I am a
#Pediatric
#Allergist
and I’m recommending
#COVIDVaccineKids
to all my patients
No increased risk of reactions
No
#anaphylaxis
in trials
Does not contain any protein that looks like food, venom or environmental allergen
USA has given > 1 million doses and no signals noted
Allergists are able to assess & determine a safe setting for vaccination.
Don’t request an
#exemption
, ask for a referral and let’s talk options.
Spoiler alert: most can be vaccinated safely.
#GetVaccinated
Seeing very young children with significant asthma at an alarming rate in our office. Kids under 6yo with asthma requiring high doses of medications, or multiple medications to get control.
Is this happening in your offices too?
#pediatrics
#familyphysicians
#medicine
#asthma
If your aunt had a penicillin allergy,
Your child is not at risk of penicillin allergy.
If your father has a venom allergy,
Your child is not at risk of a venom allergy.
If you have a medication allergy,
Your child is very likely just fine on that medicine.
Sincerely,
Allergist
Dear Non-allergist,
STOP ordering IgE food tests. Yes, I'm looking at you. Don't order a test that you don't manage. Our tests are very very dependent and context 100% matters in what we do. We are not in the business of creating artifact or selling fear.
Sincerely,
Allergist
During an allergic reaction NEVER, EVER, EVER step into the shower or bath. 🚿🛁🥜
Contact reactions don't cause systemic symptoms.
Showers will never fix breathing (in anaphylaxis).
Showers drop blood pressure.
Showers make you inaccessible.
#anaphylaxis
#epinephrine
#AIMedEd
Thanks for your referral!
Unfortunately, our office does not offer food allergy ‘panel testing’ upon request of physician, parent or patient. If there is no history of IgE mediated reaction, we will not screen or test.
Because in medicine, first do no harm is the golden rule!
@InfjHeartchakra
Save your money. Don't do it. It, and many other non-validated tests, are absolutely a scam. Here are a few articles to get you on the right track with this topic:
Happy reading!
@Newrick69
Great question: Atopy refers to the genetic tendency towards a constellation of allergic diseases including allergic rhinitis, asthma and atopic dermatitis (eczema).
It is a "March" of conditions that seem to occur in an individual over their life.
OIT in a nutshell.
Not a cure.
Not for every patient.
Not for every allergist.
Customization is key.
Shared decision making is essential. Understand the process and KNOW it’s limitations.
Right fit = amazing.
Wrong fit = disaster.
Long term & real world data coming...
I am an allergist. I still have no idea what you mean by 'please see for routine allergy testing'.
Patient: Is there a 'routine allergy test'?
Me: No. Tests answer a specific question. What's the clinical concern you would like us to evaluate?
#foodallergy
#allergy
#medtwitter
Soy lecithin is a food additive derived from soy bean oil and TYPICALLY does not contain sufficient protein to cause allergic reactions in MOST individuals allergic to soy.
Please stop making people's lives even more complicated. Simplify the message.
Sincerely,
Allergist
We get many phone calls about EGG allergy and the FLU SHOT at this time of year. No special precautions are required for the administration of influenza vaccine to egg-allergic patients no matter how severe the egg allergy.
#flushot
#egg
Worried about an allergic reaction AND you have EPINEPHRINE on hand?
FIRST use Epinephrine, THEN dial 911 and/or go to the hospital. NEVER, EVER, EVER do the reverse.
If you are waiting until someone is TRULY unwell,
you've waited too long.
#anaphylaxis
#epinephrine
#AIMedEd
Food Allergist disclosure: When a person states they "Eat may contain and has had no reactions" that means nothing regarding level of tolerance or reaction threshold. It does however give us insight into risk tolerance, but that IS personal!
#food
#allergy
#anaphylaxis
If a child has a suspected FOOD ALLERGY and their skin test and/or blood test indicates potentially NOT ALLERGIC - the next best step in their evaluation is an ORAL FOOD CHALLENGE in a medical facility, and not ORAL IMMUNOTHERAPY
Sincerely,
Allergist/OIT Enthusiast
A reminder for all awesome parents, patients, and amazing MD's
Flu Shots + EGG Allergy = OK!
There are no contraindications to routine childhood vaccinations including the flu shot despite having an egg allergy.
#besafe
#COVID19
#FluShot
#Foodallergy
I know you want to help but please STOP ordering IgE food panels on babies with eczema.
The parents get no answers.
The babies don't like it.
The ordering doctor is puzzled.
The allergist hates it.
Put the pen down, and let's talk about it.
#baby
#food
#allergy
#eczema
Routine consumption of "may contain"s:
-is NOT immunotherapy
-does not indicate tolerance to all 'may contains'
-does not indicate a high threshold reactor
-does not mean others should be fine with that too
-is a nuanced discussion
-is never a quick question
#allergy
#anaphylaxis
Proud to be the NEW OMA Section Chair for Allergy and Immunology! This is truly an incredible milestone in my career and I look forward to representing an amazing group of physicians.
@Health_Ontario_
@DrDougMackMD
@OntariosDoctors
Harms from administration of epinephrine when it wasn't needed: NONE
Harms from non-administration or delayed administration of epinephrine when it was needed: MANY
Conclusion: If you think you need it, just do it!
#epinephrine
#anaphylaxis
#foodallergy
#allergy
Did you know? In our allergy clinic we run multiple oral challenges and frequently manage allergic reactions.... we have NEVER managed a reaction with Benadryl! We have NONE of this stuff on site. It’s like a curse word in our office.
@DrDougMackMD
#foodallergy
#FoodForThought
Not every rash is allergy.
Not every rash is from food.
Not every rash is dangerous.
Not every rash will get worse.
Not every rash needs Benadryl.
Not every rash needs me.
Rashes happen- sometimes.
Sincerely,
Allergist
Sad but not surprised
#AAAAI2020
is cancelled. I am confused why this wouldn’t be converted to a virtual meeting? It’s less than a week away. Attendees have booked the time, educational content is prepared. Why not use it to test the power of technology to connect us virtually!
STOP calling night time cough at 2-3AM 'post-nasal drip'. It almost never, ever is. It's called ASTHMA - and poorly controlled at that. That's right. The word is ASTHMA. Now let's treat it as such.
#asthma
Dear
#AirCanada
,
Stop making every allergic patient's life more difficult by requiring a physician signed 8-page document to allow safe accommodations during flying. Our patients and healthcare system do not need this administrative burden.
Frustrated,
Allergist & Advocate
Some days in the allergy clinic, it's mostly discussing what is NOT an allergy, and what allergies ACTUALLY look like.
Public and medical education around allergies MUST improve. Fear-based approach isn't working.
Sincerely,
Allergist
Do you have asthma?
- No, but...
...I use puffers with colds
- ummm, that's asthma
...I just use puffers when my allergies act up
- yeah, that's also asthma
...I use puffers when I'm running lots
- yep, asthma
...But it's definitely not asthma...
- I hate to break it to you
Early Introduction and Infant Food Allergy Prevention: Where does ‘every 3 days’ come from? Is there any science/evidence for this? Is this an outdated myth? Finally, should you be recommending this?
A thread🧵
#food
#allergy
#anaphylaxis
🥚🥛🥜
Please allow children to believe in Santa. You believe in essential oils and no one is ruining it for you.
#Christmas2020
#allergies
#MedTwitter
#children
Created by someone much wiser than I, but I 100% conquer.
Seasonal allergy patient, 3 years on immunotherapy, now running his own landscaping business!
That's what we would call success 😊
Allergists have the best specialty!
#seasonal
#allergy
#pollen
As an allergist, risk is something we speak about every day. There are 3 big things you should know about risk:
1) Every decision you make carries risk
2) Risk is both mathematical and personal
3) Personal risk tolerance can change over time
Sincerely,
Allergist
The rise in allergies can be attributed to our MODERN lifestyle and an interplay with epigenetics.
There 5 environmental D's to consider:
Diet, Dogs, Dirt, Vitamin D, Dry skin
It's too much of some,
too little of other, and
timing, timing, timing.
Sincerely,
Allergist
The downfall of the allergy specialty is not due to inability to get people skin tested or allergy bloodwork fast enough... it's:
1) Lack of utilization of oral food challenges
2) Improper/over testing
3) Inaccurate interpretation of sensitization
Treat the patient not the test
Dear Ontario, Ontario doctor's are STILL here for other health concerns and those are EQUALLY as important.
We are open. We are here. We have gone through every effort to ensure your safety in our clinics. It's frankly safer than the mall!
Don't ignore your health; we won't!
Outlandish idea: In 2022, a restaurant should be able to facilitate a space that is cleaned from whatever allergen to appropriately prep a meal for a person. It’s totally not what’s convenient for the restaurant, but an expectation for serving humans food.
#allergy
Dr Hourhane- Allergists are not the food police... we are now the food fairies. We no longer want you to avoid ‘just in case’ we want you to eat it ‘just in case’
#AAAAI19
"I wish they never labelled my child as food allergic before I even fed them anything" then begins crying.
Don't be that person that panel tests.
Don't be that person that does screening tests.
Don't be that parent that demands this approach.
@WhatAllergy
We must be cautious not to confuse correlation with causation especially in chronic conditions which wax and wane as their hallmark.
Coming up with sustainable long term strategies and understanding that there are unexpected speed bumps along the way ultimately is less harmful!
Friday Myth Buster....
FICTION: My child's
#allergy
is mild/moderate/severe
FACT: The severity of an allergy is poorly predicted (in general). It's like the weather forecast... it depends on allergen, content, cofactors, and comorbidities but the storm can be unpredictable!
Health and Wellness activity...
1- Walk to your medicine cabinet
2- Grab the Benadryl
3- Throw it OUT!!
Congrats, you've just made your medicine cabinet safer for ur household!
Benadryl: sedating, impairs sleep/learning/work, 📈dementia risk, overdoses
#benadryl
#allergy
#Food
Food introduction/allergy prevention: Why is it every three days? Who came up with that thought? Is there science to support this? Or is it a perpetuated myth?
Happy to do a thread if there’s interest in this topic. 🥜 🥛 🥚
Please be advised that ANY and ALL rashes on the skin are not instantly diagnostic of an ALLERGY or even a FOOD ALLERGY and yes, this includes hives.
My
#dermatology
friends would be outraged at this pattern of thinking and my
#allergy
colleagues get grey hairs daily over this👩🦳
Eczema NOT pathognomonic for food allergy. While severe eczema may be higher risk for food allergy, not 1:1. Severe eczema no more than a moderate pre-test probability of food allergy. Soon: a recommendation against ALL dietary elimination for any severity of eczema.
#napaac22
Please be advised that no singular skin test size or blood test makes the diagnosis of allergy with 100% certainty. Also, regrettably, (not really) we do not offer testing to 'everything possible'.
Sincerely,
Allergist
Allergy Consultants are not a routine SCREENING service. We do diagnosis, prevention, and treatment. BUT, we are not advocates of aimless screening. It causes harm.
Thank you for your understanding.
#AIMedED
A rash on a baby's chin is NOT food allergy until proven otherwise.
A recurrent rash on a baby's chin is not numerous food allergies until proven otherwise.
Don't equate your fear to a proper risk assessment and food allergy diagnosis.
Sincerely,
Allergist
It's not normal for a child to require a course of oral steroids 3-4 times in a year. Not sure how else to tell you this. It's REALLY not normal.
Sincerely,
Allergist
Corticosteroids (in case you're going to think about it) has ZERO evidence to prevent biphasic reactions.
First generation antihistamines should NEVER be used in the context of anaphylaxis. Stay away! If you're even going to consider it, use 2nd and 3rd generation.
#CSACI23
Inhaled steroids in children? Concerned about final height? Data supports patients on mild/moderate doses ICS may have SLOWING of their vertical growth but eventually achieve their predicted height. However, we have great evidence that uncontrolled
#asthma
STUNTS growth forever!
Did you know? Benadryl has never saved someone’s life and yet “In 2003, 28,092 exposures to Benadryl were reported to poison control centres in the US—11,355 (40.4%) of these cases were in children under the age of 6, resulting in at LEAST 6 fatalities”
#allergies
#anaphylaxis
Do we have a portable, easy to use, pre-loaded, life-saving medication for a potential allergic reaction on board this flight?
- ummm
- not really
- but we should
- because it's 2022 and not the stone ages
- and it is as simple as ABC!
#anaphylaxis
#allergy
#health
The scariest sentences we hear:
- It's just allergies
- We were told the next reaction may be fatal
- We don't use epinephrine or it won't work
- We don't use puffers or they'll be dependent
If you've used ANY of these statements, get off Twitter and seek out an allergist. ASAP😉
News: ALLERGIC REACTION!
HIVES don't equal an allergic reaction. Public awareness (and reporting) on this must improve. Our healthcare system sucks BUT prolonged hives RARELY represent a medical emergency - or need epinephrine.
Sincerely,
Allergist
Montelukast is NOT a primary treatment of asthma. There’s international agreement on this. AND don’t forget to counsel on the black box warning associated with this medication
#asthma
#NAPAAC24
#Peanut
Allergy in Press!
Infants age 1-3 yo wore a 'sticker'
#EPIT
daily for a year! Results: increased reaction thresholds, decreased reaction severity.
Imagine, one day a diagnosis, the next day an immediate intervention catered by age & lifestyle!
I wish I could wave a magic wand and make:
- allergies disappear
- eczema non-existent
- skin not itchy
- and breathing be perfect
But for now, I rely on science and evidence based medicine and be grateful for the briefcase of options now available.
Sincerely,
Allergist
Get aggressive with managing infant eczema! It will provide the infant with good quality sleep, better development, decrease food sensitization through their skin, and make it easier for food introduction.
We can STOP uncontrolled eczema in infancy.
Sincerely,
Allergist
Did you know? While 40% of people might show detectable IgE antibodies to foods, only 5-8% are actually allergic. It's crucial to interpret these tests with care, not as black-and-white 'positive' or 'negative.'
The Atopic March makes me think of 3 rules:
1) Any food allergy pt ALWAYS screen for asthma symptoms
2) An infant with moderate/severe eczema ALWAYS discuss food allergy prevention (early intro and risks of food allergy)
3) A patient with allergic rhinitis then think of asthma
The value of 'allergy tests' (skin tests or bloodwork) is in their proper utilization AND interpretation.
The number and size of the test alone is meaningless.
Context IS everything.
Improper utilization causes harm.
Just 'cause you CAN do it,
doesn't mean we (or you) SHOULD.
Question: When an asthmatic patient comes back at follow up, taking their medications, and having ZERO symptoms, do they still have asthma?
Answer: YES! Well controlled asthma.
#asthma
#respiratory
#medicine
It is triggering for me to read about a death from food allergy. Even though occurrences are rare, it is every patient/physicians nightmare. Food is integral to us for nourishment, and intertwined into our social interactions.
#anaphylaxis
#foodallergy
A child reacted, on an otherwise boring day, on what was otherwise supposed to be a fun, casual outing/event with family or friends. They're stressed. I'm frustrated for them. Food allergies suck.
Sincerely,
Allergist
Mounting evidence and support for FEEDING babies peanut at an early age.
A reminder: FOOD belongs in the mouth and not worn on the face. Cute photo in this article but misleading- food in the mouth is best!
#peanut
#allergy
I hate school forms.
I said it.... and here's why...
'Non -life threatening anaphylactic reactions'.... give me a break! This is getting ridiculous. There is a reason why we have standardized
#anaphylaxis
action plans.
#food
#allergy
@FoodAllergyCAN
@DrDougMackMD
The biggest harm done to our specialty is routinely using wrong labels:
food allergy - when it isn't
drug allergy - when it isn't
allergy - when it isn't
and wait for it...
immunotherapy - when it isn't
The tsunami of misinformation is rampant.
#AIMedEd
#allergy
#medtwitter
Just a thought... there are shortages on Ventolin (and possibly epinephrine autoinjectors).... schools are closed and have essential medications stored for children on site... can schools arrange for safe pick ups for families?
#COVID19ON
#ONeducation
#schoolsout
#PharmacyHeroes
Don't tell me you want to learn about OIT when we haven't hammered through proper food allergy diagnosis.
Also, it's actually not OIT if the patient is not even allergic, it's actually just a colossal waste of time and healthcare resources.
As per 2019 AAP guidelines, you NO longer need to feed one new food every 3-5 days.
I repeat - DONT NEED TO DO THIS!
For patients with FPIES, consider 1 new food per meal!
#AAAAI24
To anyone that says you need to give routine Ventolin/Salbutamol BEFORE inhaled medications to “open up the airways” so that medicine can “be delivered,”
You and I need to exchange some words, and discuss evidence based practice. Do we need a thread?
#asthma
#puffers
#MedTwitter
My parents tell me that in their time, any inexplicable or random symptom was often explained away as 'allergy'.
Well... it seems the more things change, the more things really don't change at all.
While we diagnose allergy, we un-diagnose even more.
Sincerely,
Allergist
#runnynose
#congestion
- common with
#allergies
, can be seen with
#colds
, less commonly with
#COVID19
Families: use meds to control your child's allergies
Schools: asking for an MD letter documenting allergies is nonsense
Public health: we need ready access to testing
Modern allergy practice is:
a) interpreting somebody else's indiscriminate tests that have no relevance to the presentation
b) diagnosing something the had been dismissed as 'normal'
c) explaining risks
d) debunking social media blunders
Now hiring!
Sincerely,
Allergist
Baby led weaning: a method of introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult.
NOT recommended for babies with eczema.
NOT recommended for allergenic solids.
NOT recommended by allergists.
It is of low yield to introduce an 'allergen' and then never maintain it into an infants diet.
The recommendation is for early introduction AND ongoing consumption to maintain tolerance.
Sincerely,
Allergist
Please recognize that allergies don't come as:
- small, medium, large and x-large
- mild, moderate, severe and anaphylactic
- contact, ingestion, inhalational and airborne
They come as ALLERGIES.
Sincerely,
Allergist
#Ontario
COVID Vaccine medical exemptions:
- Myocarditis (heart inflammation)
- Pericarditis (inflammation of sac around heart)
- Allergist confirmed reaction
Wondering whether you can/should get vaccinated due to a medical reason? Talk to your doctor!
#COVID
#VaccinePassports
"It's probably NOT the food allergy that causes the eczema, but the uncontrolled eczema that can cause the food allergy"
AND
"Whatever food avoidance measure you may pursue because XXX said to, don't do it strictly, or for longer than 2 months!"
- Dr. Marissa Joseph,
@CSACI_ca
Missed appointments and no-shows on confirmed appointments in a fragile health care system with backlogs everywhere is entirely punitive to not just that person, but all those waiting in cue after them. Don't be that person.
#ONHealthcare