John Carlson

@AlphaGal_RES The t-cells in the skin a just clones of t-cells that stay in the lymph node. It’s the lymph node t-cells that really stimulate the b-cells that make antibodies. Or at least that’s how it’s supposed to work. AGS breaks so many rules it’s hard to know for sure what’s happening

@JohnCarlsonMD I am really interested in whether excising the tick bite soon after the bite occurred might disrupt the immune response that leads to ⬆️ AG IgE since it takes weeks to develop. If I am bitten again I will try this.

@alphagal_info To activate the t-cells which cause the itch/swelling, they must see the antigen again. So the antigen is somehow sticking around for years (it really can’t do that) or else the t-cells are activating without re-seeing the antigen (it can’t do that either) Rules are being broken!

@JohnCarlsonMD Had to use betamethasone to quell rash at site of bite over a decade (maybe >2 decades) old last night, before it got out of control, as it often does.

@Anita37176796 There are times when we no longer need epinephrine for some patients… but we usually have a long conversation before stopping the medication

@PAallergy I’m not sure that we know what the actual costs are. In the US prices are negotiable and can be waived. Eg the costs of covering ~4,000 kids in 85 New Orleans area schools with stock epinephrine was $0. onlinelibrary.wiley.com/doi/full/10.11…

@JohnCarlsonMD In concept I agree but who pays for the ongoing costs of these meds? Epi auto injectors are not $1. They run into the hundreds and thousands of dollars.

@taranaTrex @claudia_riegel Palmetto bug can mean American cockroach or Belostomatid bugs. For the cockroach species, I’ve seen up to six flying at a light together, but it seems to be a very rare behavior. It may be limited to certain populations (eg those that live in sewers but not those living above)

@theimmunodoc Verifying that the patient is getting the correct venom… I did have two cases in which they were on the wrong venom. One was a patient with Vespula allergy, going from the UK to the US. The records used the term “wasp” which generally means Polistes in the US 😬

@MichaelCosimini Those little mite squiggles… adorable.

@AlphaGal_RES @VectorCollector I had no idea that eating/licking coreid bugs was something that one would consider doing. 🤔

@VectorCollector @JohnCarlsonMD

@MelissaGansMD I would be so interested to hear if others have managed to incorporate nasal provocation challenges into their clinical practice.

@JohnCarlsonMD Agree with nasal provocation tests! I personally don’t do it in practice but I trained with an attending who did it on a research basis. It’s a pain to do but should become more standard of care in these patients.

@VectorCollector @americanbeetles @Mozziebites Can’t wait to hear that @mozziebites has arrived with his team of Flesh Flies to clean up the entrails.

@americanbeetles I really really really hope an entomologist is en route! @Mozziebites

@AllergyKidsDoc @AnnalsAllergy Thanks for taking on this hard but important work!

I am proud to announce my new role as an Associate Editor @AnnalsAllergy 👏 Our journal strives to publish both cutting edge research & guidance for clinicians who treat a variety of allergic & immunologic conditions. Relevant + practical info to help achieve optimal outcomes🙌

@KhouryMD Unless you follow them with the epinephrine! I’ve given epi to patients in the bathroom twice.

Maybe needed #MedTwitter #AIMedEd dissemination. Bottom line: don’t let a patient experiencing anaphylaxis walk to the bathroom.

@derekhennen A spicy kick- I’m going to use this for the next consult I get on centipede envenomation!

@megsquitophd @TulaneSPHTM Thanks! Upon reflection it is possible that the spiders are not employed by the School of Public Health and Tropical Medicine. They may be workers from @NolaMosquito. It was literally on the building but technically outside. I’m not sure who’s responsible, but it was high quality

@JohnCarlsonMD @TulaneSPHTM Great shot!!!

@cloud_surfr @NewsCarolyn @TulaneMedicine Mold mitigation companies are a mixed group and not necessarily better than local roofers, HVAC, carpenters and contractors. Mold in an attic means moisture in the attic; local roofers/contractors know how to fix it. I know there’s a wait list (I’m on one too) but I prefer local

@JohnCarlsonMD @NewsCarolyn @TulaneMedicine Once moldy/wet insulation is removed, should you use a mold mitigation company? A/c doesn’t run in the attic. What’s the best way to get rid of mold in the attic??

@ilanarosman @Sailor_to_Doc @jbcarmody @gbosslet @smalltownOMS The beauty of using the Biosketch model is that it is field tested for exactly this problem: the number of well-qualified candidates vastly exceed the available resources; over-stretched reviewers need a short summary of the most relevant evidence of applicant experience

Will be very curious about #medtwitter 's thoughts on this for applications this year: #match2022

@AlphaGal_RES @SpunkyFoonerism The normal process of sensitization is supposed to involve T-cells helping B-cells with affinity maturation (better recognition=localized reactions) along with isotype switching (to IgE production). In anaphylaxis something went wrong with this and we don’t really understand it

@JohnCarlsonMD @SpunkyFoonerism "...it takes time to turn on the T-cells and B-cells" What do you think the implications of this are for alpha-gal syndrome? I've wondered.

@MosquitoLab As long as it doesn't autocorrect Stegomyia etc. to Aedes I really like this idea!

Last year, 43% of graduating US MD students got their top choice in the Match. That’s the lowest in history. Meanwhile, 26% matched at their fourth or lower position - the highest ever - and another 7% were unmatched. Why is this happening? (thread)

It is early in the season right now. Colonies are small, but rapidly expanding as new ants grow. Here, one colony is trying to save pupae as the colony gets battered. Later in the season, colonies will be much larger and fire ant rafts can consist of many thousands of ants.

If that works the raft will settle and try to salvage the colony as water subsides. In bad floods, rafts float freely until it runs into something. If that something is a person or animal it doesn’t go well and there are a lot of stings. Speaking of which I’ve got a lot of stings