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2.
Br J Anaesth ; 125(6): 1025-1033, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32928517

RESUMO

BACKGROUND: Few data are available on patients who have experienced anaphylaxis and were admitted to ICUs. The purpose of this observational study was to describe the epidemiology and management of these patients. METHODS: This was a multicentre retrospective study carried out in 23 French ICUs between 2012 and 2017. All patients who suffered anaphylaxis and were transferred to an ICU were included. Data were collected using an electronic database after approval by an ethics committee. RESULTS: A total of 339 patients were included, and 17 (5%) died secondary to anaphylaxis. The main triggers were drugs (77%), contrast media (11%), and food (7%). Epinephrine was administered before ICU admission in 88% of patients with Grade III anaphylaxis and 100% of patients with Grade IV anaphylaxis. Most patients with Grades III and IV anaphylaxes did not receive the recommended dose of i.v. fluid of 30 ml kg-1 within the first 4 h of ICU admission. The time to epinephrine administration was not statistically different between survivors and non-survivors, but non-survivors received a higher dose of epinephrine (median: 5 [3-10] vs 3 [2-7] mg; P<0.0001), which suggests that some forms of anaphylactic shock may be resistant to epinephrine. In multivariate analysis, only lactate concentration at ICU admission was a predictor of death (odds ratio: 1.47 [1.15-1.88]; P=0.002). CONCLUSIONS: Lactate concentration at ICU admission appeared to be the most reliable criterion for assessing prognosis. Epinephrine is widely used during anaphylaxis, but the volume of fluid resuscitation was consistently lower than recommended. CLINICAL TRIAL REGISTRATION: NCT04290507.


Assuntos
Anafilaxia/epidemiologia , Anafilaxia/terapia , Cuidados Críticos/estatística & dados numéricos , Idoso , Anafilaxia/mortalidade , Epinefrina/uso terapêutico , Feminino , França/epidemiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sobreviventes , Resultado do Tratamento , Vasoconstritores/uso terapêutico
5.
Artigo em Inglês | MEDLINE | ID: mdl-32650469

RESUMO

Allergic disorders in the agriculture sector are very common among farm workers, causing many injuries and occupational diseases every year. Agricultural employees are exposed to multiple conditions and various allergenic substances, which could be related to onset of anaphylactic reactions. This systematic review highlights the main clinical manifestation, the allergens that are mostly involved and the main activities that are usually involved. This research includes articles published on the major databases (PubMed, Cochrane Library, Scopus), using a combination of keywords. The online search yielded 489 references; after selection, by the authors, 36 articles (nine reviews and 27 original articles) were analyzed. From this analysis, the main clinical problems that were diagnosed in this category were respiratory (ranging from rhinitis to asthma) and dermatological (eczema, dermatitis, hives) in nature, with a wide symptomatology (from a simple local reaction to anaphylaxis). The main activities associated with these allergic conditions are harvesting or cultivation of fruit and cereals, beekeepers and people working in greenhouses. Finally, in addition to the allergens already known, new ones have emerged, including triticale, wine, spider and biological dust. For these reasons, in the agricultural sector, research needs to be amplified, considering new sectors, new technologies and new products, and ensuring a system of prevention to reduce this risk.


Assuntos
Anafilaxia , Asma , Eczema , Fazendeiros , Agricultura , Alérgenos , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Humanos , Fatores de Risco
6.
Ann Allergy Asthma Immunol ; 125(4): 410-417.e2, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32535065

RESUMO

BACKGROUND: Limited information is available on the effect of anaphylaxis, a severe, potentially life-threatening allergic reaction, in the elderly population. OBJECTIVE: To elucidate the frequency of anaphylaxis and the demographic characteristics of elderly patients admitted to New York hospitals from 2000 to 2010. METHODS: A retrospective analysis of hospitalized patients aged 65 years and older in New York from 2000 to 2010 was conducted using the Statewide Planning and Research Cooperative System, a statewide administrative database. Cases were identified using anaphylaxis International Classification of Diseases, Ninth Revision (ICD-9) codes or an ICD-9-based diagnostic algorithm incorporating the National Institutes of Allergy and Infectious Disease diagnostic criteria. The χ2 test was used to measure the association between demographic characteristics and group membership. Regression was used to model group and age as a function of hospital rates. RESULTS: A total of 3673 hospitalizations were analyzed. Anaphylaxis ICD-9 codes identified 1790 cases (48.7%), the algorithms identified 1701 cases (46.3.%), and 182 cases (5.0%) were identified by both. Hospitalization rates increased significantly during this period (P < .001). Women comprised 61.5% and people of white race comprised 69.8% of the sample. Distribution by age differed by ascertainment method (ICD-9 vs algorithm) among the early-old group (65-74 years of age; 53.8% vs 41.8%) and among the late-old group (≥85 years of age; 11.2% vs 19.3%). CONCLUSION: Hospitalization rates and anaphylaxis cases increased during the study period among the hospitalized elderly population of New York. Relying on anaphylaxis ICD-9 codes alone missed approximately half of possible cases. The identification and possibly the effect of anaphylaxis among the elderly population may differ, depending on age, race, payer, New York County, and disposition.


Assuntos
Anafilaxia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , New York/epidemiologia , Estudos Retrospectivos
7.
Anaesthesia ; 75(11): 1469-1475, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32463487

RESUMO

Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1-1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4-11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8-30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.


Assuntos
Anafilaxia/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Estudos Prospectivos , Estudos Retrospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-32316622

RESUMO

Anaphylaxis is most commonly defined as an acute, severe, potentially life-threatening systemic hypersensitivity reaction. Current expert consensus has defined anaphylaxis as a serious reaction that is rapid in onset and can be fatal, and is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes of this reaction. There are no data from other health care centres in Poland presenting characteristics of anaphylactic reactions. Clinical manifestations of anaphylaxis should be analysed, because some patients (10-30%) with anaphylaxis can present without cutaneous findings. This lack of skin/mucosa involvement can lead to misdiagnosis or delayed diagnosis of anaphylaxis. Objectives-to gather epidemiological data on anaphylactic reactions, to identify clinical manifestations of anaphylaxis (organ systems involved), to present diagnostic methods useful for the identification of anaphylaxis triggers, and most importantly, to find causes of anaphylaxis. In this retrospective analysis, we used a questionnaire-based survey regarding patients visiting the Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, between 2006 and 2015. The registry comprised patients with grade II (Ring and Messmer classification) or higher anaphylaxis. Patients with grade I anaphylaxis (e.g., urticaria) were not included in the registry. The incidence of anaphylaxis was higher in women. Clinical manifestations included cutaneous and cardiovascular symptoms, but more than 20% of patients did not present with cutaneous symptoms, which may create difficulties for fast and correct diagnosis. Causes of anaphylaxis were identified and confirmed by means of detailed medical interview, skin tests (STs), and measurement of specific immunoglobulin E (sIgE) and tryptase levels. In the analysed group, the most common cause of anaphylaxis (allergic and nonallergic) was Hymenoptera stinging (wasp), drugs (nonsteroidal anti-inflammatory drugs, NSAIDs) and foods (peanuts, tree nuts, celery). The incidence of anaphylaxis is low, but because of its nature and potentially life-threatening consequences it requires a detailed approach. Comprehensive management of patients who have had anaphylaxis can be complex, so partnerships between allergy specialists, emergency medicine and primary care providers are necessary. Monitoring its range is very important to monitor changes in allergy development.


Assuntos
Anafilaxia , Adulto , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Criança , Feminino , Humanos , Masculino , Polônia/epidemiologia , Sistema de Registros , Estudos Retrospectivos
10.
Allergy Asthma Proc ; 41(2): 108-111, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32122446

RESUMO

In 2004, it was estimated that one fatal anaphylactic reaction (FR) occurred in every 2.4 million subcutaneous immunotherapy (SCIT) injection visits. Uncontrolled asthma was the most commonly cited factor that contributed to FRs. Results of the annual American College of Allergy, Asthma, and Immunology/American Academy of Allergy, Asthma and Immunology sponsored survey conducted among practicing allergists suggest that one nonfatal systemic reactions (SR) occurred in 0.15% of injection visits and in 0.7% of patients who were treated. Analysis of recent data indicated that FRs are 3.75-fold less frequent. Life-threatening grade 4 anaphylactic reactions are estimated to occur in 0.005% of patients who receive SCIT (or 1/160,000 injection visits). Analysis of data from annual surveys identified the following possible risk factors for SRs: a history of SRs to SCIT, the administration of injections in patients with uncontrolled asthma, use of accelerated buildup regimens, and never adjusting doses during the height of the allergy season. Delayed-onset SRs beginning >30 minutes after injections represented 15% of all SRs in clinics with 30-minute observation periods. The safety profile of sublingual immunotherapy is favorable, with no FRs yet identified for sublingual tablet or liquid formulations. Risk management should focus mainly on patients with uncontrolled asthma by withholding injections in such patients, with recent worsening in asthma symptoms and lung function (e.g., peak expiratory flow rate). Because nearly all FRs and SRs occur within 30 minutes of injections, a 30-minute observation period is recommended. Routinely prescribing epinephrine for all patients did not prevent severe SRs, likely due to poor adherence when SRs occurred. Also, no local or systemic infections were identified in 2.3 million patients attending 24.5 million injection visits, which allayed concerns over infections associated with compounding of allergen extracts by practicing allergists.


Assuntos
Anafilaxia/epidemiologia , Asma/epidemiologia , Dessensibilização Imunológica/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hipersensibilidade/terapia , Alérgenos/imunologia , Anafilaxia/etiologia , Animais , Dessensibilização Imunológica/efeitos adversos , Humanos , Hipersensibilidade/epidemiologia , Injeções Subcutâneas , Anamnese , América do Norte/epidemiologia , Fatores de Risco
11.
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
13.
Ann Allergy Asthma Immunol ; 124(5): 479-486, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32007568

RESUMO

BACKGROUND: Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventive measures. OBJECTIVE: To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. METHODS: Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions after unintentional peanut exposures. RESULTS: The following key unmet needs in the prevention and management of peanut allergy were identified: (1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy, (2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice, and (3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for unintentional exposures that provoke severe reactions. Practitioners should help educate caregivers about the actual risks associated with peanut allergy and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. CONCLUSION: There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.


Assuntos
Anafilaxia/epidemiologia , Anafilaxia/prevenção & controle , Prática Clínica Baseada em Evidências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hipersensibilidade a Amendoim/epidemiologia , Fatores Etários , Cuidadores , Criança , Conferências de Consenso como Assunto , Dessensibilização Imunológica , Prova Pericial , Humanos , Disseminação de Informação , Educação de Pacientes como Assunto , Risco , Estados Unidos/epidemiologia
14.
Curr Allergy Asthma Rep ; 20(2): 6, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32067114

RESUMO

PURPOSE OF REVIEW: In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. RECENT FINDINGS: Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.


Assuntos
Hipersensibilidade Alimentar/epidemiologia , Anafilaxia/epidemiologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/psicologia , Humanos , Imunoglobulina E/imunologia , Estudos Longitudinais , Prevalência , Qualidade de Vida/psicologia
15.
Allergol. immunopatol ; 48(1): 78-83, ene.-feb. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-186596

RESUMO

Background: Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. Objective: The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). Method: This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. Results: Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n = 13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95% CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. Conclusion: PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed


No disponible


Assuntos
Humanos , Feminino , Criança , Rinite Alérgica Sazonal/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Rinite Alérgica Sazonal/diagnóstico , Plantas/efeitos adversos , Frutas/efeitos adversos , Modelos Logísticos , Imunoterapia , Anafilaxia/epidemiologia
17.
J Pediatr ; 220: 159-164.e2, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31987654

RESUMO

OBJECTIVE: To assess whether a history of asthma was associated with anaphylaxis severity in children hospitalized for anaphylaxis. STUDY DESIGN: Retrospective cohort study of children ≤21 years old hospitalized for anaphylaxis from 2009 to 2016. The primary outcome was severe anaphylactic reactions defined by examination findings (stridor, respiratory distress, or hypotension) or administered therapies (≥2 dose of intramuscular epinephrine, continuous albuterol, vasopressors, or positive pressure ventilation). Multivariable analyses were used to assess whether a history of asthma was associated with severe anaphylactic reactions, adjusting for patient age, allergen, and history of atopic dermatitis or anaphylaxis. RESULTS: Among 603 children hospitalized for anaphylaxis, 231 (38.3%) had a history of asthma. Children with a history of asthma were older (median age, 6.6 years [IQR, 3.6-12.1] vs 4.0 years [IQR, 1.6-9.3]), more likely to have a history of anaphylaxis (38.1% vs 18.0%), and have food as the inciting allergen (68.0% vs 52.2%). Children with a history of asthma were not more likely to have severe anaphylactic reactions (OR, 0.97; 95% CI, 0.67-1.39). CONCLUSIONS: Children hospitalized for anaphylaxis with a history of asthma were not more likely to have severe anaphylactic reactions compared with children without asthma. This study supports managing children with anaphylaxis based on the severity of symptomatology, and, if validated, clinicians should not consider asthma comorbidity as a stand-alone criterion for hospitalization.


Assuntos
Anafilaxia/epidemiologia , Anafilaxia/etiologia , Asma/complicações , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
20.
Ann Allergy Asthma Immunol ; 124(2): 150-155, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31785369

RESUMO

OBJECTIVE: The identification of anaphylaxis cases is imperative for optimal clinicalprovider knowledge deficiencies in diagnosis and treatment and the efficacy of reimbursement codes, such as International Classification of Diseases (ICD) and current procedural terminology (CPT) codes, in detecting anaphylaxis. DATA SOURCES: Pubmed. STUDY SELECTIONS: Recent and clinically relevant literature on anaphylaxis and provider knowledge, ICD, CPT, Healthcare Common Procedural Coding System (HCPCS), and E-codes were selected and reviewed. RESULTS: Reimbursement codes are used to detect anaphylaxis in administrative claims databases. Inaccurate recognition of the diagnosis by providers, underreporting, and cause identification are challenges faced by health researchers using reimbursement codes for anaphylaxis case identification. Anaphylactic shock-specific ICD codes were noted to have a positive predictive value (PPV) of 52% to 53% of anaphylaxis events compared with physician chart review, which was improved to 63% to 67.3% when used in conjunction with anaphylaxis symptom-specific ICD, CPT, HCPCS, and E-codes 31, 34, and 35. CONCLUSION: Education of providers to properly diagnose and treat anaphylaxis requires systematic and educational investments. The ICD codes specific to anaphylactic shock have suboptimal PPV to identify anaphylaxis in administrative claims databases. Use of algorithms incorporating other reimbursement codes improve the PPV, but they are limited by inaccurate diagnoses and underreporting of anaphylaxis. Future ICD-11 reclassification may improve anaphylaxis detection by reimbursement codes.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Registros Médicos , Current Procedural Terminology , Bases de Dados Factuais , Humanos , Revisão da Utilização de Seguros , Reembolso de Seguro de Saúde , Classificação Internacional de Doenças , Vigilância em Saúde Pública
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