Discover and read the best of Twitter Threads about #AIMedEd
Most recents (8)
I am going to write part of my (unfinished) story about the K to R transition as a woman in medicine and physician scientist in a multi-disciplinary research space in a tumultuous time. I am oversharing to encourage others in a similar 🚤#medtwitter #IDTwitter #AIMedEd. /1 of 20
I study #drug #allergy. It was the inferior antibiotic choices we made for people with vague antibiotic allergies during my residency @MGHMedicine @mghmedres that initially gave me the idea. Too often the allergy lists were impeding clinical care. /2 of 20
I hypothesized that drug allergies were a problem -- that penicillin allergies alone were linked to important antibiotic stewardship and public health outcomes. I set off to prove this, and address the burden of unclear drug allergies across populations. /3 of 20
1 of 10 /Do you use an electronic health record? Did anyone ever teach you how to document #allergies? 👀Check our this #EHR allergy documentation guidance #medtwitter #idtwitter #AIMedEd @EricMacyMD @AutumnGuyer @allisoncramsey @vumc_cdsi_rsch @JACIInPractice 
2 of 10/We are excited to announce that the adverse reaction to drugs biologics and latex (ARDBL) committee of the @AAAAI_org has an #inpress workgroup report on allergy documentation in the EHR. jaci-inpractice.org/article/S2213-…
3 of 10/ In this article: current state of allergy #ehr documentation, definitions, reconfigurations, and recommendations✔️#bestpractices in documentation for #penicillin allergy ✔️what to include and what not to include in the allergy list
⭐️FIVE Little Allergy/Immunology Lessons from 5 Big Days on Consults ⭐️ @mghaifellows @MGHAllergy. #Urticaria #Angioedema #vaccine reactions eosinophilia and #drugallergy /1
ONE-To treat acute urticaria (hives), antihistamines should be nonsedating and scheduled (not diphenhydramine PRN). Allegra/fexofenadine and Zyrtec/cetirizine have large therapeutic windows and are used safely at 4+ times the daily allergic rhinitis dose/2
TWO-Angioedema in an adult without skin itching/hives/rash—check if they on an ACE inhibitor! Although ~10% get it w/in 30d, many happen after years of uneventfully being on it /3 ncbi.nlm.nih.gov/pmc/articles/P…
🧵1/ prospective cohort @JAMANetwork >64K employees receiving @pfizer @moderna_tx #CovidVaccine dose 1, 98% had no allergy symptoms, 2% had some allergy symptoms (itching/rash/hives/swelling) & #anaphylaxis occurred 2.47/10K vaccinations. jamanetwork.com/journals/jama/…
2/Allergy symptoms were slightly more with @moderna_tx (2.20% vs 1.95%; p=0.03). Although no difference in #anaphylaxis incidence by vaccine manufacturer, but different #anaphylaxis criteria led to different estimates (Brighton/NIAID/FAAN: from 1.1-2.5/10K administrations).
3/Similar to @CDCgov reports, the 16 #anaphylaxis patients were largely female (94%); 10 (63%) had prior allergy history and 5 (31%) had prior anaphylaxis history. BUT, we estimate that ~4K @MassGenBrigham employees with severe allergy histories were safely vaccinated.
1/ As #Allergists, built upon the recommendations of U.S. regulatory agencies, we can provide clear steps to the medical community on how to safely administer both doses of the #COVID vaccine in individuals with #allergic histories. #AIMedEd jaci-inpractice.org/article/S2213-…
2/ Neither the #PfizerBioNTech nor #Moderna #COVID19 mRNA vaccines are formulated with any food, drugs, or latex, but both contain the excipient #PEG. However, to date, confirmation that PEG is the cause of reactions to #CovidVaccines is lacking.
1/Here is @CDCgov guidance for #allergy considerations about the @pfizer and @moderna_tx #COVID19vaccines : cdc.gov/vaccines/covid…
#AIMedEd #medtwitter #allergyandimmunologyrocks @ericashenoy
#AIMedEd #medtwitter #allergyandimmunologyrocks @ericashenoy
2/#allergy and #anaphylaxis can happen to any #drug or #vaccine, but reactions to #COVID19vaccine are exceedingly rare (~6 in >300K vaccinations so far--> 0.002%). #vaccines have always been a rare cause of allergic reactions in healthcare.
3/Recently we looked at ~3K allergic reactions in healthcare settings @MassGenBrigham: contrasts caused allergy the most & just 6 vaccine reactions in 10-years. @NeelamPhadkeMD @MGH_ClinEpi @lizhou08 @JieHealthAI @PaigeWickner
pubmed.ncbi.nlm.nih.gov/32959347/
pubmed.ncbi.nlm.nih.gov/32959347/
1/ OK so 1 week after UK #COVID19Vaccine allergy was described, I need to reorient you to my world, the world where #drugallergy is the best field of #MedTwitter #AIMedEd #allergyimmunologyrocks. Let's get down to this confusion about the #covid19vaccine and #allergy
2/ There is no reason to think that anyone -- other than patients with a known allergy to an ingredient in this vaccine or an ingredient cross-reactive to an ingredient in this vaccine -- might have an #allergy the @pfizer #CovidVaccine.
3/ There is even very little that we think could cause an #allergy in this @pfizer vaccine. But 2 patients had #anaphylaxis after vaccination and we need to think about why. Something epidemiologically different in the UK population compared to clinical trial populations?
1/OK so there *may* be new reports of allergy to #COVID19 vaccines but many other things (e.g., vasovagal syncope) can be misdiagnosed as allergy so we need more clinical details from the UK
cnn.com/2020/12/09/hea…
cnn.com/2020/12/09/hea…
2/ BUT, it is not surprising that allergic reactions might be identified during massive vaccination but not clinical trials because #allergy to vaccines are exceedingly rare (1 per million). In the @US_FDA report, AEs within 30 min for vaccine vs placebo were similar:
3/Most vaccine allergies come from the excipients and allergists can do skin testing to the vaccine and its excipients (often facilitating safe and totally unremarkable vaccination). Excipients are often shared for many approved vaccines: cdc.gov/vaccines/pubs/…
