Overview of the PRN

ACCP’s Practice and Research Networks (PRNs) were established to connect focused groups of clinical pharmacists to enhance professional support and collaboration. Each PRN maintains an email list for members to discuss key information in their fields, and their leadership prepares educational sessions to be delivered each year at the ACCP Annual Meeting. The PRNs amplify the voices of their members, allowing them to inform and guide ACCP policy from the clinician level. The Ambulatory Care PRN is composed of pharmacists from a diverse array of outpatient settings with a particular emphasis on the provision of primary care for chronic diseases. It was one of the first 2 PRNs established in 1992 and has grown to be one of the largest. The PRN has around 2000 active members including over 100 resident/fellow members. The PRN maintains an active email list where clinicians and trainees discuss breaking research and share advice regarding practice development.

Opportunities and Resources

The Ambulatory Care PRN consists of clinical pharmacists, postgraduate trainees, and students interested in ambulatory care across all practice settings. The PRN has several committees that work throughout the year to make it one of the premier PRNs. PRN committees include Advocacy, Budget, Communications, Education, Membership, Networking, Nominations, Research Process, Scholarly Activity, Resident/Fellow, and Student.

The PRN has a variety of opportunities for students, residents, and fellows to get involved. Here are highlights of the opportunities provided:

• Involvement in committees: All trainees are welcome and encouraged to join the PRN’s committees, which will expose them to various areas of the PRN and foster ambulatory care as a practice interest and future participation in the PRN. Trainees are involved in providing new opportunities for education and engagement within the ambulatory care community.

• Travel awards: Up to 5 travel awards are given to both student and resident/fellow members of ACCP to help support attendance at the Annual Meeting. Applications usually open throughout the summer. More information will be posted to the ACCP website closer to the submission date. The awards are funded by the Ambulatory Care PRN budget.

• The Ambulatory Care Mentoring Program: The PRN hosts student and resident/fellow mentorship programs. These programs allow trainees to be paired with ambulatory care clinicians. The committees that oversee these mentoring projects send out a mentorship guide to make sure the mentor/mentees have guidance to get started in their connection. This program fosters discussions about career development, networking, leadership, and other topics relevant to professional development. Student and resident/fellow benefits:
  • Developing a professional network by getting to know practitioners within ambulatory care
  • Gaining new knowledge and skills in career advancement
  • Getting more involved in ACCP and the Ambulatory Care PRN

• Walk-Rounds: Trainee members who present posters at the ACCP Annual Meeting are also welcome to submit their name for “walk-rounds” to receive feedback regarding their project and poster. They may also participate in their own walk-rounds, which will pair them with more experienced practitioners to review posters together and learn from each other.

• The Ambulatory Care PRN Journal Club: The journal club provides an opportunity for resident/fellow members to present a journal club to a national forum regarding recent literature. Residents/fellows are usually paired with 1 or 2 mentors from the ACCP Ambulatory Care PRN to guide them on creating an engaging presentation offered through a technology-based platform.

• Access to mock residency interviews and interviews with residency program directors: Trainees will have access to a mock interview showing the difference between a “good” interview and an “excellent” interview. They will also have access to interviews with residency program directors who provide insight on what a residency is looking for in a resident/fellow.

• Access to the Ambulatory Care PRN Survival Guide: The survival guide provides information on clinical questions, together with advice on practice management in a variety of practice settings.

Additional benefits include:

• Ambulatory Care Listserv and the PRN directory
• Eligibility for research funding
• Innovation grant funding and PRN seed grants
• Academy sponsorships
• BCACP and BCPS study groups
• New member recognition spotlight
• Access to webinars, expert-facilitated roundtables, and other resources to develop and sustain an ambulatory care practice
• Publication and scholarly opportunities
• Best Poster Awards at the Annual Meeting
• Advocacy opportunities and events
• Networking events including a planned event at the Annual Meeting
• Writing Coach Program
• Writing accountability partners and encouragement to participate in the #RxWritingChallenge

We encourage all students, residents, and fellows to follow us on social media. You can find our PRN at:

Facebook: ACCP Ambulatory Care PRN

Twitter: @accpambuprn

Current Issue: α-Gal Syndrome: Recognition, Documentation, and Medication Safety

Authors: Isabel Wedig, Pharm.D.; and Deanna McDanel, Pharm.D., BCACP

α-Gal syndrome (AGS) is a serious, potentially life-threatening allergic condition caused by sensitivity to galactose-α-1,3-galactose (α-Gal), a carbohydrate found in nonprimate mammals and their byproducts, including certain medications and their excipients. Although the exact prevalence of AGS remains unknown, it is estimated that as many as 450,000 people in the United States are affected.¹ Although AGS has been recognized for several years, it remains an increasingly prominent diagnosis with persistent gaps in clinical awareness and understanding.²

The clinical significance of α-Gal–specific immunoglobulin E (IgE) was first recognized in 2007 during investigations of hypersensitivity reactions to cetuximab, a chimeric mouse-human IgG1 monoclonal antibody used as an antineoplastic agent.³ Further research at the University of Virginia formally described AGS in 2009 as a novel form of delayed anaphylaxis to red meat consumption.⁴ In 2011, the same group established the critical association between AGS and tick bites, particularly from the Lone Star tick (Amblyomma americanum).⁵ Despite these advances, the precise biological mechanism by which tick bites induce sensitization to α-Gal remains unknown. However, there are 2 leading hypotheses: (1) tick saliva contains proteins that express α-Gal, which is a carbohydrate present in ticks acquired through their prior blood meal; or (2) ticks intrinsically produce α-Gal and upon a bite may transmit this to the human host.^6,7

Compared with most food allergies, AGS presents as a delayed hypersensitivity reaction. It may take weeks to months after a tick bite for the body to produce antibodies against this foreign substance.⁸ Once sensitized, patients experience delayed reactions after exposure to α-Gal–containing products, often seen within 2 to 6 hours—significantly later than the onset ranging from minutes to 2 hours seen in conventional food allergies. This delay makes it challenging for individuals to pinpoint a certain trigger, which can also make a timely diagnosis difficult. Clinical manifestations are highly variable, ranging from nonspecific GI symptoms to severe, life-threatening anaphylaxis and death.⁸ Of note, the first fatality due to an AGS allergic reaction was confirmed in an otherwise healthy 47-year-old man in September 2024.⁹ As such, symptom presentation alone is often insufficient for diagnosis. Therefore, laboratory confirmation is necessary, and AGS is typically defined by a serum α-Gal–specific IgE concentration of 0.1 kU/L or greater.¹⁰

There is currently no cure for AGS.⁸ However, there is a time decay in α-Gal IgE concentrations because they may decrease with time through strict avoidance of α-Gal–containing products and prevention of further tick bites. Potential triggers extending beyond food include high-risk medications such as cetuximab, antivenom products, and heparin. α-Gal may also be found in nonprimate mammalian-derived medication excipients like magnesium stearate, polysorbate, glycerin, gelatin, stearates, and carrageenan.^8,11 In patients with AGS who have severe symptoms, avoidance of all possible triggers is key to preventing life-threatening allergic reactions (Figure 1).

Given the complexity of AGS diagnosis, delayed presentation, and broad range of exposure sources associated with AGS, medical record allergy documentation must be detailed and accurate. Alarmingly, discrepancies between patient-reported allergies and electronic health record (EHR) documentation have been observed in 41% of cases in the ED setting.¹² The American Academy of Allergy, Asthma & Immunology 2022 Work Group recommends that the EHR allergy list contain entries that trigger actionable clinical decision support at the point of ordering, such as medications or exposures that could result in patient harm. In contrast, the problem list should capture allergic diagnoses that describe the patient’s disease state.¹³

To address this gap, we completed a respective, single-center quality improvement study at the University of Iowa Health Care in 2026 to evaluate the appropriateness of AGS documentation within the EHR. We created criteria that may serve as helpful guidance for clinicians when documenting AGS in the problem and/or allergy lists of patients (Figure 2). Reactions were categorized as severe or standard, with severe reactions defined as documented manifestations such as respiratory distress, angioedema, or anaphylaxis, and standard reactions encompassing all other reported symptoms. According to predefined criteria, AGS was inappropriately documented within 64.3% of the study patients. No appreciable differences were identified in documentation appropriateness between patients with standard reactions and those with severe reactions. Adoption of standardized documentation criteria informed by national recommendations may improve clarity and clinical visibility of AGS within the EHR, enhancing clinical decision support and reducing the risk of inadvertent α-Gal exposure.

Overall, limited awareness of AGS among health care professionals may contribute to the inconsistent documentation practices observed nationwide. A 2023 CDC nationwide survey found that 42% of respondents (N = 1500) had never heard of AGS.² These findings emphasize the need for targeted educational initiatives to improve recognition, documentation, and management of AGS across health systems. Pharmacists are uniquely positioned to support these efforts by identifying patients at risk, evaluating medications and excipients for potential α-Gal exposure, and educating providers about the potential for cross-reactivity, especially in patients with severe AGS reactions.

Figure 1. Trigger and Reaction Risk Potential

To prevent life-threatening allergic reactions, it is important that clinicians and patients be aware of potential triggers. The risk of reaction is associated with the source, the amount, and each individual patient. Created using OpenAI on the ChatGPT platform, free version.

Abbreviations: IV, intravenous(ly); MMR, measles, mumps, rubella.

Figure 2. Documentation Criteria

Predefined documentation criteria were used to determine the appropriateness of documentation within the EHR. Standard vs severe each had specific criteria. Created using OpenAI on the ChatGPT platform, free version.

References

1. Centers for Disease Control and Prevention. About alpha-gal syndrome. Accessed April 30, 2026. https://www.cdc.gov/alpha-gal-syndrome/about/index.html

2. Carpenter A, Drexler NA, McCormick DW, et al. Health care provider knowledge regarding alpha-gal syndrome—United States, March-May 2022. MMWR Morb Mortal Wkly Rep. 2023;72(30):809-814. Published 2023 Jul 28. https://doi.org/10.15585/mmwr.mm7230a1

3. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008;358(11):1109-1117. https://doi.org/10.1056/NEJMoa074943

4. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426-433. https://doi.org/10.1016/j.jaci.2008.10.052

5. Commins SP, James HR, Kelly LA, et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol. 2011;127(5):1286-1293.e6. https://doi.org/10.1016/j.jaci.2011.02.019

6. Wilson JM, Platts-Mills TAE. The oligosaccharide galactose-α-1,3-galactose and the α-gal syndrome: insights from an epitope that is causal in IgE-mediated immediate and delayed anaphylaxis. EMJ Allergy Immunol. 2018;3(1):89-98. https://doi.org/10.1016/j.jaci.2018.10.029

7. Román-Carrasco P, Hemmer W, Cabezas-Cruz A, Hodžić A, de la Fuente J, Swoboda I. The alpha-gal syndrome and potential mechanisms. Front Allergy. 2021;2:783279. https://doi.org/10.3389/falgy.2021.783279

8. McGill SK, Hashash JG, Platts-Mills TA. AGA clinical practice update on alpha-gal syndrome for the GI clinician: commentary. Clin Gastroenterol Hepatol. 2023;21(4):891-896. https://doi.org/10.1016/j.cgh.2022.12.035

9. Platts-Mills TAE, Workman LJ, Richards NE, Wilson JM, McFeely EM. Implications of a fatal anaphylactic reaction occurring 4 hours after eating beef in a young man with IgE antibodies to galactose-α-1,3-galactose. J Allergy Clin Immunol Pract. 2025;13(12):3422-3424. https://doi.org/10.1016/j.jaip.2025.09.039

10. Kersh GJ, Salzer J, Jones ES, et al. Tick bite as a risk factor for alpha-gal-specific immunoglobulin E antibodies and development of alpha-gal syndrome. Ann Allergy Asthma Immunol. 2023;130(4):472-478. https://doi.org/10.1016/j.anai.2022.11.021

11. Leder J, Diederich A, Patel B, Bowie M, Renwick CM, Mangunta V. Perioperative considerations in alpha-gal syndrome: a review. Cureus. 2024;16(1):e53208. Published 2024 Jan 30. https://doi.org/10.7759/cureus.53208

12. Kiechle ES, McKenna CM, Carter H, et al. Medication allergy and adverse drug reaction documentation discrepancies in an urban, academic emergency department. J Med Toxicol. 2018;14(4):272-277. https://doi.org/10.1007/s13181-018-0671-7

13. Guyer AC, Macy E, White AA, et al. Allergy electronic health record documentation: a 2022 work group report of the AAAAI Adverse Reactions to Drugs, Biologicals, and Latex Committee. J Allergy Clin Immunol Pract. 2022;10(11):2854-2867. https://doi.org/10.1016/j.jaip.2022.08.020