Internal Medicine Alert – October 15, 2025

Patients Aged 6 Months and Older with Egg Allergy Should Receive Flu Vaccine

The Advisory Committee on Immunization Practices (ACIP) provided updated guidance for the 2025-2026 influenza season. After reviewing data on egg-based influenza vaccines, ACIP reinforced that individuals with egg allergies are not at increased risk of severe allergic reactions and outlined precaution and contraindication considerations in vaccine administration for this population.

Preventing SARS-CoV-2 Infection with an Allergy Nasal Spray

Use of the antihistamine azelastine nasal spray was effective in preventing SARS-CoV-2 infection in young, healthy, vaccinated outpatients.

Pertussis: Concerning News from Mexico, Brazil, and China

Related to under-immunization of pregnant women and children, pertussis is spreading in several countries within the Americas. Macrolide resistance of Bordetella pertussis is now common in China.

Increased Treatment Opportunities for Trigeminal Autonomic Cephalalgias

Trigeminal autonomic cephalalgias (TACs) include cluster headache, paroxysmal hemicrania, hemicrania continua, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing, and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms. They are female-predominant primary headache disorders that coexist with migraines and mood disorders. Indomethacin is underused in those TACs that are specifically indomethacin responsive. Noninvasive vagus nerve stimulation for TACs is well-tolerated and more effective for prevention than as an acute treatment.

Rilzabrutinib Tablets (Wayrilz)

The U.S. Food and Drug Administration has approved rilzabrutinib, the first-in-class Bruton’s tyrosine kinase inhibitor, for the treatment of persistent or chronic immune thrombocytopenia. Rilzabrutinib is distributed by Genzyme Corporation as Wayrilz.

Wellens’ Syndrome or Not?

Today’s patient is a middle-aged man who presented to the emergency department (ED) with a history of chest pain with exertion during the past two weeks. His chest pain had been increasing and was at its most severe level the day he presented to the ED. The initial serum troponin level in the ED was more than 10,000 ng/L. Does the clinical scenario suggest Wellens’ syndrome?