Tele-allergy improves access to allergy care within the Veterans Health Administration.

The shortage of Allergy & Immunology providers in the United States restricts access to specialty care. Telemedicine has the potential to expand access beyond physical locations, however, little is known regarding patient preferences for tele-allergy or the ability to successfully manage atopic conditions virtually. This retrospective analysis of a tele-allergy program at the Veterans Health Administration demonstrates that tele-allergy can provide efficient allergy care for veterans, including rural patients, although some reliance on local ancillary services was necessary.

Proactive risk stratification and low-risk penicillin allergy delabeling by an antimicrobial stewardship pharmacist.

Penicillin (PCN) allergy delabeling is an important component of antimicrobial stewardship; however, widespread implementation has lagged. We found that most patients had low-risk PCN allergy histories eligible for delabeling without skin testing. Pharmacist-led risk stratification and drug challenge expanded access to delabeling independently from an Allergy/Immunology service.

Safety of multiple aeroallergen rush immunotherapy using a modified schedule.

Rush immunotherapy (RIT) accelerates the build-up phase of traditional IT. The biggest potential benefit of using RIT is decreased time to symptomatic improvement. However, aeroallergen RIT carries an increased risk of systemic reaction (SR) compared with traditional IT.

Use of olopatadine ophthalmic solution and reactivity of histamine skin testing.

The significant morbidity of allergic rhinitis and allergic conjunctivitis necessitates that diagnosis must be as accurate as possible. However, the very drugs used to treat allergic symptoms have been found to suppress histamine-induced skin testing, making the diagnosis very challenging. Oral formulations of antihistamines are well known to diminish skin test reactivity, but ocular application has never been studied to our knowledge.

The spectrum and treatment of angioedema.

Angioedema manifests as episodes of localized swelling in the dermis and submucosa. The key to successful management is detection and avoidance of triggers, early recognition of attacks, and aggressive airway management when warranted. Review of a patient's medication list may identify drugs that include angiotensin-converting enzyme inhibitor or angiotensin receptor blockers as the cause.