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Immunology and Allergy Clinics of North... Aug 2023Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity.... (Review)
Review
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.
Topics: Humans; Kounis Syndrome; Hypersensitivity; Acute Coronary Syndrome
PubMed: 37394256
DOI: 10.1016/j.iac.2022.10.010 -
Revista Alergia Mexico (Tecamachalco,... Dec 2023In recent times, the primary approach to treating food allergies involved strict avoidance of the triggering allergen. Many considered this approach as lacking true...
In recent times, the primary approach to treating food allergies involved strict avoidance of the triggering allergen. Many considered this approach as lacking true treatment, leaving patients vulnerable to even small amounts or hidden sources of the allergenic food. Desensitization or Oral Tolerance Induction (OTI) is a studied method aiming for a lasting tolerance to the allergen. The ultimate goal is permanent tolerance, where allergic reactions won't reoccur after new exposure to the triggering allergen, following a period of abstinence. The research mainly focuses on allergen-specific immunotherapy, covering three routes: oral, sublingual, and epicutaneous immunotherapy. Milk, egg, and peanuts are the extensively studied foods due to their prevalence in allergies. The oral route is favored for inducing tolerance because ingestion of a food antigen by a non-allergic individual triggers an active immune response without causing an allergic reaction. The paradigm has shifted from recommending avoidance to early consumption strategies to prevent allergies. The period from 4 to 6 months of age is considered immunologically sensitive, where children with risk factors show increased allergic sensitization risk. Implementing these recommendations, considering family and community preferences, may reduce the burden of food allergies and healthcare costs.
Topics: Child; Humans; Animals; Desensitization, Immunologic; Health Care Costs; Milk; Allergens; Food Hypersensitivity
PubMed: 38506873
DOI: 10.29262/ram.v70i4.1339 -
Nutrients Mar 2023IgE-mediated cow's milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict... (Review)
Review
IgE-mediated cow's milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict avoidance of milk products while awaiting natural tolerance, research increasingly shows that the rates of resolution are slowing down. Therefore, there is a need to explore alternative pathways to promote tolerance to cow's milk in pediatric populations. This review aims to combine and appraise the scientific literature regarding the three CMPA management methods: avoidance, the milk ladder, and oral immunotherapy (OIT) and their outcomes in terms of efficacy, safety, and immunological effects. Cow's milk (CM) avoidance virtually protects against allergic reaction until natural tolerance occurs, with hypoallergenic substitutes available in the market, but accidental ingestion represents the main issue for this strategy. Introduction to baked milk using the milk ladder was designed, with most CMPA patients successfully completing the ladder. Similar to baked milk treatment, many OIT protocols also demonstrated decreased IgE and increased IgG4 levels post protocol, as well as a reduction in wheal size diameter. Though these strategies are shown to be safe and effective in CMPA, future clinical trials should compare the safety and effectiveness of these three management strategies.
Topics: Animals; Cattle; Female; Child, Preschool; Child; Humans; Milk Hypersensitivity; Milk; Milk Proteins; Food Hypersensitivity; Allergens; Immunoglobulin E
PubMed: 36986127
DOI: 10.3390/nu15061397 -
Current Opinion in Pediatrics Dec 2021A known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19)... (Review)
Review
PURPOSE OF REVIEW
A known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19) mRNA vaccination. It is important for pediatricians to understand the likelihood of an allergic reaction to COVID-19 mRNA vaccines, including its excipients.
RECENT FINDINGS
Episodes concerning for anaphylaxis were immediately reported following early administration of COVID-19 mRNA vaccines to adults. Although allergic type symptoms were reported equally in recipients of placebos and test vaccines in phase 3 clinical trials, post-authorization prospective studies state that 0.2-2% of vaccine recipients have experienced allergic reactions. Subsequent allergy testing of affected individuals has focused largely on evaluation of allergic sensitization to a novel vaccine excipient, polyethylene glycol (PEG). PEG is a polymer incorporated in numerous pharmaceutical products because of its favorable, inert properties. The results of allergy testing in adults to date indicate that IgE mediated anaphylaxis to PEG allergy is rarely identified after COVID-19 mRNA vaccine reactions. Numerous individuals with presumed anaphylaxis have tolerated a second vaccine after evaluation and testing by an allergist, suggesting either misdiagnosis or a novel immune mechanism.
SUMMARY
Confirmed anaphylactic reactions to COVID-19 mRNA vaccines are rare, likely due to a lack of preexisting IgE against the vaccine components, including PEG.
Topics: Adult; Anaphylaxis; COVID-19; COVID-19 Vaccines; Humans; Prospective Studies; RNA, Messenger; SARS-CoV-2
PubMed: 34670264
DOI: 10.1097/MOP.0000000000001077 -
Medicina (Kaunas, Lithuania) Sep 2019Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for... (Review)
Review
Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP).
Topics: Administration, Oral; Allergens; Child; Food Hypersensitivity; Humans; Immunoglobulin E; Immunologic Tests; Predictive Value of Tests; Systematic Reviews as Topic
PubMed: 31569825
DOI: 10.3390/medicina55100651 -
Emergency Medicine Clinics of North... Feb 2022Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity.... (Review)
Review
Acute coronary syndrome (ACS) in the setting of an allergic/immunologic reaction is known as Kounis syndrome. It is an underdiagnosed and underrecognized disease entity. One must keep a high index of suspicions when managing a patient presenting with cardiac as well as allergic symptoms. There are 3 main variants to the syndrome. Treating the allergic reaction may alleviate the pain; however, ACS guidelines should be followed if cardiac ischemia is present.
Topics: Humans; Kounis Syndrome
PubMed: 34782092
DOI: 10.1016/j.emc.2021.08.010 -
Best Practice & Research. Clinical... May 2021Perioperative allergic reactions are rare, yet important complications of anesthesia. Severe, generalized allergic reactions called anaphylaxis are estimated to have a... (Review)
Review
Perioperative allergic reactions are rare, yet important complications of anesthesia. Severe, generalized allergic reactions called anaphylaxis are estimated to have a mortality of 3.5-4.8%. Adequate recognition and handling of a severe perioperative anaphylactic reaction result in better outcomes, including less hypoxic-ischemic encephalopathy and death. The diagnosis of a perioperative allergic reaction can be difficult as the list of possible culprits of a perioperative allergic reaction is extensive. Making an informed guess on the causative agent and avoiding this agent in future anesthesia procedures is undesirable and unsafe. Therefore, to ensure future patient safety, a thorough investigation following a perioperative allergic reaction is mandatory. A collaborate approach by allergists and anesthesiologists is advised. In this article, we discuss the basic approach of the allergic patient and of patients with a suspected allergy to perioperatively administered medication.
Topics: Anaphylaxis; Anesthesia; Anesthetics; Anti-Bacterial Agents; Drug Hypersensitivity; Humans; Hypersensitivity; Neuromuscular Blocking Agents; Perioperative Care; Risk Factors
PubMed: 33742571
DOI: 10.1016/j.bpa.2020.03.003 -
Immunology and Allergy Clinics of North... Nov 2021Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction. Classically, anaphylaxis is an immunoglobulin (Ig) E-mediated reaction;... (Review)
Review
Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction. Classically, anaphylaxis is an immunoglobulin (Ig) E-mediated reaction; however, IgG or immune complex complement-related immunologic reactions that lead to degranulation of mast cells can also cause anaphylaxis. Food allergy is the most common cause of anaphylaxis, followed by drugs. Patients with anaphylaxis commonly present with symptoms involving skin or mucous membranes, followed by respiratory and gastrointestinal symptoms. Epinephrine is the drug of choice for treating anaphylaxis. Patients and caregivers should be educated on the use of epinephrine autoinjectors with periodic review of symptoms and emergency action plan for anaphylaxis.
Topics: Adolescent; Anaphylaxis; Child; Epinephrine; Food Hypersensitivity; Humans; Immunoglobulin E; Mast Cells
PubMed: 34602233
DOI: 10.1016/j.iac.2021.07.009 -
BMC Cardiovascular Disorders Mar 2021Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been...
BACKGROUND
Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging.
CASE PRESENTATION
A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made.
CONCLUSIONS
Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.
Topics: Antibiotics, Antineoplastic; Epirubicin; Humans; Iliac Artery; Injections, Intra-Arterial; Kounis Syndrome; Male; Middle Aged; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 33711934
DOI: 10.1186/s12872-021-01936-4 -
Annals of Allergy, Asthma & Immunology... Jun 2023Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis.... (Review)
Review
Around 25% to 50% of food-induced allergic reactions in adults cause anaphylaxis, and epidemiologic evidence suggests that food is the most common cause of anaphylaxis. Reaction severity is unpredictable, and patients will often experience reactions of variable severity, even to an identical exposure (both dose and allergen). A common explanation for this phenomenon has been the impact of "cofactors"-factors that might contribute to reaction severity independent of the allergen exposure. Cofactors can influence reaction severity in 2 ways: either by reducing the reaction threshold (ie, the dose needed to trigger any symptoms) so that patients have no symptoms in the absence of the cofactor and only react with the cofactor present, or by increasing reaction severity such that individuals have only mild symptoms in the absence of the cofactor, but a more severe reaction when the cofactor is present. Indeed, the same patient may have reactions with different cofactors or even need more than one cofactor to develop a severe reaction. Cofactors reportedly play a role in approximately 30% of anaphylaxis reactions in adults. Exercise, nonsteroidal, anti-inflammatory drugs, alcohol, and sleep deprivation are the most frequent cofactors reported. Routine evaluation of the possible involvement of cofactors is essential in managing patients with food anaphylaxis: in patients with a suggestive history but a negative oral food challenge, cofactors should be taken into account to provide appropriate advice to reduce the risk of future anaphylaxis.
Topics: Humans; Adult; Anaphylaxis; Food Hypersensitivity; Food; Ethanol; Allergens
PubMed: 36958469
DOI: 10.1016/j.anai.2023.03.017