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Blood Transfusion = Trasfusione Del... May 2024Anaphylaxis after blood transfusion is a feared complication accounting for severe morbidity. A retrospective study was performed at Haukeland University Hospital,...
BACKGROUND
Anaphylaxis after blood transfusion is a feared complication accounting for severe morbidity. A retrospective study was performed at Haukeland University Hospital, Bergen, Norway, to investigate the rate and features of transfusion-associated anaphylaxis (TAA) occurring between 2002-2021.
MATERIALS AND METHODS
Identified cases of TAA were studied by an immunologist and an allergist to extract information about general characteristics, amplifying factors, co-morbidity, treatment, and treatment responses. TAA was reported as perioperative or non-perioperative.
RESULTS
We identified 29 cases of TAA: 13 perioperative and 16 non-perioperative. Allergic transfusion reaction had an incidence rate of 34/100,000 transfusions and TAA a rate of 7/100,000 transfusions. The incidence of allergic reactions and TAA increased 2.6- and 6.4-fold during the study period. The first perioperative TAA was discovered 12 years into the study period but was equally frequent as non-perioperative transfusion-associated anaphylaxis in the last five years of the study period. 52% of the TAA cases had relevant co-morbidity and 100% of them had amplifying factors. Although only 38% of the non-perioperative patients received epinephrine as treatment, 94% of them had a good treatment response to their total treatment regimen. Poorer treatment response was observed with higher age, more cardiovascular- and respiratory disease, higher use of amplifying and sedating medications and a higher severity score.
DISCUSSION
Our findings indicate that TAA, especially in the perioperative setting, is underdiagnosed. The increased incidence of TAA in our study is temporally related to the introduction of a national hemovigilance program, introduction of standardized laboratory testing for anaphylaxis and increased multidisciplinary focus on the condition. In conclusion, increased awareness of TAA, and especially in the perioperative setting, is needed. A multidisciplinary approach is necessary to improve identification and reporting of TAA.
PubMed: 38814882
DOI: 10.2450/BloodTransfus.738 -
Cureus Apr 2024A 12-year-old girl with severe cow's milk allergy (CMA) was able to safely consume 300 mL of unhydrolyzed cow's milk after three and a half years of oral immunotherapy...
A 12-year-old girl with severe cow's milk allergy (CMA) was able to safely consume 300 mL of unhydrolyzed cow's milk after three and a half years of oral immunotherapy (OIT) with extensively hydrolyzed milk. The treatment consisted of gradually increasing the intake of hydrolyzed and partially hydrolyzed milk and reintroducing cow's milk. Despite some allergic reactions during treatment, the patient was able to consume more than 200 ml of milk consistently for more than six months without recurrence of symptoms. This case suggests the possibility of an alternative treatment for persistent CMA: not only OIT with cow's milk alone but also a safer introduction to treatment with extensively hydrolyzed formulas.
PubMed: 38807805
DOI: 10.7759/cureus.59188 -
Children (Basel, Switzerland) May 2024One of the most frequent triggers of food anaphylaxis in pediatric age but also among the most common, early, and complex causes of childhood food allergy is cow's milk... (Review)
Review
One of the most frequent triggers of food anaphylaxis in pediatric age but also among the most common, early, and complex causes of childhood food allergy is cow's milk protein allergy (CMPA). The diagnostic course and management of this allergy is defined in a complex clinical picture due to several factors. First of all, the epidemiological data are not uniform, mainly as a consequence of the diagnostic methodology used in the various studies and the different age ranges covered. In addition, there is the complexity of terminology, since although CMPA traditionally refers to immune-mediated reactions to cow's milk, it is a term encompassing numerous clinical features with different symptoms and the requirement for specific treatments. Moreover, the differential diagnosis with other very frequent diseases, especially in the first year of life, such as gastro-esophageal reflux disease or colic, is still complex. This can result in misdiagnosis and incorrect treatment, with harmful health consequences and significant economic repercussions. In this context, the combination of several omics sciences together, which have already proved useful in clarifying the allergenicity of cow's milk proteins with greater precision, could improve the diagnostic tests currently in use through the identification of new, more specific, and precise biomarkers that make it possible to improve diagnostic accuracy and predict the patient's response to the various available treatments for the recovery of tolerance.
PubMed: 38790557
DOI: 10.3390/children11050562 -
International Journal of Surgery Case... May 2024Hydatid disease, caused by Echinococcus granulosus, is a zoonotic infection prevalent in specific regions, including Tunisia. Complications are rare but potentially...
INTRODUCTION AND IMPORTANCE
Hydatid disease, caused by Echinococcus granulosus, is a zoonotic infection prevalent in specific regions, including Tunisia. Complications are rare but potentially life-threatening. This case report highlights the significance of early diagnosis and intervention in a unique case where anaphylaxis resulted from minor abdominal trauma in a 17-year-old male with an undiagnosed hydatid cyst.
CASE REPORT
The patient arrived at the emergency department with syncope and hypotension after a classroom accident. Physical examination showed an urticarial rash and abdominal tenderness. Anaphylactic shock was diagnosed and promptly treated. A computed tomography scan confirmed a ruptured liver hydatid cyst. The patient received anthelmintic treatment and underwent conservative surgical management. Intraoperatively, a second anaphylactic shock occurred and was promptly treated. The post-operative course was uneventful, and histopathological analysis identified Echinococcus granulosus.
CLINICAL DISCUSSION
This case emphasizes the importance of recognizing hydatid disease as a potential cause of anaphylaxis post-trauma, even in asymptomatic patients. Early diagnosis through imaging is crucial for prompt intervention. Surgical management should be considered, with conservative approaches favored in acute cases. Post-surgical albendazole treatment is essential to prevent recurrence.
CONCLUSION
This report serves as a valuable reference for healthcare professionals, highlighting the need for heightened clinical suspicion in cases like this. It underscores the significance of considering hydatid cyst rupture in the differential diagnosis of anaphylaxis following blunt trauma. Awareness among pediatricians, emergency physicians, and primary care providers can lead to early diagnosis and better patient outcomes, preventing severe complications or fatalities associated with this rare condition.
PubMed: 38781844
DOI: 10.1016/j.ijscr.2024.109779 -
Bioactive Materials Aug 2024The rapid development of messenger RNA (mRNA) vaccines formulated with lipid nanoparticles (LNPs) has contributed to control of the COVID-19 pandemic. However, mRNA...
The rapid development of messenger RNA (mRNA) vaccines formulated with lipid nanoparticles (LNPs) has contributed to control of the COVID-19 pandemic. However, mRNA vaccines have raised concerns about their potential toxicity and clinical safety, including side effects, such as myocarditis, anaphylaxis, and pericarditis. In this study, we investigated the potential of trehalose glycolipids-containing LNP (LNP S050L) to reduce the risks associated with ionizable lipids. Trehalose glycolipids can form hydrogen bonds with polar biomolecules, allowing the formation of a stable LNP structure by replacing half of the ionizable lipids. The efficacy and safety of LNP S050L were evaluated by encapsulating the mRNA encoding the luciferase reporter gene and measuring gene expression and organ toxicity, respectively. Furthermore, mice immunized with an LNP S050L-formulated mRNA vaccine expressing influenza hemagglutinin exhibited a significant reduction in organ toxicity, including in the heart, spleen, and liver, while sustaining gene expression and immune efficiency, compared to conventional LNPs (Con-LNPs). Our findings suggest that LNP S050L, a trehalose glycolipid-based LNP, could facilitate the development of safe mRNA vaccines with improved clinical safety.
PubMed: 38779592
DOI: 10.1016/j.bioactmat.2024.05.012 -
Clinical and Experimental Emergency... May 2024In a case of contrast media-induced anaphylactic shock managed with epinephrine, a 57-year-old male developed lactic acidosis without cardiogenic shock or global...
In a case of contrast media-induced anaphylactic shock managed with epinephrine, a 57-year-old male developed lactic acidosis without cardiogenic shock or global hypoperfusion, highlighting epinephrine's potential to trigger lactic acidosis. Despite previous management of similar reactions with antihistamines and corticosteroids, this case required intensive care unit admission and emergency intervention, with lactate levels peaking alarmingly. The rapid resolution of acidosis following epinephrine discontinuation underscores the need for careful monitoring and the consideration of alternative vasopressor strategies in severe anaphylaxis, illustrating the complex relationship between epinephrine's metabolic effects and anaphylaxis-induced tissue hypoperfusion.
PubMed: 38778486
DOI: 10.15441/ceem.24.239 -
Nature Communications May 2024Tools for predicting COVID-19 outcomes enable personalized healthcare, potentially easing the disease burden. This collaborative study by 15 institutions across Europe...
Tools for predicting COVID-19 outcomes enable personalized healthcare, potentially easing the disease burden. This collaborative study by 15 institutions across Europe aimed to develop a machine learning model for predicting the risk of in-hospital mortality post-SARS-CoV-2 infection. Blood samples and clinical data from 1286 COVID-19 patients collected from 2020 to 2023 across four cohorts in Europe and Canada were analyzed, with 2906 long non-coding RNAs profiled using targeted sequencing. From a discovery cohort combining three European cohorts and 804 patients, age and the long non-coding RNA LEF1-AS1 were identified as predictive features, yielding an AUC of 0.83 (95% CI 0.82-0.84) and a balanced accuracy of 0.78 (95% CI 0.77-0.79) with a feedforward neural network classifier. Validation in an independent Canadian cohort of 482 patients showed consistent performance. Cox regression analysis indicated that higher levels of LEF1-AS1 correlated with reduced mortality risk (age-adjusted hazard ratio 0.54, 95% CI 0.40-0.74). Quantitative PCR validated LEF1-AS1's adaptability to be measured in hospital settings. Here, we demonstrate a promising predictive model for enhancing COVID-19 patient management.
Topics: Humans; COVID-19; Machine Learning; Male; Female; Aged; RNA, Long Noncoding; Middle Aged; Hospital Mortality; SARS-CoV-2; Europe; Canada; Cohort Studies; Aged, 80 and over; Adult
PubMed: 38769334
DOI: 10.1038/s41467-024-47557-1 -
Cureus Apr 2024Vancomycin is a bactericidal antibiotic used for various infections but can cause hypersensitivity reactions, including vancomycin flushing syndrome (VFS) and...
Vancomycin is a bactericidal antibiotic used for various infections but can cause hypersensitivity reactions, including vancomycin flushing syndrome (VFS) and anaphylaxis. VFS, previously known as red man syndrome, is a pseudoallergic reaction characterized by flushing, erythema, and pruritus. We present a case of VFS in a female patient with recurrent Methicillin-resistant Staphylococcus aureus (MRSA) infections receiving vancomycin for back abscesses. Following the second dose, she developed a pruritic rash on her face, neck, and torso, which resolved with treatment. The differential diagnosis included hydromorphone allergy, ruled out due to previous tolerance. Anaphylaxis was unlikely due to the absence of respiratory distress, hypotension, or angioedema. Management involved discontinuing vancomycin, administering corticosteroids and antihistamines, and monitoring for anaphylaxis. The patient was transferred for surgical intervention and alternative antibiotic therapy. This case highlights the importance of recognizing and managing VFS, the significance of differential diagnoses, and the need for enhanced documentation and clinical support in managing vancomycin hypersensitivity reactions.
PubMed: 38765435
DOI: 10.7759/cureus.58487 -
The Journal of Allergy and Clinical... Aug 2024The KIT receptor tyrosine kinase and its ligand, stem cell factor (SCF), control proliferation and survival of mast cells. Thus, targeting KIT signaling may show promise...
BACKGROUND
The KIT receptor tyrosine kinase and its ligand, stem cell factor (SCF), control proliferation and survival of mast cells. Thus, targeting KIT signaling may show promise for the treatment of allergic diseases involving mast cells. Recently, we discovered a new compound, MOD000001, as a potential small-molecule KIT kinase inhibitor by using an approach.
OBJECTIVE
We sought to determine whether MOD000001 is highly selective to KIT, inhibits KIT signaling in mast cells, and affects IgE-mediated mast cell activation.
METHODS
The interaction of MOD000001 with 468 human kinases and its inhibitory activity against KIT were profiled and evaluated by using KINOMEscan (Discover X/Eurofins Corporation, Fremont, Calif) and cell-free kinase assays, respectively. The effects of MOD000001 on SCF-dependent signaling were examined by using primary mouse and human mast cells. The effects of MOD000001 on SCF-induced degranulation and passive cutaneous anaphylaxis reaction were examined in mice.
RESULTS
MOD000001 interacted with KIT and inhibited KIT kinase activity with high selectivity. MOD000001 suppressed SCF-induced KIT signaling in mouse and human mast cells and in mice. Passive cutaneous anaphylaxis reaction was suppressed in mice treated with MOD000001 both for a short-term (1 week) and for a long-term (7 weeks). Mice treated with MOD000001 for a long-term, but not for a short-term, showed skin mast cell reduction.
CONCLUSIONS
MOD000001 is a highly selective KIT inhibitor that can suppress IgE-mediated mast cell activation . MOD000001 may do so by reducing tissue mast cell numbers or by other unknown mechanisms. The findings suggest potential benefits of MOD000001 for allergic diseases involving IgE-mediated mast cell activation.
PubMed: 38764489
DOI: 10.1016/j.jacig.2024.100249 -
The Kurume Medical Journal May 2024Hypotension is a cardiovascular symptom that appears at the onset of anaphylaxis. It is considered an important factor as it affects the severity of anaphylaxis;...
INTRODUCTION
Hypotension is a cardiovascular symptom that appears at the onset of anaphylaxis. It is considered an important factor as it affects the severity of anaphylaxis; however, its details remain to be elucidated. In this study, we investigated the characteristics of hypotension at the onset of anaphylaxis during anesthesia, along with the relationship between hypotension, tryptase and histamine.
MATERIALS AND METHODS
The minimum systolic blood pressures of patients diagnosed with anaphylaxis using the clinical diagnostic criteria of the World Allergy Organization guidelines were extracted from electronic anesthesia records. We analyzed changes in tryptase and histamine that were measured after the onset of anaphylaxis. We analyzed the relationship of tryptase and histamine with the minimum systolic blood pressure and the severity of anaphylaxis.
RESULTS
Of 55,996 patients, 25 were diagnosed with anaphylaxis during anesthesia (0.045%). Among these patients, the minimum systolic blood pressure was less than 90 mmHg. Furthermore, the minimum systolic blood pressure was inversely correlated with tryptase levels immediately to 1 hour, and 2 to 4 hours after the onset of anaphylaxis. The minimum systolic blood pressure was inversely correlated with the severity of anaphylaxis. The severity of anaphylaxis was positively correlated with tryptase levels immediately to 1 hour, and 2 to 4 hours after the onset of anaphylaxis.
CONCLUSION
Hypotension tended to reflect the severity of anaphylaxis. Tryptase is an adjunct in the diagnosis of hypotension and may be a useful indicator of the severity of anaphylaxis. A larger-scale study is needed to validate these results.
PubMed: 38763736
DOI: 10.2739/kurumemedj.MS7012012