- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J, Entyvio (vedolizumab) / Takeda
Indolent Systemic Mastocytosis Presenting As An Excipient Allergy (Exhibit Hall (Upper Concourse); Monitor 02) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_841;
Case Description 43 yo woman with history of ulcerative colitis presented for evaluation of anaphylaxis to infliximab, vedolizumab, and possibly the influenza vaccine over the last year...Her symptoms resolved with rapidly administered epinephrine, methylprednisolone, and intravenous fluids...Interestingly, she tolerated other medications containing polysorbate 80 (sertraline and bupropion) and polyethylene glycol (methylprednisolone and previously a bowel prep)...Discussion In this patient with anaphylaxis to multiple medications and negative skin testing, elevated tryptase suggested an underlying mast cell disorder. KIT mutation D816V is detectable peripherally in the vast majority of SM and can help make a probable diagnosis in patients with indolent disease wishing to avoid bone marrow biopsy.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS
A Case of Toxic Epidermal Necrolysis During Immune Checkpoint Inhibitor and Platin Treatment for Cancer (Exhibit Hall (Upper Concourse); Monitor 02) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_836;
We present a case of metastatic gastroesophageal cancer treated with nivolumab and FOLFOX causing toxic epidermal necrolysis (TEN)...He received intravenous solumedrol, famotidine, and diphenhydramine and was discharged on a prednisone taper and topical triamcinolone...FOLFOX was subsequently discontinued and capecitabine was started...Patch testing is available but has little utility for TEN. Testing for platins with delayed reads along with 10-90 dosing may be useful to establish the safety of continued platin treatment.
- |||||||||| hydrocortisone / Generic mfg., paracetamol / Generic mfg.
mRNA Covid-19 Vaccine-associated Bullous Fixed Drug Eruption (Exhibit Hall (Upper Concourse); Monitor 02) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_833;
Very rarely has it been reported in association with the administration of the Covid-19 vaccines. This case illustrates a unique predicament after an unusual complication of bullous fixed drug eruption after mRNA covid-19 vaccine administration.
- |||||||||| Successful Imiglucerase Desensitization in a Patient with Severe Arthralgia and Myalgia (Exhibit Hall (Upper Concourse); Monitor 02) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_832;
The infusion was stopped, and he was treated with intravenous (IV) fluids, IV hydrocortisone, and acetaminophen...Premedication included intravenous (IV) dexamethasone twelve hours in advance, and IV dexamethasone, aspirin 325mg, IV diphenhydramine, and IV famotidine 30 minutes prior to the first bag...Discussion Adverse reactions to imiglucerase are an infrequent setback in Gaucher disease treatment, with mild cutaneous or respiratory symptoms primarily reported resolving with slowed infusion rates. Although hypersensitivity reactions suspected to be IgG-mediated have been described within the first six months of therapy, this case represents an even more rare immediate muscular hypersensitivity reaction upon first imiglucerase exposure with a successful model for desensitization and continued current tolerance of active therapy.
- |||||||||| Postsurgical Acute Generalized Exanthematous Pustulosis: Timing Is Everything (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_828;
One day prior to presentation he received meloxicam and aspirin...There were plans to perform patch testing to cefazolin, prednisone, and dexamethasone...Patch testing may be utilized to evaluate for the culprit agent; but when this is not available, the timeline between medication exposure and index reaction may aid in causal agent identification. The median time from exposure to onset of AGEP is 1 day for antibiotics versus 11 days for all other medications.
- |||||||||| Emend intravenous (fosaprepitant) / Merck (MSD), Ono Pharma
A Case of Anaphylaxis to Fosaprepitant (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_821;
He was initiated on chemotherapy with azacitidine and venetoclax...Chemotherapy was paused, and cefepime/metronidazole was started...He received 0.3mg IM epinephrine, nebulized epinephrine, 50mg IV Benadryl, and 125mg IV methylprednisolone...Chemotherapy and antibiotics were reintroduced without complication. Increased awareness of hypersensitivity reactions to fosaprepitant is critical given the growing use of this antiemetic drug for cases of refractory nausea.
- |||||||||| Xolair (omalizumab) / Roche, Novartis
A Sympathetic Case of Multiple Inhaler Intolerances (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_818;
He tolerated inhaled fluticasone and cromolyn for several days before having the same symptoms following each use...Drug challenge with budesonide, omalizumab, and albuterol revealed intense flushing, hypertension, and sense of doom within 30 mins...Dexamethasone suppression test was normal...Pseudopheochromocytoma is a rare but important cause of drug reactions that present with paroxysms of hypertension, headache, palpitations, lightheadedness, flushing, and diaphoresis due to somatic sympathetic surges. Treatment includes antidepressants and biofeedback therapy.
- |||||||||| Nucala (mepolizumab) / GSK
Treatment Of Drug Reaction With Eosinophilia And Systemic Symptoms (DRESS) With Mepolizumab (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_817;
Vancomycin, ertapenem, and gabapentin were stopped, and he was treated with intravenous methylprednisolone...He was discharged on oral prednisone 60mg and an adjusted insulin regimen due to elevated blood glucose...Three months post-discharge after a 7-week taper of steroids, he has not had recurrence of DRESS, AEC is ≤ 500/µL, and HbA1C remains within goal. Discussion Mepolizumab shows promise as a novel and safe steroid-sparing treatment for DRESS.
- |||||||||| Remicade (infliximab) / Merck (MSD), Mitsubishi Tanabe, J&J
A Delayed Drug Rash in a Patient with Ulcerative Colitis: Infliximab-Induced Psoriasis. (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_815;
The psoriasis was treated with triamcinolone 0.1% cream using wet dressing technique and resolved within 2 months...Discussion Most side effects from TNF-α inhibitors are observed during the first six months of use including: injection site reactions, cutaneous infections, immune-mediated complications (psoriasis and lupus), and even skin cancers. Identifying the difference between classic psoriasis and drug-induced psoriasis may be challenging due to the variable clinical and histopathological features.
- |||||||||| aspirin / Generic mfg.
Possible Anaphylaxis to Aspirin in a Pediatric Patient (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_811;
Case Description A 6-year-old boy with history of allergic rhinitis and asthma received oral ibuprofen for fever and within 1 hour developed isolated eye and lip swelling, which persisted for several days despite taking diphenhydramine...He initially received his daily inhaled corticosteroid (fluticasone) and nasal corticosteroid (fluticasone), as well as albuterol, with partial improvement in cough...That night, he developed upper eyelid swelling, treated with diphenhydramine, followed by lower eyelid swelling and nasal congestion the next day, for which he was started on twice-daily cetirizine 10 mg...Discussion Although IgE mediated anaphylaxis to aspirin has not been reported, this patient experienced symptoms suggestive of anaphylaxis after a graded oral challenge to aspirin. Alternatively, symptoms may represent a blended non-IgE mediated reaction.
- |||||||||| pantoprazole / Generic mfg., omeprazole / Generic mfg.
Anaphylactic Reaction to Omeprazole After Negative Pantoprazole Allergy Testing (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_810;
To treat the H. pylori infection, the patient took Talicia (amoxicillin, rifabutin, and omeprazole) and developed generalized pruritus, itchy tongue, throat, and bilateral hand swelling within 20 minutes of taking this medication...The patient was taken to the emergency department and received IV Benadryl (25 mg), famotidine (20 mg), methylprednisolone (125 mg), and intravenous fluids (1L NS), with an improvement in his symptoms...The cross-reactivity between different PPIs is not currently well described, and other PPIs should be avoided unless an SKT and oral drug challenge are performed under close observation. Further studies are needed to provide more information on cross-reactivity among PPIs.
- |||||||||| diphenhydramine / Generic mfg., epinephrine / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
Pollen Induced Anaphylaxis Through Skin Abrasion (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_799;
Discussion Grass pollens hypersensitivity is common allergic rhinitis trigger, however, anaphylaxis from exposure via a skin abrasion is not reported to the best of our knowledge. We would like to draw attention that grass pollen sensitization as a potential source of anaphylaxis following exposure to the blood stream via significant abraded skin.
- |||||||||| Kounis Syndrome, The Allergic Heart Attack (Exhibit Hall (Upper Concourse); Monitor 01) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_797;
Upon admission, she received epinephrine...The patient received intravenous (IV) Norepinephrine, IV diphenhydramine, IV Famotidine, IV methylprednisolone, Aspirin, and continuous IV heparin for emergent coronary angiography...Biomarkers in allergies, such as serum tryptase, may provide a potential marker of CAD. Novel medications that stabilize mast cells and reduce inflammation known to control allergies may ultimately reduce cardiovascular events (4).
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
Objective Measurement Of Adherence To Asthma Treatment With A Maintenance And Reliever Digital System (Exhibit Hall (Upper Concourse); Monitor 13) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_683;
P4
In the Maintenance and Reliever Digital System (MRDS), the Digihaler integrated inhalers (fluticasone propionate/salmeterol [FS] and albuterol Digihalers) transmit data wirelessly to a mobile application, which synchronizes with a Digital Health Platform to store and transfer data to a web-based Dashboard...Results The mean monthly adherence to maintenance treatment in participants in the MRDS (n=210) started at 79.2% at Month 1, changed to 70.0% at Month 3, and thereafter remained relatively stable at 68.6% by Month 6 (Figure). Conclusion Study participants using the MRDS maintained good adherence throughout the 6-month study period, despite the pragmatic nature of this study without pre-determined adherence thresholds for action.
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
Data From A Maintenance And Reliever Digital System Support Patient–Clinician Interactions In Asthma (Exhibit Hall (Upper Concourse); Monitor 13) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_681;
P4
Introduction In the Maintenance and Reliever Digital System (MRDS), the Digihaler integrated inhalers (fluticasone propionate/salmeterol and albuterol Digihalers) transmit data wirelessly to a mobile application, which transfers data to a web-based Dashboard...Conclusion A correlation was observed between use of the MRDS and interactions prompted by and leading to discussions on inhaler technique/adherence. These results suggest that the MRDS provides relevant information for asthma management.
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
Effectiveness Of A Maintenance And Reliever Digital System To Improve Asthma Control (Exhibit Hall (Upper Concourse); Monitor 13) - Oct 10, 2022 - Abstract #ACAAI2022ACAAI_680;
P4
Introduction In the Maintenance and Reliever Digital System (MRDS), Digihaler integrated inhalers (fluticasone propionate/salmeterol and albuterol Digihalers) transmit data wirelessly to a mobile application, which synchronizes with a Digital Health Platform to store and transfer data to a web-based Dashboard...The mean odds ratio (95% CrI) for MRDS/SoC was 1.35 (0.846, 2.038), demonstrating that, on average, participants in the MRDS group had 35% higher odds of achieving meaningful improvement in asthma control than those in the SoC group (Figure). Conclusion After 6 months, participants using the MRDS had greater odds of clinically meaningful improvements in asthma control versus SoC.
- |||||||||| Maxidex (dexamethasone eye drops, suspension) / Novartis, dexamethasone cyclodextrin nanoparticle ophthalmic suspension (OCS-01) / Oculis
Eye drops for retinal disease (Auditorium) - Oct 10, 2022 - Abstract #EVER2022EVER_4;
Eye drop formulations based on γ-cyclodextrin (γCD)-based nanoparticle aggregates were developed and deliver therapeutic concentrations of drugs (dorzolamide and dexamethasone) to both anterior and posterior segments of the eye in animal models and clinical studies...Pilot studies with dexamethasone/γCD eye drops showed clinical effect in a range of human conditions, including diabetic macular oedema, cystoid macular oedema and vitritis secondary to uveitis, inflammation after cataract surgery and postoperative treatment in trabeculectomy...OCS-01 was well-tolerated, and increased intraocular pressure was the most common adverse event. Cyclodextrin nanoparticle eye drops deliver drugs to the retina in therapeutically relevant concentrations and promise a non-invasive alternative in drug treatment of retinal diseases.
- |||||||||| dexamethasone / Generic mfg.
SENORINEURAL HEARING LOSS IN SARS CoV2 INFECTION (Convention Center - Hall 4A (4th Floor); In-Person-Only) - Oct 9, 2022 - Abstract #ASTMH2022ASTMH_2404;
ENT evaluation suggested sensorineural pattern of hearing loss and she was started dexamethasone along with supportive management...This case emphasizes one of the rarely reported manifestations of COVID-19, in the form of sudden-onset sensorineural hearing loss. Early detection of same may help in early initiation of steroid with mortality benefit.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma, Kevzara (sarilumab) / Asahi Kasei, Regeneron, Sanofi
Clinical, Retrospective data, Review, Journal: Systematic review and meta-analysis of interleulin-6 inhibitors in reducing mortality for hospitalized patients with COVID-19. (Pubmed Central) - Oct 9, 2022
More randomized clinical trials, mainly focused in atients at high mortality risk, are needed to confirm the benefit of interleukine- 6 inhibitors for COVID-19. Sarilumab was underrepresented in the meta- analysis.
- |||||||||| Orencia (abatacept) / BMS
Journal: Tolerogenic nanovaccine for prevention and treatment of autoimmune encephalomyelitis. (Pubmed Central) - Oct 9, 2022
Notably, treatment of EAE symptom-developed mice with AbaLDPN-MOG significantly alleviated the symptoms, indicating that the nanovaccine had therapeutic effects. Although we used AbaLDPN for MOG peptide delivery in the EAE model, the concept of AbaLDPN can be widely applied for the prevention and alleviation of other autoimmune diseases.
- |||||||||| Byetta (exenatide) / AstraZeneca
Journal: A case report of severe adverse reaction of exenatide: Anaphylactic shock. (Pubmed Central) - Oct 8, 2022
Exenatide has immunogenicity with the potential to elicit an allergic reaction upon administration. Clinicians should always pay more attention to the anaphylactic shock of exenatide, when prescribing for diabetics.
- |||||||||| dexamethasone / Generic mfg.
Preclinical, Journal: Non-invasive in vivo assessment of 11β-hydroxysteroid dehydrogenase type 1 activity by F-Magnetic Resonance Spectroscopy. (Pubmed Central) - Oct 7, 2022
Mono-fluorinated steroids, dexamethasone and 11-dehydrodexamethasone, were detected in phantoms but not in vivo in human liver following oral dosing...We conclude that there is insufficient sensitivity to measure mono-fluorinated tracers in vivo in man with current dosage regimens and clinical scanners. However, since reductase activity was observed in rats using poly-fluorinated tracers, this concept could be pursued for translation to man with further development.
- |||||||||| dexamethasone / Generic mfg.
Journal: Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19. (Pubmed Central) - Oct 7, 2022
Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (OR = 1.07; 95% CI 1.02-1.13, p = 0.008) Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.
- |||||||||| dexamethasone / Generic mfg.
Journal: Correlation analysis of clock genes and MEN2 medullary thyroid carcinoma (Pubmed Central) - Oct 7, 2022
With lipopolysaccharide to stimulate cultured cells in vitro after dexamethasone rhythm synchronization, the expressions of CLOCK and BMAL1 in MEN2 MTC cells (0.47±0.22 and 2.60±1.48) at 12 hours of synchronization were significantly lower than those in para-cancerous tissues (1.70±1.62 and 8.23±2.52), the difference was statistically significant(t=5.04, P=0.007; t=3.34, P=0.029). CLOCK and BMAL1 are correlated with the occurrence and development of MEN2 MTC, and may be potential targets for the development of new therapeutic strategies for MEN2 MTC.
- |||||||||| triamcinolone acetonide / Generic mfg.
Observational data, Retrospective data, Journal: Clinical effects of pulsed dye laser dynamically combined with triamcinolone acetonide in the treatment of keloids (Pubmed Central) - Oct 7, 2022
The number of follow-up of patients' keloids within 12 months after treatment in dynamic treatment group was significantly more than that in TAC group (t=-2.94, P0.05). Compared with TAC injection alone, PDL dynamically combined with TAC in the treatment of keloid can shorten the effective time, reduce the number of TAC injection, and improve the patient's compliance and clinical efficacy.
- |||||||||| tobramycin/dexamethasone / Generic mfg., ofloxacin ophthalmic / Generic mfg.
Journal: Unilateral vortex keratopathy of unknown etiology. (Pubmed Central) - Oct 7, 2022
What would be the most appropriate surgical and/or medical interventions? What would you counsel in prognosis for this patient?
- |||||||||| Darzalex (daratumumab) / J&J
Trial initiation date: A Study of Daratumumab (clinicaltrials.gov) - Oct 7, 2022
P3b, N=400, Not yet recruiting,
What would you counsel in prognosis for this patient? Initiation date: Aug 2022 --> Dec 2022
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