Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012.

BACKGROUND: The incidence of anaphylaxis might be increasing. Data for fatal anaphylaxis are limited because of the rarity of this outcome. OBJECTIVE: We sought to document trends in anaphylaxis admissions and fatalities by age, sex, and cause in England and Wales over a 20-year period. METHODS: We extracted data from national databases that record hospital admissions and fatalities caused by anaphylaxis in England and Wales (1992-2012) and crosschecked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal anaphylaxis caused by food, drugs, and insect stings. RESULTS: Hospital admissions from all-cause anaphylaxis increased by 615% over the time period studied, but annual fatality rates remained stable at 0.047 cases (95% CI, 0.042-0.052 cases) per 100,000 population. Admission and fatality rates for drug- and insect sting-induced anaphylaxis were highest in the group aged 60 years and older. In contrast, admissions because of food-triggered anaphylaxis were most common in young people, with a marked peak in the incidence of fatal food reactions during the second and third decades of life. These findings are not explained by age-related differences in rates of hospitalization. CONCLUSIONS: Hospitalizations for anaphylaxis increased between 1992 and 2012, but the incidence of fatal anaphylaxis did not. This might be due to increasing awareness of the diagnosis, shifting patterns of behavior in patients and health care providers, or both. The age distribution of fatal anaphylaxis varies significantly according to the nature of the eliciting agent, which suggests a specific vulnerability to severe outcomes from food-induced allergic reactions in the second and third decades.

Evaluation of two thermal processing schedules at low relative humidity for elimination of Escherichia coli O157:H7 and Salmonella serovars in chopped and formed beef jerky.

Foodborne outbreaks have been linked to jerky produced under insufficient thermal processing schedules. Reduction of Escherichia coli O157:H7 and Salmonella serovars during thermal processing of chopped and formed beef jerky was evaluated under two processing schedules representative of those used by large-scale (LS) and small-scale (SS) jerky production facilities. Fresh chopped and formed all-beef jerky batter was inoculated with 5.8 to 7.3 log CFU of E. coli O157:H7 or Salmonella per g, extruded into strips, and thermally processed by LS or SS schedules. A >or=5.0-log CFU/g reduction of both pathogens occurred with <10% relative humidity and a cumulative process of 44 min at 55.6 degrees C followed by 46 min at 77.8 degrees C into the LS schedule. Additional drying at 77.8 degrees C for 3.5 h was needed to achieve a water activity of 0.67 and a moisture-to-protein ratio (MPR) of 0.77. For the SS process, a >or=5.0-log CFU/g reduction of both pathogens occurred with 15 to 20% relative humidity and a cumulative process of 45 min at 52 degrees C, 60 min at 57 degrees C, 45 min at 60 degrees C, 45 min at 63 degrees C, 90 min at 68 degrees C, and finishing with 30 min at 77 degrees C. After processing for an additional 90 min at 77 degrees C, water activity was 0.60 while the MPR was 0.82. The LS and SS processes for producing chopped and formed jerky provided >or=5.0 log lethality to control E. coli O157:H7 and Salmonella. However, both processes would require additional drying to achieve an MPR of 0.75 to be labeled as jerky.

Emergency treatment of anaphylactic reactions--guidelines for healthcare providers.

*The UK incidence of anaphylactic reactions is increasing. *Patients who have an anaphylactic reaction have life-threatening airway and, or breathing and, or circulation problems usually associated with skin or mucosal changes. *Patients having an anaphylactic reaction should be treated using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. *Anaphylactic reactions are not easy to study with randomised controlled trials. There are, however, systematic reviews of the available evidence and a wealth of clinical experience to help formulate guidelines. *The exact treatment will depend on the patient's location, the equipment and drugs available, and the skills of those treating the anaphylactic reaction. *Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. *Despite previous guidelines, there is still confusion about the indications, dose and route of adrenaline. *Intravenous adrenaline must only be used in certain specialist settings and only by those skilled and experienced in its use. *All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy. *Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use. *There is a need for further research about the diagnosis, treatment and prevention of anaphylactic reactions.

Survival and growth of foodborne microorganisms in processed and individually wrapped cheese slices.

The objectives of the research reported here were to determine the growth, survival, or inactivation of selected microorganisms on individually wrapped processed cheese (IWC) slices stored at 5 degrees C and 22 degrees C, and to compare quality indices. IWC slices were spot-inoculated with foodborne pathogenic bacteria (Listeria monocytogenes, Staphylococcus aureus, and Salmonella spp.), spoilage bacteria (Pseudomonas spp. and Lactobacillus spp.), and spoilage molds (Penicillium spp. and Cladosporium spp.). Each bacterium was inoculated at 10(5) CFUs/g for determination of growth, survival, or inactivation. Molds were inoculated at 10(2) spores per gram and observed for growth. Fifty percent of the inoculated product samples were held at 5 degrees C (to simulate refrigeration), and the other 50 percent were held at 22 degrees C (to simulate ambient temperature) throughout shelf life. Samples taken on days 0, 3, 7,10, 14, and 28 and after 2, 3, 6, and 9 months, and were evaluated for surviving cells (by means of appropriate selective media), color (with the cheese color guide), and lipid oxidation (by means of peroxide values). Bacterial inactivation was observed in all conditions. At 14 days, a 5-log reduction was observed for Listeria monocytogenes and Salmonella, while a 3-log reduction was observed for Staphylococcus aureus. For Pseudomonas spp. and Lactobacillus spp., a 2-log reduction was observed within 3 days, with an additional 1-log reduction noted after several months. Mold levels showed no change during the first several weeks of storage. At 84 days, mold levels decreased at 5 degrees C, but they showed growth at 22 degrees C, to approximately 10(5) CFUs/g. Visual color was evaluated on a 10-point National Cheese Institute scale. During storage at 5 degrees C or 22 degrees C, color became darker and values increased from 4 to 5 and 4 to 7, respectively. Higher peroxide values were also obtained for the samples held at 22 degrees C versus 5 degrees C. From a microbiological standpoint, pathogenic and spoilage bacteria were unable to grow in this product; however, long-term storage at 22 degrees C led to lower product quality and mold growth.

Effect of salt reduction on growth of Listeria monocytogenes in meat and poultry systems.

Reducing sodium in food could have an effect on food safety. The objective was to determine differences in growth of Listeria monocytogenes in meat and poultry systems with salt substitutes. For phase 1, fresh ground beef, pork, and turkey with NaCl, KCl, CaCl(2), MgCl(2), sea salt, or replacement salt added at 2.0% were inoculated with L. monocytogenes to determine growth/survival during 5 d at 4 °C to simulate a pre-blend process. L. monocytogenes populations significantly decreased (0.41 log CFU/g) during the storage time in beef, but no differences (P > 0.05) were observed over time in pork or turkey. Salt type did not affect (P > 0.05) L. monocytogenes populations during pre-blend storage. MgCl(2) and NaCl allowed significant growth of aerobic populations during storage. For phase 2, emulsified beef and pork products were processed with 2% NaCl, KCl, sea salt, or a NaCl/KCl blend and post-process surface-inoculated with L. monocytogenes to determine growth/survival at 4 °C for 28 d. Pork products showed significantly greater L. monocytogenes population growth at all sampling times (0, 7, 14, 21, and 28 d) than beef products, but salt type had no effect on L. monocytogenes populations with sampling times pooled for data analysis. Although salt types had no impact on L. monocytogenes populations in preblend and emulsified meat products, pork and turkey preblends and emulsified pork had greater L. monocytogenes populations compared with beef products. These studies demonstrate that sodium may not affect the safety of preblends and emulsified meat and poultry products.

Effect of packaging and storage time on survival of Listeria monocytogenes on kippered beef steak and turkey tenders.

UNLABELLED: The objective of our study was to determine effect of packaging method and storage time on reducing Listeria monocytogenes in shelf-stable meat snacks. Commercially available kippered beef steak strips and turkey tenders were dipped into a 5-strain L. monocytogenes cocktail, and dried at 23 °C until a water activity of 0.80 was achieved. Inoculated samples were packaged with 4 treatments: (1) vacuum, (2) nitrogen flushed with oxygen scavenger, (3) heat sealed with oxygen scavenger, and (4) heat sealed without oxygen scavenger. Samples were stored at 23 °C and evaluated for L. monocytogenes levels at 0, 24, 48, and 72 h. Initial levels (time 0) of L. monocytogenes were approximately 5.7 log CFU/cm² for steak and tenders. After 24 h of storage time, a 1 log CFU/cm² reduction of L. monocytogenes was observed for turkey tenders for all packaging treatments. After 48 h, turkey tenders showed >1 log CFU/cm² reduction of L. monocytogenes for all packaging treatments except for vacuum, where only 0.9 log CFU/cm² reduction was observed. After 72 h, reductions for all packaging treatments for turkey tenders ranged from 1.5 to 2.4 log CFU/cm². For kippered beef steak, there was no interaction between the packaging treatments and all storage times (P > 0.05) whereas, time was different (P <0.05). For kippered beef steak, there was 1 log reduction of L. monocytogenes at 24 and 48 h of storage times at 23 °C for all packaging treatments and a 2.1 log CFU/ cm² L. monocytogenes reduction at 72 h of storage time. PRACTICAL APPLICATIONS: Processors of kippered beef steak and turkey tenders could use a combination of vacuum or nitrogen-flushing or heat sealed with an oxygen scavenger packaging methods and a holding time of 24 h prior to shipping to reduce potential L. monocytogenes numbers by ≥1 log. However, processors should be encouraged to hold packaged product a minimum of 72 h to enhance the margin of safety for L. monocytogenes control.

Comparing the mannitol-egg yolk-polymyxin agar plating method with the three-tube most-probable-number method for enumeration of Bacillus cereus spores in raw and high-temperature, short-time pasteurized milk.

The U.S. Food and Drug Administration's Bacteriological Analytical Manual recommends two enumeration methods for Bacillus cereus: (i) standard plate count method with mannitol-egg yolk-polymyxin (MYP) agar and (ii) a most-probable-number (MPN) method with tryptic soy broth (TSB) supplemented with 0.1% polymyxin sulfate. This study compared the effectiveness of MYP and MPN methods for detecting and enumerating B. cereus in raw and high-temperature, short-time pasteurized skim (0.5%), 2%, and whole (3.5%) bovine milk stored at 4°C for 96 h. Each milk sample was inoculated with B. cereus EZ-Spores and sampled at 0, 48, and 96 h after inoculation. There were no differences (P > 0.05) in B. cereus populations among sampling times for all milk types, so data were pooled to obtain overall mean values for each treatment. The overall B. cereus population mean of pooled sampling times for the MPN method (2.59 log CFU/ml) was greater (P < 0.05) than that for the MYP plate count method (1.89 log CFU/ml). B. cereus populations in the inoculated milk samples ranged from 2.36 to 3.46 and 2.66 to 3.58 log CFU/ml for inoculated milk treatments for the MYP plate count and MPN methods, respectively, which is below the level necessary for toxin production. The MPN method recovered more B. cereus, which makes it useful for validation research. However, the MYP plate count method for enumeration of B. cereus also had advantages, including its ease of use and faster time to results (2 versus 5 days for MPN).

Package systems and storage times serve as postlethality controls for Listeria monocytogenes on whole-muscle beef jerky and pork and beef smoked sausage sticks.

To validate how packaging and storage reduces Listeria monocytogenes on whole-muscle beef jerky and smoked pork and beef sausage sticks, four packaging systems (heat sealed [HS] without vacuum, heat sealed with oxygen scavenger, nitrogen flushed with oxygen scavenger [NFOS], and vacuum) and four ambient temperature storage times were evaluated. Commercially available whole-muscle beef jerky and smoked pork and beef sausage sticks were inoculated with a five-strain L. monocytogenes cocktail, packaged, and then stored at 25.5 °C until enumerated for L. monocytogenes at 0, 24, 48, and 72 h and 30 days after packaging. The interaction of packaging and storage time affected L. monocytogenes reduction on jerky, but not on sausage sticks. A >2-log CFU/cm(2) reduction was achieved on sausage sticks after 24 h of storage, regardless of package type, while jerky had <2-log reductions for all packaging types. At 48 h, log reductions were similar (P. 0.05) for all types of jerky packaging, ranging from 1.26 to 1.72 log CFU/cm(2); however, at 72 h, mean L. monocytogenes reductions were >2 log CFU/cm(2), except for NFOS (1.22-log CFU/cm(2) reduction). Processors could package beef jerky in HS packages with oxygen scavenger or vacuum in conjunction with a 24-h holding time as an antimicrobial process to ensure a >1-log CFU/cm(2) L. monocytogenes reduction or use a 48-h holding time for HS- or NFOS-packaged beef jerky. A >3-log CFU/cm(2) mean reduction was observed for all beef jerky and sausage stick packaging systems after 30 days of 25.5 °C storage.

Costing day case anesthesia: obtaining accurate patient-based costs for adults and children.

OBJECTIVES: This study proposes the method requirements for a valid costing study in anesthesia to allow differences to be identified between treatments and uses these method requirements to design and conduct a robust costing study. METHODS: A prospective, patient-based costing study was carried out in adult and pediatric day surgery in the United Kingdom. The perspective was that of the National Health Service and the patient. Data were collected for each patient until 7 days after hospital discharge. RESULTS: Data were collected for 1063 adults and 322 children undergoing day surgery between October 1999 and January 2001. Statistically significant differences were found only between variable costs, which accounted for 11.4 percent and 9.0 percent of adult and pediatric costs, respectively. There were no differences in length of stay, fixed costs, or semi-fixed costs. Differences were not found in total costs in adults but were found in children. By day 7, postdischarge primary and secondary care costs were not different between groups in either study. No differences were found in costs to patients or parents. CONCLUSIONS: The use of prospective, patient-based cost data enabled the detection of differences in variable costs between difference anesthetic regimens in day surgery. The stochastic nature of the data provided a measure of variability around mean cost estimates. Practice patterns in the study reflected normal practice in the United Kingdom so the costing data have direct clinical relevance. The use of different anesthetic agents only affected variable costs and had no effect on larger cost drivers such as length of stay or staff input.