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Anaphylaxis

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21. Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies. (PubMed)

Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies. Opportunity exists to reduce unnecessary hospitalizations for children with anaphylaxis given wide variation in admission rates across U.S. emergency departments (EDs). We sought to identify children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies, as these patients may be candidates for ED discharge rather than inpatient hospitalization.We (...) conducted a single-center retrospective cohort study of children 1-21 years of age hospitalized with anaphylaxis from 2009 to 2016. Acute inpatient therapies included intramuscular (IM) or racemic epinephrine, bronchodilators, fluid boluses, vasopressors, non-invasive ventilation, or intubation. We derived age-specific (pre-verbal [<36 months] vs. verbal [≥ 36 months]) prediction rules using recursive partitioning to identify children at low risk of receiving acute inpatient therapies.During the study

2019 PLoS ONE

22. Drug‐induced anaphylaxis in the emergency room (PubMed)

Drug‐induced anaphylaxis in the emergency room Anaphylaxis is a life-threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing (...) fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized

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2017 Acute medicine & surgery

23. Anaphylaxis: assessment and referral after emergency treatment

Anaphylaxis: assessment and referral after emergency treatment Anaph Anaphylaxis: assessment and referr ylaxis: assessment and referral al after emergency treatment after emergency treatment Clinical guideline Published: 14 December 2011 nice.org.uk/guidance/cg134 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE (...) in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Anaphylaxis: assessment and referral after emergency treatment (CG134) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

24. A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis

A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis A systematic review and cost-effectiveness analysis of specialist services and adrenaline auto-injectors in anaphylaxis Journals Library An error has occurred in processing the XML document An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from (...) the navigation or try a website search above to find the information you need. >> >> >> >> Issue {{metadata .Issue }} Toolkit 1)"> 0)"> 1)"> {{metadata.Title}} {{metadata.Headline}} Study found a lack of good data to inform the effectiveness of anaphylaxis intervention but concluded that both referral to a specialist service (SS) and prescription of adrenaline injectors are likely to be cost-effective, and so consideration of randomised controlled trials of the components of care in SSs was recommended

2013 NIHR HTA programme

25. Angio-oedema and anaphylaxis

Angio-oedema and anaphylaxis Angio-oedema and anaphylaxis - NICE CKS Share Angio-oedema and anaphylaxis: Summary Angio-oedema is swelling of deep dermis, subcutaneous, or submucosal tissue, often affecting the face (lips, tongue, and eyelids), genitalia, hands, or feet. Less commonly, submucosal swelling affects the bowel and airway. The main types are allergic angio-oedema, non-allergic drug reaction (usually caused by angiotensin-converting enzyme [ACE] inhibitor treatment), hereditary angio (...) -oedema (an inherited genetic abnormality), acquired angio-oedema (usually secondary to lymphoma or a connective tissue disorder), and idiopathic angio-oedema. Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes. The mechanism for angio-oedema and anaphylaxis is the same, as both histamine and/or bradykinin are involved

2018 NICE Clinical Knowledge Summaries

26. Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis? (PubMed)

Epidemiology of severe anaphylaxis: can we use population-based data to understand anaphylaxis? The observed increase in incidence of allergic disease in many regions over the past 3 decades has intensified interest in understanding the epidemiology of severe allergic reactions. We discuss the issues in collecting and interpreting these data and highlight current deficiencies in the current methods of data gathering.Anaphylaxis, as measured by hospital admission rates, is not uncommon and has (...) increased in the United Kingdom, the United States, Canada, and Australia over the last 10-20 years. All large datasets are hampered by a large proportion of uncoded, 'unspecified' causes of anaphylaxis. Fatal anaphylaxis remains a rare event, but appears to be increasing for medication in Australia, Canada, and the United States. The rate of fatal food anaphylaxis is stable in the United Kingdom and the United States, but has increased in Australia. The age distribution for fatal food anaphylaxis

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2016 Current Opinion in Allergy and Clinical Immunology

27. Humanized mouse model of mast cell-mediated passive cutaneous anaphylaxis and passive systemic anaphylaxis. (PubMed)

Humanized mouse model of mast cell-mediated passive cutaneous anaphylaxis and passive systemic anaphylaxis. Mast cells are a critical component of allergic responses in humans, and animal models that allow the in vivo investigation of their contribution to allergy and evaluation of new human-specific therapeutics are urgently needed.To develop a new humanized mouse model that supports human mast cell engraftment and human IgE-dependent allergic responses.This model is based on the NOD-scid (...) and -independent manner, and can be readily cultured in vitro for additional studies. Intradermal priming of engrafted NSG-SGM3 mice with a chimeric IgE containing human constant regions resulted in the development of a robust passive cutaneous anaphylaxis response. Moreover, we describe the first report of a human mast cell antigen-dependent passive systemic anaphylaxis response in primed mice.NSG-SGM3 BLT mice provide a readily available source of human mast cells for investigation of mast cell biology

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2016 Journal of Allergy and Clinical Immunology

28. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. (PubMed)

Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description.We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents.The European Anaphylaxis (...) Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form.Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis

2016 Journal of Allergy and Clinical Immunology

29. Duration of Observation for Detecting a Biphasic Reaction in Anaphylaxis: A Meta-Analysis. (PubMed)

Duration of Observation for Detecting a Biphasic Reaction in Anaphylaxis: A Meta-Analysis. We conducted a meta-analysis to determine a practical observation time for detecting a biphasic reaction after resolution of the initial anaphylactic reaction.A systematic literature search identified studies on adult patients with anaphylaxis and a subsequent biphasic reaction due to various causes that contained sufficient data to extract outcomes. The outcomes were pooled using a random-effects (...) model.Twelve studies with a total of 2,890 adult patients with anaphylaxis and 143 patients with a biphasic reaction were included. In terms of the pooled negative predictive value, 1 h of observation achieved a 95.0% negative predictive value and ≥6 h of observation provided a 97.3% negative predictive value (95% CI: 95.0-98.5). The negative predictive value for a biphasic reaction increased with a longer observation time after initial anaphylaxis, and the increasing trend slowed down from 6 h

2019 International Archives of Allergy and Immunology

30. Epinephrine Administered for Anaphylaxis Unmasking a Type 1 Brugada Pattern on Electrocardiogram. (PubMed)

Epinephrine Administered for Anaphylaxis Unmasking a Type 1 Brugada Pattern on Electrocardiogram. Brugada pattern on electrocardiography (ECG) can manifest as type 1 (coved pattern) and type 2 (saddleback pattern). Brugada syndrome represents an ECG with Brugada pattern in a patient with symptoms or clinical factors, including syncope, cardiac arrest, ventricular dysrhythmias, and family history. Brugada syndrome is caused by a genetic channelopathy, but the Brugada pattern may be drug-induced (...) . Epinephrine-induced Brugada pattern has not been reported previously.A 63-year-old man developed anaphylaxis secondary to a bee sting, had a transient loss of consciousness, and self-administered intramuscular epinephrine. He subsequently presented to the emergency department and was found to have a type 1 Brugada pattern on ECG that resolved during observation. A historic ECG was reviewed that demonstrated a baseline type 2 Brugada pattern. His anaphylaxis was managed with steroids and antihistamines. He

2019 Journal of Emergency Medicine

31. Anaphylaxis to Carboxymethylcellulose: Add Food Additives to the List of Elicitors. (PubMed)

Anaphylaxis to Carboxymethylcellulose: Add Food Additives to the List of Elicitors. A 14-year-old girl developed 4 episodes of anaphylaxis of unknown etiology, which required intramuscular adrenaline administration each time. She had eaten pizza and a cheeseburger immediately before the first 2 episodes, respectively, but had not eaten anything for several hours before the last 2 episodes. It turned out that she had eaten the same ice lolly 4 hours before the first 3 episodes and a Café au lait (...) -soluble polymer derived from native cellulose, is considered to be unabsorbable from the human gut and has been widely and increasingly used in pharmaceutical preparations, cosmetics, and food. This article is the first report of anaphylaxis caused by carboxymethylcellulose-containing foods, whereas anaphylaxis to carboxymethylcellulose has been rarely associated with carboxymethylcellulose-containing pharmaceuticals. Although the exact mechanisms underlying the induction of late-onset anaphylaxis

2019 Pediatrics

32. Anaphylaxis Hands On simulation workshop - Twitter summary from #ACAAI18 meeting

Anaphylaxis Hands On simulation workshop - Twitter summary from #ACAAI18 meeting Allergy Notes: Anaphylaxis Hands On simulation workshop - Twitter summary from #ACAAI18 meeting Allergy, Asthma and Immunology News Updated Daily by Board-certified Allergist at Cleveland Clinic Florida Pages Anaphylaxis Hands On simulation workshop - Twitter summary from #ACAAI18 meeting Studies have demonstrated that hands on practice offered by case simulation is more effective than standard classroom (...) instruction. You can do simulation in your office. A 3$ doll from Value village can serve as your "mannequin". Simulation mannequins are now very high fidelity - can show vitals, O2 sat, wheeze, cry, turn cyanotic, have heart murmurs. When practicing for management of #anaphylaxis in your office - use closed loop communication - ie Give Epinephrine 0.3mg IM now -- "0.3mg Epi given" - document all steps taken like in a real scenario. Plan for your worst day in clinic, not your typical day - know your

2019 Allergy Notes blog

33. The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. (PubMed)

The global incidence and prevalence of anaphylaxis in children in the general population: a systematic review. Despite an increasing number of publications from individual countries and regions, there is still no systematic review of the global epidemiology of anaphylaxis in the general paediatric population.We conducted a systematic review, using a protocol registered and published with the international prospective register of systematic reviews (PROSPERO). Results were reported following (...) and 17 reported prevalence data. The incidence of anaphylaxis in children worldwide varied widely, ranging from 1 to 761 per 100 000 person-years for total anaphylaxis and 1 to 77 per 100 000 person-years for food-induced anaphylaxis. The definition of anaphylaxis from NIAID/FAAN was the most commonly used. Gender and ethnicity were demographic risk factors associated with anaphylaxis in children. Increasing total or food-induced anaphylaxis incidence over time was reported by 19 studies.The reported

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2019 Allergy

34. Common causes of emergency department visits for anaphylaxis in Korean community hospitals: A cross-sectional study. (PubMed)

Common causes of emergency department visits for anaphylaxis in Korean community hospitals: A cross-sectional study. Anaphylaxis can cause death and requires immediate management. For prevention and education programs for anaphylaxis, it is important to be aware of the common triggering factors. We investigated the triggers of anaphylaxis in the emergency departments (EDs) of community hospitals in Korea.Patients who visited the EDs of 7 community hospitals for anaphylaxis from January 1, 2012 (...) to December 31, 2016 were enrolled. Anaphylaxis was defined according to the World Allergy Organization criteria and identified via a thorough review of the medical records of patients who were diagnosed with anaphylaxis (ICD-10 codes: T780, T782, T805, and T886) at the ED or administered epinephrine in the ED. Triggers of anaphylaxis were also evaluated by a review of the medical records.We identified 1021 ED visits for anaphylaxis. The incidence of anaphylaxis ED visits was 0.08%. The triggers of ED

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2019 Medicine

35. Anaphylaxis after Elosulfase A infusion: Omalizumab as coadyuvant for enzyme replacement therapy desensitization. (PubMed)

Anaphylaxis after Elosulfase A infusion: Omalizumab as coadyuvant for enzyme replacement therapy desensitization. Type IV A Mucopolysaccharidosis (MPS IV A) is a lysosomal storage disease caused by an autosomal recessive mutation in the gene encoding the enzyme galactosamine-6-sulfatase, which catalyses the degradation of glycosaminoglycans (GAGs). It leads to the accumulation of GAGs keratan sulfate. Symptoms include skeletal dysplasia, atlantoaxial instability, pectus carinatum, short stature

2019 Pediatric Allergy and Immunology

36. Paired acute-baseline serum tryptase levels in perioperative anaphylaxis: an observational study 97/100. (PubMed)

Paired acute-baseline serum tryptase levels in perioperative anaphylaxis: an observational study 97/100. Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time (...) frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination.A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured.Based on EAACI guidelines, clinical diagnostic criteria

2019 Allergy

37. Should I really have admitted that kid with anaphylaxis?

Should I really have admitted that kid with anaphylaxis? Should I really have admitted that kid with anaphylaxis? – PEMBlog Search for: Search for: Should I really have admitted that kid with anaphylaxis? Anaphylaxis is a common diagnosis in the Pediatric Emergency Department. We know that the risk of biphasic reaction exists, and that it can occur as far out as 72 -hours after the initial reaction. Many will observe children for up to 4 to 6 hours after the initial presentation and treatment (...) in the ED and if symptoms persist or recur admit to an inpatient ward. But what happens to those patients? Are we admitting too many of them? How van we know which kids have a higher risk of progression to more serious disease and need more interventions on an inpatient setting? attempted to answer these very questions. What d oes this study show? This was a retrospective look at a single center’s admissions for anaphylaxis. The authors then created rules to predict children at low risk for acute

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2019 PEM Blog

38. Cecilia Trigg: More needs to be done to prevent food anaphylaxis deaths

Cecilia Trigg: More needs to be done to prevent food anaphylaxis deaths Cecilia Trigg: More needs to be done to prevent food anaphylaxis deaths - The BMJ ---> Recent inquest reports into suspected food anaphylaxis deaths make harrowing reading. The recent cases were teenagers who lost their lives to a preventable cause of death. The incidence of food allergies is on the rise, and more needs to be done to prevent food anaphylaxis deaths Complete avoidance of the food allergen is the most (...) reliable way to prevent food anaphylaxis. This may seem simple, but becomes increasingly difficult when assessing labels on processed foods, eating out at catering establishments or at other people’s homes. As a consultant Allergist I frequently hear of near misses. Trusted friends or relations can fail to check ingredients, as can caterers. The individual may make assumptions without checking when a food appears safe—for instance, vegan cakes can contain unexpected nuts. Food labelling can also

2018 The BMJ Blog

39. Diagnosis and management of drug-induced anaphylaxis in children: an EAACI position paper. (PubMed)

Diagnosis and management of drug-induced anaphylaxis in children: an EAACI position paper. Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life-threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug-induced (...) anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non-steroidal anti-inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children

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2019 Pediatric Allergy and Immunology

40. Epidemiology and trends of anaphylaxis in the United States, 2004-2016. (PubMed)

Epidemiology and trends of anaphylaxis in the United States, 2004-2016. No national study has examined the epidemiology of anaphylaxis after introduction of the codes of the International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, Clinical Modification (ICD-10 CM). Our objective was to examine the trends in incidence and hospitalization rates in the United States utilizing ICD-9 and ICD-10 CM codes.We used the Clinformatics database from 2004 to 2016 (...) . Our outcome measures included incidence of anaphylaxis and hospitalization trends. Multivariable logistic regression was used to assess the predictors of anaphylaxis and hospitalization.There were a total of 462,906 anaphylaxis cases. The incidence increased from 153 in 2004 to 218 in 2016 (per 100,000). Women were 1.19 (95% confidence interval, 1.18-1.20) times more likely to present with anaphylaxis. Medication-induced anaphylaxis increased 15-fold.This is the first population-based study

2019 International forum of allergy & rhinology

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