Hypersensitivity to Drugs and Rapid Desensitization - Twitter summary from 2012 #AAAAI meeting

This summary was compiled from the tweets posted by the following allergists/immunologists who attended the 2012 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI): Matthew Bowdish MD ‏@MatthewBowdish: The tweets were labeled #AAAAI. The text was edited and modified by me.

Mariana Castells discussed Hypersensitivity to Drugs and Rapid Desensitization in the 21st Century:

Reaction to medications can be IgE- or non-IgE mediated. Often, we don't understand the exact mechanism of the reactions.

After drug desensitization, the dose needs to be repeated every 2-2.5 half lives.

Rapid drug desensitization is a high risk procedure. It is often performed on critically-ill patients without other viable treatment options.

An allergist should always be on board for ordering rapid desensitization protocols, but other doctors can supervise actual procedure.

Exclusion criteria for rapid desensitization:

- type III reactions (CIC)
- severe skin disease
- Stevens-Johnson syndrome (SJS)
- ACE-induced angioedema

Remember, pain is not a symptom of allergy but it is a symptom of angioedema due to activation of kallikrein system.

Dr. Castells has a manuscript (in publication) for skin test dosing to chemotherapeutics.

A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions was published in JACI 2012: http://www.jacionline.org/article/S0091-6749(11)01618-6/abstract

Safety of rapid desensitization

Severe reactions occurred in only 6% of cases at the Brigham hospital. It's not always possible to desensitize everyone, but the team there has had a very high rate of success (99%).

Useful recent article: Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment: http://www.jacionline.org/article/S0091-6749(09)01338-4/abstract

Aspirin desensitization can often be performed in the outpatient setting these days, especially with the use of leukotriene inhibitors (LTRA).

Minimum requirements for rapid desensitization: 1-on-1 RN, CPR/ACLS, crash cart, Epi at bedside, anesthesia/code team, allergist 3 minutes from bedside.

Although the number of allergists is small, we can have a far reach. Rapid desensitization is one niche we should “own” in order to help patients best.

Classification of adverse reactions to drugs, using the "SOAP III" mnemonic (click to enlarge the image):

Allergists achieved highest use of social media by any specialty

During the 2012 AAAAI meeting, the allergists achieved the highest use of social media by any specialty. There are more than 100 allergists on Twitter and 30 of them posted simultaneously from the annual meeting, broadcasting thousands of tweets tagged with #AAAAI. The annual AAAAI meeting was attended by approximately 5,000 people. In comparison, the 30 allergists on Twitter reached 250,000 people (measured by TweetReach.com on 03/04/2012).

This summary was compiled from some of the tweets posted by Matthew Bowdish MD ‏@MatthewBowdish. I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

Disclaimer: The text was edited, modified, and added to by me. This is one of a series of posts that will be published during the next few weeks.

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