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Anaphylaxis in Seniors Receiving Intravenous Antibiotics in Long-Term Care: Clinical Evidence and Guidelines TITLE: Anaphylaxis in Seniors Receiving Intravenous Antibiotics in Long-Term Care: Clinical Evidence and Guidelines DATE: 30 October 2013 RESEARCH QUESTIONS 1. What is the clinical evidence regarding the occurrence of anaphylaxis in seniors receiving IV antibiotics for common acute infections in long-term care? 2. What are the evidence-based the guidelines regarding monitoring (...) and administration of IV antibiotics to seniors with common acute infections in long-term care? KEY MESSAGE No relevant technology assessment reports, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies, or evidence-based guidelines regarding the occurrence of anaphylaxis in seniors in long term care receiving IV antibiotics or the guidelines for their use were identified. METHODS A limited literature search was conducted on key resources including PubMed, Medline
Anaphylaxis identification, management and prevention 38 Reprinted from AustRAliAn F Amily PhysiciAn Vol. 42, no. 1/2, jAnuARy/FebRuARy 2013 Background Anaphylaxis is a severe allergic reaction that can cause death. In a similar trend to allergic conditions more broadly, anaphylaxis presentations are increasing in Australia. Objective This article summarises current knowledge regarding the identification, management and prevention of anaphylaxis, highlighting risk minimisation strategies (...) relevant to general practitioners. Discussion The most common causes of anaphylaxis are medication, food and insect venom. Medications are the most common cause of anaphylaxis in older adults, particularly antibiotics, anaesthetic drugs, nonsteroidal anti-inflammatory drugs and opiates. Food allergy is the most common cause of anaphylaxis in children, but rarely results in death. Anaphylaxis is a medical emergency requiring immediate treatment with adrenaline, as well as ongoing management. Important
anaphylaxis], is [the use of propofol as a sedative/anaesthetic agent] likely to result in an [allergic/anaphylactic reaction]? Clinical Scenario As you prepare one of your patients for conscious sedation in the emergency department she tells you that she has been allergic to eggs since childhood. Your colleague states that a documented egg allergy is a contraindication for the use of propofol but you have your doubts. You wonder if there is any published evidence or whether this is another medical myth (...) that implies that the observed anaphylactic reaction was attributable to a pre-existing allergies Murphy et al, 2011, Australia 28 Egg allergic children (aged 1–15 years) with 43 propofol administrations identified through an 11-year retrospective review. Two children had had egg anaphylaxis, the rest had a positive skin prick test to egg white Case series Anaphylaxis 0 Retrospective study Allergic reaction One—in a child with previous egg anaphylaxis Comment(s) The main triggers for egg anaphylaxis
Anaphylaxis in seniors eeceiving intravenous antibiotics in long-term care: clinical evidence and guidelines Anaphylaxis in seniors eeceiving intravenous antibiotics in long-term care: clinical evidence and guidelines Anaphylaxis in seniors eeceiving intravenous antibiotics in long-term care: clinical evidence and guidelines CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has (...) been made for the HTA database. Citation CADTH. Anaphylaxis in seniors eeceiving intravenous antibiotics in long-term care: clinical evidence and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response - Summary of Abstracts. 2013 Authors' conclusions No relevant technology assessment reports, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies, or evidence-based guidelines regarding the occurrence of anaphylaxis
Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline (epinephrine) auto-injectors are recommended as the initial, potentially life-saving treatment of choice for anaphylaxis in the community, but they are not universally available and have limitations in their use.To assess the effectiveness of adrenaline (epinephrine) auto (...) -injectors in relieving respiratory, cardiovascular, and other symptoms during episodes of anaphylaxis that occur in the community.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE (Ovid SP) (1950 to January 2012), EMBASE (Ovid SP) (1980 to January 2012 ), CINAHL (EBSCO host) (1982 to January 2012 ), AMED (EBSCO host) (1985 to January 2012 ), LILACS, (BIREME) (1980 to January 2012 ), ISI Web of Science (1950 to January 2012 ). We
for a reaction. The best defined example is food-dependent exercise induced anaphylaxis. Many cases of exercise induced anaphylaxis can be related to a food allergen ingested before the reaction. Concurrent ingestion of aspirin or NSAIDs may be a further contributor in some cases. 6 Pathophysiology Anaphylaxis results from the cascade of many anaphylactic mediators causing: vasodilation fluid extravasation smooth muscle contraction increased mucosal secretions. The fact that multiple mediators (...) prescribing guidelines and examples of written management plans: . Conflict of interest: none declared. References L iew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol 2009;123:434–42. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992;327:380– 4. Khan DA, Solensky R. Drug allergy. J Allergy Clin Immunol 2010;125(2 Suppl 2):S126–37. Brown SGA, Franks RW, Baldo BA
Glucocorticoids for the treatment of anaphylaxis. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.In our previous version we searched the literature until September 2009. In this version we searched the Cochrane Central Register of Controlled (...) Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE (Ovid) (1956 to September 2011), EMBASE (Ovid) (1982 to September 2011), CINAHL (EBSCOhost) (to September 2011). We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material.We planned to include randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline
Anaphylaxis from peanuts ingested by blood donors? 21879920 2011 09 09 2018 05 10 1533-4406 365 9 2011 09 01 The New England journal of medicine N. Engl. J. Med. Anaphylaxis from peanuts ingested by blood donors? 867-8; author reply 868 10.1056/NEJMc1106934 Vickery Brian P BP Burks A Wesley AW Sampson Hugh A HA eng Letter Comment United States N Engl J Med 0255562 0028-4793 0 Allergens AIM IM N Engl J Med. 2011 May 19;364(20):1981-2 21591965 Allergens blood Anaphylaxis etiology Arachis
#notice-of-rights). Page 2 of 26Contents Contents Introduction 5 Drug recommendations 6 Who this guideline is for 6 Patient-centred care 8 1 Recommendations 9 1.1 List of all recommendations 9 2 Notes on the scope of the guidance 12 3 Implementation 13 4 Research recommendations 14 4.1 Mediators of anaphylactic reactions 14 4.2 The frequency and effects of biphasic reactions 14 4.3 Length of observation period following emergency treatment for anaphylaxis 15 4.4 Prevalence of anaphylactic reactions (...) above may be classified as having a 'severe allergic' reaction rather than an 'anaphylactic' reaction. Throughout this guideline, anyone who presents with such signs and symptoms is classed as experiencing a 'suspected anaphylactic reaction' , and should be diagnosed as having 'suspected anaphylaxis' . People who have had a mild or moderate allergic reaction are at risk of, and may subsequently present with, suspected anaphylaxis. Certain groups may be at higher risk, either because of an existing
Anaphylactic Cross-Reactivity Between Penicillin and Cephalosporin UTCAT848, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Minimal Risk Of Severe Type 1 Hypersensitivity Reaction To Third Generation Cephalosporin In Patients Who Experience Type 1 Hypersensitivity Reaction And Allergy To Penicillin Clinical Question Do patients who experience a severe type 1 hypersensitivity reaction to penicillin and demonstrate (...) an allergy to cephalosporin experience a severe type 1 hypersensitivity reaction to the cephalosporin? Clinical Bottom Line It appears that patients who have a severe type 1 hypersensitivity reaction to penicillin do not have an increased risk of anaphylaxis to cephalosporins. This evidence may be skewed however by adherence to the recommendation not to give cephalosporins to individuals with a history of penicillin anaphylaxis. (See Comments on the CAT below) Best Evidence (you may view more info
Glucocorticoids for the treatment of anaphylaxis. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid) (1966 to September (...) 2009), EMBASE (Ovid) (1988 to September 2009), CINAHL (EBSCOhost) (to September 2009) and The Science Citation Index Expanded (SCI-EXPANDED) (1945 to September 2009). We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material.We included randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine
Nebulised salbutamol or nebulised adrenaline for wheeze in anaphylaxis BestBets: Nebulised salbutamol or nebulised adrenaline for wheeze in anaphylaxis Nebulised salbutamol or nebulised adrenaline for wheeze in anaphylaxis Report By: Deepak Doshi - Specialist Registrar in Emergency Medicine Search checked by Bernard A Foëx - Consultant in Emergency Medicine and Critical Care Institution: Manchester Royal Infirmary Date Submitted: 2nd April 2007 Date Completed: 14th October 2009 Last Modified (...) : 1st September 2009 Status: Green (complete) Three Part Question In [patients with anaphylaxis] is [nebulised salbutamol better than nebulised adrenaline] at [reducing wheeze]? Clinical Scenario A 33 year school teacher arrives in the Emergency Department following a trip to the local botanical gardens. She has breathing difficulty with extensive expiratory wheeze and a florrid urticarial rash. She was given salbutamol by nebulizer in the ambulance. She continued to wheeze in the Emergency
in anaphylaxis, such trials are unlikely to be performed in individuals with anaphylaxis. Indeed, they might be unethical because prompt treatment with adrenaline is deemed to be critically important for survival in anaphylaxis. Also, such studies would be difficult to conduct because anaphylactic episodes usually occur without warning, often in a non-medical setting, and differ in severity both among individuals and from one episode to another in the same individual. Consequently, obtaining baseline (...) Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline is recommended as the initial treatment of choice for anaphylaxis.To assess the benefits and harms of adrenaline (epinephrine) in the treatment of anaphylaxis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to March 2007), EMBASE
Question In [children with anaphylaxis] does [self-injection of epinephrine] lead to [reduced mortality and morbidity]? Clinical Scenario A five year-old boy is admitted with severe anaphylactic shock having inadvertently ingested peanuts at a birthday party. He had a previous reaction two years ago and was given an epinephrine auto-injector for use at home. His mother had used this when the reaction first started but to no avail. You administer intramuscular epinephrine while wondering whether (...) of Epipen. Time since index reaction not standardised. In-hospital adrenaline use apparently assessed by parental interview. Severity of episodes not objectively measured. Epipen use in anaphylaxis Epipen given in 13 (29%) of 45 anaphylactic reactions. Of those not given Epipen, 15 (45%) were later given epinephrine in hospital. Of those given Epipen, 2 of 13 (15%) later received epinephrine in hospital (P Hospital admission Epipen not given: 15 of 32 (47%) admitted; Epipen given: 2 of 13 (15%) admitted
Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. Cetuximab, a chimeric mouse-human IgG1 monoclonal antibody against the epidermal growth factor receptor, is approved for use in colorectal cancer and squamous-cell carcinoma of the head and neck. A high prevalence of hypersensitivity reactions to cetuximab has been reported in some areas of the United States.We analyzed serum samples from four groups of subjects for IgE antibodies against cetuximab: pretreatment
Platelet-activating factor, PAF acetylhydrolase, and severe anaphylaxis. Platelet-activating factor (PAF) is an important mediator of anaphylaxis in animals, and interventions that block PAF prevent fatal anaphylaxis. The roles of PAF and PAF acetylhydrolase, the enzyme that inactivates PAF, in anaphylaxis in humans have not been reported.We measured serum PAF levels and PAF acetylhydrolase activity in 41 patients with anaphylaxis and in 23 control patients. Serum PAF acetylhydrolase activity (...) was also measured in 9 patients with peanut allergy who had fatal anaphylaxis and compared with that in 26 nonallergic pediatric control patients, 49 nonallergic adult control patients, 63 children with mild peanut allergy, 24 patients with nonfatal anaphylaxis, 10 children who died of nonanaphylactic causes, 15 children with life-threatening asthma, and 19 children with non-life-threatening asthma.Mean (+/-SD) serum PAF levels were significantly higher in patients with anaphylaxis (805+/-595 pg per
H1-antihistamines for the treatment of anaphylaxis with and without shock. Anaphylaxis is an acute systemic allergic reaction, which can be life-threatening. H1-antihistamines are commonly used as an adjuvant therapy in the treatment of anaphylaxis.To assess the benefits and harm of H1-antihistamines in the treatment of anaphylaxis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library), MEDLINE (1966 to June 2006);EMBASE (1966 to June 2006); CINAHL (...) (1982 to June 2006) and ISI Web of Science (1945 to July 2006). We also contacted pharmaceutical companies and international experts in anaphylaxis in an attempt to locate unpublished material.Randomized and quasi-randomized controlled trials comparing H1-antihistamines with placebo or no intervention.Two authors independently assessed articles for inclusion.We found no studies that satisfied the inclusion criteria.Based on this review, we are unable to make any recommendations for clinical practice
An economic evaluation of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis An economic evaluation of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis An economic evaluation of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis Shaker M S Record Status This is a critical abstract of an economic evaluation that meets the criteria (...) for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The study evaluated the cost-effectiveness of prophylactic self-injectable epinephrine to prevent fatalities in children with mild venom anaphylaxis. The author concluded that the intervention is not a cost-effective option if the annual venom-associated fatality rate is less than 2 per
and clinical immunology 2004;114(2):371-6. 2 Kane KE, Cone DC. Anaphylaxis in the pre-hospital setting. The Journal of emergency medicine 2004;27(4):371-7. 3 McLean-Tooke AP , Bethune CA, Fay AC, Spickett GP . Adrenaline in the treatment of anaphylaxis: what is the evidence? BMJ 2003;327(7427):1332-5. 4 Chamberlain D, Fisher J, Ward M, Cant A, Dawson P , Ewan P , et al. The Emergency Medical Treatment of Anaphylactic Reactions for First Medical Responders and for Community Nurses Resuscitation Council (UK (...) ):584-91. 10 Thompson K, Chandra R. The management and prevention of food anaphylaxis. Nutrition Research 2002;22:89-110. 11 Af?liation: Royal College of Paediatrics and Child Health UKCAPToTRC. Update on the emergency medical treatment of anaphylactic reactions for ?rst medical responders and for community nurses. Resuscitation 2001;48(3):241-3. 12 Project Team of The Resuscitation Council (UK). Update on the emergency medical treatment of anaphylactic reactions for ?rst medical responders
are the second most common cause. Bees may leave a venom sac which should Insect sting- be scraped off (not squeezed). induced Injected allergens commonly anaphylaxis result in cardiovascular compromise, with hypotension and shock predominating. Medications, particularly penicillin, account for a large Drug-induced percentage of anaphylacticanaphylaxis reactions. Slow release drugs prolong absorption and exposure to the allergen. Other causes Latex, and exercise. For background and pathphysiology (...) ? possible continuing absorption of the allergen ? previous history of biphasic reactions. Key Points – Anaphylaxis in children ? Anaphylaxis may be dif?cult to diagnose. ? Remove the allergen. ? Epinephrine is the mainstay of treatment. ? Reactions may recur. ? Hydrocortisone is not part of the immediate treatment. REFERENCES 1 Chamberlain D. Emergency medical treatment of anaphylactic reactions. Project Team of the Resuscitation Council (UK). J Accid Emerg Med 1999 16(4):243-247. 2 Revell M, Porter K