- |||||||||| hydroxychloroquine / Generic mfg., methotrexate IV / Generic mfg.
EARLY DIAGNOSIS OF EOSINOPHILIC FASCIITIS IN A 16 YEAR-OLD FEMALE (Hall B (1st Floor); Monitor 08) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_893;
Infectious work-up revealed positive Toxocara IgG levels, which prompted albendazole treatment...This vaccine could have triggered an inflammatory process in the patient’s already hyper-reactive immune system. It is important to promptly recognize EF, as prolonged symptoms prior to diagnosis is associated with a poor treatment response.
- |||||||||| cetirizine oral / Generic mfg., ceftriaxone / Generic mfg.
EVALUATION OF THE HYPERSENSITIVITY RISK OF THE COVID-19 VACCINE COMPONENTS: A SERIES OF CASE REPORTS (Hall B (1st Floor); Monitor 08) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_892;
Applying SARS-Cov2 vaccines containing polyethylene glycol and polysorbate is not recommended in this patient. Discussion Patients with a history of allergy to PEG or polysorbate need a prior assessment by the allergist and are qualified to educate and guide patients about covid-19 vaccination.
- |||||||||| NOT A CASE OF POST-SURGICAL SITE INFECTION (Hall B (1st Floor); Monitor 07) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_883;
Case Description A 16-year-old non-atopic male with negative pre-operative metal patch testing presented 2 months post Nuss procedure with yellow foul-smelling surgical wound discharge non-responsive to oral Bactrim...He received IV clindamycin, topical corticosteroids, and an allergy consult was requested...Treatment with IV methylprednisolone and a 21-day oral prednisone taper was recommended, with repeat metal patch testing in 6 weeks post steroid course...With proper identification and treatment of his metal allergy the burden and costs of additional procedures for bar removal and replacement were avoided. Post Nuss Bar Procedure Skin Changes
- |||||||||| fluticasone propionate/salmeterol xinafoate inhalation powder / Generic mfg.
A MULTIFACETED APPROACH TO DIAGNOSIS AND MANAGEMENT OF POST COVID-19 ASSOCIATED DYSPNEA IN ADOLESCENTS (Hall B (1st Floor); Monitor 07) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_873;
She was started on fluticasone propionate and salmeterol twice daily...Once they were diagnosed with asthma and EILO it was also discovered that other conditions including GERD and anxiety were likely exacerbating their dyspnea. A multidisciplinary team including gastroenterology, social work, psychiatry, and psychology was able to diagnose and treat these conditions as well.
- |||||||||| montelukast / Generic mfg., fluticasone / Generic mfg.
HYPEREOSINOPHILIA IN A PATIENT WITH UNCONTROLLED ASTHMA (Hall B (1st Floor); Monitor 07) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_867;
Discussion Hypereosinophilia is a serious condition with potentially severe systemic consequences. Asthma rarely causes marked elevations in peripheral eosinophils, however in this case, an individual with uncontrolled asthma and hypereosinophilia demonstrated complete resolution of his eosinophilia with medical management of his asthma.
- |||||||||| famotidine / Generic mfg., diphenhydramine / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
RE-ACQUIRED TOLERANCE TO SOME MAMMALIAN MEATS ONE YEAR AFTER ANAPHYLAXIS AND CONFIRMED GALACTOSE-A-1,3-GALACTOSE SENSITIZATION (Hall B (1st Floor); Monitor 06) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_846;
Discussion Our patient tolerates some types of mammalian meat one year after an anaphylactic reaction and despite laboratory and SPT evidence of sensitization to these meats. Cases such as this suggest that portion size, processing, doneness, fat content, and/or meat cut might play a role in mammalian meat tolerance.
- |||||||||| methylprednisolone oral / Generic mfg., ondansetron intravenous / Generic mfg.
RAPID ONSET OF FOOD PROTEIN-INDUCED ENTEROCOLITIS SYNDROME (FPIES) IN A 2-YEAR-OLD (Hall B (1st Floor); Monitor 06) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_838;
Discussion In contrast to the typical FPIES, we present a case of FPIES with rapid onset occurring less than 30 minutes after ingestion, which has not been previously reported. Having a CBC with differential at both baseline and after a reaction can be useful in confirming a diagnosis of FPIES when the presentation is atypical.
- |||||||||| cetirizine oral / Generic mfg., budesonide / Generic mfg.
GASTROINTESTINAL PRESENTATION OF MASTOCYTOSIS: A CASE REPORT (Hall B (1st Floor); Monitor 05) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_810;
Mastocytic enterocolitis is a variant of mastocytosis with isolated gastrointestinal tract affection and no criteria for systemic mastocytosis including infiltration of the skin, bone marrow, liver, spleen, or lymph nodes. The patient does not present evidence of extra gastrointestinal infiltration, since she only reports symptoms at this level, most often abdominal pain and diarrhea.
- |||||||||| Rituxan (rituximab) / Biogen, Zenyaku Kogyo, Roche
PERSISTENT HYPOGAMMAGLOBULINEMIA IN A PEDIATRIC PATIENT FOLLOWING RITUXIMAB TREATMENT FOR AUTOIMMUNE ENCEPHALITIS (Hall B (1st Floor); Monitor 05) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_806;
Discussion : Our patient’s course underscores the potential for persistent humoral immunodeficiency following Anti-CD20 therapy, which may manifest as hypogammaglobulinemia with or without a serum B-cell deficiency. This case also demonstrates an ongoing deficit in the isotype-switched memory B-cell compartment in conjunction with hypogammaglobulinemia despite CD19 normalization and suggests that B-cell subset recovery may not be uniform following anti-CD20 therapy.
- |||||||||| Dupixent (dupilumab) / Sanofi, Regeneron
NOVEL ERBIN VARIANT AND ASSOCIATED SEVERE ECZEMA IN A 3-MONTH-OLD (Hall B (1st Floor); Monitor 04) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_794;
He had progressively worsening eczema since he was 2 weeks old despite emollients, hydrocortisone, and ketoconazole...Dupilumab was discussed as potential treatment for his eczema; however, it was deferred due to improvement with emollient, wet wraps, and topical steroids...Discussion This case illustrates a novel variant in the ERBIN gene that leads to a similar immunophenotype and clinical phenotype to ERBIN deficiency that has been reported in the literature. Through genetic testing, we were able to identify additional potential clinical manifestations and therapeutic targets.
- |||||||||| Poteligeo (mogamulizumab) / Kyowa Kirin
SUCCESSFUL REINTRODUCTION OF MOGAMULIZUMAB VIA OUTPATIENT ONE DILUTION DESENSITIZATION PROTOCOLS FOLLOWING RECURRENT DELAYED CUTANEOUS REACTIONS (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_732;
Case Descriptions: A 65-year-old woman developed recurrent mogamulizumab-associated rash with onset 1 day after each infusion, refractory to oral methylprednisolone 6-day tapers (24-20-16-12-8-4mg) and cetirizine 20mg twice daily...A 73-year-old man developed mogamulizumab-associated rash with onset 1 day after each infusion, refractory to fexofenadine 180mg daily and diphenhydramine 25mg daily but responsive to methylprednisolone 6-day tapers...Desensitization may be a novel approach for reintroduction of mogamulizumab following recurrent delayed cutaneous reactions while minimizing oral steroid requirements. Further investigation into the use of desensitization to prevent delayed cutaneous reactions may allow more patients to continue mogamulizumab treatment.
- |||||||||| SCIT: AN EFFECTIVE MOUSETRAP (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_725;
To our knowledge, this is the first case of successful mouse desensitization clinically proven in a patient with mouse bite anaphylaxis that experienced an in-vivo subsequent mouse bite following SCIT. Desensitization with SCIT in patients with anaphylaxis to mouse bites with our protocol should be considered in individuals who cannot limit their allergen exposure based on their employment.
- |||||||||| carboplatin / Generic mfg., paclitaxel / Generic mfg.
COMPLETE METABOLIC RESPONSE AFTER CARBOPLATIN DESENSITIZATION IN PERITONEAL CARCINOMATOSIS (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_723;
Figures D, E and F.) March 2021 18-FDG PET/CT axial fusion images of the same patient after the restart of carboplatin/paclitaxel cycles show the absence of metabolism of the lesions demonstrated on the previous scan. Empty arrows.
- |||||||||| pegylated liposomal doxorubicin / Generic mfg.
DESENSITIZATION AND STEPPED REINTRODUCTION IN ANAPHYLAXIS TO PEGYLATED LIPOSOMAL DOXORUBICIN IN KAPOSI'S SARCOMA (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_722;
Subsequently, the PLD infusion was administered in a conventional manner every 3 weeks successfully. Discussion In our patient, the administration of PLD was essential due to the efficacy that has been demonstrated in the treatment of Kaposi's sarcoma, so the performance of desensitization provides a new horizon in the prognosis in patients with hypersensitivity reactions to drugs.
- |||||||||| dexamethasone / Generic mfg., cyclosporine / Generic mfg.
TOXIC EPIDERMAL NECROLYSIS FOLLOWING MACROPHAGE ACTIVATION SYNDROME (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_721;
Her symptoms began one week after her second SARS-CoV-2 mRNA vaccine and did not respond to outpatient treatment with azithromycin and steroids for presumed upper respiratory infection...Dexamethasone and anakinra were initiated on day 29 of illness with prophylactic atovaquone and pantoprazole...Potential culprit drugs were held (pantoprazole, atovaquone, and cephalosporins) and she received a short course of IVIG and cyclosporine in addition to anakinra and steroids...She has recovered well and remains on prednisone and canakinumab...Inflammatory markers, illness events, and treatments are displayed chronologically according to days from initial onset of macrophage activation syndrome. Lab values are normalized for comparison.
- |||||||||| dexamethasone / Generic mfg.
A CASE OF PERIOPERATIVE ANAPHYLAXIS: HIGH-RISK DRUG ALLERGY TESTING IN THE INPATIENT SETTING (Hall B (1st Floor); Monitor 02) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_714;
Iodine, ChloraPrep, and tincture of benzoin were applied topically...Given the patient’s likely need for future procedures requiring anesthesia and history of severe, life-threatening reaction, the decision was made to pursue drug allergy testing. We demonstrate a systematic approach for high-risk drug allergy testing that was facilitated by admission to the ICU.
- |||||||||| fluticasone / Generic mfg.
MOTOR TICS, AN UNKNOWN SIDE EFFECT OF INTRANASAL FLUTICASONE (Hall B (1st Floor); Monitor 01) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_708;
Exogenous suppression of the HPA axis has been proposed as a cause, as patient’s with tics have lower levels of evening cortisol. Care should be taken when initiating fluticasone in this population as there is likely a link.
- |||||||||| Benlysta (belimumab) / GSK
A SUCCESSFUL BELIMUMAB DESENSITIZATION (Hall B (1st Floor); Monitor 01) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_707;
The infusion was discontinued and the patient received 50 mg diphenhydramine IV and 40 mg methylprednisolone IV...An 8-step desensitization protocol was developed (including pretreatment with oral 50 mg diphenhydramine, 650 mg acetaminophen and 40 mg prednisone) and performed successfully in the Medical Intensive Care Unit...Although desensitization protocols to other monoclonal antibodies have been published, no such protocols specific to belimumab were available prior to this desensitization. This case report adds to the literature by describing a successfully implemented belimumab desensitization protocol.
- |||||||||| diphenhydramine / Generic mfg., methylprednisolone sodium succinate / Generic mfg.
A CASE OF ANAPHYLAXIS TO IV CONTRAST MEDIA RESULTING IN CARDIAC ARREST (Hall B (1st Floor); Monitor 01) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_703;
This case illustrates a rare presentation of anaphylaxis to IV contrast media characterized by diaphoresis and shortness of breath followed by PEA arrest. Clinicians should be aware of the rare, but present, risk of anaphylaxis to IV contrast and management strategies, as these patients may require iodinated contrast in the future.
- |||||||||| dexamethasone / Generic mfg., cetirizine oral / Generic mfg.
THE STINGS THAT KEEP ON GIVING: DELAYED ANAPHYLAXIS TO HYMENOPTERA VENOM (Hall B (1st Floor); Monitor 01) - Nov 2, 2021 - Abstract #ACAAI2021ACAAI_693;
Discussion This patient’s symptoms were consistent with anaphylaxis, with no likely alternative cause besides a Hymenoptera venom allergy. Identifying a sting days preceding anaphylaxis may identify candidates for venom immunotherapy, ultimately providing a life-saving therapy.
- |||||||||| Thymoglobulin (anti-thymocyte globulin (rabbit)) / Sanofi, Nulojix (belatacept) / BMS
Enrollment change, Trial primary completion date: Belatacept Pilot Study in Lung Transplantation Immunosuppression in Lung Transplantation (clinicaltrials.gov) - Nov 2, 2021
P2, N=27, Active, not recruiting,
Identifying a sting days preceding anaphylaxis may identify candidates for venom immunotherapy, ultimately providing a life-saving therapy. N=40 --> 27 | Trial primary completion date: Feb 2022 --> Aug 2021
- |||||||||| dexamethasone / Generic mfg.
Preclinical, Journal: Yunnan Black Tea Flavonoids Can Improve Cognitive Dysfunction in Septic Mice by Activating SIRT1. (Pubmed Central) - Nov 1, 2021
The component analysis results showed that YBTF contained 9 compounds, including catechin, gallocatechin gallate, rutin, hyperoside, epicatechin gallate, dihydroquercetin, quercetin, myricetin, and sulphuretin. From these results, YBTF could activate SIRT1 through its active compound components to improve the cognitive dysfunction of septic mice.
- |||||||||| remdesivir / Generic mfg., dexamethasone injection / Generic mfg.
[VIRTUAL] SARS-CoV2 Encephalitis Spares Memory, Affects Language and Attention () - Nov 1, 2021 - Abstract #AAPMR2021AAPMR_663;
Encephalitis in the setting of SARS-CoV2 infection may present with deficits in attention and impulsivity while sparing memory and general mobility. This patient benefitted from the structured brain injury acute rehabilitation program as he recovered.
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