Disclosures: Zeiger reports being the CEO of Canna Research Foundation and receiving funds from ACCAI, CSACI, EAACI and Allergists for Israel. Please see the study for all other authors’ relevant financial disclosures.

May 10, 2022
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Doctors’ knowledge, attitudes about cannabis impact allergy treatment

Disclosures: Zeiger reports being the CEO of Canna Research Foundation and receiving funds from ACCAI, CSACI, EAACI and Allergists for Israel. Please see the study for all other authors’ relevant financial disclosures.

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Knowledge about and attitudes toward cannabis use vary among allergists, with significant impacts on the way these clinicians approach the care of those who use it, according to a study published in Annals of Allergy, Asthma & Immunology.

“Physician knowledge regarding cannabis has been shown in the literature to be lacking. Until recently, there hasn’t been a conduit for learning about cannabis,” Joanna S. Zeiger, MS, PhD, CEO of the Canna Research Foundation, told Healio.

31% of allergists held a traditional attitude toward cannabis, 48.3% were progressive, and 20.7% were unsure.
Data were derived from Zeiger JS, et al. Ann Allergy Asthma Immunol. 2022;doi:10.116/j.anai.2022.04.021.
Joanna S. Zeiger

“We wanted to identify the deficits in knowledge and determine what kind of knowledge system would be of interest to allergists,” Zeiger said.

Prior work by the researchers had found that 18% of people with allergies and asthma had used cannabis within the previous 2 weeks, and more than 50% of them consumed it via inhalation methods.

“This could potentially exacerbate asthma symptoms of coughing and wheezing for those with asthma, especially if their asthma is not well controlled,” Zeiger said.

Many of these respondents reported beneficial effects on sleep, pain and anxiety from using cannabis, Zeiger continued. Only 19% of these patients wanted to discuss cannabis with their physicians, while only 34% of physicians asked about cannabis use.

“We wanted to understand if knowledge and attitudes regarding cannabis influenced physician comfort speaking to patients about cannabis, whether they counseled cessation of inhaling cannabis, whether they asked patients how often they used cannabis and their preferred route of administration,” said Zeiger.

As part of the Cannabis Allergy KAP (Knowledge, Attitudes, Practice) Collaboration, the researchers surveyed 207 members of the American College of Allergy, Asthma and Immunology, 47 members of the Canadian Society of Allergy and Clinical Immunology (CSACI) and 191 members of the European Academy of Allergy and Clinical Immunology (EAACI).

The cohort was 49.7% female, with 65.2% born between 1946 and 1964. Also, 54.4% had less than 20 years of experience, 54.9% practiced in nonacademic or research settings and 93.1% had Doctor of Medicine, Doctor of Osteopathic Medicine or Doctor of Philosophy degrees.

The survey included seven items about cannabis knowledge related to allergy care, 13 items pertaining to attitudes toward cannabis and four questions addressing practice approaches to cannabis.

According to the survey, 51.2% of respondents had fielded patient complaints of cannabis allergy, with the highest percentage at 74.5% of the CSACI members and the lowest percentage at 36.2% of the ACAAI members (P < .001).

Also, 84.5% of the respondents had seen between one and nine patients with suspected cannabis allergy, with symptoms including urticaria/angioedema (27.1%), nasal congestion (24.6%), rhinitis (23.2%), cough (23%) and anaphylaxis (14.9%).

Skin prick testing for cannabis sensitization was performed by 71.4% of CSACI members, 35.4% of EAACI members and 25.3% of ACAAI members. Also, only 5.3% performed in vitro testing for cannabis sensitization.

On a scale of 0 to 7, with 0 indicating no correct responses and 7 indicating all correct responses, the researchers found an overall mean of 3 (standard deviation [SD], 1.7) for knowledge. The ACAAI respondents had a mean of 3.5 (SD, 1.6), the CSACI respondents had a mean of 3.3 (SD, 1.6) and the EAACI respondents had a mean of 2.4 (SD, 1.6).

Analysis also led the researchers to classify attitudes toward cannabis as traditional (n = 138; 31%), progressive (n = 215; 48.3%) or unsure (n = 92; 20.7%). The ACAAI respondents included 22.7% traditional, 60.4% progressive and 16.9% unsure. The CSACI respondents included 10.6% traditional, 66% progressive and 23.4% unsure. The EAACI respondents included 45% traditional, 30.9% progressive and 24.1% unsure.

Overall, 70.1% of respondents said they were comfortable talking to patients about cannabis, including 67.6% for the ACAAI, 76.6% for the CSACI and 66% for the EAACI, yet only 35.5% said they verbally queried patients about cannabis use or did so on their intake form.

Similarly, only 28.9% had verbally asked patients about cannabis use in the previous month even though 46.2% said they had noticed an increase in cannabis use among their patients. Queries most often involved how often and how patients used it (56.8% and 51.2%, respectively).

When patients indicated that they smoked or vaporized cannabis, 30.9% of the doctors said they always counseled cessation, and 29.1% said they sometimes counseled cessation.

Further, there were differences in the discussion of cannabis by the three allergy societies, as 28.6% of EAACI members, 13.5% of ACAAI members and 4.3% of CSACI members did not discuss cannabis with their patients.

Doctors who were more knowledgeable about cannabis were more likely to be comfortable discussing it with their patients, asking patients about how and how frequently it was used, and counseling patients about cessation (P < .001), the researchers said.

However, doctors classified with unsure attitudes toward cannabis were less comfortable in speaking to patients about it, while those with progressive attitudes were the most comfortable (P < .001). In fact, 37% of those with unsure attitudes did not discuss cannabis with their patients at all, compared with 15% of those with traditional attitudes and 14% of those with progressive attitudes.

Knowledge and attitudes may supersede demographics, location and legality in approach to care, the researchers said, adding that knowledge impacts attitudes, which then impact care.

“We found that allergists who had more knowledge about cannabis tended to have more progressive attitudes regarding cannabis, and this led to more comfort speaking to patients about cannabis and asking patients about how often they used cannabis and what method of consumption they used,” Zeiger said.

Conversely, doctors with unsure attitudes had the lowest knowledge and were least likely to discuss cannabis with their patients. The researchers indicated that a lack of training in cannabis and the endocannabinoid system is one of the most common barriers to knowledge and willingness to consult with patients.

“Patients with all types of conditions are using cannabis. Thus, it is important that physicians learn about cannabis so they can ask their patients the right questions, either verbally or on intake forms — or both — about their cannabis use and discuss cannabis without judgement,” Zeiger said.

Though cannabis can be beneficial in many situations, it has adverse effects as well, Zeiger cautioned. Patients need to be educated by reputable sources to maximize the positive effects of cannabis while minimizing its harm, she continued, and they are looking for guidance.

“Right now, dosing, frequency of use and cannabinoid ratios are difficult to address since scant research has been done, and these parameters likely differ depending on the symptoms/conditions being treated,” Zeiger said.

The researchers called on professional societies to create cannabis content that provide general information geared toward their specialty. Also, the researchers said, doctors need to understand the laws regarding cannabis use where they practice.

The survey indicated that 48.5% of allergists want didactic learning, 46.7% would like pro/con learning and 41.1% said modules would meet their needs, with 68.8% preferring webinars and 56.4% favoring national meetings.

“The more physicians engaged in this type of discourse, the better, because this will help grow the knowledge base in a real-world setting,” Zeiger said.

“Physicians can help destigmatize cannabis and make access easier for those who need to use it medically and perhaps even provide influence to make cannabis federally legal, which will make the study of cannabis much more feasible,” she said.

The researchers plan to continue similar surveys in other physician and patient groups.

“Additionally, we will be creating educational materials to help allergists learn about many facets of cannabis to aid them in their patient interactions regarding cannabis,” Zeiger said.

“The more physicians know about cannabis, the more likely they are to discuss it with patients, and this engenders a safer and potentially more effective situation for cannabis use.”

For more information:

Joanna S. Zeiger, MS, PhD, can be reached at joannazeiger@comcast.net.