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Anaphylaxis

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161. Low Incidence of Biphasic Allergic Reactions in Patients Admitted to Intensive Care after Anaphylaxis. (Abstract)

Low Incidence of Biphasic Allergic Reactions in Patients Admitted to Intensive Care after Anaphylaxis. Recurrent manifestations of anaphylaxis after treatment, termed biphasic reactions, are estimated to occur in 1 to 23% of reactionsHowever, little is known about the incidence, triggers, symptoms, and management of biphasic reactions WHAT THIS ARTICLE TELLS US THAT IS NEW: In 83 cases of patients admitted to intensive care units in Denmark after anaphylaxis, suspected biphasic reactions (...) occurred in 4 (4.8%) of patientsThe incidence of biphasic reactions was low, 3 out of 4 were considered possible, and only 1 considered a probable biphasic allergic reaction BACKGROUND:: Biphasic allergic reactions-recurrence of allergy symptoms after a symptom-free period-are reported to occur in 1 to 23% of allergic reactions. Patients admitted to an intensive care unit after anaphylaxis potentially have more severe reactions and a higher risk of biphasic allergic reactions. The purpose of this study

2018 Anesthesiology

162. Massive release of the histamine-degrading enzyme diamine oxidase during severe anaphylaxis in mastocytosis patients. Full Text available with Trip Pro

Massive release of the histamine-degrading enzyme diamine oxidase during severe anaphylaxis in mastocytosis patients. Histaminolytic activity mediated by diamine oxidase (DAO) is present in plasma after induction of severe anaphylaxis in rats, guinea pigs, and rabbits. Heparin released during mast cell degranulation in the gastrointestinal tract might liberate DAO from heparin-sensitive storage sites. DAO release during anaphylaxis has not been demonstrated in humans.Plasma DAO, tryptase (...) , and histamine concentrations of four severe anaphylaxis events were determined at multiple serial time points in two patients with systemic mastocytosis. The histamine degradation rates were measured in anaphylaxis samples and in pregnancy sera and plasma with comparable DAO concentrations.Mean DAO (132 ng/mL) and tryptase (304 ng/mL) concentrations increased 187- and 4.0-fold, respectively, over baseline values (DAO 0.7 ng/mL, tryptase 76 ng/mL) during severe anaphylaxis. Under non-anaphylaxis conditions

2018 Allergy

163. Anaesthesia for a biopsy of corpus callosum in patient with a recent intra-operative anaphylaxis to an unknown anaesthetic allergen: a case report. Full Text available with Trip Pro

Anaesthesia for a biopsy of corpus callosum in patient with a recent intra-operative anaphylaxis to an unknown anaesthetic allergen: a case report. Anaphylaxis in general anaesthesia occurs with a frequency of 1:5000-1:20000. This clinical summary reports on the use of an effective risk management strategy employing second line anaesthesia agents and alternative endotracheal intubation tools in a patient with a recent history of an intra-operative anaphylaxis to an unknown anaesthetic agent.A (...) 71-year-old male presented for a repeat biopsy of corpus callosum 4 days following the cancellation of the procedure for a presumed anaphylactic reaction to an unknown anaesthetic agent. During the repeat care episode, the decision was made to proceed based on the urgent need for tissue diagnosis to facilitate further treatment and lack of feasibility for more definitive identification of the causative agent(s). A consideration was made of the optimum ways to manage and mitigate risk

2018 BMC Anesthesiology

164. Management of anaphylaxis and allergies in patients with long QT syndrome: A review of the current evidence. Full Text available with Trip Pro

Management of anaphylaxis and allergies in patients with long QT syndrome: A review of the current evidence. To develop a treatment algorithm for patients with long QT syndrome (LQTS) in case they need antiallergic medications for allergic reactions, including asthma and anaphylaxis.A literature review was performed to assess safety and to develop antiallergic treatment strategies for patients with LQTS.LQTS is a heterogeneous group of myocardial repolarization disorders characterized (...) by prolongation of the QT interval that potentially results in life-threatening torsades de pointes tachycardia. Data on pharmacologic treatment in case of anaphylaxis in LQTS are sparse. For this narrative review, all currently available articles on the use of antiallergic drugs for allergic reactions, anaphylaxis, and asthma in patients with LQTS were used.Local allergic symptoms can be safely treated primarily with fexofenadine, levocetirizine, desloratadine, or cetirizine and, if needed, a short course

2018 Asthma & Immunology

165. Risk factors for recurrent anaphylaxis-related emergency department visits in the United States. (Abstract)

Risk factors for recurrent anaphylaxis-related emergency department visits in the United States. Anaphylaxis is a potentially life-threatening allergic reaction with a strong risk of recurrence.To assess risk factors associated with recurrent anaphylaxis-related emergency department (ED) visits within 1 year of an ED visit for anaphylaxis in a large observational cohort study.We used an administrative claims database to identify patients seen from 2008 through 2012 in the ED for anaphylaxis (...) based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Patients with at least 2 years of continuous enrollment in a health plan were included. Multivariable logistic regression analysis was used to determine associations with recurrence of anaphylaxis within 1 year.During the 5-year study period, 7,367 patients (median age, 42 years; <18 years old, 23.3%) met the inclusion criteria. The most common anaphylaxis trigger was unspecified

2018 Asthma & Immunology

166. Increasing Specific Immunoglobulin E Levels Correlate with the Risk of Anaphylaxis during an Oral Food Challenge. Full Text available with Trip Pro

cases). Among 979 challenge-positive patients, anaphylactic reactions were observed in 334 cases. A statistically significant association was observed between anaphylaxis during OFC and higher sIgE levels to causative foods (odds ratio: 2.71, 95% confidence interval: 1.94-3.78, for the third compared to the first tertile, P-value for trend <.001). Only gastrointestinal, respiratory, cardiovascular, and neurological symptoms were also statistically significantly associated with higher sIgE levels (...) 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

2018 Pediatric Allergy and Immunology

167. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. (Abstract)

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

168. Specific IgE for Fag e 3 Predicts Oral Buckwheat Food Challenge Test Results and Anaphylaxis: A Pilot Study. Full Text available with Trip Pro

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 (...) - and Fag e 3-sIgE data obtained using the ImmunoCAP® assay system and fluorescent enzyme-linked immunosorbent assay from children who underwent OFC using 3,072 mg of BW protein between July 2006 and March 2014 at Sagamihara National Hospital, Kanagawa, Japan.We analyzed 60 patients aged 1.9-13.4 years (median 6.0 years); 20 (33%) showed objective symptoms upon BW OFC. The patients without symptoms had significantly lower Fag e 3-sIgE than those with non-anaphylactic (p < 0.001) and anaphylactic

2018 International Archives of Allergy and Immunology

169. Improving Anaphylaxis Care: The Impact of a Clinical Pathway. Full Text available with Trip Pro

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

170. Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis. (Abstract)

Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis. Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil (...) activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis.Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative

2018 Anesthesia and Analgesia

171. Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study. (Abstract)

Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study. Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of cephalosporin-induced anaphylaxis and evaluate the clinical efficacy of screening skin tests.In this retrospective cohort study, we obtained information (...) on total cephalosporin use and cephalosporin-induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into 4 groups according to similar side-chain structures. The incidence of cephalosporin-induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation, and side-chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention

2018 Allergy

172. Mast cell activation test in the diagnosis of allergic disease and anaphylaxis. Full Text available with Trip Pro

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

2018 Journal of Allergy and Clinical Immunology

173. Anaphylactic Shock After Intravenous Fluorescein Administration for Intraoperative Cystoscopy. (Abstract)

Anaphylactic Shock After Intravenous Fluorescein Administration for Intraoperative Cystoscopy. Rates of administration of intravenous sodium fluorescein during cystoscopy have increased since indigotindisulfonate sodium was removed from the market in 2014. Although sodium fluorescein has been extensively evaluated and found to be safe, side effects including anaphylaxis have been observed, with an incidence between 0.05% and 1.0%.We present a case of anaphylactic shock after administration

2018 Obstetrics and Gynecology

174. School nurse perspectives on school policies for food allergy and anaphylaxis. Full Text available with Trip Pro

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

175. Clinically suspected anaphylaxis induced by sugammadex in a patient with Weaver syndrome undergoing restrictive mammoplasty surgery: A case report with the literature review. Full Text available with Trip Pro

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 (...) was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil. At the end of the operation, sugammadex was administered and resulted in initially hypotension and bradycardia then the situation worsened by premature ventricular contraction and bigeminy with tachycardia, bronchospasm, and hypoxia.The Ring and Messmer clinical severity scale grade 3 anaphylactic reaction occurred just after

2018 Medicine

176. Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. Full Text available with Trip Pro

Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. The proportion of patients receiving intravenous gelatin-based colloids has increased in the last decade due to safety concerns about starch-based products. Recent research suggests hypersensitivity reactions to intravenous gelatin-based solutions occur at similar rates per administration as non-depolarising neuromuscular blocking agents such as rocuronium (6.2/100,000 administrations (...) ). There are scant published data on clinical features, diagnosis and time course of these reactions. We undertook a review of cases reported and tested at one of the UK's largest drug allergy clinics. All patients seen in the drug allergy clinic at Imperial College Healthcare NHS Trust (London, UK) with a confirmed diagnosis of anaphylaxis to gelatin-based solutions between May 2013 and May 2018 were included. We retrospectively reviewed clinical histories, skin test results and severity of reactions

2018 Anaesthesia

177. Recurrent anaphylaxis during cardiac catheterization due to ethylene oxide Full Text available with Trip Pro

Recurrent anaphylaxis during cardiac catheterization due to ethylene oxide 29715563 2018 12 02 2213-2201 6 6 2018 Nov - Dec The journal of allergy and clinical immunology. In practice J Allergy Clin Immunol Pract Recurrent anaphylaxis during cardiac catheterization due to ethylene oxide. 2148-2150 S2213-2198(18)30294-0 10.1016/j.jaip.2018.04.017 Hamad Ahmad A Department of Medicine, Division of Rheumatology, Allergy, Immunology, University of North Carolina School of Medicine, Chapel Hill, NC

2018 The journal of allergy and clinical immunology. In practice

178. Protocol of Reintroduction of Beta-lactams in Children at Low Risk of Anaphylaxis.

Protocol of Reintroduction of Beta-lactams in Children at Low Risk of Anaphylaxis. Protocol of Reintroduction of Beta-lactams in Children at Low Risk of Anaphylaxis. - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before (...) adding more. Protocol of Reintroduction of Beta-lactams in Children at Low Risk of Anaphylaxis. (TRO-b-lact) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03553251 Recruitment Status : Not yet recruiting First Posted

2018 Clinical Trials

179. Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany: Major impact of early information Full Text available with Trip Pro

Current state of follow-up care for patients with Hymenoptera venom anaphylaxis in southwest Germany: Major impact of early information Up to 3.5% of the population experience anaphylactic reactions in response to Hymenoptera stings. Current guidelines are in place for the diagnostic workup and follow-up care of patients with Hymenoptera venom anaphylaxis (HVA). However, little is known about the degree of implementation of the recommendations and patient attitudes toward the recommendations (...) in the general patient population.For the analysis of the follow-up care in real life, a retrospective questionnaire-based study was conducted in unselected patients who had received treatment from an emergency medical response team for HVA, as documented in records of three regional Medical Emergency Response Centers.From over 125,000 cases, a filtered list of 1895 patients that coded for anaphylaxis was generated and examination of paper records identified 548 patients with a documented insect sting

2018 Allergo Journal International

180. Are Registration of Disease Codes for Adult Anaphylaxis Accurate in the Emergency Department? Full Text available with Trip Pro

Are Registration of Disease Codes for Adult Anaphylaxis Accurate in the Emergency Department? There has been active research on anaphylaxis, but many study subjects are limited to patients registered with anaphylaxis codes. However, anaphylaxis codes tend to be underused. The aim of this study was to investigate the accuracy of anaphylaxis code registration and the clinical characteristics of accurate and inaccurate anaphylaxis registration in anaphylactic patients.This retrospective study (...) . Anaphylactic patients with cardiovascular symptoms, severe symptoms, and epinephrine use were more likely to be accurately registered with anaphylaxis disease codes.In case of anaphylaxis, more patients were registered inaccurately under other allergy-related codes and symptom-related codes rather than accurately under anaphylaxis disease codes. Cardiovascular symptoms, severe symptoms, and epinephrine treatment were factors associated with accurate registration with anaphylaxis disease codes in patients

2018 Allergy, asthma & immunology research

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