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
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: Image
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/…
4/The excipient in the Pfizer vaccine is PEG2000. The main #COVID19 vaccines we know about use either PEG or polysorbates. As #allergists, we will identify protocols for skin testing to these agents should this be necessary but we expect this will be RARE. Image
5/Allergy to PEG appears also to be exceedingly rare; reports of PEG3350 anaphylaxis to the FDA were from <10 per year since 2005 @vumc_cdsi_rsch
6/While we wait to learn more about these events, it is important to note that allergy is an antigen-specific process. What does that mean? Severe allergy to peanut or penicillin (or whatever) does not mean you will have an allergy to a vaccine (containing PEG).
7/ So, let's prepare ourselves for the arm swelling and fever that we will get (in return for immunity and our lives back!). Allergy may happen in rare cases, but I fully anticipate finding a safe #COVID19 vaccine, even for the rare allergic patient./

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More from @KimberlyBlumen1

Apr 20
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
Read 21 tweets
Sep 27, 2022
Tomorrow is #NationalPenicillinAllergyDay in the US! In advance of that, I will share some of my favorite resources on #penicillin #allergy. Please share these broadly with your networks. We have >30mil Americans to evaluate... let's get started! #NPAD 1/7 Image
@MGHAllergy has hosted a multi-site network called @USdrugallergy since 2017 and we have 7 engaged sites with 1,796 enrolled. On our website usdar.massgeneral.org we have @YouTube videos on #drugallergy and #penicillin allergy and post our latest research findings! 2/7
@AAAAI_org has a penicillin allergy center with easy links to educational videos and infographics. Educate yourself and your patients. Increase awareness with images for social media @allisoncramsey @AutumnGuyer education.aaaai.org/penicillin-all… 3/7 Image
Read 8 tweets
Sep 24, 2022
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
Read 11 tweets
Mar 5, 2022
We allergists have historically considered the risk of “cross reaction” between FQs ~30%. These are great new real-world data with a practical inpatient application for individuals with a FQ allergy label and rxn suggestive of immediate HSR. @PaulSaxMD @BrianTanChan /1
This study is unlikely to be capturing true “cross reaction” rate because these individuals did not have a confirmed FQ immediate hypersensitivity and there is likely a natural selection bias with respect to which patients were challenged to another FQ and which were not. /2
The prospective observational study that is the largest I know of evaluated patients a median on 9.5 months after their FQ rxn and prospectively assessed “cross reaction” with single blind placebo controlled challenges and the rates were higher : pubmed.ncbi.nlm.nih.gov/28497922/ 3
Read 6 tweets
Dec 11, 2021
⭐️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…
Read 8 tweets
Mar 8, 2021
🧵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.
Read 7 tweets

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