The Experts below are selected from a list of 57 Experts worldwide ranked by ideXlab platform
Thanh D. Hoang - One of the best experts on this subject based on the ideXlab platform.
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A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism
AACE clinical case reports, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Thanh D. HoangAbstract:The galactose-alpha-1,3-galactose (alpha-gal) allergy, an IgE-mediated response to nonprimate Meat, has a singular pathogenesis linked to tick bites and a delayed allergic presentation, which makes it especially cumbersome to diagnose and manage. As a large array of enteral medications contain ingredients derived from Meat Byproducts, this can affect the care of alpha-gal patients across multiple medical disciplines. Our objective is to present a patient with an alpha-gal allergy, which can complicate hypothyroidism treatment selection. In this case of difficulty tailoring thyroid replacement therapy secondary to the alpha-gal allergy, the diagnostic studies included IgE immunoassays for alpha-gal as well as thyroid function tests. A 45-year-old woman with postoperative hypothyroidism and a history of an alpha-gal allergy (diagnosed after an anaphylactic reaction to beef) could not be immediately started on any common thyroid hormone replacement formulation because of our concern regarding the possible presence of nonprimate mammalian Meat byproduct components in the thyroid hormone medication. After consulting allergy and immunology specialists and compounding pharmacists and contacting multiple drug companies in an effort to confirm the nature of the inactive ingredients in their thyroid hormone products, she was prescribed a plant-based compounded levothyroxine preparation with good clinical results. This case emphasizes the importance of recognizing various risk factors and common drugs which may be associated with the alpha-gal allergy. It is not known how to best tailor enteral medications for patients with an alpha-gal allergy. Further research and pharmaceutical attention to this allergy are needed. Copyright © 2020 AACE.
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SAT-511 Alpha Gal Allergy in a Hypothyroid Patient
Journal of the Endocrine Society, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Elizabeth M. Bauer, Thanh D. HoangAbstract:Abstract Background: The IgE-mediated allergy to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate expressed on nonprimate mammalian proteins, has gained more clinical significance as it can present with serious, potentially fatal anaphylaxis or angioedema. In general, recognizing a specific allergy is the first step in prescribing avoidance; but with delayed symptoms, uncertain prevalence, and unclear diagnostic approach, alpha-gal allergies are difficult to recognize and prevent. To further complicate the clinical picture, some patients can tolerate small portions of nonprimate mammalian Meat or tolerate one kind of Meat over another. We hereby present a case that highlights the lack of guidance and resources currently available to treat a patient with alpha-gal allergy and hypothyroidism. Case Presentation: A 45-year-old woman with a history of an alpha-gal allergy and follicular thyroid neoplasm status post right hemithyroidectomy presented with postoperative hypothyroidism. After the surgery, she had undetectable serum thyroglobulin levels; her thyroid stimulating hormone (TSH) levels were ranging 5–6 µIU/mL (not on thyroid replacement). The goal was to prescribe thyroid replacement to initiate cancer suppressive strategy. The American Thyroid Association (ATA) recommends a TSH of 0.5-to-2 mcIU/mL in low risk patients postoperatively. The standard treatment of choice for correcting hypothyroidism is synthetic thyroxine (T4, levothyroxine). Commercially available levothyroxine, liothyronine, combo, and desiccated thyroid formulations - whether brand name, generic, tablet, soft gel capsule, or liquid - all contain Meat Byproducts and can be a concern for anaphylaxis or angioedema if one has an alpha gal allergy. Because of the possible reactions with all common formulations of thyroid hormone replacement in this patient, choosing a safe option was complicated and involved a multidisciplinary team, including allergy and immunology consultation. Daily parenteral synthetic thyroid hormone therapy was considered; however, it is not practical and was not feasible for the patient. She was eventually prescribed pure Levothyroxine, with a plant-based filler and vegetarian capsule. She tolerated this pure levothyroxine well without any adverse reactions, and the TSH goal was achieved. Conclusion: This case emphasizes the importance of recognizing various risk factors and common drugs associated with the alpha-gal allergy. Further research and pharmaceutical attention to this allergy is needed.
Gang Liu - One of the best experts on this subject based on the ideXlab platform.
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Efficiency and Carbon Footprint of the German Meat Supply Chain
Environmental science & technology, 2019Co-Authors: Li Xue, Neele Prass, Sebastian Gollnow, Jennifer Davis, Silvia Scherhaufer, Karin Östergren, Shengkui Cheng, Gang LiuAbstract:Meat production and consumption contribute significantly to environmental impacts such as greenhouse gas (GHG) emissions. These emissions can be reduced via various strategies ranging from production efficiency improvement to process optimization, food waste reduction, trade pattern change, and diet structure change. On the basis of a material flow analysis approach, we mapped the dry matter mass and energy balance of the Meat (including beef, pork, and poultry) supply chain in Germany and discussed the emission reduction potential of different mitigation strategies in an integrated and mass-balance consistent framework. Our results reaffirmed the low energy conversion efficiency of the Meat supply chain (among which beef was the least efficient) and the high GHG emissions at the Meat production stage. While diet structure change (either reducing the Meat consumption or substituting Meat by edible offal) showed the highest emissions reduction potential, eliminating Meat waste in retailing and consumption and Byproducts generation in slaughtering and processing were found to have profound effect on emissions reduction as well. The rendering of Meat Byproducts and waste treatment were modeled in detail, adding up to a net environmental benefit of about 5% of the entire supply chain GHG emissions. The combined effects based on assumed high levels of changes of important mitigation strategies, in a rank order considering the level of difficulty of implementation, showed that the total emission could be reduced by 43% comparing to the current level, implying a tremendous opportunity for sustainably feeding the planet by 2050.
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Efficiency and Carbon Footprint of the German Meat Supply Chain
2019Co-Authors: Li Xue, Neele Prass, Sebastian Gollnow, Jennifer Davis, Silvia Scherhaufer, Shengkui Cheng, Karin Östergren, Gang LiuAbstract:Meat production and consumption contribute significantly to environmental impacts such as greenhouse gas (GHG) emissions. These emissions can be reduced via various strategies ranging from production efficiency improvement to process optimization, food waste reduction, trade pattern change, and diet structure change. On the basis of a material flow analysis approach, we mapped the dry matter mass and energy balance of the Meat (including beef, pork, and poultry) supply chain in Germany and discussed the emission reduction potential of different mitigation strategies in an integrated and mass-balance consistent framework. Our results reaffirmed the low energy conversion efficiency of the Meat supply chain (among which beef was the least efficient) and the high GHG emissions at the Meat production stage. While diet structure change (either reducing the Meat consumption or substituting Meat by edible offal) showed the highest emissions reduction potential, eliminating Meat waste in retailing and consumption and Byproducts generation in slaughtering and processing were found to have profound effect on emissions reduction as well. The rendering of Meat Byproducts and waste treatment were modeled in detail, adding up to a net environmental benefit of about 5% of the entire supply chain GHG emissions. The combined effects based on assumed high levels of changes of important mitigation strategies, in a rank order considering the level of difficulty of implementation, showed that the total emission could be reduced by 43% comparing to the current level, implying a tremendous opportunity for sustainably feeding the planet by 2050
Tanner A. Slayden - One of the best experts on this subject based on the ideXlab platform.
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A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism
AACE clinical case reports, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Thanh D. HoangAbstract:The galactose-alpha-1,3-galactose (alpha-gal) allergy, an IgE-mediated response to nonprimate Meat, has a singular pathogenesis linked to tick bites and a delayed allergic presentation, which makes it especially cumbersome to diagnose and manage. As a large array of enteral medications contain ingredients derived from Meat Byproducts, this can affect the care of alpha-gal patients across multiple medical disciplines. Our objective is to present a patient with an alpha-gal allergy, which can complicate hypothyroidism treatment selection. In this case of difficulty tailoring thyroid replacement therapy secondary to the alpha-gal allergy, the diagnostic studies included IgE immunoassays for alpha-gal as well as thyroid function tests. A 45-year-old woman with postoperative hypothyroidism and a history of an alpha-gal allergy (diagnosed after an anaphylactic reaction to beef) could not be immediately started on any common thyroid hormone replacement formulation because of our concern regarding the possible presence of nonprimate mammalian Meat byproduct components in the thyroid hormone medication. After consulting allergy and immunology specialists and compounding pharmacists and contacting multiple drug companies in an effort to confirm the nature of the inactive ingredients in their thyroid hormone products, she was prescribed a plant-based compounded levothyroxine preparation with good clinical results. This case emphasizes the importance of recognizing various risk factors and common drugs which may be associated with the alpha-gal allergy. It is not known how to best tailor enteral medications for patients with an alpha-gal allergy. Further research and pharmaceutical attention to this allergy are needed. Copyright © 2020 AACE.
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SAT-511 Alpha Gal Allergy in a Hypothyroid Patient
Journal of the Endocrine Society, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Elizabeth M. Bauer, Thanh D. HoangAbstract:Abstract Background: The IgE-mediated allergy to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate expressed on nonprimate mammalian proteins, has gained more clinical significance as it can present with serious, potentially fatal anaphylaxis or angioedema. In general, recognizing a specific allergy is the first step in prescribing avoidance; but with delayed symptoms, uncertain prevalence, and unclear diagnostic approach, alpha-gal allergies are difficult to recognize and prevent. To further complicate the clinical picture, some patients can tolerate small portions of nonprimate mammalian Meat or tolerate one kind of Meat over another. We hereby present a case that highlights the lack of guidance and resources currently available to treat a patient with alpha-gal allergy and hypothyroidism. Case Presentation: A 45-year-old woman with a history of an alpha-gal allergy and follicular thyroid neoplasm status post right hemithyroidectomy presented with postoperative hypothyroidism. After the surgery, she had undetectable serum thyroglobulin levels; her thyroid stimulating hormone (TSH) levels were ranging 5–6 µIU/mL (not on thyroid replacement). The goal was to prescribe thyroid replacement to initiate cancer suppressive strategy. The American Thyroid Association (ATA) recommends a TSH of 0.5-to-2 mcIU/mL in low risk patients postoperatively. The standard treatment of choice for correcting hypothyroidism is synthetic thyroxine (T4, levothyroxine). Commercially available levothyroxine, liothyronine, combo, and desiccated thyroid formulations - whether brand name, generic, tablet, soft gel capsule, or liquid - all contain Meat Byproducts and can be a concern for anaphylaxis or angioedema if one has an alpha gal allergy. Because of the possible reactions with all common formulations of thyroid hormone replacement in this patient, choosing a safe option was complicated and involved a multidisciplinary team, including allergy and immunology consultation. Daily parenteral synthetic thyroid hormone therapy was considered; however, it is not practical and was not feasible for the patient. She was eventually prescribed pure Levothyroxine, with a plant-based filler and vegetarian capsule. She tolerated this pure levothyroxine well without any adverse reactions, and the TSH goal was achieved. Conclusion: This case emphasizes the importance of recognizing various risk factors and common drugs associated with the alpha-gal allergy. Further research and pharmaceutical attention to this allergy is needed.
Li Xue - One of the best experts on this subject based on the ideXlab platform.
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Efficiency and Carbon Footprint of the German Meat Supply Chain
Environmental science & technology, 2019Co-Authors: Li Xue, Neele Prass, Sebastian Gollnow, Jennifer Davis, Silvia Scherhaufer, Karin Östergren, Shengkui Cheng, Gang LiuAbstract:Meat production and consumption contribute significantly to environmental impacts such as greenhouse gas (GHG) emissions. These emissions can be reduced via various strategies ranging from production efficiency improvement to process optimization, food waste reduction, trade pattern change, and diet structure change. On the basis of a material flow analysis approach, we mapped the dry matter mass and energy balance of the Meat (including beef, pork, and poultry) supply chain in Germany and discussed the emission reduction potential of different mitigation strategies in an integrated and mass-balance consistent framework. Our results reaffirmed the low energy conversion efficiency of the Meat supply chain (among which beef was the least efficient) and the high GHG emissions at the Meat production stage. While diet structure change (either reducing the Meat consumption or substituting Meat by edible offal) showed the highest emissions reduction potential, eliminating Meat waste in retailing and consumption and Byproducts generation in slaughtering and processing were found to have profound effect on emissions reduction as well. The rendering of Meat Byproducts and waste treatment were modeled in detail, adding up to a net environmental benefit of about 5% of the entire supply chain GHG emissions. The combined effects based on assumed high levels of changes of important mitigation strategies, in a rank order considering the level of difficulty of implementation, showed that the total emission could be reduced by 43% comparing to the current level, implying a tremendous opportunity for sustainably feeding the planet by 2050.
-
Efficiency and Carbon Footprint of the German Meat Supply Chain
2019Co-Authors: Li Xue, Neele Prass, Sebastian Gollnow, Jennifer Davis, Silvia Scherhaufer, Shengkui Cheng, Karin Östergren, Gang LiuAbstract:Meat production and consumption contribute significantly to environmental impacts such as greenhouse gas (GHG) emissions. These emissions can be reduced via various strategies ranging from production efficiency improvement to process optimization, food waste reduction, trade pattern change, and diet structure change. On the basis of a material flow analysis approach, we mapped the dry matter mass and energy balance of the Meat (including beef, pork, and poultry) supply chain in Germany and discussed the emission reduction potential of different mitigation strategies in an integrated and mass-balance consistent framework. Our results reaffirmed the low energy conversion efficiency of the Meat supply chain (among which beef was the least efficient) and the high GHG emissions at the Meat production stage. While diet structure change (either reducing the Meat consumption or substituting Meat by edible offal) showed the highest emissions reduction potential, eliminating Meat waste in retailing and consumption and Byproducts generation in slaughtering and processing were found to have profound effect on emissions reduction as well. The rendering of Meat Byproducts and waste treatment were modeled in detail, adding up to a net environmental benefit of about 5% of the entire supply chain GHG emissions. The combined effects based on assumed high levels of changes of important mitigation strategies, in a rank order considering the level of difficulty of implementation, showed that the total emission could be reduced by 43% comparing to the current level, implying a tremendous opportunity for sustainably feeding the planet by 2050
Mohamed K.m. Shakir - One of the best experts on this subject based on the ideXlab platform.
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A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism
AACE clinical case reports, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Thanh D. HoangAbstract:The galactose-alpha-1,3-galactose (alpha-gal) allergy, an IgE-mediated response to nonprimate Meat, has a singular pathogenesis linked to tick bites and a delayed allergic presentation, which makes it especially cumbersome to diagnose and manage. As a large array of enteral medications contain ingredients derived from Meat Byproducts, this can affect the care of alpha-gal patients across multiple medical disciplines. Our objective is to present a patient with an alpha-gal allergy, which can complicate hypothyroidism treatment selection. In this case of difficulty tailoring thyroid replacement therapy secondary to the alpha-gal allergy, the diagnostic studies included IgE immunoassays for alpha-gal as well as thyroid function tests. A 45-year-old woman with postoperative hypothyroidism and a history of an alpha-gal allergy (diagnosed after an anaphylactic reaction to beef) could not be immediately started on any common thyroid hormone replacement formulation because of our concern regarding the possible presence of nonprimate mammalian Meat byproduct components in the thyroid hormone medication. After consulting allergy and immunology specialists and compounding pharmacists and contacting multiple drug companies in an effort to confirm the nature of the inactive ingredients in their thyroid hormone products, she was prescribed a plant-based compounded levothyroxine preparation with good clinical results. This case emphasizes the importance of recognizing various risk factors and common drugs which may be associated with the alpha-gal allergy. It is not known how to best tailor enteral medications for patients with an alpha-gal allergy. Further research and pharmaceutical attention to this allergy are needed. Copyright © 2020 AACE.
-
SAT-511 Alpha Gal Allergy in a Hypothyroid Patient
Journal of the Endocrine Society, 2020Co-Authors: Tanner A. Slayden, Mohamed K.m. Shakir, Elizabeth M. Bauer, Thanh D. HoangAbstract:Abstract Background: The IgE-mediated allergy to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate expressed on nonprimate mammalian proteins, has gained more clinical significance as it can present with serious, potentially fatal anaphylaxis or angioedema. In general, recognizing a specific allergy is the first step in prescribing avoidance; but with delayed symptoms, uncertain prevalence, and unclear diagnostic approach, alpha-gal allergies are difficult to recognize and prevent. To further complicate the clinical picture, some patients can tolerate small portions of nonprimate mammalian Meat or tolerate one kind of Meat over another. We hereby present a case that highlights the lack of guidance and resources currently available to treat a patient with alpha-gal allergy and hypothyroidism. Case Presentation: A 45-year-old woman with a history of an alpha-gal allergy and follicular thyroid neoplasm status post right hemithyroidectomy presented with postoperative hypothyroidism. After the surgery, she had undetectable serum thyroglobulin levels; her thyroid stimulating hormone (TSH) levels were ranging 5–6 µIU/mL (not on thyroid replacement). The goal was to prescribe thyroid replacement to initiate cancer suppressive strategy. The American Thyroid Association (ATA) recommends a TSH of 0.5-to-2 mcIU/mL in low risk patients postoperatively. The standard treatment of choice for correcting hypothyroidism is synthetic thyroxine (T4, levothyroxine). Commercially available levothyroxine, liothyronine, combo, and desiccated thyroid formulations - whether brand name, generic, tablet, soft gel capsule, or liquid - all contain Meat Byproducts and can be a concern for anaphylaxis or angioedema if one has an alpha gal allergy. Because of the possible reactions with all common formulations of thyroid hormone replacement in this patient, choosing a safe option was complicated and involved a multidisciplinary team, including allergy and immunology consultation. Daily parenteral synthetic thyroid hormone therapy was considered; however, it is not practical and was not feasible for the patient. She was eventually prescribed pure Levothyroxine, with a plant-based filler and vegetarian capsule. She tolerated this pure levothyroxine well without any adverse reactions, and the TSH goal was achieved. Conclusion: This case emphasizes the importance of recognizing various risk factors and common drugs associated with the alpha-gal allergy. Further research and pharmaceutical attention to this allergy is needed.