Metal Hypersensitivity in Total Joint Arthroplasties - PowerPoint Presentation

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Metal Hypersensitivity in Total Joint Arthroplasties

Sravani Penumarty, MD

Linh-An Tuong, MD

Reena Khianey, MD

John Oppenheimer, MD

Ann Allergy Asthma Immunol. June 2020;124(6):546-547

Prearthroplasty

Algorithm for the Evaluation of Metal Allergy in Patients with a History of Metal Hypersensitivity to Previous Orthopedic Implants

Penumarty S, et al. Ann Allergy Asthma Immunol. June 2020;124(6):546-547

Addressing the Epidemic of Antibiotic “Allergy”

Over-Diagnosis

Eric Macy, MD, MS

Ann Allergy Asthma Immunol.

June 2020;124(6):550-557

Three Important Ways to Avoid Inappropriate Antibiotic Use

Macy E. Ann Allergy Asthma Immunol. June 2020;124(6):550-557

Elements in the Antibiotic-Associated Adverse Reaction History Suggestive of Immunologically Mediated Hypersensitivity Where Testing is Indicated

Macy E. Ann Allergy Asthma Immunol. June 2020;124(6):550-557

Children with Reported Penicillin Allergy

David Vyles, DO, MS

James W. Antoon, MD, PhD

Allison Norton, MD

Cosby A. Stone Jr., MD, MPHJason Trubiano, MBBS, PhD

Alexandra Radowicz, BSElizabeth J. Phillips, MD, FIDSA, FAAAAIAnn Allergy Asthma Immunol.

June 2020;124(6):558-565

Children with Reported Penicillin Allergy

Key Messages

Vyles D, et al. Ann Allergy Asthma Immunol. June 2020;124(6):558-565

Most allergies in pediatric patients are self-reported and often inconsistent with true allergy. Most of these supposed allergic reactions are attributed to β-lactam antibiotics.

Traditional penicillin allergy testing has involved a 3-tier approach; however, mounting evidence indicates that a direct oral challenge in children with low-risk allergy symptoms may be the optimal approach to delabel a child with reported β-lactam allergy.Children with reported penicillin or drug allergies are often found to have an increase in alternative prescriptions for their bacterial illness.Prescription costs are 30% to 40% higher in patients with suspected penicillin allergy.With the evidence indicating the safety of delabeling

and the accumulating evidence for the negative economic, individual, and public health burden of a penicillin allergy diagnosis, there is a need to establish strategies and programs to develop feasible, scalable, and effective approaches.

Antibiotic Pathway in Children with Penicillin Allergy

Vyles D, et al. Ann Allergy Asthma Immunol. June 2020;124(6):558-565

Risk-Stratified Pathway for Penicillin Allergy Evaluation

Vyles D, et al. Ann Allergy Asthma Immunol. June 2020;124(6):558-565

Drug Hypersensitivity in the Fast Lane:

What Clinicians Should Know About Phenotypes, Endotypes, and Biomarkers

Baruch D. Jakubovic, MD

Leticia de las Vecillas, MD

Teodorikez Wilfox Jimenez-Rodriguez, MDSoledad Sanchez-Sanchez, MD

Mariana Castells, MD, PhDAnn Allergy Asthma Immunol. June 2020;124(6):566-572

Drug Hypersensitivity in the Fast Lane

Key Messages

Jakubovic BD, et al. Ann Allergy Asthma Immunol. June 2020;124(6):566-572

Drug hypersensitivity represents a small area of focus within allergy & immunology with broad clinical impact.

Categorization of drug hypersensitivity can be amplified with current evidence-based studies of reactions to chemotherapy and monoclonal antibodies.A novel model of drug hypersensitivity classification involving phenotypes, endotypes, and biomarkers is appropriate for precision medicine.Drug desensitization is an evidence-based and robust therapeutic procedure for use in selected patients with immediate hypersensitivity reactions.

A Contemporary Model for Drug Hypersensitivity: Viewing Reactions through the Prism of Phenotypes, Endotypes, and Biomarkers

Jakubovic BD, et al. Ann Allergy Asthma Immunol. June 2020;124(6):566-572

Classification of Phenotype-Endotype Relationships in Immediate Hypersensitivity Reactions

Jakubovic BD, et al. Ann Allergy Asthma Immunol. June 2020;124(6):566-572

Procedural Considerations Regarding Rapid Drug Desensitization

Jakubovic BD, et al. Ann Allergy Asthma Immunol. June 2020;124(6):566-572

Clinical Aspects of Sublingual Immunotherapy

Tablets and Drops

Mike Tankersley, MD, MBA

Joseph K. Han, MD

Hendrik Nolte, MD, PhD

Ann Allergy Asthma Immunol. June 2020;124(6):573-582

Clinical Aspects of Sublingual Immunotherapy

Tablets and Drops Key Messages

Tankersley M, et al. Ann Allergy Asthma Immunol. June 2020;124(6):573-582

Storage requirements and stability differ between sublingual immunotherapy (SLIT) via tablets (SLIT-T) vs liquid drops (SLIT-D).

Whether there are any differences in mechanism of action between SLIT-T and SLIT-D is currently unknown.Optimal doses for SLIT-T have been established in randomized, double-blind, clinical trials, whereas there is no standard dosing or dosing formula for SLIT-D in the United States. Rigorous placebo-controlled, double-blind trials are needed to determine the effective dose ranges of SLIT-D in North America.The efficacy of SLIT for allergic rhinoconjunctivitis and asthma has been demonstrated in multiple meta-analyses, but most meta-analyses do not distinguish between trials of SLIT-T and SLIT-D. No head-to-head trials of SLIT-T and SLIT-D have been conducted.The safety profiles of SLIT-T and SLIT-D appear similar, and both formulations are safer than subcutaneous immunotherapy.

Class effects between SLIT-T and SLIT-D cannot be assumed, and individual products need to be evaluated in well-controlled clinical trials to establish dosing, efficacy, and safety.

Fate of the Allergen After Sublingual Administration

Tankersley M, et al. Ann Allergy Asthma Immunol. June 2020;124(6):573-582

Potency of Cumulative Monthly Maintenance Dose of Sublingual Immunotherapy Via Liquid Drops (SLIT-D) Prescribed by US Allergists as Reported in a 2018 Survey

Tankersley M, et al. Ann Allergy Asthma Immunol. June 2020;124(6):573-582