#NewProfilePic
Welcome new followers! 👋🏼 I’m a Holistic Allergy & Immunology Physician. I tweet about cutting edge research, mind-body practices, patient care, health equity, wilderness medicine and nature therapy. Click here to get to know me better:
As a pediatric immunologist, I get this question all the time “what did kids do before vaccines?”
They died … by the millions. Parents in remote areas of the World walk days to vaccinate kids. Anti-VAxers display ignorance + fear + immense privilege and put us all at risk.
Go to an old cemetery. See all the baby graves from before the 1950s & 60s? After that, hardly any. That's when people started vaccinating their children against deadly childhood diseases. If you're unsure what to do to protect your kids, the answer is literally written in stone.
@RealPureLove
For 1 one of those stories, I can tell 100 others of children who are not vaccinated and died before our eyes, despite all our advanced technology. I’m glad your child is doing better.
#Vaccines
save lives. As an allergist I see the reactions too. But the diseases are worse.
@mmforsmann
You have to look it up because
#vaccines
have almost eradicated those illnesses . The refusal to vaccinate comes from the luxury of never having seen the disease and its epidemic state. We humans are terrible at assessing risk so if don’t see children dying think it’s safe
@JawadHusainMD
I also work every Christmas to cover for my colleagues. I have done that my entire career. As a Baha’i I want to be off on my religious holy days too But not every job has allowed me to do that.
@jointdocShields
@AshleyGWinter
I have also slept in the peds playroom. There are these foam pads and also sometimes beanbags.
Worst: MS 3 On sitting on the toilet put my elbows on my knees & head down on my arms for “just a sec” - woke up to pounding on the door a few minutes later 😳
This thread is sad 😢
@TheKidKidDoc
As an immunologist I can tell you that a vaccine doesn’t hang out in your body and then do something terrible five years later. But viruses do. Viruses cause long-term effects not vaccines. We know
#Coronavirus
can cause
#LongCovid
and measles can cause delayed panencephalitis
@EM_RESUS
As soon as I saw this EKG, I flashed back to my 3rd call night on Pediatric ICU during residency. It looked just like this - so I call PICU pharmacist over immediately to get calcium & bicarb, then called the fellow. 😥 I knew the child was seconds from coding.
#PALS
ftw 🙌
@acweyand
@seattlechildren
Yes, I’ve been that rural pediatrician called to the hospital for all pediatric emergencies with closest Backup hours away. The 26 week twins that we had to stabilize before the transport team got there - remembering still gives me anxiety.A baby’s life depends on
#RuralMedicine
Microbial Transplant in oral encapsulated fecal material in peanut allergy patients may offer a
#microbiome
reconstitution method that could modulate allergy severity and promote tolerance. Phase 1 Study showed no safety issues so Therapuetic trials are beginning.
#aaaai22
@ABtheMD
Yeah I worked at a refugee clinic in residency and as a young attending. When I see people working there who have no empathy at all for the refugee experience and I tell people that I was a refugee….And just watch them squirm.
Why are they here in this profession?
#CovidVaccine2nd
dose today! In a few weeks I will be protected from severe
#COVID19
disease. As a front line healthcare worker, it’s important that I’m healthy so I can care for patients. I chose
#vaccination
that I know is safer than gambling on
#coronavirus
infection risk
@Grant_Forks
@szakiya82
@Christine242
@MaryKoCo
I photograph license plates when he pulls up - could be a rental car or stolen but I do what I can. I met a hot guy dancing last night & we went for a drink after - sent his phone number, pic of him & his license plate to my sis before leaving the dance hall
#SafetyFirst
We found
#Microbiome
of
#FoodAllergy
children was different (Clostrida predominance) from their siblings without food allergy (Bacteroides) but even more different from healthy unrelated age-matched controls(pathogens & different Clostridial commensals).
@TCHFoodMD
#AAAAIWAO18
Koreans masked even outdoors during
#pandemic
- masks reduce pollen deposits in nasal passages. Mask wearing seems to protect against allergic sensitization to pollen in children- less allergen getting in to cause development of allergies.
#whyIMask
#AAAAI23
Having been called to several medical emergencies in flight I can attest that airplane medical kits do vary significantly between airlines. Agree Glucometer, EpiPens, automatic blood pressure cuff ARE essential items that should not be left out of even short flight kits.
@Delta
Dear
@Delta
, I just assisted in a medical emergency in the air. Your medical kits need a glucometer, epi pen, and automatic blood pressure cuffs- it’s impossible to hear with a disposable stethoscope in the air. Please improve this for passenger safety!
#ACAAI23
Baseline serum tryptase &
#AlphaGal
#IgE
should be measured in recurring
#anaphylaxis
& in
#biphasic
-consider even if
#foodAllergy
suspected. Educate patients to ask ED for tryptase to be measured in 1st 90 minutes during severe reactions. Criteria for anaphylaxis vary
Dr. Julie Wang & Committee reported
#FoodAllergy
in schools in
@JACIInPractice
. Surprisingly allergen free schools didn’t lower reactions needing epi. School staff training DOES work. For info & resources on what parents, staff & health providers can do
@AllergyHome_org
@uche_blackstock
thank you for showing us how far we have to go to bolster the black physician workforce- I feel gratitude in my heart for each one of you amazing black doctors, who made it through a system stacked against you to represent & heal.
@atulbutte
Complete immune system and genomic analysis on more than 10,000 patients going public will help us figure out
#Percision
#medicine
for immunological diseases, eg. which biologics are likely to work?
#AAAAIWAO18
@AmyDentata
@DrIbram
I wish it was that plain for everyone because ample videographic evidence exists. People still "well, some police officers act on their own, make mistakes...." Trying to pretend it's not general training and policy.
#ACAAI21
@AmerAcadPeds
Keet et al : early introduction of
#peanut
protein at 4-6 months of age proven to be protective against developing
#foodallergy
to peanut - does require regular ingestion but even once a month worked.
@thepedipals
Hard NO! 50 years of research shows most effective discipline is social & preference related consequences – like losing privileges.
#violencefreefamily
is very important to me.
Disagreements should be settled without yelling& calling names & hitting, between partners & kids
Did you know abdominal pain and /or hives, or full blown
#anaphylaxis
can be an acquired
#foodallergy
after tick bite called
#AlphaGal
? Reaction can delayed by 8-14 hours so the food may not be suspected, especially since it may be dose dependent and not occur every time.
I just got my 1st dose of
#Coronavirus
#vaccine
& I am halfway to protected against severe
#COVID
-19 disease. I’m still going to wear PPE at work, always wear my mask, wash my hands, practice social distancing - ‘cause I could still have asymptotic infection & be contagious.
Structural
#racism
& income
#inequality
lead to increased
#asthma
risk and worse outcomes, are the most important factors in health. We must face and eliminate racism &
#poverty
: life and death issues. Dr. Elizabeth Matsui: Investing Together in Our Future Award
#AAAAIWAO18
@maka1687
President of my class was 42 years old when we started - He’d been a tax attorney for 15 years. Did OB/GYN and living his dream. You’re gonna be better prepared and appreciate the journey. 🙌🏽
Mouse models: TSLP surge can reverse type2DM and metabolic syndrome- also lost weight despite eating more. Type 2 inflammation plays a role in metabolic control - the extra calories and fat went towards sebum oil secretion from skin. Brilliant work from
@TakuKambayashi
#AAAAI23
My Sisters 🙌🏽 Happy
#Nationalwomenphysiciansday
to all the bold brilliant doctors who serve in the trenches, had my back & paved the way for the next generation of women. Your dedication & excellence save so many lives. So inspired by you- so grateful for you.
#womenofpower
Changes in modern lifestyle have altered gut
#microbiome
to promote not only food allergy & environmental allergies but also obesity and other chronic diseases
#AAAAI23
#AAAAI24
Non-allergic rhinitis is a difficult to treat common condition in which sensitivity to smells, fumes or cold ❄️ dry air causes nasal congestion & runny nose. Allergy meds often don’t help. New hope: low dose 🌶 capsaicin nasal treatment decreased reactivity. Spicy!
Vernix has antmicrobe peptides protect from pathogens; prevents water loss in newborns - so why do we quickly rub it all off? If leave it on for longer increase skin moisture & decrease pH over 16 hrs establish “acid mantle” to help good microbe balance
#microbiome
#AAAAI23
#MarchForOurLives
Seattle: use your outside voice demand protection or children and teachers not for gun rights. Child’s Right to Live far outweighs anyone’s right to own a gun.
We are seeing more allergic reactions to marijuana products. Several Allergens identified in Cannabis thus far.
#ACAAI19
but reaction to Can S 3 may be predictive of systemic reaction and plant food syndrome to peach, peanut, apple.
@ErickR1982
@arghavan_salles
Why should the doctor have to take on that risk? Why shouldn’t the law actually enable a doctor to practice good evidence based medicine to save a patience life? These are the real questions you should be asking.
Patients and allergists are looking forward to approval of “the patch” which will make peanut EPIT available to many more people.
@TCHFoodMD
presents the safety & efficacy data.
#AAAAI19
#ACAAI23
Infants with
#anaphylaxis
can present with subtle behavioral changes like irritability or sleepiness- recognizing these signs even in the absence of hives, swelling or vomiting can be crucial to treating promptly with
#epinephrine
and be lifesaving
CEGIR/TIGERS symposium debate: Dr. Lisa Spencer argues while mast cells play a role, eosinophils + their tissue deposited granules may be the source of mast cell activating mediators so Eosinophils more important in EGID. Good guys but with cytotoxic chemicals.
#AAAAIWAO18
#AAAAI22
Dr. Sam Boderman (pictured) & Dr. Sameer Mathur found that >90% who thought they were at risk for severe
#COVIDvaccine
reaction actually tolerate vaccine without problems- including those who had reported reactions with 1st dose.
@FacetiousKhan
@springwitty
@MdSheryl
@Joe_Roberts01
She was not asking for your forgiveness or anyone’s. She doesn’t need forgiveness. How do you know if she didn’t already pay for it? Those who sit in judgment are the worst sinners.
Dr. Maureen George: Shared decision making can help compliance: patients feel heard, understood and have buy in for intervention. We need infographics for low
#healthliteracy
#EMR
shortcuts, more time with our patients .
#AAAAI19
@AAAAI_org
Adequate maternal vitamin D levels (supplements >4000 Iu/day) can be protective against asthma in offspring but later on in life blood levels did not prevent
#asthma
exacerbation
@elizabe91393425
@JawadHusainMD
Oh 🥰love hearing stories about Baha’is who have been there for neighbors & built community since it’s so core to the tenets of our faith: “Be worthy of the trust of thy neighbor and look on him with a bright and friendly face.” Baha’i Sacred Writings
#ACAAI23
@AllergyKidsDoc
points out that randomized controlled trials are not always feasible & cannot be the only benchmark for valid science. You can pull this slide out when answering challenges from the anti-vax community. 100 years of
#publichealth
observational data counts
@EricMacyMD
@KPShare
practical approach to drug related adverse reactions, distinguishing true allergy, radiocontrast reactions, possible aspirin sensitivity, challenging for local anesthetic reactions. Removing inaccurate EMR warnings may expedite correct prescribing.
#ACAAI18
#ACAAI23
the majority of Emergency doctors, PA’s, NP’s & primary care physicians surveyed were either completely unaware of
#AlphaGal
syndrome or were not able to articulate symptom cluster & screening guidelines. May not note Tick bite. Role of
#allergist
in diagnosis is key.
Airway mycosis may link multiple endotypes of
#asthma
and chronic rhinosinusitis including aspirin exacerbated respiratory disease, even if not IgE sensitized. Consider anti-fungal especially if positive culture.
@zwmarshall
#AAAAIWAO18
#ACAAI23
Dr. Romi Saini
@JohnsHopkins
on Chronic Urticaria Comorbid conditions, including
#psychiatric
& cardiovascular. New insights into underlying pathology may suggest other treatments but so many unanswered questions remain.
#hives
@DrJimSublett
shares practical tips on choosing biologics, coding&billing, resources for reimbursement:
@ACAAI
Severe Asthma Shared Decision Making Toolkit & Prior Authorization Toolkit. Good discussion of strategies for health systems v solo practice
#ACAAI18
#ACAAI21
Dr. Kari Nadeau & her team are investigating the role of gamma delta T-cells in peanut oral immunotherapy - trying to understand how tolerance works. Aren’t volcano plots cool?
#foodallergy
😕We can’t eliminate SARS2 spread.
💪But we CAN slow it down in the places over / at risk of exceeding hospital capacity.
🚨That’s what our circuit breaker dashboard is designed to do.
🙌To give local officials warning in time to act and save lives.
@snide_sally
@k_fernholz
@Joe_Roberts01
As a pediatrician I have always been infuriated by this. At a practice I once worked at the office manager said I was giving away too many cans of formula. I asked her what else she expected me to do? That’s what the samples are there for and can’t watch a baby starve.
@acweyand
@jenredmiles
This is a common reason I end up testing kids. Food aversion is often mistaken for
#foodallergy
by kids, parents & teachers. Your friendly neighborhood allergist here to clear up confusion 👩🏽⚕️
To my friend’s& followers: I’m under attack on Instagram and Clubhouse by someone I have never met or directly engaged. Have reason to Believe she has already been Suspended by Twitter before I even became aware of who she was, But in case she finds a way to stalk me here too:
Dr. Hirano advocates EGD monitoring annually or after therapy change in Eosinophilic Esophagitis since Symptoms are unreliable indicator of disease severity. Histopathology is important determinant of disease outcome.
#AAAAIWAO18
Can’t just hand them
#peanut
patch and see them twice a year. EPIT patients still need support education and close follow up during
#foodallergy
treatment.
#ACAAI18
@AAAAI_org
& all my colleagues- Thanks for a great
#AAAAI23
annual meeting- learned so much and truly enjoyed connecting with mentors & great minds from all over the world! San Antonio was lovely! See you next year in DC!
@melhkwan
There is literally no worse feeling, even if we think we’ve done everything we possibly could to save that little one. Just know that we feel you. 💔
Training sessions for
#FoodAllergy
teens improved comfort level for
#epinephrine
auto-injector use. Protective factors for risk taking behavior surrounding Food Allergy modulated by school plans, bullying, parents alertness.
#AAAAIWAO2018
Very early onset
#IBD
rates rising worldwide (<6yo at diagnosis) could this be caused by dysregulation of gut
#microbiome
due to environmental changes? Gut inflammation can lead to
#autoimmune
pathway.
#AAAAI23
@IDnibbler
epidemiology of PICU anaphylaxis, using VPS database of US & Canada, found more frequently young males, more Asian from all causes, food related cause in <7 year olds, milk & peanut associated with higher risk of death.
@TCHFoodMD
#AAAAIWAO18
#acaai23
@scott_commins
reports some vaccine reactions may be
#AlphGal
#foodallergy
to the
#gelatin
component of the vaccine or manufacture in mammalian cells. So if reaction to one these vaccines is suspected, testing for alpha-gal should be part of the evaluation.
Privileged to hear
@AmbAndrewYoung
and
@jessewashington
speak on
#race
and
#justice
in America at the Association for Baha’i Studies conference in Atlanta. Sports, journalism, rights, systemic injustice, non-violent protest, and ways to build a new spiritual society.
#ACAAI23
Did you have a severe allergic reaction to insect sting? See allergist ASAP for blood or skin testing -these methods are complimentary- if you test negative to one you may need the other. Blood testing is 1 needle & fast but results take days.