I taught a teenage patient how to shave.

You should be asking why or how this would ever come up during a visit for food allergies.

This one may surprise you. A little thread ⬇️
#SundayThoughts
1/9 This was a brand new patient to me. I started as I always do:
"I'm so glad you're here. How can I help you today?"

Then I heard about prior suspected food allergy reactions & avoidance of certain foods.

I also observed. There was tension between this mother and her son.
2/9

As businesses & restaurants reopen, it’s important to remember that #COVID19 is still here, waiting for opportunities to infect as many people as possible.

We can take some basic measures to limit spread, but it requires an understanding of why that’s still important. Thread⬇️ We still don’t know how many people have been or are currently infected with #COVID19.

More testing is necessary to help us understand basic principles about prevalence and incidence, which informs just about all other public health measures.

Singular (generic = montelukast) is a medication commonly used to treat #asthma & allergic rhinitis.

Last week, the FDA announced a ‘boxed warning’ & new discussion points with patients regarding side effects.

I’ll provide some thoughts in this thread fda.gov/news-events/pr… Montelukast blocks part of the leukotriene pathway, which can be activated as part of the late phase allergic response for people with environmental allergies (pets, pollen, etc) or asthma.

It is NOT an antihistamine.

It has NEVER been a 1st line treatment for asthma/allergies.

For my #TuesdayThoughts thread, I'd like to discuss farts.

My farts, to be specific.

You see, I farted a lot last week. I was also bloated. I was curious why, so I turned to the internet.

The 1st link informed me that I may have a food intolerance, so I looked that up ⬇️ I quickly found some handy dandy quizzes designed to see if I may have a food intolerance.

Question 1 - excessive flatulence. Check.
Question 2 - wait, what? Why is a food intolerance quiz asking if I have metallic taste in my mouth or blurry vision?

There's more ⬇️

10% of people reading this believe they are allergic to penicillin, but >95% of you are not actually allergic.

Inappropriate labeling of penicillin allergy is rampant and leads to unnecessary avoidance, use of less effective alternatives, & antibiotic resistance. Thread⬇️ Too many unqualified people have the ability to label someone as having penicillin allergy, which stays on the medical record forever.

The fact is, true allergy is much more rare than suspected. Side effects are common, as are other symptoms, which get mislabeled as ‘allergy’

Lots of information surrounding yesterday's FDA meeting to approve the 1st treatment for peanut allergy.

As always, there is lots of misinformation as well.

I'll address some important points to consider in this #SaturdayMorning thread ⬇️

abcn.ws/2UV2PUZ Results of Aimmune's Phase 3 trial were published in 2018: nejm.org/doi/full/10.10…

Primary outcome - 67% of participants could tolerate a single dose of 600 mg (total 1043 mg) peanut vs 4% in placebo after ~12 months of peanut oral immunotherapy (300 mg daily maintenance)

Anyone who uses IgE allergy tests should be able to predict results BEFORE testing is done...and communicate that to the patient

IgE tests are NOT 'positive' or 'negative'. Can only determine likelihood of allergy being present, determined by history. A #WednesdayWisdom thread⬇️ The most important concept for patients and medical providers to understand about IgE testing is the HUGE difference between sensitization and allergy.

Example: ~30% of people have detectable IgE to foods, but only 5-8% are actually allergic.

Rely on test alone = overdiagnosis

Are you ready for the annual autumn #asthma spike in symptoms and exacerbations?

Happens every year, roughly 3 weeks after school starts.

Why? Schools are cess pools. Viruses = major asthma trigger.
Also weather changes, ragweed, mold contribute. Friday #Facts Thread⬇️ Important to prepare for autumn #asthma management by assessing current level of control AND having up to date prescriptions (home AND school) & treatment plan.

Asthma changes throughout the year & over time, which means treatment should be fluid to match needs.

Today's thread will discuss allergy testing, which is surrounded by rampant misinformation, misinterpretation, and poor understanding.

For this thread, allergy tests = skin prick, intradermal and blood IgE tests. These all evaluate for the presence of allergen specific IgE. Allergy tests cannot diagnose non-IgE conditions;if you have chronic GI complaints w/o identifiable trigger - this is not caused by IgE allergy. Thus, allergy tests are not useful.

Allergy tests are not screening tests - cannot just 'see what shows up' huffpost.com/entry/read-thi…

Environmental allergies are extremely common - affect ~40% of people.
Many upper/lower respiratory symptoms due to allergies but undiagnosed or treated incorrectly.
Likewise, many symptoms NOT due to allergies, also treated incorrectly.
This #MondayMorning thread will discuss⬇️ 4 main nasal symptoms due to allergies:
-Sneezing
-Itching
-Congestion
-Runny nose (clear mucous)

No itching + mainly congestion = likely nonallergic causes.

Important to note that #asthma & allergies often go hand in hand. Poor control of rhinitis = cough, wheeze

I've had this conversation many times:
Patient: I'm allergic to benadryl
Why did you take it?
I had hives
What happened?
My hives got worse

This highlights several important reasons why EVERY suspected allergy should be evaluated/questioned with details. Thread⬇️ #FridayThoughts Is the suspected trigger a known or common cause of allergic reactions?
(Benadryl is a very rare cause of true allergic reactions)

What were the circumstances surrounding exposure?
If symptoms were already occurring but worsened, this is likely natural part of process

College students will soon move into their dorms or apartments to get ready for fall semester.

There are many challenges to independent living & teens w #asthma #foodallergy or other allergic conditions have to incorporate self management as well. Thread ⬇️ #WednesdayWisdom A few things adolescents w #asthma #foodallergy need to learn how to manage:
- Communication
- Access to meds at all times
- Prescription refills
- Doctor appointments
- Environmental assessment/avoidance
- Recognition of symptoms
- Treatment if symptoms occur
- Risky situations

The #FirstDayofSummer means increasing outdoor activities and tis the season for stings.

Many people are misdiagnosed as having venom allergy...and others with true allergy do not receive proper treatment.

I'll address some misconceptions in this thread ⬇️ #FridayThoughts Venom is naturally irritating - a NORMAL response after being stung is redness, swelling, pain, itching.

Treatment is supportive with ice, pain meds, antihistamines.
This is not infection (no need for antibiotics). This does not increase risk for future allergy.

Whether it’s vaccines or fads such as celery juice to treat chronic inflammation (spoiler - it doesn’t)...social media is filled with opinions of people who have done their own ‘research’.

This thread discusses some problems with that statement ⬇️ #TuesdayThoughts Many people use the word ‘research’ but I do not think it means what you think it means.

Research begins w a question, followed by a thorough & careful view of ALL evidence to support or refute.

Many mistakenly begin with a suspected conclusion, then work backwards.

As #FoodAllergyAwarenessWeek winds down, it is important to discuss exciting recommendations about PREVENTION of #foodallergy. Wouldn't it be great if we could curb the rise? This thread will address interventions that may impact this (if adopted on a wide scale) ⬇️ Introducing allergenic foods such as peanut, egg, wheat, milk into a baby's diet early - beginning around 4-6 months AND keeping in the diet is:
-SAFE
-Beneficial
-In line with current recommendations from Allergy orgs and @AmerAcadPeds pediatrics.aappublications.org/content/143/4/…

Epinephrine is the ONLY effective treatment for anaphylaxis.
It is:
-Safe
-Fast
-Effective for all symptoms

There should be no question to use epi for anaphylaxis. But, deciding whether anaphylaxis is present is the tricky part. I'll address here⬇️ #FoodAllergyAwarenessWeek Anaphylaxis is a rapidly progressive, systemic allergic reaction that can occur from allergies to food, medication, venom, etc.
Easiest definition is any combo of 2 or more organ systems:
Skin=hives/swelling
Lungs=cough/wheeze
GI=vomiting
Nose=congestion
aaaai.org/Aaaai/media/Me…

I thought I'd start #FoodAllergyAwarenessWeek by describing how I (a board certified pediatric allergist) establish the diagnosis of #foodallergy.

This is a life altering diagnosis & it's important to get it right;unfortunately many are misdiagnosed. Follow this thread ⬇️ #FAAW When I first meet a family with concern about #foodallergy, I introduce myself 😁 and ask "How can I help you today?". Then I let them talk...uninterrupted.

I then learn what concerns they have and gain insight into foods, symptoms, etc. #FoodAllergyAwarenessWeek