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Anaphylaxis

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101. Specific IgE for Fag e 3 Predicts Oral Buckwheat Food Challenge Test Results and Anaphylaxis: A Pilot Study. (PubMed)

Specific IgE for Fag e 3 Predicts Oral Buckwheat Food Challenge Test Results and Anaphylaxis: A Pilot Study. Buckwheat (BW) is the source of a life-threatening allergen. Fag e 3-specific serum IgE (sIgE) is more useful than BW-sIgE for diagnosis; however, it is unknown whether Fag e 3-sIgE can predict oral food challenge (OFC) results and anaphylaxis. This study aimed to clarify the efficacy of Fag e 3-sIgE in predicting OFC results and anaphylaxis.We conducted a retrospective review of BW (...) reactions to BW (p = 0.004). Fag e 3-sIgE was the only tested factor that significantly predicted positive OFC results (odds ratio 8.93, 95% confidence interval 3.10-25.73, p < 0.001) and OFC-induced anaphylaxis (2.67, 1.12-6.35, p = 0.027). We suggest that a threshold Fag e 3-sIgE level of 18.0 kUE/L has 95% probability of provoking a positive reaction to BW.Fag e 3-sIgE predicted OFC results and OFC-induced anaphylaxis. We further emphasize paying careful attention to the risk of BW OFC-induced

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2018 International Archives of Allergy and Immunology

102. Short and long-term management of cases of venom induced anaphylaxis (via) is suboptimal. (PubMed)

Short and long-term management of cases of venom induced anaphylaxis (via) is suboptimal. Venom-induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short- and long-term management of VIA patients.To assess the short- and long-term management of VIA.Using a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to emergency departments in Montreal and to emergency medical services (EMSs) in western Quebec over a 4-year period. Data were

2018 Asthma & Immunology

103. Neuromuscular Blocking Agents induced anaphylaxis: Results and trends of a French Pharmacovigilance survey from 2000 to 2012. (PubMed)

Neuromuscular Blocking Agents induced anaphylaxis: Results and trends of a French Pharmacovigilance survey from 2000 to 2012. Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE-mediated mechanism. In France, this life-threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000-2012 period which objectives were (...) to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period.The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and positive skin tests were qualified as "confirmed cases." Subgroup analysis compared atracurium and cisatracurium vs suxamethonium and rocuronium.A total of 680 confirmed cases and 944 nonconfirmed cases were identified. Suxamethonium was the most implied NMBA

2018 Allergy

104. Management of anaphylaxis in Spain: pediatric emergency care providers' knowledge. (PubMed)

Management of anaphylaxis in Spain: pediatric emergency care providers' knowledge. Acute care providers must diagnose and treat patients with anaphylaxis. The objective was to analyze Spanish pediatric emergency departments' (ED) providers' knowledge of the international recommendations for the management of anaphylaxis.A web-based survey including providers (both attending and residents) from seven Spanish pediatric EDs was conducted. To analyze the knowledge of the identification (...) of anaphylaxis, we used the diagnostic criteria given by the National Institute of Allergy and Infectious Disease and Food Allergy and the Food Allergy and Anaphylaxis Network (2005). To analyze the management, we used the practical recommendations on the management of anaphylaxis published by the Joint Task Force on Practice Parameters (2014).A total of 425 physicians received the link and 337 (79.2%) completed the survey (138 attending, 76.6%; 199 residents, 81.2%, P<0.05). More than 90% of the providers

2018 European Journal of Emergency Medicine

105. Improving Anaphylaxis Care: The Impact of a Clinical Pathway. (PubMed)

Improving Anaphylaxis Care: The Impact of a Clinical Pathway. Recommended durations of observation after anaphylaxis have been widely variable, with many ranging from 4 to 24 hours. Prolonged durations often prompt admission for ongoing observation.In a multidisciplinary quality improvement initiative, we revised our emergency department (ED) anaphylaxis clinical pathway. Our primary aim was to safely decrease the recommended length of observation from 8 to 4 hours and thereby decrease (...) unnecessary hospitalizations. Secondary aims included provider education on anaphylaxis diagnostic criteria, emphasizing epinephrine as first-line therapy, and implementing a practice of discharging ED patients with an epinephrine autoinjector in hand. The study period consisted of the 18 months before pathway revision (baseline) and the 18 months after revision.The overall admission rate decreased from 58.2% (106 of 182) in the baseline period to 25.3% (65 of 257) after pathway revision (P < .0001

2018 Pediatrics

106. Outcome of repeat anaesthesia after investigation for perioperative anaphylaxis. (PubMed)

Outcome of repeat anaesthesia after investigation for perioperative anaphylaxis. Perioperative anaphylaxis (POA) is infrequent, but remains an important and potentially life-threatening complication of general anaesthesia. The diagnostic uncertainty surrounding the investigation of anaesthetic allergy poses numerous challenges. We aimed to inform practice by auditing the outcomes of repeat anaesthesia, after an investigation for previous POA.One-hundred and seventy-four subjects were (...) investigated after suspected POA between December 2002 and August 2015. Outcome data were obtained for a total of 70 patients who underwent repeat anaesthesia after investigation in the drug-allergy clinic.Sixty-seven out of the 70 patients studied underwent repeat anaesthesia without further complications. Three individuals experienced a further episode of anaphylaxis. In two cases, incomplete referral information led to the offending drugs being omitted from initial testing. The third was found to have

2018 British Journal of Anaesthesia

107. Food-induced Anaphylaxis in Infants and Children. (PubMed)

Food-induced Anaphylaxis in Infants and Children. Recent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis.This study describes the symptomatology of food-induced anaphylaxis (FIA) in infants (<12 months) compared with older pediatric cohorts.Retrospective review between June 2015 and June 2017 of children presenting with FIA at a large urban children's hospital emergency department (ED).A total of 357 cases

2018 Asthma & Immunology

108. Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery: A case report with the literature review. (PubMed)

Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery: A case report with the literature review. Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration.A 22-year-old woman with diagnosis of Weaver syndrome

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2018 Medicine

109. Mast cell activation test in the diagnosis of allergic disease and anaphylaxis. (PubMed)

Mast cell activation test in the diagnosis of allergic disease and anaphylaxis. Food allergy is an increasing public health issue and the most common cause of life-threatening anaphylactic reactions. Conventional allergy tests assess for the presence of allergen-specific IgE, significantly overestimating the rate of true clinical allergy and resulting in overdiagnosis and adverse effect on health-related quality of life.To undertake initial validation and assessment of a novel diagnostic tool

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2018 Journal of Allergy and Clinical Immunology

110. School nurse perspectives on school policies for food allergy and anaphylaxis. (PubMed)

School nurse perspectives on school policies for food allergy and anaphylaxis. Although school health care professionals are integral to the management of students with food allergy, their views on school food allergy policies have not yet been reported.To characterize food allergy policies currently being used in schools and their utility and potential barriers to implementation from the perspective of school health care professionals.An electronic survey was disseminated to school nurses (...) of policies, including anaphylaxis training for staff (96.7%), stock epinephrine availability (81.7%), designated lunch areas (62.2%), and food guidelines for classrooms (61.8%). Barriers to implementation included financial, time, and attitudinal considerations. Schools with pre-K or kindergarten students had higher odds of having designated lunch areas (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0-4.1; P < .05). The odds of having emergency epinephrine available were higher

2018 Asthma & Immunology

111. Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age. (PubMed)

Cause and Clinical Presentation of Anaphylaxis in Singapore: From Infancy to Old Age. The study objective was to compare age-related differences in the cause and clinical presentation of anaphylaxis.We conducted a prospective study of patients visiting the emergency department for anaphylaxis. Data were collected from 3 emergency departments from 1 April 2014 to 31 December 2015. Patient electronic records with the diagnoses of allergy, angioedema, urticaria, and anaphylaxis (ICD-9 codes 9953 (...) , 9951, 7080, 9950, 7089) were screened and cases fulfilling World Allergy Organisation criteria for anaphylaxis were included.A total of 426 cases of anaphylaxis were identified with a median age of 23 years (range 3 months to 88 years and 9 months). The causes of anaphylaxis were food (n = 236, 55%), drugs (n = 85, 20%), idiopathic (n = 64, 15%), and insect bites or stings (n = 28, 7%). The most common food was shellfish (n = 58, 14%) and the most common drugs were non-steroidal anti-inflammatory

2018 International Archives of Allergy and Immunology

112. Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999-2001 versus 2013-2015. (PubMed)

Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999-2001 versus 2013-2015. Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known.To describe temporal changes in ED concordance with guidelines for the management of SIIAs.We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic (...) reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2

2018 Asthma & Immunology

113. Downstream consequences of diagnostic error in pediatric anaphylaxis. (PubMed)

Downstream consequences of diagnostic error in pediatric anaphylaxis. Pediatric anaphylaxis is commonly misdiagnosed in the Emergency Department (ED). We aimed to determine the impact of inaccurate diagnosis on the management and follow-up of pediatric anaphylaxis presenting to the ED.Retrospective chart review of ED management of children aged 0-18 years with allergic presentations to three EDs in Melbourne, Australia in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded (...) , or the presentation met international consensus criteria for anaphylaxis.Of the 60,143 pediatric ED presentations during the study period, 1551 allergy-related presentations were identified and reviewed. 187 met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED. Those diagnosed with anaphylaxis were more likely to receive

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2018 BMC Pediatrics

114. Increasing Specific Immunoglobulin E Levels Correlate with the Risk of Anaphylaxis during an Oral Food Challenge. (PubMed)

Increasing Specific Immunoglobulin E Levels Correlate with the Risk of Anaphylaxis during an Oral Food Challenge. Oral food challenges (OFCs) are necessary to diagnose food allergies; however, these tests can cause anaphylaxis. Higher specific immunoglobulin E (sIgE) levels to causative food have been associated with a positive OFC. To date, no data have been found to indicate the factors associated with severe symptoms or anaphylaxis among challenge-positive patients. This study aimed (...) to clarify the association of sIgE with causative foods and anaphylaxis during OFC among the whole study population and challenge-positive patients.This cross-sectional study collected symptom and severity data between June 2012 and December 2016 during an open OFC to diagnose food allergy or confirm tolerance acquisition. We analyzed the risk factors for anaphylaxis during OFC.A total of 2272 cases were analyzed (median age: 3.5 years; egg: 1166 cases; milk: 589 cases; wheat: 388 cases; and peanut: 129

2018 Pediatric Allergy and Immunology

115. Markers of anaphylaxis - a systematic review.

Markers of anaphylaxis - a systematic review. Anaphylaxis is defined as severe, life-threatening, systemic or general, immediate reaction of hypersensitivity, with repeatable symptoms caused by the dose of stimulus which is well tolerated by healthy persons. The proper diagnosis, immediate treatment and differential diagnosis are crucial for saving patient's life. However, anaphylaxis is relatively frequently misdiagnosed or confused with other clinical entities. Thus, there is a continuous (...) need for identifying detectable markers improving the proper diagnosis of anaphylaxis. Here we presented currently known markers of anaphylaxis and discussed in more detail the most clinically valuable ones: tryptase, platelet activacting factor (PAF), PAF-acethylhydrolase, histamine and its metabolites.Copyright © 2017 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.

2018 Advances in medical sciences

116. National Trends in Emergency Department Visits and Hospitalizations for Food-Induced Anaphylaxis in US Children. (PubMed)

National Trends in Emergency Department Visits and Hospitalizations for Food-Induced Anaphylaxis in US Children. Food is the leading cause of anaphylaxis in children seen in emergency departments in the United States, yet data on emergency department visits and hospitalizations related to food-induced anaphylaxis are limited. The objective of our study was to examine national time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations.We conducted (...) an observational study using a national administrative claims database from 2005 through 2014. Participants were younger than 18 years with an emergency department visit or hospitalization for food-induced anaphylaxis. Outcome measures of our study included time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations, including observations (in an emergency department or a hospital unit), inpatient admissions, and intensive care unit admissions.During the study

2018 Pediatric Allergy and Immunology

117. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. (PubMed)

Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies. Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding (...) of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy. Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise. Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes

2018 Medical Journal of Australia

118. S1P4 Regulates Passive Systemic Anaphylaxis in Mice but Is Dispensable for Canonical IgE-Mediated Responses in Mast Cells (PubMed)

S1P4 Regulates Passive Systemic Anaphylaxis in Mice but Is Dispensable for Canonical IgE-Mediated Responses in Mast Cells Mast cells are key players in the development of inflammatory allergic reactions. Cross-linking of the high-affinity receptor for IgE (FcεRI) on mast cells leads to the generation and secretion of the sphingolipid mediator, sphingosine-1-phosphate (S1P) which is able, in turn, to transactivate its receptors on mast cells. Previous reports have identified (...) and peritoneal mouse mast cells indicated that this receptor is dispensable for mast cell degranulation, cytokine/chemokine production and FcεRI-mediated chemotaxis in vitro. However, interleukin-33 (IL-33)-mediated enhancement of IgE-induced degranulation was reduced in S1P₄-deficient peritoneal mast cells, revealing a potential negative regulatory role for S1P₄ in an IL-33-rich environment. Surprisingly, genetic deletion of S1pr4 resulted in exacerbation of passive systemic anaphylaxis to IgE/anti

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2018 International journal of molecular sciences

119. A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis (PubMed)

A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis Anaphylaxis is a life threatening systemic inflammatory process that share mediators involved in the coagulation cascade. Platelet activating factor, known to increase platelet aggregation, has also been implicated as an important mediator of anaphylaxis. Although other inflammatory reactions are associated with an increased risk of thrombosis, anaphylaxis (...) is currently not reported as one of them. Furthermore the role platelets may have in the perianaphylaxis period is not well understood. We here in present a retrospective case series of three patients that had platelet aberrations suggestive of PAF involvement and clinically significant thrombosis in close relationship with anaphylaxis.To investigate platelet response before and after anaphylaxis and indirect observation evidence of platelet activating factors involvement with possible increased risk

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2018 Immunity, Inflammation and Disease

120. Fenugreek Anaphylaxis in a Pediatric Patient (PubMed)

Fenugreek Anaphylaxis in a Pediatric Patient Fenugreek (Trigonella foenum-graecum) is a food product that belongs to the Leguminosae family along with other legumes. It has been used in India, Greece, and Egypt for culinary and medical purposes since ancient times, and today, fenugreek is used for flavoring foods, dyes, and drugs throughout the world. Many members of the Leguminosae family have been associated with allergies including soybean, green pea, and peanut. Fenugreek is also included (...) in this family and may result in allergic reactions. Two cases of anaphylaxis have been described in children after ingestion of curry and pastes that contain fenugreek, although the true nature of the causative agent was unclear. We report the first case of fenugreek anaphylaxis in a pediatric patient defined by skin testing, immunoglobulin E ImmunoCAP assays, and clear ingestion.

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2018 Allergy & Rhinology

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