Are we at the end of the beginning Christian RosasSalazar MD MPH Juan C Celedón MD DrPH Ann Allergy Asthma Immunol July 2019123135 Health Disparities in Asthma are Multifactorial ID: 935732
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Slide1
Slide2Eliminating Health Disparities in Asthma
Are we at the end of the beginning?
Christian Rosas-Salazar, MD, MPH
Juan C.
Celedón
, MD, DrPH
Ann Allergy Asthma Immunol. July 2019;123(1):3-5
Slide3Health Disparities in Asthma are Multifactorial
Rosas-
Salazar
C and Celedón JC. Ann Allergy Asthma Immunol. July 2019;123(1):3-5
Slide4Ann Allergy Asthma Immunol. July 2019;123(1):6-8
Life
-long
Learning and the American Board of Allergy and Immunology
Mitchell H. Grayson, MD
John Oppenheimer, MD
Mariana Castells, MD
Anna Nowak-Wegrzyn, MD, PhD
Slide5The Maintenance of Certification (MOC) Pathway for the American Board of Allergy and Immunology (ABAI)
Grayson MH, et al. Ann Allergy Asthma Immunol. July 2019;123(1):6-8
Slide6Acute Care Beta-Lactam Allergy Pathways: Approaches and Outcomes
Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Anna R. Wolfson, MD
Emily M. Huebner, MSc
Kimberly G. Blumenthal, MD, MSc
Slide7Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Acute Care Beta-Lactam Allergy Pathways: Approaches and Outcomes Key Messages
Acute care beta-lactam allergy pathways are coordinated allergy assessment programs for hospitalized patients as an antibiotic stewardship tool, which can be based on the allergy history alone, or use the allergy history to guide procedures such as drug challenges and/or penicillin skin testing.
Pathways commonly targeted patients likely to benefit from acute care penicillin allergy evaluations: patients on specific broad-spectrum antibiotics, referred from Infectious Diseases specialists, and/or patients with specific infections or bacterial culture results.
Acute care beta-lactam pathways were safe and report decreased alternative antibiotic use and increased beta-lactam antibiotic use.
Slide8Partners HealthCare System (PHS) Penicillin Hypersensitivity Pathway (Boston, MA)
Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Slide9Partners HealthCare System (PHS) Penicillin Hypersensitivity Pathway (Boston, MA) (
continued
)
Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Slide10Penicillin Allergy History Algorithm
(Rochester, NY)
Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Slide11Penicillin Allergy History Algorithm (Rochester, NY) (continued)
Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Slide12Proposed Approach for Specialist Triage All Inpatients with Documented Penicillin Allergy (Bethesda, MD
)
Wolfson AR, et al. Ann Allergy Asthma Immunol. July 2019;123(1):16-34
Slide13Hypersensitivity to Monoclonal Antibodies Used for Cancer and Inflammatory or Connective Tissue Diseases
Ann Allergy Asthma Immunol. July 2019;123(1):35-41
David Hong, MD
David E. Sloane, MD, EdM
Slide14Hypersensitivity to Monoclonal Antibodies Used for Cancer and Inflammatory or Connective Tissue Diseases Key Messages
Hong D and Sloane DE. Ann Allergy Asthma Immunol. July 2019;123(1):35-41
Hypersensitivity reactions to therapeutic monoclonal antibodies for malignant tumors and inflammatory diseases can be classic type I (mast cell mediated, perhaps IgE dependent) reactions, cytokine release reactions, or type IV cell-mediated reactions.
Classic allergic reactions to monoclonal antibodies, presumed to be mast cell mediated and possibly IgE dependent, can be treated with rapid drug desensitization. Rapid drug desensitization is effective and safe for carefully selected patients, allowing them to continue to receive first-line therapy.
It is dubious whether rapid drug desensitization is effectively for cytokine release reactions to monoclonal antibodies, but such reactions can be effectively limited or prevented with appropriate
premedications
, intravenous fluids, and dose or frequency adjustment of the monoclonal antibody.
Type IV cell-mediated reactions, such as erythema
multiforme
, Stevens-Johnson syndrome, toxic epidermal
necrolysis
, drug reaction with eosinophilia and systemic symptoms, and other blistering reactions are absolute contraindications to
reexposure
to the implicated agent.
Slide15An Example of a
TmAb
RDD Protocol for
Tocilizumab
Hong D and Sloane DE. Ann Allergy Asthma Immunol. July 2019;123(1):35-41