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1.
Zhongguo Zhong Yao Za Zhi ; 44(17): 3763-3772, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31602951

RESUMO

The detection of drug-induced anaphylactoid reactions remains a global challenge,still lacking mature and reliable animal models or test methods. Therefore,the purpose of this paper is to explore and establish the test methods and evaluation standards for anaphylactoid reactions that apply to injection drugs. Based on the anaphylactoid reaction symptoms of mice induced by intravenous injection drugs C48/40 and Tween 80,a list of systemic anaphylactoid reaction symptoms in mice was sorted out and an evaluation standard of anaphylactoid reactions symptoms was established by applying symptom intensity coefficient K( that can represent these verity of anaphylactoid reaction symptoms) and its calculation formula Accordingly,histamine,tryptase,and Ig E were selected as blood indicators of anaphylactoid reactions,so that a test method combining symptoms evaluation and blood makers detection was established.This test method could be used to evaluate the characteristics of anaphylactoid reactions: coefficient K,blood histamine levels were highly and positively correlated with C48/80 and Tween 80 dose; The log value of histamine was highly and positively correlated with K; tryptase level may rise,or remain steady,or drop,possibly associated with the characteristics of the tested object and time for blood taking; and Ig E level would drop or remain steady,but it would not rise,which can be clearly distinguished from type I allergic reactions. On this basis,tiohexol,iopromide,paclitaxel,Xuesaitong Injection,Shuanghuanglian Injection and Shengmai Injection were used to investigate the applicability. The testing results showed a high degree of consistency with the actual clinical situation. The results suggest that the method of systemic anaphylaxis test in mice has high sensitivity,specificity and good consistency with clinical practice.It is suggested to be further validated and popularized.


Assuntos
Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Modelos Animais de Doenças , Animais , Medicamentos de Ervas Chinesas/toxicidade , Histamina/sangue , Imunoglobulina E/sangue , Injeções Intravenosas , Camundongos , Choque/induzido quimicamente , Choque/diagnóstico , Testes de Toxicidade , Triptases/sangue
3.
Orv Hetil ; 160(38): 1514-1518, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31537093

RESUMO

Immunglobulin E (IgE)-based, irregularly recurring, severe anaphylactic reactions occurred in a 50-year-old European white male patient suffering also from Crohn's disease. On the base of immunologic laboratory tests concerning the mechanism of the phenomenon, the idea arose whether molecules derived for certain microbial derivatives could enter the blood circulation via the damaged bowel walls in the patient with Crohn's disease and they might act as allergens. The microbial analysis diagnosed atypical Staphylococcus in the stool. The serum level of IgE was very high. The concomitant use of targeted antibiotics and anti-allergy and immunosuppressive agents resulted in a complete remission during a couple of months. Not only Crohn's disease has improved, but also the total serum IgE level has decreased significantly, and the unpredictable anaphylactic attacks have been completely eliminated. In Crohn's disease, the anaphylactic complications induced by atypical microbial allergens (e.g., derivatives of Staphylococcus) can be effectively treated after the recognition of this pathological mechanism. This is the first description of such a pathologic state. Orv Hetil. 2019; 160(38): 1514-1518.


Assuntos
Anafilaxia/tratamento farmacológico , Antialérgicos/uso terapêutico , Antibacterianos/uso terapêutico , Doença de Crohn/complicações , Imunoglobulina E/sangue , Imunossupressores/uso terapêutico , Staphylococcus , Anafilaxia/diagnóstico , Anafilaxia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Resultado do Tratamento
5.
Int Arch Allergy Immunol ; 180(1): 44-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256161

RESUMO

Mast cell activation syndrome (MCAS) is a condition characterized by recurrent episodes of clinically relevant, systemic, severe reactions to mast cell (MC)-derived mediators released in the context of anaphylaxis or another acute MC-related event. It is important to document MC involvement in these reactions in order to establish the diagnosis MCAS. The most specific and reliable marker of systemic MC activation is an acute and substantial event-related (transient) increase in the serum tryptase level over the individual's baseline value. However, the baseline level of tryptase varies depending on the underlying disease and the genetic background. For example, an estimated 3-5% of healthy individuals exhibit duplications or multiple copies of the TPSAB1 gene encoding for alpha-tryptase, and over 30% of all patients with myeloid neoplasms, including mastocytosis, have elevated basal tryptase levels. Therefore, it is of utmost importance to adjust the event-related diagnostic (MCAS-confirming) increase in tryptase over the individual baseline in a robust approach. To address this challenge, the 20% + 2 formula was proposed by the consensus group in 2012. Since then, this approach has been validated in clinical practice by independent groups and found to be sound. In the current article, we discuss the emerging importance and value of the 20% + 2 formula in clinical practice and its role as a criterion of severe systemic MC activation and MCAS.


Assuntos
Biomarcadores , Mastócitos/enzimologia , Mastocitose/sangue , Mastocitose/diagnóstico , Triptases/sangue , Anafilaxia/sangue , Anafilaxia/diagnóstico , Humanos , Mastócitos/imunologia , Mastocitose/imunologia , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
6.
Am J Forensic Med Pathol ; 40(4): 356-360, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31318708

RESUMO

We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.


Assuntos
Antivenenos/administração & dosagem , Antivenenos/efeitos adversos , Dendroaspis , Mordeduras de Serpentes/complicações , Venenos de Serpentes/imunologia , Adulto , Anafilaxia/diagnóstico , Animais , Diagnóstico Diferencial , Coagulação Intravascular Disseminada/etiologia , Oxigenação por Membrana Extracorpórea , Humanos , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , África do Sul
7.
Dtsch Med Wochenschr ; 144(13): 884-891, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31252442

RESUMO

Diagnosing and managing patients in shock is a challenge for the treating clinicians in acute medicine. Early diagnosis and treatment are crucial. Mortality of septic shock is between 40 % and 60 %, and that of the cardiogenic shock about 40 %. This article provides an overview of diagnostic approaches to the patient in shock, different aetiologies and treatment strategies, and it guides the clinician through the management from first contact until definite treatment.


Assuntos
Anafilaxia , Choque Cardiogênico , Choque Séptico , Doença Aguda , Anafilaxia/diagnóstico , Anafilaxia/fisiopatologia , Anafilaxia/terapia , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Choque Séptico/diagnóstico , Choque Séptico/fisiopatologia , Choque Séptico/terapia
8.
Pediatr Emerg Med Pract ; 16(6): e1-e2, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31157970

RESUMO

Anaphylaxis is a time-sensitive, clinical diagnosis that is often misdiagnosed because the presenting signs and symptoms are similar to those of other disease processes. This issue reviews the criteria for diagnosing a pediatric patient with anaphylaxis and offers evidence-based recommendations for first- and second-line treatment, including the use of epinephrine, antihistamines, and corticosteroids. Guidance is also provided for the appropriate disposition of patients with anaphylaxis, including prescribing epinephrine autoinjectors and offering training on how to use them, educating patients and families on avoidance of known offending allergens, and referring the patient to a specialist in allergy and immunology. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.]


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/terapia , Anafilaxia/etiologia , Broncodilatadores/uso terapêutico , Criança , Procedimentos Clínicos , Diagnóstico Diferencial , Diagnóstico Precoce , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Humanos , Anamnese , Exame Físico , Fatores de Risco , Vasopressinas/uso terapêutico
9.
Ticks Tick Borne Dis ; 10(5): 1057-1059, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176665

RESUMO

The α-Gal syndrome is a tick-associated and emerging IgE-mediated hypersensitivity reaction directed against the carbohydrate Galα1-3Galß1-(3)4GlcNAc-R (α-Gal) epitope after red meat intake. Herein, we describe a clinical case of a 44-year-old French patient who suffered from recurrent anaphylactic reactions after mammalian meat consumption for five years before the final diagnosis of the α-Gal syndrome was established in 2018. The patient also reported multiple tick bites prior to symptom onset. This unique type of allergy has increasingly been reported across the world, but it is still unknown in many European countries. Therefore, the present clinical case should increase awareness among primary care practitioners and further improve the early diagnosis of the α-Gal syndrome in affected individuals.


Assuntos
Anafilaxia/diagnóstico , Galactose/efeitos adversos , Hipersensibilidade Tardia/diagnóstico , Carne , Picadas de Carrapatos/complicações , Carrapatos/imunologia , Adulto , Anafilaxia/parasitologia , Animais , Dieta , Epitopos/efeitos adversos , Feminino , França , Galactose/análogos & derivados , Humanos , Hipersensibilidade Tardia/parasitologia
10.
Rev Chil Pediatr ; 90(1): 44-51, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095218

RESUMO

INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Competência Clínica/estatística & dados numéricos , Epinefrina/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Simpatomiméticos/uso terapêutico , Argentina , Criança , Estudos Transversais , Emergências , Pesquisas sobre Serviços de Saúde , Hospitais Pediátricos , Humanos , Injeções Intramusculares , Pediatras/normas , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas
11.
Pediatr Emerg Med Pract ; 16(6): 1-24, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124642

RESUMO

Anaphylaxis is a time-sensitive, clinical diagnosis that is often misdiagnosed because the presenting signs and symptoms are similar to those of other disease processes. This issue reviews the criteria for diagnosing a pediatric patient with anaphylaxis and offers evidence-based recommendations for first- and second-line treatment, including the use of epinephrine, antihistamines, and corticosteroids. Guidance is also provided for the appropriate disposition of patients with anaphylaxis, including prescribing epinephrine autoinjectors and offering training on how to use them, educating patients and families on avoidance of known offending allergens, and referring the patient to a specialist in allergy and immunology.


Assuntos
Anafilaxia/diagnóstico , Manuseio das Vias Aéreas/métodos , Anafilaxia/terapia , Criança , Diagnóstico Diferencial , Epinefrina/uso terapêutico , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto
12.
Br J Anaesth ; 123(1): e135-e143, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954238

RESUMO

BACKGROUND: Neuromuscular blocking agents (NMBAs) remain the leading cause of perioperative anaphylaxis in Australia. Standard evaluation comprises history, skin tests, and in vitro specific immunoglobulin E tests. Drug provocation tests to suspected NMBA culprits are associated with a significant risk. Basophil activation testing (BAT) is a potentially useful in vitro test that is not commercially available in Australia or as part of standard evaluation. METHODS: All patients attending the Anaesthetic Allergy Clinic in Sydney, Australia between May 2017 and July 2018 exposed to an NMBA before the onset of anaphylaxis during their anaesthetic qualified for the study. We recruited 120 patients sequentially who received standard evaluation plus BAT using CD63, CD203c, and CD300a as surface activation markers. RESULTS: BAT results were expressed as % upregulation above the negative control and stimulation index (mean fluorescence index of stimulated sample divided by the negative control). We calculated cut-offs of 4.45% and 1.44 for CD63, and 8.80% and 1.49 for CD203c, respectively. Sensitivity was 77% with specificity of 76%. A subgroup of 10 patients with NMBA anaphylaxis had no sensitisation on skin tests. BAT using CD63 and CD203c showed sensitisation in six of these 10, and adding CD300a identified sensitisation in nine patients. BAT was positive in seven of nine patients with anaphylaxis of unknown aetiology. CONCLUSIONS: BAT may be a useful supplement to the standard evaluation in diagnosing NMBA anaphylaxis in patients with suggestive histories, but no sensitisation on skin tests. Ongoing study of this specific group of patients is required to clarify its utility in clinical practice.


Assuntos
Anafilaxia/diagnóstico , Basófilos/imunologia , Hipersensibilidade a Drogas/diagnóstico , Complicações Intraoperatórias/induzido quimicamente , Bloqueadores Neuromusculares/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Adolescente , Adulto , Idoso , Anafilaxia/imunologia , Austrália , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/imunologia , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/imunologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/imunologia , Sensibilidade e Especificidade , Adulto Jovem
13.
J Korean Med Sci ; 34(13): e106, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30950251

RESUMO

BACKGROUND: Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers. METHODS: The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea. RESULTS: We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kUA/L for those under the age of 1 and 15 kUA/L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kUA/L for those under the age of 2 and 7 kUA/L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector. CONCLUSION: Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity. Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.


Assuntos
Anafilaxia/diagnóstico , Alérgenos/imunologia , Anafilaxia/tratamento farmacológico , Anafilaxia/epidemiologia , Anafilaxia/imunologia , Animais , Broncodilatadores/uso terapêutico , Pré-Escolar , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Ovo/tratamento farmacológico , Hipersensibilidade a Ovo/epidemiologia , Epinefrina/uso terapêutico , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoglobulina E/sangue , Lactente , Recém-Nascido , Masculino , Leite/imunologia , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/tratamento farmacológico , Hipersensibilidade a Leite/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
14.
Psychiatr Danub ; 31(Suppl 1): 50-59, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30946718

RESUMO

Every agent used during the perioperative period may be involved and have the potential to trigger both allergic, IgE and non-IgE reaction as well as non-specific (non-allergic) reactions. In many cases, an allergic mechanism cannot be ruled out and systematic investigations should be tested of all drugs and agents the patient was exposed to prior to the reaction. The complexity of agents used for anaesthesia and surgery present challenges when attempting to identify the culprit drugs and select proper testing to better recognition of trigger. The diagnosis of preoperative anaphylactic or anaphylactoid reaction is clinical and based upon the presence of characteristic symptom and signs that begin suddenly and developed rapidly in most cases. Elevations of mast cell mediators such as tryptase and histamine in the blood can help to distinguish anaphylaxis from other disorders that present with similar clinical picture. The secondary investigations of adverse perioperative drug reactions are highly specialised and include skin testing, in vitro testing and in some cases challenge tests. Any suspected reaction during anaesthesia must be extensively investigated and these diagnostic tests should be done in specialised centres. The cooperation between anaesthesiologists and allergists is necessary to provide the necessary diagnostic tests to identify the responsible drug, to carry out prevention and to provide recommendations for future anesthetic procedures.


Assuntos
Anafilaxia , Anestesia , Anestésicos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Anestésicos/administração & dosagem , Humanos , Testes Cutâneos
15.
Nihon Shokakibyo Gakkai Zasshi ; 116(4): 330-335, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30971670

RESUMO

A 44-year-old man was administered Niflec® containing macrogol 4000 as a bowel cleanser for colonoscopic examination. Immediately after ingestion, he experienced oral cavity discomfort and nasal congestion, followed by acute urticaria and presyncope. His systolic blood pressure and peripheral capillary oxygen saturation dropped to 66mmHg and 89%, respectively. Fluid infusion, as well as steroid and epinephrine administration, improved his symptoms. Skin prick tests were then performed using Niflec®, macrogol 4000, and Actosin® ointment (containing macrogol 4000), all of which were positive. Therefore, the patient was diagnosed with anaphylactic shock caused by macrogol 4000 included in Niflec®. Macrogol present in bowel cleansers used for colonoscopy rarely causes anaphylactic shock. However, clinicians need to be mindful of this risk. Prompt and appropriate treatment is needed should this condition occur.


Assuntos
Anafilaxia/diagnóstico , Polietilenoglicóis/efeitos adversos , Adulto , Anafilaxia/induzido quimicamente , Humanos , Masculino
16.
Allergol. immunopatol ; 47(2): 128-132, mar.-abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180800

RESUMO

Introduction: Beta-lactams are the most frequently used antibiotics in pediatric age. Anaphylactic reactions may occur and need to be properly studied, but studies in children are scarce. Objective: Characterization of case reports of anaphylaxis in children referred to an allergy department with suspected beta-lactams hypersensitivity. Materials and methods: Retrospective analysis of all children referred to our Drug Allergy Center with suspected beta-lactams hypersensitivity between January 2011 and December 2016. Description of the drug allergy work-up performed studied according to standardized diagnostic procedures of ENDA/EAACI, including specific-IgE assay, skin prick and intradermal tests and diagnostic/alternative drug challenge tests. Results: 146 children with suspected beta-lactams hypersensitivity were studied, and in 21 (14.4%) the diagnosis was confirmed. In all of them, except for three children, an alternative beta-lactam was found. In seven children (33.3% of those with confirmed beta-lactams hypersensitivity) anaphylaxis was confirmed, and all of them described reactions with cutaneous and respiratory or gastrointestinal involvement. The culprit drug was amoxicillin in six and flucloxacillin in one. In this sample, we also performed oral challenge with cefuroxime, being negative in all cases. Almost all cases of confirmed anaphylaxis (six from seven cases) were IgE mediated, with positive skin tests despite negative serum specific-IgE. Conclusions: Allergic reactions to beta-lactams, although rare in children, require a detailed clinical history and a specialized drug allergy work-up to allow a correct diagnosis as well as to avoid the possibility of a potential life-threatening reaction and provide alternative drugs


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Alérgenos/imunologia , Anafilaxia/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Pele/patologia , beta-Lactamas/imunologia , Imunoglobulina E/sangue , Estudos Retrospectivos , Testes Cutâneos , Inquéritos e Questionários
17.
Acta Med Port ; 32(2): 91-100, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30896389

RESUMO

INTRODUCTION: Anaphylaxis is significantly underdiagnosed, and the medical community's knowledge about it is precarious. The aim of this study is to characterize the patient population and the Emergency Department approach of anaphylaxis. MATERIAL AND METHODS: Retrospective study of adult patients attending the Emergency Department of a tertiary care Portuguese hospital, over a year, with anaphylaxis. Data were obtained from each patient's clinical records and anonymized. A questionnaire evaluating knowledge about the notification of anaphylaxis was applied to Emergency Department physicians. RESULTS: The study included 69 patients. Cutaneous (97%) and respiratory features (80%) were most prevalent; 22% of patients presented with shock or related symptoms. There were no reported biphasic reactions or deaths. The likely allergen was identified in 73%, most commonly food; 12% of reactions were related to a previously known allergen. Epinephrine was administered to 15%. Referral to an Immunoallergologist was done in 36% of patients, and 10% received or already possessed an epinephrine autoinjector. Among six parameters recommended for auditing clinical practice, 70% of cases fulfilled less than half. Only 13% of physicians knew it was mandatory to register all cases in the Portuguese Catalogue of Allergies and Other Adverse Reactions, and only 4% knew how to do it; regarding notification to the National Authority of Medicines and Health Products results were slightly better. DISCUSSION: Many patients with anaphylaxis present to the Emergency Department every year, and their clinical approach is not in agreement with national guidelines. CONCLUSION: An educational program to increase medical awareness of the national guidelines and mandatory notification of all anaphylactic reactions should be implemented.


Assuntos
Anafilaxia/diagnóstico , Competência Clínica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alérgenos/efeitos adversos , Alérgenos/análise , Anafilaxia/etiologia , Notificação de Doenças , Epinefrina/uso terapêutico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
18.
Vnitr Lek ; 65(2): 149-156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30909706

RESUMO

Anaphylactic symptoms and anaphylactic shock are serious, rapidly developing and potentially fatal systemic reactions occurring after contact with the trigger, followed by release of a number of substances that affect vascular permeability, smooth muscle tone of blood vessels and bronchi with activation of the systemic inflammatory cascade. From a pathophysiological point of view, it can be an IgE-mediated immune response followed by massive release of biologically active mediators from mast cells and basophils (IgE dependent). If the mastocyt/basophil is degranulated via a direct IgE-free pathway, it is non-allergic (non-IgE dependent, anaphylactoid anaphylaxis). The diagnosis of anaphylaxis is determined on the basis of clinical criteria, taking into account the need to initiate therapy in a life-threatening condition without delay. Adrenaline is the first-line drug in the treatment of anaphylaxis and there is no contraindication to its use. Early provision of venous intake is essential for the patient to develop hypotension.


Assuntos
Anafilaxia , Anafilaxia/complicações , Anafilaxia/diagnóstico , Basófilos , Humanos , Mastócitos
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