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Anaphylaxis

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181. Epinephrine in Anaphylaxis: Preclinical Study of Pharmacokinetics after Sublingual Administration of Taste-Masked Tablets for Potential Pediatric Use Full Text available with Trip Pro

Epinephrine in Anaphylaxis: Preclinical Study of Pharmacokinetics after Sublingual Administration of Taste-Masked Tablets for Potential Pediatric Use Epinephrine is a life-saving treatment in anaphylaxis. In community settings, a first-aid dose of epinephrine is injected from an auto-injector (EAI). Needle phobia highly contributes to EAI underuse, leading to fatalities-especially in children. A novel rapidly-disintegrating sublingual tablet (RDST) of epinephrine was developed in our laboratory (...) epinephrine 0.15 mg. The Cmax of both doses was significantly higher than the Cmax of 7.5 ± 1.7 ng/mL of endogenous epinephrine after placebo. These taste-masked RDSTs containing a 30 mg dose of epinephrine have the potential to be used as an easy-to-carry, palatable, non-invasive treatment for anaphylactic episodes for children in community settings.

2018 Pharmaceutics

182. Brain Stem Ischemic Stroke Associated with Anaphylaxis Full Text available with Trip Pro

Brain Stem Ischemic Stroke Associated with Anaphylaxis Anaphylaxis is a serious allergic reaction that may have different manifestations including hypotension. It is reported that vertebral artery hypoplasia (VAH) may be present in up to 20% of the general population. Previous studies have demonstrated that patients with VAH have a higher risk of developing an ischemic stroke in the area supplied by this hypoplastic artery. This paper describes the case of a patient with preexistent VAH who (...) presented with lateral medullary syndrome associated with a hypotensive episode secondary to anaphylaxis. To the best of the authors' knowledge, this association has not previously reported.

2018 Cureus

183. Anaphylaxis in atypical cold urticaria: case report and review of literature Full Text available with Trip Pro

Anaphylaxis in atypical cold urticaria: case report and review of literature Cold-induced urticaria is a kind of physical urticaria characterized by the appearance of wheals after exposure to cold. The atypical form is a rare sub-type characterized by appearance of hives even in areas not directly exposed to the cold and by a negative cold stimulation test. Its diagnosis is often challenging because of the lack of specific tests and it is usually based on the patient's clinical history (...) to cold and a negative response to the cold stimulation test, are the characteristic features of this rare form of cold urticaria.Atypical cold urticaria should be suspected in all cases of anaphylaxis related to cold exposure (i.e. contact with water) with a negative cold stimulation test.

2018 Italian journal of pediatrics

184. Anaphylactic reaction in patient allergic to mango Full Text available with Trip Pro

Anaphylactic reaction in patient allergic to mango An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions between mango and pear, apple, and peach. A panallergen with a structure similar to mugwort defensin (Art v 1) which cross-reacts with celery, carrot, peanuts, pepper, aniseed, and caraway has been previously described.A female patient, 30 (...) rPhl p 1 (timothy grass) and Art v 1 (mugwort). We also performed the IgE inhibition test using both mango extract and ImmunoCap matrix and confirmed a cross-reaction with Art v 1 in the pathogenesis of symptoms observed in the patient.An anaphylactic reaction to consumed mango, resulting from cross-allergy with mugwort Art v 1 was diagnosed in the patient. Acute urticarial in this case is a manifestation of IgE-mediated food allergy. During in vitro diagnostic procedures we found an elevated

2018 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

185. First-reported pediatric cases of American ginseng anaphylaxis and allergy Full Text available with Trip Pro

First-reported pediatric cases of American ginseng anaphylaxis and allergy Ginseng is a perennial herb used in traditional Chinese medicine, which has become increasingly popular world-wide due to its proposed medicinal effects. There are two major species of ginseng, Panax ginseng (Korean or Asian ginseng), and Panax quinquefolius (American ginseng). Although cases of allergy due to Korean ginseng have been reported in adults, there are no reported cases of allergy to American ginseng (...) , and no reported cases of ginseng allergy in pediatric patients.We present two unique cases of pediatric patients with suspected allergic reactions to American ginseng. The first patient is a 6-year-old girl who presented to the emergency department in anaphylaxis (urticaria and respiratory symptoms) minutes after inhaling powdered American ginseng. There was evidence of sensitization to American ginseng on skin prick testing (SPT) (13 × 12 mm wheal) and evidence of allergy to American ginseng on basophil

2018 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

186. Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka Full Text available with Trip Pro

Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in South Asian countries have not been reported. We sought to determine the causes of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka.238 episodes of anaphylaxis were (...) reviewed in 188 patients who were referred and skin prick tests and in vitro tests (ImmunoCap) were carried out to assess the presence of allergen specific IgE. Clinical features and severity of anaphylaxis was also recorded along with treatment received.Anaphylaxis to food either following direct exposure 90/238 (37.5%) or after exercise in the form of food dependent exercise induced anaphylaxis 29/238 (12.2%) was the predominant cause of anaphylaxis. Allergy to cow's milk and red meat, after

2018 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

187. Corilagin Attenuates Allergy and Anaphylactic Reaction by Inhibiting Degranulation of Mast Cells Full Text available with Trip Pro

Corilagin Attenuates Allergy and Anaphylactic Reaction by Inhibiting Degranulation of Mast Cells BACKGROUND This study evaluated the anti-allergic activity of corilagin and also postulates the possible mechanism of its action. MATERIAL AND METHODS Corilagin was given orally at dose of 10, 20, and 40 mg/kg/day. All the animals (guinea pigs, rats, and mice) were sensitized for allergy such as eosinophilia and leukocytosis induced by milk; degranulation of mast cell by compound 48/80; and passive (...) and active anaphylaxis. Moreover, the antagonistic effect was determined by estimating the effect of corilagin on contraction of guinea pig tracheal chain and ileum induced by Ach and histamine, respectively. RESULTS There was a significant decrease in the leukocyte and eosinophil counts in the corilagin-treated group compared to the negative control group. Treatment with corilagin significantly protects the degranulation of mast cells, and it also has significant anti-muscarinic and antihistaminic

2018 Medical science monitor : international medical journal of experimental and clinical research

188. In situ simulation in the management of anaphylaxis in a pediatric emergency department. (Abstract)

In situ simulation in the management of anaphylaxis in a pediatric emergency department. Anaphylaxis is a potentially life-threatening, rapid-onset hypersensitive reaction, usually treated in the emergency department (ED). Failure to recognize anaphylaxis leads to under-treatment with epinephrine and even when correctly diagnosed, epinephrine is not always administered. In addition, often patients who are treated in the ED are not referred for allergy work-up. Simulation is a tool (...) that increases exposure to events in a safe environment, allowing trainers to develop skills without harming patients. The main purpose of our study was to determine whether in situ simulation training increases the frequency of epinephrine use. The secondary aim was to observe whether simulation modifies the number of children investigated over the years before and after the setting up of the simulation training. All patients with anaphylaxis referred to the Pediatric Emergency Department (PED) of the Anna

2018 Internal and emergency medicine

189. Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children. (Abstract)

Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children. Food-related anaphylactic reactions may require treatment with more than 1 dose of epinephrine. Current guidelines advise patients at risk of anaphylaxis to carry 2 epinephrine autoinjectors.The objective of this study was to determine risk factors of multiple-dose epinephrine treatment in pediatric food-related anaphylaxis.Parents of children with physician-confirmed diagnosis of food allergy were (...) ratio [OR] 3.2; 95% confidence interval [CI] 1.2-8.4) and treatment with oxygen (OR 5.0, 95% CI 2.0-12.4) were significant risk factors for requiring multiple doses of epinephrine to treat an allergic reaction.This study demonstrates that treatment of anaphylaxis may require more than 1 epinephrine injection. Reactions triggered by milk or requiring treatment with oxygen are at higher risk for needing more than 1 dose of epinephrine. Families of food-allergic children should be counseled

2018 Asthma & Immunology

190. Effects of Glucocorticoids on Hospitalized Children With Anaphylaxis. (Abstract)

Effects of Glucocorticoids on Hospitalized Children With Anaphylaxis. The benefits of glucocorticoid treatment and recent trends of adjunctive treatments during episodes of anaphylaxis remain unclear.The aims of this study were to investigate the recent practice patterns and compare the effects of glucocorticoid for children hospitalized with anaphylaxis.Using the Japanese Diagnosis Procedure Combination inpatient database, we compared the length of hospital stay, risk of 10-day readmission

2018 Pediatric Emergency Care

191. Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy. (Abstract)

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy. Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions.Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January (...) 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests.We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE

2018 International Archives of Allergy and Immunology

192. Nationwide Survey of Hospitalization Due to Pediatric Food-Induced Anaphylaxis in the United States. (Abstract)

Nationwide Survey of Hospitalization Due to Pediatric Food-Induced Anaphylaxis in the United States. Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear.Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were (...) weighted to estimate the number of hospitalizations in the United States. We identified annual hospitalization rates by patients' characteristics and anaphylaxis-trigger foods and investigated factors associated with severity and use of mechanical ventilation with multivariable logistic regression.A total of 3427 hospitalizations were obtained, and annual hospitalization rates showed a significantly increasing trend from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012 (P < 0.001

2018 Pediatric Emergency Care

193. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Full Text available with Trip Pro

Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.The 6th National Audit Project (NAP6) on perioperative anaphylaxis collected and reviewed 266 reports of Grades 3-5 anaphylaxis over 1 yr from all NHS hospitals in the UK.The estimated incidence was ≈1:10 000 anaesthetics. Case exclusion (...) because of reporting delays or incomplete data means true incidence might be ≈70% higher. The distribution of 199 identified culprit agents included antibiotics (94), neuromuscular blocking agents (65), chlorhexidine (18), and Patent Blue dye (9). Teicoplanin comprised 12% of antibiotic exposures, but caused 38% of antibiotic-induced anaphylaxis. Eighteen patients reacted to an antibiotic test dose. Succinylcholine-induced anaphylaxis, mainly presenting with bronchospasm, was two-fold more likely than

2018 British Journal of Anaesthesia

194. Myths, facts and controversies in the diagnosis and management of anaphylaxis. Full Text available with Trip Pro

Myths, facts and controversies in the diagnosis and management of anaphylaxis. Anaphylaxis is a serious systemic allergic reaction that is rapid in onset and may cause death. Despite numerous national and international guidelines and consensus statements, common misconceptions still persist in terms of diagnosis and appropriate management, both among healthcare professionals and patient/carers. We address some of these misconceptions and highlight the optimal approach for patients who

2018 Archives of Disease in Childhood

195. Asian children living in Australia have a different profile of allergy and anaphylaxis than Australian-born children: a State-wide survey. Full Text available with Trip Pro

Asian children living in Australia have a different profile of allergy and anaphylaxis than Australian-born children: a State-wide survey. Asian children born in Australia have higher rates of eczema and nut allergy than non-Asian children. However, it is not known whether this country of birth differential exists for other allergies or anaphylaxis risk.We investigated the influence of maternal and child's country of birth on the prevalence of parent-reported eczema, asthma, food allergy (...) and being diagnosed by a doctor as being "at risk of anaphylaxis."We assessed the relationship between mother and child country of birth and allergies using the 2010 School Entrant Health Questionnaire, completed for 57 005 5-year old children (85.8% response rate) in Victoria, Australia. Analyses were conducted using logistic regression with results presented as odds ratios (OR) with 95% confidence intervals (CIs).Children born in Australia to Asian-born mothers were more likely to have parent-reported

2018 Clinical and Experimental Allergy

196. Current trends in food allergy-induced anaphylaxis management at school. (Abstract)

treatment with intramuscular epinephrine. Anaphylaxis can be associated with poor quality of life. There is renewed recent focus on anaphylaxis management in schools. This interest has been spurred by an increase in the number of children with food allergy who are attending school, data that support up to 25% of first-time anaphylactic events occurring on school grounds, and a well-publicized fatality that helped to initiate a movement for stock, undesignated, non-student-specific epinephrine. Stock (...) Current trends in food allergy-induced anaphylaxis management at school. To review the evidence and current policies regarding the use of epinephrine at schools and child care centers DATA SOURCES AND STUDY SELECTIONS: A narrative review was performed based on the result of conference proceedings of a group of interprofessional stakeholders who attended the USAnaphylaxis Summit 2017 presented by Allergy & Asthma Network.Anaphylaxis is a well-recognized medical emergency that requires prompt

2018 Asthma & Immunology

197. Low-dose oral immunotherapy for children with anaphylactic peanut allergy in Japan. (Abstract)

Low-dose oral immunotherapy for children with anaphylactic peanut allergy in Japan. Oral immunotherapy (OIT) is a promising treatment for persons with allergy; however, it can also cause adverse allergic reactions. In this study, we investigated the efficacy of low-dose OIT for anaphylactic peanut allergy.Twenty-four children (median age, 9.6 years) with anaphylaxis to peanuts were hospitalized for 5 days and then gradually fed increasing amounts of peanut powder up to 133 mg/day. One year (...) later, they underwent an oral food challenge after 2 weeks of peanut avoidance. Those who were asymptomatic after ingesting 795 mg of peanut protein were defined as having achieved sustained unresponsiveness. We measured peanut- and Ara h2-specific immunoglobulin (Ig) E, IgG, and IgG4 levels at 0, 1, 3, 6, and 12 months in the OIT group and at 0 and 12 months in the control group.At baseline, all children in the OIT group and 8 in the control group had a history of anaphylaxis. The median peanut

2018 Pediatric Allergy and Immunology

198. The orphan nuclear receptor NR4A1 promotes FcεRI-stimulated mast cell activation and anaphylaxis by counteracting the inhibitory LKB1/AMPK axis. (Abstract)

The orphan nuclear receptor NR4A1 promotes FcεRI-stimulated mast cell activation and anaphylaxis by counteracting the inhibitory LKB1/AMPK axis. Nuclear receptor subfamily 4 group A member 1 (NR4A1), an orphan nuclear receptor, has been implicated in several biological events such as metabolism, apoptosis, and inflammation. Recent studies indicate a potential role for NR4A1 in mast cells, yet its role in allergic responses remains largely unknown.The aim of this study was to clarify the role (...) of NR4A1 in mast cell activation and anaphylaxis.To evaluate the function of NR4A1 in mast cells, the impacts of siRNA knockdown, gene knockout, adenoviral overexpression, and pharmacological inhibition of NR4A1 on FcεRI signaling and effector functions in mouse bone marrow-derived mast cells (BMMCs) in vitro and on anaphylactic responses in vivo were evaluated.Knockdown or knockout of NR4A1 markedly suppressed degranulation and lipid mediator production by FcεRI-crosslinked BMMCs, while its

2018 Allergy

199. Anaphylaxis: emergency management for health professionals Full Text available with Trip Pro

Anaphylaxis: emergency management for health professionals 29670313 2018 04 19 0312-8008 41 2 2018 Apr Australian prescriber Aust Prescr Anaphylaxis: emergency management for health professionals. 54 10.18773/austprescr.2018.014 eng Journal Article Review 2018 04 03 Australia Aust Prescr 7804938 0312-8008 2018 4 20 6 0 2018 4 20 6 0 2018 4 20 6 1 ppublish 29670313 10.18773/austprescr.2018.014 austprescr-41-54 PMC5895473

2018 Australian Prescriber

200. Critical view of anaphylaxis epidemiology: open questions and new perspectives Full Text available with Trip Pro

Critical view of anaphylaxis epidemiology: open questions and new perspectives In contrast to the majority of allergic or hypersensitivity conditions, worldwide anaphylaxis epidemiological data remain sparse with low accuracy, which hampers comparable morbidity statistics. Data can differ widely depending on a number of variables. In the current document we reviewed the forms on which anaphylaxis has been defined and classified; and how it can affect epidemiological data. With regards (...) to the methods used to capture morbidity statistics, we observed the impact of the anaphylaxis coding utilizing the World Health Organization's International Classification of Diseases. As an outcome and depending on the anaphylaxis definition, we extracted the cumulative incidence, which may not reflect the real number of new cases. The new ICD-11 anaphylaxis subsection developments and critical view of morbidity statistics data are discussed in order to reach new perspectives on anaphylaxis epidemiology.

2018 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

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