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2.
Vnitr Lek ; 66(6): 335-339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33380136

RESUMO

Anaphylaxis is a serious, potentially lifethreatening condition, and all healthcare professionals should be aware of it. Prompt recognition of anaphylaxis signs and early initiation of adequate treatment are essential for successful acute management. The firstline treatment is the administration of intramuscular adrenalin, followed by other interventions. Patients should be moni tored after recovery for possible biphasic reaction. Before discharge, the individual risk of further reaction should be assessed and where appropriate an adrenalin autoinjector should be prescribed. Allergy specialist followup is essential for the identification of possible triggers and cofactors. Elimination of these factors reduces the risk of future reactions. Useful preventive measure is allergen immunotherapy, which is definitely indicated in patients with anaphylaxis induced by an insect sting.


Assuntos
Anafilaxia , Anafilaxia/diagnóstico , Anafilaxia/terapia , Conscientização , Epinefrina , Humanos , Especialização
3.
Med Klin Intensivmed Notfmed ; 115(8): 699-707, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32910216

RESUMO

The spectrum of dermatological emergencies is diverse. Infections, in particular sexually transmitted infections, anaphylactic reactions, and cutaneous drug reactions are common causes for patients to present themselves to the dermatological emergency service. If a sexually transmitted infection is suspected, it is important for the physician to recognize which diseases need immediate treatment to avoid late complications. This requires a reliable diagnosis and knowledge of the appropriate therapy. Cutaneous drug reactions can take many forms. There is a spectrum of reactions that occur immediately after the administration of a medication (which manifest themselves as anaphylaxis), to those that can appear weeks after the initiation of a therapy. These reactions can be harmless and self-limiting, but also be life-threatening. It is essential for physicians in everyday clinical practice to recognize drug intolerances in time and to treat them appropriately.


Assuntos
Anafilaxia , Angioedema , Dermatologia , Gonorreia , Anafilaxia/diagnóstico , Anafilaxia/terapia , Emergências , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos
8.
Iran J Allergy Asthma Immunol ; 19(1): 27-34, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32245318

RESUMO

Sesame food allergy (SFA); especially anaphylaxis, is a life-threatening condition. The accurate diagnosis of SFA is done by skin prick test (SPT), skin prick to prick (SPP) or specific IgE (sIgE) and is confirmed by oral food challenge (OFC). Since there are few studies evaluating and comparing the utility of these methods for diagnosis of sesame anaphylaxis in adult patients, we aimed to compare OFC with diagnostic tests, including SPT, SPP, and sesames IgE; using ImmunoCAP considering the sensitivity and specificity issues in patients with sesame anaphylaxis. Twenty patients with sesame anaphylaxis were diagnosed based on OFC. Then SPT, SPP, and sIgE were evaluated. Sixteen patients had positive OFC; while 4 patients had negative results. Out of 16 OFC+ patients, 7 patients were SPT+, 15 patients were SPP+, and 2 patients had detectable sIgE. A positive SPT indicated 44% sensitivity and 50% specificity. A positive SPP showed 87.5% sensitivity and 75% specificity. A positive ImmunoCAP test demonstrated 12.5% sensitivity and 75% specificity. The AUC of SPP was significant for the diagnosis of sesame anaphylaxis (p=0.038). In conclusion, when the OFC is not possible, the SPP test with natural sesame seed may be applicable in patients with a convincing history instead of the artificial or commercial extracts of sesame used for SPT. Positive SPP is a good alternative diagnostic method for patients with sesame anaphylaxis. Also, the poor sensitivity of SPT and sIgE may indicate the poor discriminative capability of these tests.


Assuntos
Alérgenos/administração & dosagem , Hipersensibilidade Alimentar/diagnóstico , Testes Imunológicos/métodos , Sesamum/imunologia , Testes Cutâneos/métodos , Administração Oral , Adolescente , Adulto , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Sesamum/efeitos adversos , Adulto Jovem
12.
Ann Allergy Asthma Immunol ; 124(6): 526-535.e2, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32199979

RESUMO

OBJECTIVE: To review GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methods and discuss the clinical application of conditional recommendations in clinical guidelines, specifically in the context of anaphylaxis. DATA SOURCES: Articles that described GRADE, evidence synthesis, evidence to recommendation frameworks, and shared decision making were used to discuss conditional recommendations of the 2020 Anaphylaxis GRADE guideline. STUDY SELECTIONS: A narrative review detailing concepts of GRADE and approaches to translate conditional recommendations to individualized and contextualized patient care. RESULTS: GRADE methods encourage a nuanced relationship between certainty of evidence and strength of recommendations. Strength of recommendation must incorporate key factors, including the balance between benefits and harms, patient values and preferences, and resource allocation (costs), with equity, feasibility, and acceptability also often included as considerations. GRADE guidelines provide recommendations that are characterized by directionality (for or against) and strength (strong or conditional). A conditional recommendation is tailored to context and primarily applied through a lens of patient preferences related to the likelihood of outcomes of importance and a shared decision-making approach. Although the 2020 Anaphylaxis GRADE guideline better informs the practice of anaphylaxis prevention through (1) identification and mitigation of risk factors for biphasic anaphylaxis and (2) evaluation of the use of glucocorticoid and/or antihistamine pretreatment, all GRADE recommendations, although directional, are conditional and as such should not be universally applied to every circumstance. CONCLUSION: Clinical guidelines provide an important opportunity to critically appraise evidence and translate evidence to practice. Patients, practitioners, and policy makers should appreciate the strength of recommendation and certainty of evidence and understand how this affects guideline applicability and implementation.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/terapia , Guias de Prática Clínica como Assunto , Anafilaxia/etiologia , Tomada de Decisão Clínica , Gerenciamento Clínico , Medicina Baseada em Evidências/métodos , Humanos , Medicina de Precisão/métodos , Viés de Publicação
13.
Spine Deform ; 8(2): 327-331, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32030641

RESUMO

STUDY DESIGN: Case report. OBJECTIVES: To describe intraoperative administration of albumin as a cause of immunoglobulin E (IgE)-mediated anaphylaxis and cardiac arrest in an adolescent with adolescent idiopathic scoliosis. BACKGROUND: Albumin is considered the reference intraoperative colloidal solution, and is used commonly as a volume expander for treating hypovolemia. Albumin rarely causes an anaphylactic reaction, with a documented rate of only 0.099%. METHOD: An adolescent with scoliosis experienced acute, intraoperative hypotension during exposure for planned T5-L4 posterior spinal fusion shortly after infusion of albumin. She was treated rapidly and successfully with CPR and epinephrine. RESULTS: Intraoperative transesophageal echocardiogram, chest radiograph, and serum histamine, serum tryptase, and urine N-methyl-histamine laboratory tests confirmed albumin anaphylaxis to be the etiology of the intraoperative event. Further postoperative complications were avoided as a result of the rapid diagnosis and treatment. CONCLUSIONS: Although rare, IgE-mediated anaphylaxis to albumin, if administered, must be considered a possible cause of acute, intraoperative hypotension. Rapid management of anaphylaxis with communication between the surgeon, anesthesia team, and operative staff are essential if additional complications are to be avoided.


Assuntos
Albuminas/administração & dosagem , Albuminas/efeitos adversos , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Cuidados Intraoperatórios/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Escoliose/cirurgia , Fusão Vertebral/métodos , Doença Aguda , Adolescente , Albuminas/imunologia , Anafilaxia/imunologia , Anafilaxia/terapia , Reanimação Cardiopulmonar , Diagnóstico Precoce , Epinefrina/uso terapêutico , Feminino , Humanos , Hipotensão/etiologia , Imunoglobulina E , Complicações Intraoperatórias/terapia , Período Intraoperatório , Resultado do Tratamento
15.
Ann Allergy Asthma Immunol ; 124(5): 466-472, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32044450

RESUMO

OBJECTIVE: Tree nuts are common causes of food-related allergic reactions and anaphylaxis. Resolution of tree nut allergy is thought to be low, yet studies of the natural history of tree nut allergy are limited. This review summarizes the available literature regarding tree nut allergy prevalence and natural history and discusses emerging diagnostic and prognostic developments that will inform clinical management of tree nut allergy. DATA SOURCES: A comprehensive literature search using PubMed was performed. STUDY SELECTIONS: Peer-reviewed publications relating to tree nut allergy prevalence, resolution, and diagnosis were selected, and findings were summarized using a narrative approach. RESULTS: Tree nut allergy prevalence varies by age, region, and food allergy definition, and ranges from less than 1% to approximately 3% worldwide. Reports on the natural history of tree nut allergy data are limited to retrospective clinical data or cross-sectional survey data of self-reported food allergy, with reported resolution ranging from 9% to 14%. Component-resolved diagnostics and basophil activation testing offer the potential to improve the diagnostic accuracy and predicted prognosis of specific tree nut allergy, but studies are limited. CONCLUSION: Tree nut allergy remains an understudied area of food allergy research with limited region-specific studies based on robust food allergy measures in population cohorts with longitudinal follow-up. This currently limits our understanding of tree nut allergy prognosis.


Assuntos
Anafilaxia/epidemiologia , Hipersensibilidade a Noz/epidemiologia , Alérgenos/imunologia , Anafilaxia/diagnóstico , Antígenos de Plantas/imunologia , Humanos , Hipersensibilidade a Noz/diagnóstico , Nozes/imunologia , Prevalência , Prognóstico
16.
Curr Opin Pediatr ; 32(2): 321-327, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32068593

RESUMO

PURPOSE OF REVIEW: To review phenotyping and risk classification of penicillin allergy and provide an update on penicillin allergy delabeling strategies for primary care. RECENT FINDINGS: Beta-lactams are considered the treatment of choice for a wide range of bacterial pathogens; however, many patients receive second-line agents due to being labeled as having an allergy to penicillin. This approach can lead to antibiotic resistance and inferior health outcomes. While 10% of the population is labeled as penicillin allergic, penicillin anaphylaxis occurs in less than 1% of patients. For patients with delayed benign skin rashes (e.g., urticaria or maculopapular exanthem >1 h after administration) attributable to beta-lactam administration occurring more than 12 months ago, direct oral challenge (rechallenge with antibiotic in the clinical setting) can be a safe and effective strategy, with immediate reactions occurring in less than 5% of such low-risk patients and delayed reactions appearing infrequently. In patients with penicillin-associated immediate urticaria, other IgE-mediated features, or anaphylaxis, further allergy evaluation and penicillin skin testing is warranted. Any severe idiosyncratic cutaneous adverse reaction is rare, but can be dangerous so prompt removal of the inciting agent is required. SUMMARY: Penicillin allergy delabeling is a high-value service that can be effectively delivered through a multidisciplinary collaborative approach.


Assuntos
Alérgenos/imunologia , Antibacterianos/imunologia , Hipersensibilidade a Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Penicilinas/imunologia , Testes Cutâneos/métodos , Anafilaxia/diagnóstico , Antibacterianos/administração & dosagem , Humanos , Imunoglobulina E , Testes Imunológicos , Penicilinas/administração & dosagem , Guias de Prática Clínica como Assunto , beta-Lactamas
17.
Curr Allergy Asthma Rep ; 20(1): 4, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31993777

RESUMO

PURPOSE OF REVIEW: Progestogen hypersensitivity (PH) is a condition which typically occurs in women in childbearing years with a spectrum of symptoms ranging from urticaria with or without angioedema, dermatitis to systemic anaphylaxis. Herein, a clinical case of PH is presented followed by a discussion on the evaluation, diagnosis, and management of PH. RECENT FINDINGS: Progestogen hypersensitivity (a.k.a. "autoimmune progesterone dermatitis") symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. This condition can be difficult to recognize due to its heterogeneous clinical presentation. The mechanism of PH is believed to be primarily IgE-mediated; however, less commonly other immune responses may be involved. There is now a useful progesterone specific IgE immunoassay to assist in diagnosis and well-defined treatment algorithms that can be used to successfully manage PH. The epidemiology of PH is still poorly elucidated but is likely to be encountered by clinicians and especially allergists given the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone required to support pregnancy in IVF. Including PH in the differential diagnosis of women presenting with cyclic hypersensitivity will accelerate diagnosis and successful management of this condition.


Assuntos
Anafilaxia/induzido quimicamente , Doenças Autoimunes/induzido quimicamente , Dispositivos Intrauterinos Medicados/efeitos adversos , Progesterona/efeitos adversos , Progestinas/efeitos adversos , Urticária/induzido quimicamente , Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Antialérgicos/uso terapêutico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Dermatite/diagnóstico , Dermatite/tratamento farmacológico , Dessensibilização Imunológica , Remoção de Dispositivo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina E/sangue , Omalizumab/uso terapêutico , Urticária/diagnóstico , Urticária/tratamento farmacológico , Adulto Jovem
18.
Talanta ; 209: 120539, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31892067

RESUMO

Anaphylactoid reactions induced by drugs are serious and can be life-threatening, and screening the anaphylactoid ingredients especially in complex samples is challenging. Here, a multi targeted cell membrane chromatography method, based on the Mas-related G protein coupled receptor X2, Fc epsilon RI and H1 receptors, online coupled with LC-MS system provides a comprehensive solution for screening the anaphylactoid components from complex samples. The validation including selectivity and suitability of this system has been evaluated, and it shows promising results. With optimized conditions, this method has been utilized to screen the anaphylactoid ingredients from Shenmai Injection. Ginsenoside Rb1, ginsenoside Rb2, ginsenoside Rc, ginsenoside Rd and 20(S)-ginsenoside Rg3 were identified as anaphylactoid components. The anaphylactoid effects of these five components were further verified by the in vitro sensitization assay, showing promising effects on some or all sensitization cells. In conclusion, the multi targeted cell membrane chromatography online coupled with LC-MS system developed throughout this study could be used to fully screen anaphylactoid components in complex samples. Moreover, it also provides new insights for drug quality control.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Medicamentos de Ervas Chinesas/química , Ginsenosídeos/análise , Anafilaxia/diagnóstico , Membrana Celular/química , Combinação de Medicamentos , Células HEK293 , Humanos , Espectrometria de Massas/métodos , Receptores Acoplados a Proteínas-G/química , Receptores Histamínicos H1/química , Receptores de IgE/química
20.
J Korean Med Sci ; 35(3): e23, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31950778

RESUMO

BACKGROUND: Barley is a grain that is consumed in various forms in Asia. Studies on barley allergy are limited to a few case reports about hypersensitivity reactions to beer, but there is no barley allergy study in children. This study aimed to identify the phenotype and immunologic findings in Korean children with barley allergy. METHODS: Forty-two participants with a history of ingesting barley who underwent serum specific immunoglobulin E to barley (barley-sIgE) assay at the Department of Pediatrics in Ajou Medical Center were enrolled through a retrospective analysis of medical records from March 2008 to February 2018. The demographic characteristics, symptoms, and immunologic parameters of the patients were assessed. RESULTS: Twenty subjects presented with clinical barley allergy (B-allergic group), and 22 were atopic controls without allergic reactions after the ingestion of barley (B-tolerant group). The median ages of the B-allergic and B-tolerant groups were 1 and 3 years, respectively. In the B-allergic group, the cutaneous system (90.0%) was most frequently affected, followed by the respiratory system (40.0%). Anaphylaxis was observed in 35.0% of the B-allergic group. The median level of barley-sIgE was 13.90 kUA/L (range, 0.14-101.00 kUA/L) in the B-allergic group, and this value was significantly higher (P < 0.001) than that of the B-tolerant group (0.30 kUA/L; range, 0.01-24.40 kUA/L), with an optimal cutoff level of 1.24 kUA/L (sensitivity, 85.0%; specificity, 86.4%). A positive correlation was found between the serum levels of barley-sIgE and wheat-sIgE in the B-allergic group with clinical wheat allergy. CONCLUSION: Barley is an important allergen for children in Korea. This study showed the clinical characteristics of barley allergy and suggested optimal cut-off levels of barley-sIgE for clinical barley allergy. Clinically, cross-reactivity or co-sensitization is often observed between barley and wheat.


Assuntos
Alérgenos/imunologia , Hipersensibilidade Alimentar/diagnóstico , Hordeum/metabolismo , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Área Sob a Curva , Criança , Pré-Escolar , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Imunoglobulina E/sangue , Lactente , Masculino , Curva ROC , República da Coreia , Estudos Retrospectivos
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