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Anaphylaxis

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141. Biphasic anaphylaxis: A review of the literature and implications for emergency management. (Abstract)

Biphasic anaphylaxis: A review of the literature and implications for emergency management. The biphasic reaction is a feared complication of anaphylaxis management in the emergency department (ED). The traditional recommended ED observation time is 4-6 h after complete resolution of symptoms for every anaphylaxis patient. However, there has been great controversy regarding whether this standard of care is evidence-based.Articles were selected using a PubMed, MEDLINE search for the keywords (...) "biphasic anaphylaxis", yielding 155 articles. Articles were filtered by English language, and the keyword biphasic in the title. Case reports and case series were excluded, narrowing to 33 articles. Then, articles were filtered by relevance to the ED setting, and studies conducted in outpatient clinic settings were excluded, narrowing the search to 16 articles. All remaining articles were reviewed and findings were discussed.The reported mean time to onset between the resolution of initial anaphylaxis

2018 American Journal of Emergency Medicine

142. Outcome of repeat anaesthesia after investigation for perioperative anaphylaxis. Full Text available with Trip Pro

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

143. Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) Investigation of Perioperative Anaphylaxis. Full Text available with Trip Pro

Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) Investigation of Perioperative Anaphylaxis. The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for 1 year in the UK.To describe the causes and investigation of anaphylaxis in the NAP6 cohort, in relation to published guidance and previous baseline survey results.We used a secure registry (...) to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail. Panel consensus diagnosis, reaction grade, review of investigations and clinic assessment are reported and compared to the prior NAP6 baseline clinic survey.A total of 266 cases met inclusion criteria between November 2015 and 2016, detailing reactions and investigations. One hundred and ninety-two of 266 (72%) had anaphylaxis with a trigger identified, of which 140/192 (75

2018 Clinical and Experimental Allergy

144. Deciphering biochemical basis of Qingkailing injection-induced anaphylaxis in a rat model by time-dependent metabolomic profiling based on metabolite polarity-oriented analysis. (Abstract)

Deciphering biochemical basis of Qingkailing injection-induced anaphylaxis in a rat model by time-dependent metabolomic profiling based on metabolite polarity-oriented analysis. Qingkailing injection (QKLI) is prepared from eight traditional Chinese medicinal materials or their extracts, which is widely used in clinical practice to treat the upper respiratory inflammation, pneumonia, high fever and viral encephalitis, nonetheless, suffering from serious anaphylaxis.This study aims to develop (...) an integrative metabolomics approach for deciphering the biochemical basis of QKLI induced anaphylaxis (QKLI-IA).The accuracy of animal modeling, the coverage of detected metabolites and the timeliness of pathological reaction are three key factors for revealing the biochemical basis of disease with untargeted metabolomics. In this study, firstly, the allergic rats (responders) were first screened by passive cutaneous anaphylaxis experiment and then were utilized for modeling. To cover a wider range

2018 Journal of Ethnopharmacology

145. Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department. (Abstract)

Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department. Underdiagnosis of anaphylaxis is a major concern in the pediatric emergency department (PED), leading to failure to administer and prescribe intramuscular epinephrine treatment.To examine the clinical features, triggers, and management of anaphylaxis in the PED, with a special focus on the rate of cases diagnosed and treated correctly over time, and to compare correctly diagnosed (...) and misdiagnosed cases.All records of patients presenting to a tertiary care PED between 2013 and 2016 with a final diagnosis of anaphylaxis or allergic reaction were reviewed.The rate of anaphylaxis increased from 0.1% between 2013 and 2014 and 0.24% between 2015 and 2016. Symptoms such as breathing difficulties and wheezing were found significantly less among misdiagnosed patients compared with patients correctly diagnosed with anaphylaxis. Food was the most common causative agent in both of the study

2018 Asthma & Immunology

146. Food-induced Anaphylaxis in Infants and Children. (Abstract)

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

147. Anaphylaxis admissions to pediatric intensive care units in France. (Abstract)

Anaphylaxis admissions to pediatric intensive care units in France. 29787624 2018 08 31 1398-9995 73 9 2018 Sep Allergy Allergy Anaphylaxis admissions to pediatric intensive care units in France. 1902-1905 10.1111/all.13483 Pouessel G G http://orcid.org/0000-0003-4118-6385 Department of Pediatrics, Children's Hospital, Roubaix, France. Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille, France. Chagnon F F Pediatric Intensive Care Unit, CHU Lille, Lille

2018 Allergy

148. Epinephrine, auto-injectors and anaphylaxis: challenges of dose, depth and device. (Abstract)

Epinephrine, auto-injectors and anaphylaxis: challenges of dose, depth and device. This review was undertaken to review epinephrine dosing, site and route of administration, focusing on special populations (patients weighing less than 15 kg, and obese patients); and to discuss storage and delivery of epinephrine in prehospital and hospital settings.Review of published literature.Relevance.The recommended 0.01-mg/kg (maximum 0.3-0.5 mg) epinephrine dose in anaphylaxis is based on limited (...) pharmacokinetic data in healthy volunteers. No pharmacokinetic or pharmacodynamics studies involving patients in anaphylaxis have been published. When epinephrine auto-injectors (EAIs) are used in infants, the dose increasingly exceeds the recommended dose as weight decreases, although the clinical significance of this is unclear. Limited data indicate that the intramuscular route and lateral thigh site are superior. Ultrasound studies suggest that 0.15 EAI needles may be too long for many patients weighing

2018 Asthma & Immunology

149. Neurologic manifestations in anaphylaxis due to subcutaneous allergy immunotherapy: A case report. Full Text available with Trip Pro

Neurologic manifestations in anaphylaxis due to subcutaneous allergy immunotherapy: A case report. Life-threatening anaphylactic shock is a rare (1 in 1 million) but documented occurrence in response to subcutaneous immunotherapy. Immediate administration of Epinephrine (Epi) is critical to save lives in these situations. The current protocol for systemic reactions in immunotherapy is for the prescribing physician to reassess the dosing and schedule as well as the risk:benefit assessment (...) for the therapy and determine whether or not to proceed.The patient revealed concerns regarding the neurologic sequela sustained after undergoinig life-threatening anaphylactic shock.The patient was diagnosed with anaphylactic shock and treated appropriately.The patient experienced shortness of breath and was promptly administered 2 shots of 0.3mg Epi followed by a loss of consciousness (LOC) and a series of 4 consecutive seizures accompanied with LOC and urinary incontinence. Seizures as a manifestation

2018 Medicine

150. Anaphylaxis by exclusive allergy to swordfish and identification of a new fish allergen. (Abstract)

Anaphylaxis by exclusive allergy to swordfish and identification of a new fish allergen. 29698550 2019 01 11 2019 01 11 1399-3038 29 5 2018 08 Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology Pediatr Allergy Immunol Anaphylaxis by exclusive allergy to swordfish and identification of a new fish allergen. 563-565 10.1111/pai.12916 Valverde-Monge M M Allergy Department, Niño Jesús University Hospital, Madrid, Spain. Allergy (...) , Madrid, Spain. eng Case Reports Letter 2018 05 29 England Pediatr Allergy Immunol 9106718 0905-6157 0 Allergens 0 Fish Proteins, Dietary 0 Parvalbumins 37341-29-0 Immunoglobulin E EC 2.7.1.40 Pyruvate Kinase IM Allergens immunology Anaphylaxis diagnosis immunology Animals Child Child, Preschool Fish Products Fish Proteins, Dietary immunology Fishes immunology Food Hypersensitivity diagnosis immunology Humans Immunoglobulin E metabolism Male Parvalbumins immunology Protein Binding Pyruvate Kinase

2018 Pediatric Allergy and Immunology

151. Downstream consequences of diagnostic error in pediatric anaphylaxis. Full Text available with Trip Pro

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

2018 BMC Pediatrics

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

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

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

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

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

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

155. Management of anaphylaxis in Spain: pediatric emergency care providers' knowledge. (Abstract)

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

156. Morphine and pholcodine-specific IgE have limited utility in the diagnosis of anaphylaxis to benzylisoquinolines. (Abstract)

Morphine and pholcodine-specific IgE have limited utility in the diagnosis of anaphylaxis to benzylisoquinolines. Investigation of immediate hypersensitivity reactions in the perioperative setting involves skin testing and measurement of specific IgE (sIgE) as standard practice. In the case of the neuromuscular blocking agents (NMBAs), the main allergenic epitopes have been shown to be substituted ammonium groups. Commercial assays are available for detection of sIgE to these epitopes using (...) morphine and pholcodine substrates but questions have been raised about the effectiveness of these assays in the diagnosis of benzylisoquinoline anaphylaxis. This study was therefore undertaken to assess the effectiveness of these assays in the diagnosis of hypersensitivity reactions to this group of NMBAs.Analysis was carried out on all available results for patients assessed at the Royal North Shore Hospital Anaesthetic Allergy Clinic during the period June 2009 to June 2016. Standardised intradermal

2018 Acta Anaesthesiologica Scandinavica

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

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

158. Mast Cell CRF<sub>2</sub> Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability. Full Text available with Trip Pro

Mast Cell CRF2 Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability. Psychological stress and heightened mast cell (MC) activation are linked with important immunologic disorders, including allergy, anaphylaxis, asthma, and functional bowel diseases, but the mechanisms remain poorly defined. We have previously demonstrated that activation of the corticotropin-releasing factor (CRF) system potentiates MC degranulation (...) responses during IgE-mediated anaphylaxis and psychological stress through corticotropin-releasing factor receptor subtype 1 (CRF1) expressed on MCs.In this study we investigated the role of corticotropin-releasing factor receptor subtype 2 (CRF2) as a modulator of stress-induced MC degranulation and associated disease pathophysiology.In vitro MC degranulation assays were performed with bone marrow-derived mast cells (BMMCs) derived from wild-type (WT) and CRF2-deficient (CRF2-/-) mice and RBL-2H3 MCs

2018 Journal of Allergy and Clinical Immunology

159. Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients. (Abstract)

Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients. To investigate the potential risk factors in patients who have experienced anaphylaxis from drugs.The study included 281 adult patients (median age 40 years; 76.5% female) who experienced immediate types of hypersensitivity reaction to a drug. The patients were divided into an anaphylaxis group and a nonanaphylaxis group. The anaphylaxis group was diagnosed according to the criteria of the World Allergy (...) in the patient's history and the study evaluation was 7 months (range 1-120 months). In 52.3% of the patients, reactions were defined as anaphylaxis. The most common culprit drugs were NSAIDs (56.9%) and β-lactams (34.7%). The culprit drugs were used parenterally in 13.2% of the patients. 34.9% of the patients had comorbid diseases and 24.6% used additional drugs, the most common being antihypertensives (10%). Atopy was determined in 28.8% and 28.1% of the patients were smokers. The median serum level

2018 International Archives of Allergy and Immunology

160. Allergic acute coronary syndrome in exercise-induced anaphylaxis. (Abstract)

Allergic acute coronary syndrome in exercise-induced anaphylaxis. In this case report we present a 49-year-old male who was seen in the emergency department after collapsing due to anaphylactic shock, with ECG findings suggesting myocardial ischaemia. We linked both diagnoses to Kounis syndrome, which describes an acute coronary syndrome due to an allergic event. His circulatory collapse was explained by exercise-induced anaphylaxis.

2018 Netherlands Journal of Medicine

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