-
Allergology International : Official... Jul 2022
Topics: Anaphylaxis; Child; Humans; Urticaria
PubMed: 35450803
DOI: 10.1016/j.alit.2022.02.008 -
BMJ Case Reports May 2012A 23-year-old man presented with acute flushing, pruritus and warmth followed by collapse after vigorous exercise in a gymnasium. After resting for 30 min and receiving...
A 23-year-old man presented with acute flushing, pruritus and warmth followed by collapse after vigorous exercise in a gymnasium. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, he was finally stable. He admitted that he had a similar experience 5 years earlier during exercise. Based on the patient's history, his symptoms were attributed to exercise-induced anaphylaxis. None of his episodes was associated with any suspicious co-triggers of anaphylaxis. He was successfully discharged from hospital without any complications after receiving guidance on how to prevent this condition.
Topics: Anaphylaxis; Auscultation; Basketball; Blood Pressure; Diagnosis, Differential; Heart Rate; Humans; Male; Physical Exertion; Young Adult
PubMed: 22669856
DOI: 10.1136/bcr.01.2012.5671 -
European Annals of Allergy and Clinical... Jul 2023Hereditary α-tryptasemia (HαT) is a common autosomal dominant genetic trait with variable penetrance associated with increased serum baseline tryptase (SBT) levels.... (Review)
Review
Hereditary α-tryptasemia (HαT) is a common autosomal dominant genetic trait with variable penetrance associated with increased serum baseline tryptase (SBT) levels. Clinical manifestations may range from an absence of symptoms to overtly severe and recurrent anaphylaxis. Symptoms have been claimed to result from excessive activation of EGF-like module-containing mucin-like hormone receptor-like 2 (EMR2) and protease-activated receptor 2 (PAR-2) receptors by α/β-tryptase heterotetramers. Herein, we aimed to review the evidence on whether HαT can be considered a hereditary risk factor or a modifying factor for anaphylaxis.Increased SBT levels have been linked to an increased risk of anaphylaxis. Likewise, recent studies have shown that HαT might be associated with a higher risk of developing anaphylaxis and more severe anaphylaxis. The same has also been shown for patients with clonal mast cell disorders, in whom the co-existence of HαT might lead to a greater propensity for severe, potentially life-threatening anaphylaxis. However, studies leading to such conclusions are generally limited in sample size, while other studies have shown opposing results. As such, further studies investigating the potential association of HαT with anaphylaxis caused by different triggers, and different severity grades, in both patients with clonal mast cell activation syndromes and the general population are still needed.
Topics: Humans; Anaphylaxis; Mast Cells; Mast Cell Activation Syndrome; Mastocytosis; Risk Factors; Tryptases
PubMed: 36927821
DOI: 10.23822/EurAnnACI.1764-1489.288 -
Ugeskrift For Laeger May 2014Anaphylaxis is a potentially life-threatening systemic allergic reaction involving several organ systems. Recognition of the reaction leading to prompt treatment is... (Review)
Review
Anaphylaxis is a potentially life-threatening systemic allergic reaction involving several organ systems. Recognition of the reaction leading to prompt treatment is essential for a good outcome. The lifesaving treatment is intramuscular injection of adrenaline (0.3-0.5 mg for adults and children > 40 kg, 0.3 mg for children 20-40 kg and 0.15 mg for infants < 20 kg). The patient must be placed on the back with elevated lower extremities to improve cerebral and cardiac circulation. High dose oxygen and crystalloid fluid load are needed to improve oxygenation and cardiac output.
Topics: Adult; Algorithms; Anaphylaxis; Child; Diagnosis, Differential; Epinephrine; Humans
PubMed: 25352003
DOI: No ID Found -
British Journal of Clinical Pharmacology Jul 2014Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours... (Review)
Review
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive.
Topics: Anaphylaxis; Diagnostic Techniques and Procedures; Drug Hypersensitivity; Humans
PubMed: 24286446
DOI: 10.1111/bcp.12297 -
Journal of Paediatrics and Child Health Aug 2022Explore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7-year period.
AIM
Explore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7-year period.
METHODS
Retrospective audit of all children (0-18 years) presenting to emergency from 1 January 2010 to 31 December 2016 with anaphylaxis, defined by Australasian Society of Clinical Immunology and Allergy definitions and doctor diagnosis.
RESULTS
Seven hundred and twenty-four patients were identified with allergic diagnosis, 60% were diagnosed with non-anaphylaxis allergic reactions or unspecified urticaria and 40% with anaphylaxis (n = 286). Annual prevalence of anaphylaxis remained stable over the study period (M = 30.9/10 000 cases, range: 20.8-48.3/10 000). Gender distribution was equal, median age was 9.48 years (interquartile range = 4-15). Most (71%) arrived by private transport. 23% had a prior history of anaphylaxis. Food triggers (44%) were the most common cause of anaphylaxis. Insect bites/stings triggers occurred in 21%. Patients were promptly assessed (average wait time = 13 min), 16% received prior adrenaline injections. Adrenaline was administered in 26% and 20% were admitted to hospital. On discharge, 29% had a follow-up plan, 9% received an allergy clinic referral, 6% anaphylaxis action plan, 26% adrenaline autoinjector prescriptions and allergy testing performed in 6%.
CONCLUSIONS
We found a relatively low prevalence of overall childhood anaphylaxis in a regional area. The two most common causes of anaphylaxis in this population (food and bites/stings) recorded increased prevalence providing an opportunity for further study. Significant gaps in evidence-based care of anaphylaxis were noted, demonstrating the need for improved recognition and treatment guideline implementation in regional areas.
Topics: Anaphylaxis; Child; Emergency Service, Hospital; Epinephrine; Humans; Referral and Consultation; Retrospective Studies
PubMed: 35506702
DOI: 10.1111/jpc.16006 -
Current Allergy and Asthma Reports Feb 2021The aim of this systematic review is to present the proposed theories of pathogenesis for idiopathic anaphylaxis (IA), to discuss its classification, its diagnostic... (Review)
Review
PURPOSE OF REVIEW
The aim of this systematic review is to present the proposed theories of pathogenesis for idiopathic anaphylaxis (IA), to discuss its classification, its diagnostic approach, and management.
RECENT FINDINGS
IA represents a major diagnostic challenge and is diagnosed when excluding the possible identifiable triggers of anaphylaxis. The current research, however, revealed that certain conditions including mastocytosis, mast cell activation syndromes, and hereditary alpha tryptasemia can masquerade and overlap with its symptomatology. Also, newly identified galactose-alpha-1,3-galactose mammalian red meat allergy has recently been recognized as underlying cause of anaphylaxis in some cases that were previously considered as IA. IA comprises a heterogenous group of conditions where, in some cases, inherently dysfunctional mast cells play a role in pathogenesis. The standard trigger avoidance strategies are ineffective, and episodes are unpredictable. Therefore, prompt recognition and treatment as well as prophylaxis are critical. The patients should always carry an epinephrine autoinjector.
Topics: Allergists; Anaphylaxis; Diagnosis, Differential; Food Hypersensitivity; Humans; Mast Cells; Mastocytosis; Tryptases
PubMed: 33560495
DOI: 10.1007/s11882-021-00988-y -
Acta Bio-medica : Atenei Parmensis Mar 2022Kounis syndrome (KS) is a coronary syndrome in the setting of allergic/anaphylactic reactions and can be classified in three variants: vasospastic allergic angina (type... (Review)
Review
Kounis syndrome (KS) is a coronary syndrome in the setting of allergic/anaphylactic reactions and can be classified in three variants: vasospastic allergic angina (type I), allergic myocardial infarction (type II) and stent thrombosis (type III). The early diagnosis is of paramount importance for the correct management and the prognosis, being KS a life-threatening emergency condition. KS is not uncommon, but it is frequently unrecognized or undiagnosed in virtue of its broad clinical manifestations. The diagnosis should be based on the combination of cardiovascular and allergic/anaphylactic clinical symptoms and signs, as well as on laboratory, electrocardiographic, echocardiographic, and angiographic evidence. ECG monitoring, cardiac enzymes and troponin are mandatory to confirm or exclude KS in a patient with subclinical or clinical, acute or chronic allergic reactions. Nevertheless, the treatment is a real challenge for the emergency clinicians because guidelines have not been established yet, and the therapy is based on the variant type. We herein report the case of type I KS in a woman with no prior history of allergy, admitted to our emergency department for abdominal pain, nausea and hematochezia. Starting from this case we conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline, using the keywords of "Kounis syndrome", "coronary spams", "cardiac arrest", "sudden death", "allergy", and "anaphylaxis". The main purpose of this review is to remind emergency clinicians to keep a high index of suspicion regarding KS when dealing with patients with allergic reactions or anaphylaxis to promptly identify and correctly manage KS.
Topics: Acute Coronary Syndrome; Anaphylaxis; Electrocardiography; Emergency Service, Hospital; Female; Humans; Kounis Syndrome
PubMed: 35315408
DOI: 10.23750/abm.v93i1.11862 -
Minerva Anestesiologica May 2004Immediate hypersensitivity reactions to anaesthetic and associated agents used during the perioperative period have been reported with increasing frequency in most... (Review)
Review
Immediate hypersensitivity reactions to anaesthetic and associated agents used during the perioperative period have been reported with increasing frequency in most developed countries. Most reactions are of immunologic origin (IgE mediated, anaphylaxis) or related to direct stimulation of histamine release (anaphylactoid reactions). The incidence of anaphylaxis is estimated between 1 in 10000 and 1 in 20000 anaesthesia, and any drug administered in the perioperative period can potentially produce life-threatening immune-mediated hypersensitivity reactions. Neuromuscular blocking agents (NMBAs), latex and antibiotics represent the most frequently involved substances. However, anaphylactic reactions cannot be clinically distinguished from non-immune mediated reactions which account for 30% to 40% of hypersensitivity reactions. Therefore, any suspected anaphylactic reaction must be extensively investigated using combined peroperative and postoperative testing to confirm the nature of the reaction, the responsibility of suspected drugs and to provide precise recommendations for future anaesthetic procedures. These investigations include plasma histamine, tryptase and specific IgE concentration determination at the time of the reaction, and skin tests 6 weeks later. In addition, since no specific treatment has been shown to reliably prevent the occurrence of anaphylaxis, allergy assessment must be performed in all high-risk patients. The need for proper epidemiological studies and the relative complexity of allergy investigation should be underscored. They represent an incentive for further development of allergo-anaesthesiology clinical networks to provide expert advice for anaesthetists and allergologists.
Topics: Anaphylaxis; Anesthetics; Humans; Risk Factors
PubMed: 15181405
DOI: No ID Found -
Annals of Cardiac Anaesthesia 2022Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical...
INTRODUCTION
Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate.
METHODS
This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK.
RESULTS
A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed.
CONCLUSION
As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10-20 times higher than in the general surgical population.
Topics: Anaphylaxis; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Humans; Incidence; Retrospective Studies
PubMed: 35799561
DOI: 10.4103/aca.aca_170_21