Reactions to venoms, foods and drugs - Twitter summary from 2014 #ACAAI meeting

Allergy to antihistamines and steroids

Dr Bahna: Antihistamine pills can contain foods like gelatin, lactose, starches (corn/wheat), cinnamon, cocoa butter - it may explain some reactions.

Dr Mariana Castells discussed allergic reactions to steroids. Most steroid products are modifications of cortisol including adding bonds, halogenation, methylation, esterification, etc. So, if you have a reaction to methylprednisolone, changing to a different steroid may not be the solution.

Bee sting and bloody diarrhea

Bee stings can cause a variety of reactions. This is the first patient described who has bloody diarrhea to bee stings [Mingomataj, Clin Rev Allergy Immunol, 2014] These were delayed reactions (24 hours after stings) that occurred on at least two separate occasions. The presenter proposed two possible mechanisms: immune complex deposition in GI tract or direct cytotoxic effect of bee venom melittin. Venom IT was not recommended in this patient since it was thought to be primarily due to a delayed type hypersensitivity reaction.

Cow's milk allergy and short bowel syndrome

A case of cow's milk allergy and short bowel syndrome. Short bowel syndrome is a condition that occurs when part of the small intestine is missing or has been removed during surgery. Nutrients are not properly absorbed into the body (malabsorption) as a result. Dr Fiocchi's group looked at 32 patients at an Italian kids' hospital with short bowel syndrome, 3 of which had cow's milk allergy, 2/3 had anaphylaxis to cows milk. 3 out of 32 was a higher percentage of cows milk allergy than general population - 9% vs 2%. Dr Fiocchi thought that something about the surgical process or even the underlying pathology of GI tract increased incidence. There is no correlation with the length of the bowel remaining in SBS pts vs SBS with cow’s milk allergy.

Penicillin allergy disproved in 94% of patients

Surgical infections account for 14-18% of all healthcare related infections and 10% of surgical patients report PCN allergy (huge numbers). A study on pre-op screening for PCN allergy at a hospital in Jacksonville showed that 9% of pre-op patients reported PCN allergy (n=384), 94% (n=360) of those were skin test negative to PCN. This saved the use of broad spectrum antibiotics in quite a few patients. They are currently looking at how much money was saved as well as other parameters (types of possible reactions). BTW, these are the data that are getting a wide exposure in the press

Anaphylaxis to orange

The patient was eventually intubated after the first exposure to cutie orange. The patient was extubated and eventually tested positive to peach, lemon and orange later as an an outpatient. Two main allergens (Cit s1 and Cit s2) are responsible for most hypersensitivities to orange that we have seen. Also Cit s3 is a minor antigen.

A difficult case of FPIES

FPIES is a severe systemic reaction to food protein that usually occurs 1 to 4 hrs after eating causative food and frequently develops early in life. FPIES is not an IgE mediated disease. FPIES studies are currently focusing on jejunum where increased numbers of IgM- and IgA-containing plasma cells have been found. The most common foods for FPIES reactions are soy, milk, rice, oat, chicken, peanut, potato, fish, and egg.

This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here:

The Twitter summary was made possible by @DrAnneEllis and @MatthewBowdish

Several allergists did a great job posting updates from the 2014 meeting of the #ACAAI. I used the website “All My Tweets” to review the tweets. For comparison, here are the tweets from previous #ACAAI meetings (scroll down the page for the past years):

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