Dr Montanaro discussed updates on drug allergy, immunotherapy and anaphylaxis:
1. Consequences of PCN allergy - Macy JACI 2014. Hospital costs of PCN allergy alone may account for $20M/year in just one large hospital system. -- "It would be reasonable to test all presurgical patients who claim to be allergic to penicillin if these patients will be needing perioperative antibiotic therapy. There are a lot of people out there who report a penicillin allergy and are unnecessarily being prescribed a wider-spectrum antibiotic than they really need. If you can work in a multidisciplinary capacity with your colleagues in surgery and anesthesia to come up with a system in which these patients can come to the allergy department as part of their preop evaluation, collectively we can reduce the use of these broader-spectrum antibiotics. More important, we can let these patients know that they're not allergic, so we really can potentially open up their antibiotic armamentarium" http://buff.ly/1xK7Yjx
2. PEN G testing in children - Picard, Annals 2014. Negative Predictive Value of Pen G skin test and challenge was 95%. This compares favorably with protocols using PPL and MDM. The cost of NOT testing for PCN allergy is high!
3. PPI Allergy - Bose, Annals, 2013. Authors reviewed 39 publications and 119 cases of allergy to five different PPI, omeprazole was the most common. Most frequent PPI reactions were: urticaria [54%], angioedema [38%], hypotension [23%] and SOB [20%]. Tested as follows: SPT 20-40mg/ml, ID 0.04-40mg/ml. Omeprazole cross-reacts with pantoprazole. They found 3 different cross-reactivity patterns with PPIs: omeprazole cross-reacts with all, lansoprazole cross-reacts with rabeprazole but not any others.
4. ACEI/VIT - Stoevesandt Clin Exp All. It's important to check serum tryptase in all patients undergoing workup for venom allergy to rule out indolent mastocytosis. ACEI or beta-blocker prescription was not associated with increased risk of systemic reaction, but the study was not powered to answer b-blocker question.
5. Fire Ant Rush IT - Arseneau, Annals, 2013. RIT is safe/efficacious in most patients, it may improve adherence, premed decreases systemic reactions, but there was higher than normal build-up.
6. A Long Study of Stinging Insect Anaphylaxis - Rudders, Annals 2013. Only 70% of patients with stinging insect allergy fill their epinephrine prescriptions.
7. Anaphylaxis in America - Wood, JACI, 2014. Anaphylaxis is common (1 in 20 adults), 50% never received epi, the majority have life-threatening reactions. Anaphylaxis represents a huge opportunity for clinical improvement.
This is a Twitter summary from 2014 #ACAAI meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/ACAAI
The Twitter summary was made possible by @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): http://allergynotes.blogspot.com/search/label/ACAAI
Drug allergy management in 5 steps (click to enlarge the image).