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

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 @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

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-…

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

https://twitter.com/PaulSaxMD/status/1499883800402219009

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

⭐️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

🧵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).

1/Brief #COVID19vaccine allergy update: LARGE LOCAL REACTIONS! These all were after #Moderna. Itchy, swollen, erythema, edema. Comes on late (>5 days) and can last weeks .Tx is symptomatic: antihistamine (e.g., fexofenadine), NSAID/Tylenol, ice. 2/ Importantly, you CAN still get the second dose! In the #modernavaccine trial, delayed large locals like these occurred 4x less with 2nd dose than 1st dose. Fewer large locals AND more efficacy, sign me up!

It has been a busy month learning about #allergy after #COVID19Vaccines but we so excited to receive this broad information from @CDCgov. Highlights below!/1
cdc.gov/mmwr/volumes/7… *Potential #anaphylaxis 175 of 1,893,360 1st doses of @pfizer vaccines (0.009%; 90 per million)
*Confirmed #anaphylaxis, 21 of 1,893,360 1st doses of @pfizer vaccines (0.0011%; 11 per million)
-->Better than we thought (1 per 100,000)but greater than usual 1 per million)/2

1/Here is @CDCgov guidance for #allergy considerations about the @pfizer and @moderna_tx #COVID19vaccines : cdc.gov/vaccines/covid…
#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.

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.

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… 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:

I am excited for America and #publichealth that my mentor, @RWalensky will be leading the @CDCgov — she is a professor @harvardmed, an #NIH funded scientist, no stranger to testifying in congress, leader of @mgh_id, mentor to so many(a few here: @KelliOLaughlin @EmilyHyle @ericashenoy @aciaranello @zach_wallace_md @ChanaSacks) including taking on me — an #alergist @AAAAI_org @AaaaiFoundation, but also a superhuman role model for all who prioritizes family @LorenWalensky #momofthreeboys