies. — Sources: American Academy of Allergy, Asthma & Immunology, the National Institutes of Health and www.WebMD.org

Keeping it clean How to avoid indoor allergens

illions of people suffer with allergies. For some, it’s the pollen in the air during springtime. For others, there’s no relief, and they suffer from allergies spring, summer, winter and fall. These are called perennial allergies, and they are triggered by indoor allergens such as dust mites and cockroach droppings, animal dander (dead skin flakes) and indoor molds.

Controlling dust mites House dust consists of small particles of plant and animal material in the home. What makes this even more unappealing is that microscopic creatures called dust mites thrive in it. The droppings of these tiny creatures are the most common triggers of indoor allergies. To reduce dust mites in your home, it is important to keep humidity to below 50 percent in your home by using a dehumidifier or air conditioning. Wall-to-wall carpeting should be removed if possible. Hardwood, tile, vinyl or linoleum floors are better for those with allergies. Washable throw rugs may be used if washed or dry-cleaned regularly. Mite levels usually are higher in the bedrooms because people spend so much time there. Encase mattresses, box springs and pillows in airtight, zippered plastic or special allergy-proof covers. Bedding should be washed regularly in hot water. If your comforter or pillow is made of natural fibers (such as feathers or cotton), it should be replaced with items made from synthetic fibers. Uncluttered surfaces of your dresser or television cabinet are a good idea. Those knick-knacks may be cute, but they collect dust. Weekly vacuuming can help eliminate allergies, but those with allergies might want to use a high-efficiency particulate air (HEPA) vacuum, because standard or water-filtered vacuums stir dust into the air. If you have allergies, it’s also a good idea to wear a dust mask when cleaning. [Health Advantage does not cover items such as high-efficiency particulate air (HEPA) vacuum cleaners, air purifiers, humidifiers, vaporizers, mattress covers or pillow covers.]

Controlling animal dander Having a Chihuahua rather than Chow Chow is not going to help your allergies. People are not allergic to animal hair, but rather to a protein found in the saliva, dander or urine of animals with fur. These proteins are carried in small, invisible particles. The most effective way to control allergies to animal dander is to remove the animal from your home and avoid all contact. Keeping your pet outdoors is only a partial solution, because even homes with pets outside have higher concentrations of animal dander indoors. If you can’t give your pet to a trusted friend or family member to keep (or don’t want to), try to minimize contact. Keep the pet out of the bedroom and other rooms where you spend a good amount of time. Although some studies have indicated that bathing the pet weekly may reduce animal dander, this issue remains controversial. If you do plan to bathe your pet weekly, consult your veterinarian on recommendations on shampoo and how to prevent excessive dryness to your pet’s skin. While dander and saliva are the sources for your allergies from cats and dogs, urine is the source of allergens if your pet is a rabbit, hamster or guinea pig. If possible, ask someone else to clean the pet’s cage.

Controlling cockroaches For 300 million years, cockroaches have roamed the earth. And, if that’s not bad enough, there is a protein in their droppings that serves as a trigger for asthma symptoms, especially for children living in overpopulated, urban neighborhoods. To rid your home of cockroaches, block areas where roaches can enter, such as crevices, wall cracks, windows, woodwork, drains, cellars or floor gaps. Cockroaches thrive in water and high humidity. That’s a good reason to fix leaky faucets and keep sinks and tubs clean and dry. Roaches don’t care for clean, dry surroundings. Put pet dishes away when pets are through eating and keep food in tightly sealed containers. It’s a good idea to keep the kitchen clean by sweeping and vacuuming after meals, washing dishes (and countertops) after eating, taking out garbage frequently and cleaning under stoves, refrigerators or toasters to get rid of crumbs. (Indoor allergens, continued on Page 17) Blue & You Autumn 2003

Taking the

ddddd Insect Sting Allergies When you are outside enjoying comfortable temperatures, you also are at a greater risk for insect stings. Each year stinging insects, such as bees, wasps, hornets, yellow jackets and fire ants, sting many people. Most will experience temporary redness, swelling and itching at the site of the sting. But for those allergic to stinging insects, the immune system will overreact to the venom injected by the insects, resulting in a much more severe, anaphylactic reaction. An allergic reaction may include hives, itching and swelling in areas other than the sting site, tightness in the throat or chest, and difficulty breathing. Up to 5 percent of Americans are at risk for this severe, potentially life-threatening allergic reaction from stinging insects, according to the American Academy of Allergy, Asthma and Immunology.

The usual suspects • •

•

Five types of insects cause most sting reactions: Yellow jackets are black with yellow markings and are found in various climates. Honeybees have a rounded, “fuzzy” body with dark brown coloring and yellow markings. Upon stinging, the honeybee usually leaves its barbed stinger in its victim. The bee dies as a result. Paper wasps’ slender, elongated bodies are black, brown, or red with yellow markings. Their nests are often located under eaves, behind shutters, or in shrubs or woodpiles. Hornets are black or brown with white, orange or yellow markings and are usually larger than yellow jackets. Hornets’ nests are usually found high above ground on branches of trees, in shrubbery, on gables or in tree hollows. Fire ants are reddish-brown stinging insects related to bees and wasps. Fire ants may attack with little warning. After firmly grasping the victim’s skin with its jaws, the fire ant arches its back as it inserts its rear stinger into the skin. It then pivots at the head and typically inflicts about eight stings in a circular pattern.

Avoiding the sting Some strategies to escape the prick of stinging insects include: Blue & You Autumn 2003

sting out of an insect bite

• Keep your distance. These creatures are provoked if their homes are disturbed, so it’s important to destroy hives and nests near your home. Be aware of nests in bushes, eaves and attics. Hornets are especially aggressive and have been known to chase people for miles. • Do not wear flowery scents or bright clothing. Stinging insects are searching for nectar and may mistake you as a source. • Use caution when cooking and eating outdoors. The smell of food and sweet drinks attracts insects, especially yellow jackets. Inspect food and drink carefully, so as not to accidentally ingest an insect. • Insects are attracted to trash containers; keep these areas clean and keep covers on the containers. • Wear closed-toed shoes and avoid going barefoot. • Avoid loose-fitting clothing that can trap insects between the material and skin. • If you do encounter a stinging insect, remain calm and quiet and move slowly. Do not “swat” it. • Keep insecticides readily available to kill stinging insects from a distance. However, be aware that they are not affected by insect repellants. • Hire a trained exterminator to destroy the hives and nests around your home.

The best laid plans If, despite your best efforts, you do get stung, remember that treatment for insect sting allergies depends on the severity of the reaction. Mild reactions can often be treated with cold packs and medications for pain and swelling. Severe reactions are potentially fatal and require emergency care. People who have had allergic reactions should try to avoid the insects they are allergic to; those who have had severe allergic reactions should carry emergency kits. When there is a history of severe reactions, doctors also recommend allergy shots (immunotherapy) that may reduce or eliminate sensitivity to the insect venom. — Sources: The American Academy of Allergy, Asthma and Immunology and www.WebMD.org

ANAPHYLAXIS Allergic reaction to the extreme

Anaphylaxis, or anaphylactic shock, is a rare but

potentially life-threatening condition in which several different parts of the body experience allergic reactions. It is the extreme end of allergic reactions and may include itching, hives, swelling of the throat, difficulty breathing and unconsciousness. Other common symptoms of anaphylaxis may include: • A metallic taste or itching in the mouth • Generalized flushing, itching or redness of the skin • Abdominal cramps, nausea, vomiting or diarrhea • Increased heart rate • Rapidly decreasing blood pressure (and accompanying paleness) • A sudden feeling of weakness • Anxiety or an overwhelming sense of doom • Collapse Common causes of anaphylaxis include foods such as peanuts, tree nuts (i.e. almonds, walnuts, cashews, Brazil nuts), sesame seeds, fish, shellfish, dairy products and eggs. Non-food causes include wasp or bee stings, natural latex (rubber), penicillin or any other drug or injection. In some people, exercise can trigger a severe reaction, either on its own or in combination with other factors such as food or drugs (i.e. aspirin). Another cause of anaphylaxis is stinging insect venom. Each year, stinging insects such as yellow jackets, honeybees, paper wasps, hornets or fire ants sting many Americans. For most, these stings bring pain and discomfort generally lasting only a few hours. Some people, however, have severe allergic reactions to stings. Approximately 50 people in the United States die from allergic reactions to insect stings each year. Anaphylaxis is triggered in the same way other allergies are: the immune system — which serves as the body’s defense against countless substances — overreacts to a substance generally considered harmless. However, for those with severe allergies, such substances can be dangerous. During anaphylaxis, blood

vessels leak, bronchial tissues swell and blood pressure drops, causing choking and collapse. Adrenaline acts quickly to constrict blood vessels, relax smooth muscles in the lungs to improve breathing, stimulate the heartbeat and helps to stop swelling around the face and lips. Symptoms usually appear rapidly, sometimes within minutes of exposure to the allergen, and can be lifethreatening. Immediate medical attention is necessary when anaphylaxis occurs. Standard emergency treatment often includes an injection of epinephrine (adrenaline) to open up the airway and blood vessels. Since immediate administration of epinephrine can be the difference between life and death, parents of children with life-threatening food allergies should alert their child’s school of the particular allergen and make sure their child’s teachers and caregivers have an epinephrine auto-injector on hand and know how to administer it. Be certain that others in your family also know how to administer the adrenaline kit — and when to use it. If you (or anyone you are with) begin experiencing severe allergy symptoms, call for medical help or go to an emergency room, where you will receive an epinephrine shot and other medications, such as antihistamines or steroids, if needed. The sooner the reaction is treated, the less severe it will be. Even if you have received immediate medical treatment on site, you should be transported to a hospital for further evaluation and treatment.

Advertise if you’re allergic If you know you are allergic to insect venom, wear a MedicAlert or other type of medical identification so that medical personnel will know what’s wrong and how to treat you. To order MedicAlert identification, call 800-IDALERT. Many people with insect-venom or food allergies (Anaphylaxis, continued on Page 17) Blue & You Autumn 2003

(Skin, continued from Page 9)

comes from the bark of a tree native to El Salvador and is used in perfumes, toiletries, spices and food flavoring, may cause allergic contact dermatitis. Skin patch testing can determine this type of allergy. People allergic to balsam of Peru usually test allergic to fragrance mix, a combination of other commonly used fragrances. Some common items that may contain balsam of Peru are perfume; deodorant; after-shave lotion; make-up; medicinal creams and lotions; baby powder; sunscreen and suntan lotion; shampoo and conditioner; perfumed tea, coffee and tobacco; baked goods; cola and other soft drinks; aperitifs; spices, such as cinnamon, cloves, vanilla, nutmeg, paprika and curry; calamine lotion; dental cement; cough medicine and lozenges; lip balm; insect repellants; surgical dressings; toothpaste and mouthwash; and wound spray. Other fragrances that occur in perfumes, cosmetics, hair care products, skin care products, laundry products, toothpaste, cleaning products, detergents, insecticides, pharmaceutical creams and food also may cause allergic contact dermatitis. Treatment is the same as for eczema (atopic dermatitis).

Irritant contact dermatitis can result from something that actually damages the skin. Water with added soaps and detergents is the most common cause. Contact with caustic chemicals, solvents, acids, metalworking fluids and friction also may cause irritant dermatitis. This type of dermatitis can be prevented by wearing protective clothing and avoiding the offending substances. Treatment consists of relieving symptoms and preventing further damage. — Sources: 1. American Academy of Allergy, Asthma & Immunology (http://www.aaaai.org) 2. MEDLINEplus, U.S. National Library of Medicine and the National Institutes of Health (http://www.nim.nih.gov/ medlineplus) 3. National Institute of Arthritis and Musculoskeletal and Skin Diseases (http://www.niams.nih.gov) 4. New Zealand Dermatological Society (http://www.dermnetnz.org)

(Anaphylaxis, continued from Page 16)

(Indoor allergens, continued from Page 14)

carry a small kit containing a syringe of epinephrine to use if they begin to develop signs of an anaphylactic reaction. Minimize the risk by taking great care and being vigilant. If you are food allergic, read food labels carefully. Be particularly careful in restaurants, where proprietors are under no obligation to list ingredients. Be alert to all symptoms and take them seriously. Reach for the adrenaline (epinephrine) if you think you are beginning to show signs of a severe reaction. Do not wait until you are sure.

Controlling indoor molds

— Sources: www.intelihealth.com, www.allergic-reactions.com, www.WebMD.org, American Academy of Allergy Asthma & Immunology, and The Food Allergy & Anaphylaxis Network Blue & You Autumn 2003

Damp basements and bathroom windows are prime targets for indoor mold. These molds send out spores than can trigger allergy symptoms. The good news is that indoor molds can easily be controlled once they have been discovered. Use a cleaning solution containing 5 percent bleach and a small amount of detergent. If you find mildew or mold in your carpet or wallpaper, you should remove those items from your home. Seal leaking roofs or pipes to prevent mold. And, never put carpeting on concrete or damp floors. Remember that all rooms, especially basements and bathrooms, require ventilation and consistent cleaning to deter mold and mildew growth.

Final thought Ridding your home of allergens takes time. However, it will be worth it in the long run. Remember that progressive changes will create an environment that is better for those with allergies, easier to clean (and cleaner) and healthier for the whole family. — Sources: The American Academy of Allergy, Asthma & Immunology and www.WebMD.org

Antihistamines are nothing to sniff at

hen hay fever (allergic rhinitis) hits, those suffering (more than 35 million people in the United States) are looking for relief. And relief usually comes in the form of antihistamines, because they are the most widely used medications for allergic diseases. Although other treatments for allergic rhinitis are available, they are usually prescribed in conjunction with antihistamines. Many different antihistamines are available, either over-the-counter (OTC) or with a prescription. Various forms include eye drops, nose sprays, liquids and pills (either as an antihistamine alone or mixed with other medications, especially decongestants) to relieve a larger range of symptoms.

How can antihistamines help? These drugs work by combating the effects of histamine — a substance produced by the body during an allergic reaction. Histamine binds to receptors (particular sites on cells) causing local blood vessels to enlarge and leak fluid. This may result in nasal congestion; asthma symptoms such as wheezing; or skin reactions such as raised, red bumps called urticaria or hives. Histamine also stimulates mucus production and binds to nerve endings, resulting in sneezing and itching. If the histamine receptors are blocked by an antihistamine, histamine cannot bind, and its negative effects will be blocked. If histamine has already bound to a receptor, symptoms occur immediately and cannot be reversed by an antihistamine. As a result, antihistamines work best if taken before exposure to an allergic sub-

stance. In contrast, decongestants do help treat immediate symptoms of congestion by shrinking swollen blood vessels and decreasing mucus production. For this reason, they are often combined with antihistamines.

Knocking out your allergies When you are taking an antihistamine, make sure you read the label to see if it causes drowsiness. You may be familiar with the OTC medications called ChlorTrimeton and Benadryl. If you take these medications before bedtime, they have the desired effect of providing you with symptom relief plus a good night’s sleep. However, it can be undesirable to take them during the day, especially if you are going to be doing any tasks that require hand and eye coordination, including driving a car or operating any type of heavy machinery. There are other, newer OTC medications now available, such as Claritin and Allavert, which do not cause drowsiness. Exciting advances are continuously being made in the management and treatment of allergic diseases. But currently, antihistamines continue to provide symptom relief for the majority of allergy sufferers. During this fall ragweed season — or any time you are suffering from symptoms of allergic rhinitis — see your physician, who will work with you to determine the allergy treatment plan that’s best for you. — Sources: The American Academy of Allergy, Asthma & Immunology and www.WebMD.org

In the market for a good antihistamine? W

hen you are searching for an over-the-counter (OTC) antihistamine at your local pharmacy, remember to look for the following “active ingredients” before you buy.

or nursing, or are below 6 years of age. Many of these OTC antihistamines also are available as combination products with a decongestant, such as pseuActive Ingredient Common Brand Names Comments doephedrine (Claritin-D, Tavistloratadine Claritin, Alavert non-sedating antihistamine D), or a pain reliever like chlorpheniramine Chlor-Trimeton Allergy acetaminophen (Tylenol Aldiphenhydramine Benadryl lergy). Always remember to read clemastine Tavist Allergy the label to know what you are triprolidine Actifed getting. If you have any medical conditions, talk to your doctor Talk to you doctor before using any of the above before taking these combination products. products if you have liver or kidney disease, are pregnant — Source: AdvancePCS Blue & You Autumn 2003

The Phar macist is in Do you have any questions? Medications changing from prescription status to over-the-counter status During the past several years, many medications have evolved from being prescription only to being available over the counter (OTC) at your local pharmacy. It has been interesting to observe throughout the years that many medications, including Claritin, Zantac, Tagamet and Pepcid, were considered too dangerous for a person to use without a physician’s supervision. When these and other medications first became available, they required a physician’s prescription, but as their patent protection expired (usually after about 15 years), they suddenly became safe to be sold OTC or without a prescription. The switch from “prescription required” to OTC status brings tremendous savings to the consumer because the price drops significantly. For example, Claritin recently changed to OTC status in December

2002. The wholesale prescription price dropped from $3 to $1 or less per tablet when sold OTC. The remaining prescription antihistamines — Zyrtec, Allegra and Clarinex — remain on prescription-status-only, at wholesale prices of about $2 per tablet or capsule. Recently, Prilosec (for gastritis) lost its patent protection and will offer consumers amazing savings. The Prilosec 20mg wholesale prescription price on prescription is $4.61 per capsule and the 40mg strength is $6.62 per capsule. Prilosec 20mg became available OTC in September for approximately $1 per capsule, but the pill isn’t purple, it’s yellow. You can get 30 (yellow) Prilosec 20mg for $30 OTC, but a prescription for the (purple) Prilosec 20mg will cost about $138. It’s no wonder that the pricing of pharmaceutical drugs is considered by many to be a baffling and controversial topic.

Claritin now available over the counter Zyrtec range in price from $2.90 to $3.75 per tablet. I n December 2002, Claritin, a popular allergy medication, became available without a prescription. Generic Claritin (loratadine) tablets are available This brand-name medication recently lost its patent over the counter for less than $10 for a one-month protection, which means that the generic equivalent is supply. The following is a summary of the lowest availnow in the marketplace. This usually results in a deable prices found for various formulations of loratadine crease in sales for the brand-name medication. As a from on-line and discount pharmacies: result, some pharmaceutical compaPRODUCT NAME LOWEST AVAILABLE PACKAGE SIZE nies are taking their brand-name medications “over the counter” to COST PER DOSE save their market share. This is what Claritin 79 cents 20 happened with Claritin. Alavert 63 cents 30 As a prescription medication, the Tavist-ND 55 cents 30 Loratadine (generic) 28 cents 30 average cost of Claritin was $3.25 per Loratadine (generic) 29 cents 100 tablet. As an over-the-counter medication, Claritin costs $1 or less per It’s important to be an educated consumer. Ask for tablet. Alavert, an over-the-counter medication that is the generics when they are available. Know when prescripbioequivalent of Claritin, sells for 85 cents or less per tion medications will be available as over-the-counter tablet. The generic equivalent of Claritin (loratadine) medications. By making informed decisions, you will sells for 50 cents or less per tablet. It makes sense for save money now … and in the long run, when it comes consumers (and health insurance companies) to prefer to your health insurance. the over-the-counter medications when equivalent prescription medications such as Allegra, Clarinex and — Source: Prime Therapeutics, Inc. Blue & You Autumn 2003

“Blue comes through” in responding

You talk. We listen.

You, our members, tell us that four things are very important to you when it comes to being satisfied customers. You want: 1. More affordable health insurance options. 2. More information about your benefits and staying healthy. 3. Your claims paid quickly and accurately. 4. Any problems resolved quickly and conveniently. Here are some of the ways that “Blue comes through” in meeting these needs.

1. New, More Affordable Plans Whatever your budget or your coverage needs, we have a plan for you. In addition to our full menu of traditional major medical, PPO, HMO and POS plans, we’ve introduced several new health plans that make health care even more affordable: • BasicBlue® for individuals and families provides essential coverage at a more affordable cost. This plan provides a $1 million lifetime maximum benefit for covered services. BasicBlue does not require covered individuals to choose physicians, specialists and hospitals from a predetermined list. They have the freedom to use any health care provider. • Group BasicBlue® provides similar group coverage for employees at a much lower cost to employers. • MyChoice Blue offers all the advantages of traditional PPO plans, and each employee may choose the plan that best fits his or her needs, making it truly “my choice.” With MyChoice Blue, employers can offer each employee (whether they have two or 200) the opportunity to select from one of four benefit plans. • Open Access Point of Service is an innovative plan from Health Advantage that is a hybrid of traditional HMO coverage and POS benefits. The member pays a copayment for preventive and routine services from his or her primary care physician. For services provided by in-network specialty physicians and hospitals (without the need for a referral), the member pays applicable deductible, copayments and coinsurance. The member also has the option of using out-of-network providers, receiving the lower level of out-of-network benefit coverage. • MSA Blue® (for groups and individuals) is a qualified

health insurance plan that allows the insured member to contribute to a medical savings account. For those interested in the ability to create tax savings while setting aside funds to pay future medical expenses, MSA Blue is a qualified health insurance plan worth considering. • MyHRA Blue is a consumer-driven health plan that centers around qualified Health Reimbursement Arrangements (HRA) and Flexible Spending Arrangements (FSA) as defined by the IRS. The plan gives employees more control over how their health care dollars are spent; more flexibility in managing out-of-pocket costs; more choice in network and non-network providers; and the ability to roll over eligible, unused dollars into the next year for future health care expenses while covered by the plan. Web-based tools help guide the member to make the best use of health care dollars.

2. Information on Benefits & Health • Web site tools available on our Web sites (www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com and www.BlueAdvantageArkansas.com) provide a variety of information resources, including: — My Blueprint: Personal Benefits and Claims Tracker, a secure, self-service center, which allows you to: ◊ Check the status of your claims and review your claims history ◊ Check eligibility for you and your covered spouse and children ◊ Review primary care physician history ◊ Order a replacement ID card — Prescription drug information, a customized Web section that enables you to: ◊ Look up your specific drug coverage (formulary information and pricing) ◊ Check your prescription claims history ◊ Locate a pharmacy ◊ Access a drug dictionary ◊ Check drug-to-drug interactions — Provider directories, lists of physicians, dentists, hospitals, pharmacies and facilities participating in our networks and serving our members. — Coverage policies, a database of policies to help inform members and their physicians why certain medical procedures may or may not be covered under our health plans. — Wellness discounts, a list of health clubs and fitness equipment companies that offer discounts to our members. Blue & You Autumn 2003

to “Top Four” customer needs • Blue & You magazine is a quarterly publication mailed to members’ homes, containing articles on staying healthy and benefit information. • Understanding Your Health Care Costs is a booklet and video about what drives health care costs up and what you can do to help hold costs down. To read the booklet on-line or view the video, go to www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com, click on “Members,” then click on “Understanding Your Health Care Costs.” • Brand Name or Generic Drugs? What you don’t know can cost you is a special, 16-page booklet to help Arkansans understand how and why using generic drugs is the smart choice (and why generic drugs cost less than brand-name drugs). The booklet is available on our Web sites to print. • Health Education Programs, available free to members, provide information and links to local, regional and national resources to help members manage disease and prevent complications of illness. Programs are available for diabetes, respiratory health, low back pain and cardiovascular health. Additionally, we offer Special Delivery, which educates expectant mothers about pre-term births. • Blue & Youth Health Program uses a big blue sheep, BlueAnn Ewe, to teach school-aged children the importance of practicing healthy habits. Through an elementary classroom presentation, a middle-school mentoring program (High School Heroes), a health “club” for kids, animated musical television commercials and a wild and woolly Web site for kids (www.BlueAnnEweark.com), the Blue & Youth programs have taken healthy lessons to more than 480,000 Arkansas youth in the past seven years.

3. Paying Claims Quickly & Accurately • Fast turnaround – After we receive your medical claims from your doctor or hospital, we process your claims in an average of six days. So, for most of the claims processed, you receive your explanation of payments within 10 days after we receive the claim. • High accuracy rate – For the first six months of 2003, we

Blue & You Autumn 2003

achieved a dollar accuracy rate of 99.4 percent in paying your claims. This is impressive when you consider that we process more than 8 million claims a year. • Investment in Technology – Arkansas Blue Cross has invested in technology that facilitates the electronic submission of claims from providers. As a result, approximately 70 percent of all claims are submitted electronically, speeding up the process. Arkansas Blue Cross now gives doctors and hospitals free access to the Advanced Health Information Network (AHIN), giving them access to eligibility, claims, claim-status and related data. A unique feature allows direct claim submission as well as on-line, real-time correction of erroneous claims.

4. Resolving Any Problems Whether you prefer picking up the telephone, checking a Web site or visiting face-to-face, Arkansas Blue Cross and its family of companies are working to make customer service easy and convenient: • My BlueLine, our self-service Interactive Voice Response System, recognizes speech patterns to help answer questions when customers call customer service telephone lines. By simply speaking a response to the questions asked by the automated system, customers can get questions answered quickly and easily with no buttons to push. My BlueLine is available 24 hours a day, seven days a week. It can help customers who have questions about benefits, status of claims and premium payments, and help customers order a new ID card, provider directory or claim form. And if you prefer to speak directly to one of our 200 customer service representatives, you can do so at any time during normal business hours. • My Blueprint, our on-line service center, lets you check your own claims and get answers 24 hours a day, seven days a week in a customized, secure Web environment. • Personal service, close to home, is available for customers who prefer face-to-face interaction (rather than a telephone call or Web contact) by visiting any of our seven convenient locations in Arkansas. Our offices, located in Fayetteville, Fort Smith, Hot Springs, Little Rock, Jonesboro, Pine Bluff and Texarkana, offer sales, customer service, medical management and provider relations services to members in all areas of the state. These are some of the ways Arkansas Blue Cross and its affiliated companies are meeting the needs of our customers. When you need answers, Blue comes through … for you.

luesEnroll, a new Web-based enrollment method for Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas group members, will help reduce paperwork and put control of enrollment in the hands of groups. BluesEnroll was developed with the help of Benefitfocus.com, Inc., 2001 Emerging Business of the Year Award winner and leading producer of employee benefits software for use via the Internet and easy-to-use touch-screen kiosks. Currently, BluesEnroll is available to groups with 50 or more members. With on-line enrollment, group members are able to complete initial and open enrollment as well as life status changes (new baby, divorce, etc.) quickly and easily. Information only has to be entered one time. Eventually, paper enrollment and change forms will be a thing of the past. Members will have two options for online enrollment. Members can enter enrollment information on-line (using a secure user ID and password) and have the information approved by the group administrator. The other option is that group members can provide enrollment information to the group administrator, and the group administrator will submit the information on-line. The group administrator will deter-

mine the appropriate enrollment method. Arkansas Blue Cross group members began on-line enrollment on July 1, 2003; Health Advantage group members began on-line enrollment in early September; and BlueAdvantage group members will begin on-line enrollment in mid-October. BluesEnroll allows members to spend less time on paperwork and reduce the cost of human resources management functions. With BluesEnroll, new-hire processing and open enrollment will be much easier. And, best of all, online enrollment can be completed quickly and with fewer errors. Groups who are interested in more information on BluesEnroll or would like to be included in the new on-line enrollment process should contact their sales representative. BluesEnroll will customize on-line enrollment for each group based on its benefit package and location. According to Bob Heard, vice president of Information Technology Infrastructure and executive sponsor for the project, “This was an opportunity for us to provide enhanced enrollment services to our groups, and our groups responded enthusiastically. With this product, the enrollment process with be improved from end to end, benefiting the groups, their employees and our own internal processes.”

Race & Watch T

he Komen Arkansas Race For The Cure celebrates its 10th Anniversary on Saturday, Oct. 4, 2003, with the theme “Saving Lives for 10 Years Running.” And for the third year, Arkansas Blue Cross and Blue Shield will be bringing the spirit and scenes of the race into your living room through the 2003 Race For The Cure Recap Show. Arkansas Blue Cross will serve as presenting sponsor of the show, which will be produced by Clear Channel Communications, and shown at 6 p.m. on Oct. 4, on UPN 38-TV, and again at 9 p.m. on Oct. 4, on FOX 16-TV. The 2003 Race For The Cure Recap Show will capture the sights and stories, people and voices of those participating in the race, which is expected to draw 40,000 folks to downtown Little Rock. Race For The Cure. If you are interested in raising

money and awareness for the fight against breast cancer, join those who share your aspiration and are expected to participate in the Susan G. Komen Breast Cancer Foundation’s 2003 Arkansas Race For The Cure on Oct. 4. For more information, please call (501) 202-4009. Race Recap Show. Then, tune into the 2003 Race For The Cure Recap Show. You’ll get to relive the moments of the day during the 30-minute television special. You may even see yourself “proud in the crowd.” Pace the race, then relax and watch the show. Blue & You Autumn 2003

interactive voice response system

Customer Service available 24 hours a day, 7 days a week A rkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas customers now can access personal health insurance information with a simple telephone call. The new interactive voice response (IVR) system, called My BlueLine, recognizes speech patterns to help answer questions when customers call current customer service telephone lines. When customers call a customer service line, the new system will immediately answer the call and by simply responding to the questions asked by the system — with no buttons to push — customers can

get numerous questions answered quickly and easily. And even better, the IVR system is available 24 hours a day, seven days a week. The new system can help customers who have questions about benefits, status of claims and premium payments and help customers order a new ID card, provider directory or claim form. And, during regular business hours, customers can request to speak to the next available customer service representative at any time during the telephone call. The IVR system can’t help customers with all of their needs, so Arkansas Blue Cross and its family of companies will always have customer service representatives available.

Women’s Health and Cancer Rights Act T he Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for mastectomy. In accordance with the law, all group and individual health plans that provide medical and surgical benefits for mastectomy now will cover reconstructive breast surgery, if elected by the covered individual following mastectomy, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema. The provisions of the Women’s Health and Cancer

Rights Act of 1998 apply to all group health insurance coverage effective on the first day of the plan year (which, in most cases, is the anniversary date of the group contract) after Oct. 21, 1998. The law went into effect on all individual insurance policies (UniqueCare Blue, UniqueCare, etc.) issued, renewed or in effect on or after Oct. 21, 1998. These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield and Health Advantage, as well as plans administered by BlueAdvantage Administrators of Arkansas, and are subject to the applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums. For questions about your insurance coverage, contact your group benefits administrator or customer service at your local Arkansas Blue Cross office.

Arkansas Blue Cross seeks judicial clarification of law In the last several months, Arkansas Blue Cross and Blue Shield has received demands from St. Vincent Infirmary Medical Center, Southwest Regional Medical Center, and Little Rock Cardiology Clinic, P.A., all in Little Rock, to be admitted into the Arkansas’ FirstSource PPO network of providers. Their demands are based on their interpretation of a 2003 Supreme Court “any willing provider” decision involving a case in Kentucky. St. Vincent’s July 22 letter to Arkansas Blue Cross threatened to file suit seeking damages against Arkansas Blue Cross if its demand was not accepted. Blue & You Autumn 2003

Arkansas Blue Cross disagrees with their interpretation on this decision, contending that the Kentucky case does not apply to Arkansas. Therefore, as the simplest and fastest way to have this disagreement resolved, Arkansas Blue Cross filed a lawsuit in August to seek a judicial clarification of the law. It is a cost-saving benefit to our members to be able to offer a PPO product that includes some, but not all, of the hospitals in a geographic area such as Little Rock. We have filed the lawsuit to clarify the law, in order to preserve our ability to offer cost-effective health insurance products to our members.

MEMBERS GIVE A “THUMBS UP“ TO HEALTH EDUCATION PROGRAMS

he results of the recent Respiratory Education Program and Diabetes Education Program Member Satisfaction Surveys are in, and our members who participated gave a “thumbs up” to the programs when it comes to their satisfaction. As a part of the annual evaluation of the Diabetes and Respiratory Education Programs, those enrolled who have been active in each program since their beginnings were asked to rate their satisfaction with the information received. The results for each program are below.

Respiratory Education Program Survey Results*** Indicator

Percentage of Improvement from Beginning of Program to 15-month Survey Flu Immunization Increased 29% Pneumonia Immunization Increased 19% Smoker Decreased 42% 1-3 Workdays Lost due to a Respiratory Illness Decreased 10% 4-5 Workdays Lost due to a Respiratory Illness None 5+ Workdays Lost due to a Respiratory Illness Decreased 29% ***Out of 1,802 enrollees who were asked to respond, 643 responded.

Respiratory Education Program Member Satisfaction Results* Measure of Satisfaction Results Satisfied or More Than Satisfied with Overall Program 91% Materials Easy to Read 95% Materials Easy to Understand 94% Materials Addressed Appropriately 95% Information was Needed by the Member 88% Information Used to Discuss with Their Physician 83% Information Provided was not Previously Known by Member 76% *Out of 1,802 enrollees who were asked to respond, 643 enrollees responded.

Diabetes Education Program Member Satisfaction Results** Measure of Satisfaction Results Satisfied or More Than Satisfied with Overall Program 92% Materials Easy to Read 96% Materials Easy to Understand 96% Materials Addressed Appropriately 96% Information was Needed by the Member 88% Information Used to Discuss with Their Physician 84% Information Provided was not Previously Known by Member 77%

The second part of the Diabetes Education Program evaluation included a comparison of the percentage of those enrolled who received the following care measures (measured by claims data) in the year before the program began, and again after 15 months into the program. The care measures and percentage of improvement are listed below: Diabetes Education Program Care Measure Results**** Care Measure Percentage of Improvement from Beginning to 15-month Re-measure of Claims Blood Test for Lipids (at least once per year) Increased 14% Urine Test for Microalbuminuria (at least once per year) Increased 7% Blood Test for Hemoglobin A1c (at least twice per year) None Doctor Visits (at least twice per year) None Eye Exam Some improvement but not (at least once per year) statistically significant

**Out of 1,101 enrollees who were asked to respond, 306 responded.

****1,102 of those enrolled at the beginning of the program and who were still enrolled after 15 months of the program.

The second part of the Respiratory Education Program evaluation included a comparison of the percentage of enrollees who at the beginning of the program, and again after 15 months into the program, answered “yes” to receiving or experiencing certain indicators in the past year. The indicators and percentage of improvement are listed in the following table:

Thanks to the high satisfaction ratings from the Member Satisfaction Survey, Arkansas Blue Cross and Blue Shield will continue to provide health information to those enrolled in these programs. If you would like more information about our Health Education Programs, visit our Web sites at www.ArkansasBlueCross.com and www.HealthAdvantage-hmo.com. Blue & You Autumn 2003

Techno-pop pixie and

boy band “rock” airwaves

ove over *NSYNC … look out Gwen Stefani … “no doubt” there’s cool competition in the music field with the “BlueAnn Rocks” Top Ten television commercials. Two new, animated, musical television commercials premiered during family programming in July and will run through October. The TV commercials are designed to teach children about health and safety through fun, memorable music and images. They focus on avoiding tobacco products (“Love Your Lungs”) and flexing the gray muscle (“Exercise Your Brain”). There are now 10 TV messages featuring BlueAnn Ewe, Arkansas Blue Cross and Blue Shield’s ambassador of health and wellness, who is the central figure of its Blue & Youth Health Program. The previous eight TV commercials also feature other melodic characters and kids. In 1999, the first two animated television commercials focused on nutrition (the “Food Pyramid”) and peer pressure (“Backbone”). In 2000, two more commercials premiered on the topics of exercise (“Exercise Beat”) and safety (“Safety Song”). In 2001, hygiene (“Squeaky Clean”) and emotions (“E-eemotions”) were the health topics expressed, followed by the importance of good sleep (“You Need Your Rest”) and good dental hygiene (“Brush With Me!”) for overall wellness in 2002. Affectionately referred to as “BlueAnn Rocks,” the musical health messages support topics taught in the Blue & Youth Health Program and offer a fun medium for kids to learn about health and wellness. The plan is to develop two new commercials each year focused on a different health topic in an effort to create a library of “music videos.” The “BlueAnn Rocks” commercials also can be

“Love Your Lungs” Blue & You Autumn 2003

viewed on BlueAnn’s Wild & Woolly Web site and at the Museum of Discovery in Little Rock as part of the “Who Wants to Feel Like A Million Bucks?” interactive health game at the Health Hall kiosk. Watch for the new and classic “Rocks” commercials on family and kids’ programming including Nickelodeon, Discovery Channel, ABC, NBC, CBS, Fox 16 and UPN 38. In case you want to sing along, here are the lyrics to the new commercials:

“Love Your Lungs” You’re smart enough (smart enough). To know not to puff (oh, no don’t puff). Love your lungs (and your heart, too). Don’t let tobacco poison you! Love your lungs! (Love your lungs!) Love your lungs! (yeah)! Don’t smoke, don’t choke, choose not to chew. Love your lungs like I (I) love (love) you!

“Exercise Your Brain” Watching your TV all day … That won’t build your brain! You gotta’ think, (you got to think) To exercise your brain. Do a puzzle, write a poem, read a book. Use your head, you’ll get hooked! You gotta’ think, (you got to think) Avoid the brain drain… And exercise your brain!

“Exercise Your Brain”

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BlueAnn Class Club Members Win Sundae Parties

even classrooms of students from throughout Arkansas constructed creamy creations recently with the assistance of BlueAnn Ewe, the six-foot blue ambassador of health for Arkansas Blue Cross and Blue Shield, at “Build a Healthy Sundae” parties in their classrooms. The students, who are members of the BlueAnn Class Club, completed a Healthy Habits Activity Calendar under the direction of their teachers to become eligible for a “Build a Healthy Sundae Party” with BlueAnn in their classroom. To complete the Healthy Habits Activity Calendar, students practiced at least one healthy habit each day — brushed their teeth, got a good night’s sleep, exercised, buckled their seat belt, ate healthy foods, etc. — and recorded their habits with a sticker on a calendar for 20 school days. As a reward for their efforts, BlueAnn Ewe paid a visit to the classrooms and served the students frozen vanilla yogurt, which they topped with granola, bananas, multi-grain cereal, strawberries, cherries, nuts, sprinkles and/or fat-free whipped topping. Students also enjoyed low-fat animal crackers, juice and water with their treats. Following their cool refreshments, the students played games with BlueAnn, and watched and learned the words to BlueAnn’s animated, musical health videos. Each student and the teacher also received a party favor during the festivities. Winners of the “Build a Healthy Sundae Party” with BlueAnn for 2003, as pictured to the right, were: 1. Paige Catt’s second-grade class, Park Elementary School in Corning, Northeast Region. 2. Rita Kay Holthoff’s special education class, Reed Elementary School in Dumas, Southeast Region. 3. Ann Hutcheson’s first-grade class at Eagle Heights Elementary School in Harrison, Northwest Region. 4. Gina Buth’s third-grade class at Langston Science and Math Magnet School in Hot Springs, South Central Region. 5. Margaret Gustafson’s second-grade class at Acorn Elementary School in Mena, West Central Region. 6. Karen Allen’s first-grade class at Nashville Primary School in Nashville, Southwest Region. 7. Anita Holland’s kindergarten class at Crestwood Elementary School in North Little Rock, Central Region. The BlueAnn Class Club is a free club offered through Arkansas Blue Cross, designed for students in kindergarten, first grade and second grade to provide them with opportunities to learn about healthy habits

and to participate in activities that encourage overall healthy behaviors. Teachers enroll their classes for the BlueAnn Class Club. Participation in the BlueAnn Class Club is for one school year, renewable each fall as the new school year begins. The BlueAnn Class Club is part of Arkansas Blue Cross’ Blue & Youth Health Program, a health education effort designed to improve the well-being of Arkansas citizens, beginning with the young people of the state. To join the BlueAnn Club, call toll-free 1-800-515BLUE or visit BlueAnn’s Web site at www.BlueAnnEweark.com.

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Blue & You Autumn 2003

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rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. All Heart Arkansas Blue Cross employee teams turned out in force for the Northwest Arkansas, Faulkner County and Central Arkansas American Heart Association (AHA) Heart Walks in March and April to help raise money and awareness for heart disease and stroke. In March, Arkansas Blue Cross employees joined hundreds Northwest Regional Office staff assemble of walkers for the American Heart Association inside Bud Heart Walk in Fayetteville. Walton Arena on the University of Arkansas at Fayetteville campus, then stepped outside to walk around the campus and raise more than $191,000 for the work of the AHA. In April, Arkansas Blue Cross employees walked along the toad trail in Conway to help raise more than $66,400 for the cause in the Faulkner County Walk, which had more than 1,000 total participants and honored more than 100 survivors with Red Caps. In Faulkner County, Arkansas Blue Cross was the top fund-raising company team. Also in April, Arkansas Blue Cross employees were among the more than 2,000 people who walked along the north side of the Arkansas River to raise money at the Central Arkansas Heart Walk, which raised more than $236,400 for research and education programs. Back to School Health Arkansas Blue Cross’ Southwest Regional Office again served as a title sponsor of the “Wild About Wellness” Back-to-School Health Fair for kids held in July at the Four States’ Fairgrounds in Texarkana. BlueAnn Ewe and our employees were on hand to greet thousands of kids and their parents from Arkansas, Louisiana, Oklahoma and Texas as they came through to get ready to go back Blue & You Autumn 2003

into the classroom — happy and healthy. Arkansas Blue Cross employees helped kids fill in their health charts by measuring their height and weight. Kids also could take advantage of free Saundra Fulce, Southwest Regional health screenings Office/Texarkana, helps kids get Wild such as vision, About Wellness. hearing and speech from local health care providers at the Fair and could even get their immunizations on-site. Kids could also sign up for BlueAnn’s Health Club. Home Run! Bats, gloves and BlueAnn Ewe were among the highlights for kids to enjoy at two Arkansas Travelers baseball games in July in Little Rock. BlueAnn appeared at Ray Winder Field for a Travs homestand on free bat and free glove nights and joined the players as they autographed sports memorabilia. She even signed her very own “baseball card.” Kids could sign up for the BlueAnn Club and got to take home a “Wild & Woolly Health Tips for Kids” coloring book with their souvenirs. It was a “zoo” (across the street from the Zoo) as BlueAnn and fans at the Arkansas Travelers BlueAnn traded baseball game. antics with Shelly the Horse (the Traveler mascot) and Monkey Boy, a featured guest at the game. BlueAnn greeted kids on “first” when they ran the bases after the games each night. It was a great night for baseball and fun!

www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com

View prescription claims history on-line Arkansas Blue Cross and Blue Shield, Health Advantage and qualified BlueAdvantage Administrators of Arkansas members now have on-line access to their prescription drug history. To get to this history, visit www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com or www.BlueAdvantageArkansas.com. On the Arkansas Blue Cross and Health Advantage sites, click on the link on the home page called Prescription Drug Information. On the BlueAdvantage site, click on the link on the “Members” page. The link opens the https://arbcbsAdvanceRx.com site, which is customized for Arkansas Blue Cross and Health Advantage members by AdvancePCS, your pharmacy benefit manager. If you are a BlueAdvantage member, you may need to check with your group administrator or human resources office to see whether AdvancePCS is your pharmacy benefit manager. AdvanceRx.com also allows you to locate a network pharmacy, determine if a drug is covered, compare drug prices, and review extensive information about drugs, their uses, side effects and interactions. To access the full menu of information, you must register on the site. You will need the information from your health plan ID card or drug card to register. To view your prescription history, you must enter a recent prescription number. This extra step helps protect the privacy of your personal information. The initial registration process will require you to enter your e-mail address and select a password. Once you are logged in, click on the Prescriptions link in the blue bar near the top of the page to locate the link to your prescription history. On the “Prescriptions” page, click on Click here to view prescription claims history now. You will see your prescription record for the past 12 months. It will include drug name, prescription number, days’ supply, fill date, retail price, what you paid, your cost savings (what your insurance company paid), the pharmacy that filled the prescription and prescribing physician. You will be able to sort your history by time period, drug name, prescribing physician or pharmacy. To see drug coverage and pricing, click on the Look Up Drug Coverage & Pricing link on the home page. Blue & You Autumn 2003

You’ll see a page explaining what a formulary is and how it is used. Click on Search Your Formulary to look up a drug by name or category to see if it is on your formulary. When the drug information appears, you can request other drugs in the same class and drug pricing information on any of the drugs listed. For a complete description of the drug, its uses, dosage and side effects, click on Drug Dictionary on the home page of the site or on the drug name on the formulary search results page. On the “Drug Dictionary” search page, you may enter the name of a drug to bring up its information. To check interactions, you can click at the bottom of the drug description page or go back to the home page and click on Drug to Drug Interaction Checker. To locate a pharmacy that participates in your health plan network, click on Locate a Pharmacy on the home page. Enter your ZIP code or address, the distance you are willing to travel and any services you require (open 24 hours, delivery, drive through, etc.). The results will give you a list of in-network pharmacies that meet your search criteria, as well as a map and driving directions. To access your medical claims information, register for My Blueprint on the Arkansas Blue Cross, Health Advantage or BlueAdvantage site. You’ll see the button on the home page of the appropriate site.

Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181