Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.583
Filtrar
1.
Arerugi ; 69(1): 34-39, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32051367

RESUMO

OBJECTIVE: We aim to examine the characteristics of the symptoms induced by exercise provocation tests following allergen consumption in patients who have undergone oral immunotherapy (OIT). METHOD: Patients who were positive for exercise provocation tests in Miyagi Children's Hospital from April 2012 to January 2019 were retrospectively analyzed. Patients were classified into food-dependent exerciseinduced anaphylaxis (FDEIA) group and post-OIT-FDEIA group. RESULT: Six patients in the FDEIA group and 19 patients in the post-OIT-FDEIA group were analyzed. There were no significant differences in age, sex, and number of complications between the FDEIA and post-OIT-FDEIA groups, except for level of total serum immunoglobulin E. The median time from the start of exercise to onset of symptoms was 20 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. The rate of adrenaline administration in post-OIT-FDEIA group was significantly lower. The median time from exercise to onset of severe symptoms requiring adrenaline was 32.5 min in the FDEIA group and 25 min in the post-OIT-FDEIA group. CONCLUSION: These data suggest that FDEIA and post-OIT-FDEIA patients can exhibit similar clinical symptoms, and all symptoms occurred in 60 minutes after exercise.


Assuntos
Anafilaxia/terapia , Asma Induzida por Exercício/terapia , Hipersensibilidade Alimentar/terapia , Imunoterapia , Administração Oral , Alérgenos , Criança , Epinefrina/administração & dosagem , Humanos , Estudos Retrospectivos
3.
Rev Alerg Mex ; 66 Suppl 2: 1-39, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31443138

RESUMO

Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.


Assuntos
Anafilaxia , Guias de Prática Clínica como Assunto , Agonistas Adrenérgicos/administração & dosagem , Agonistas Adrenérgicos/uso terapêutico , Adulto , Algoritmos , Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Anafilaxia/terapia , Reanimação Cardiopulmonar , Criança , Terapia Combinada , Gerenciamento Clínico , Vias de Administração de Medicamentos , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Glucagon/administração & dosagem , Glucagon/uso terapêutico , Humanos , Testes Imunológicos , Educação de Pacientes como Assunto , Autoadministração , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
5.
Dtsch Med Wochenschr ; 144(15): 1051-1054, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31350747

RESUMO

Allergic reactions caused by sting of honeybees or wasps are very often and make also very severe anaphylactic reaction, up to 3,5 % of population. Mostly sting reactions are dependent to IgE induced reactions type I.Established are history, skin tests and specific IgE antibodies. Recombinant antibodies complete diagnostics in special cases. Specific immunotherapy is recommended as a very successful therapy in treating allergies due to honeybees and wasps. Many protocols are established, the standard maintenance dose is 100 mg. The hyposensitization is very successful with rates of nearly 100 % success. In most times a dose of 100 mg is sufficient, in some cases the dose must be increased to 200 mg. In most patients immunotherapy can be stopped after 3-5 years. Sting challenge tests should be done for proving the efficiency of immunotherapy. Many patients after immunotherapy have an improved live quality after sting provocations.


Assuntos
Anafilaxia , Venenos de Abelha , Himenópteros , Venenos de Vespas , Anafilaxia/induzido quimicamente , Anafilaxia/mortalidade , Anafilaxia/prevenção & controle , Anafilaxia/terapia , Animais , Venenos de Abelha/efeitos adversos , Venenos de Abelha/imunologia , Humanos , Hipersensibilidade , Imunoterapia , Venenos de Vespas/efeitos adversos , Venenos de Vespas/imunologia
6.
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
7.
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
8.
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
9.
Curr Opin Pediatr ; 31(3): 426-432, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31090587

RESUMO

PURPOSE OF REVIEW: To provide an updated framework of management for allergic emergencies. RECENT FINDINGS: The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care. Outcomes of allergic emergencies can be improved by educational efforts that focus on adherence to emergency plans, as well as asthma controller treatments in patients with persistent asthma. Though venom immunotherapy is known to decrease the risk for stinging insect anaphylaxis, the role of emerging strategies for food allergen immunotherapy in reducing cases of anaphylaxis requires further study. SUMMARY: Fatalities resulting from anaphylaxis and asthma are rare. Patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.


Assuntos
Anafilaxia , Emergências , Hipersensibilidade Alimentar , Anafilaxia/diagnóstico , Anafilaxia/terapia , Criança , Dessensibilização Imunológica , Epinefrina , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/terapia , Humanos
10.
Rev Alerg Mex ; 66(1): 18-26, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31013403

RESUMO

BACKGROUND: Several reports show deficiencies in the knowledge of physicians about the diagnostic criteria and the treatment of anaphylaxis, a condition that can have fatal consequences. OBJECTIVE: To evaluate the knowledge of physicians in Colombia on the fundamental aspects of anaphylaxis in diagnosis and treatment. METHODS: Analytical cross-sectional study, carried out through a survey of 11 questions that evaluate clinical aspects of anaphylaxis, addressed to general practitioners and specialists in different health areas resident in Colombia. The analysis of the results was based on the correct answers. For approval, a score higher than 70% was needed. RESULTS: A total of 447 non-allergic doctors analyzed were included, of which only 110 (24.6%) approved the questionnaire in both the questions aimed at the diagnosis and in the treatment of anaphylaxis. Among the factors that were associated with the failure of the survey were the age of the doctor (p <0.01) and work at the first level of care (p <0.01). CONCLUSIONS: Like previous studies, knowledge in the diagnosis and treatment of anaphylaxis is scarce among Colombian physicians. The factors associated with said result are potentially modifiable.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/terapia , Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Medicina
11.
Rev Alerg Mex ; 66(1): 99-114, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31013411

RESUMO

Reactions to medications can occur through a mechanism mediated by immunoglobulin or otherwise, not both. Drug allergy is a type of adverse reaction to the drug and comprises a range of hypersensitivity reactions mediated by different immunological mechanisms with diverse clinical manifestations. A rate of 3.2 fatal cases of anaphylaxis associated with drugs per 100,000 inhabitants per year is estimated, which seems to be approximately 10 times higher in hospitalized patients. The incidence of perioperative anaphylactic reactions is estimated at 1 in 10,000-20,000 anesthetic procedures. The diagnosis is based on a careful clinical history and physical examination. In some cases, skin tests, progressive challenges and methods to induce tolerance to the medication may be required. In hospitalized patients and at perioperative intervals, muscle relaxants, neuroleptics and morphinomimetics are frequently used and adverse reactions may occur to these drugs. This review shows a general description of the reactions of these medications, emphasizes allergic reactions and analyzes strategies for the diagnosis and treatment of these reactions.


Assuntos
Anafilaxia/induzido quimicamente , Hipersensibilidade a Drogas/etiologia , Assistência Perioperatória , Medicamentos sob Prescrição/efeitos adversos , Anafilaxia/diagnóstico , Anafilaxia/terapia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Humanos , Derivados da Morfina/efeitos adversos , Síndrome Maligna Neuroléptica/etiologia , Fármacos Neuromusculares/efeitos adversos , Assistência Perioperatória/efeitos adversos , Síndrome da Serotonina/etiologia
12.
Int Arch Allergy Immunol ; 179(3): 201-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893687

RESUMO

BACKGROUND: Anaphylaxis is a severe and potentially fatal allergic disease or hypersensitivity reaction with variable clinical presentation. Biomarkers in anaphylaxis could be useful to improve diagnosis, to allow endotyping of patients, and to predict risk. OBJECTIVE: To investigate the role of serum basal tryptase (sBT) levels in the management of patients with anaphylaxis. METHODS: Patients with at least 1 episode of anaphylaxis were selected among those who attended the Allergy Clinics of the Clinical Hospital of the Ribeirão Preto Medical School, University of São Paulo, Brazil, upon evaluation by allergy/immunology specialists of our medical staff. Demographic and clinical data were obtained using a structured questionnaire. sBT levels were determined using the ImmunoCAP Tryptase immunoassay. RESULTS: 57 patients (56.1% female) with a median age of 35 years (range 7-87 years) participated in the study. sBT levels ranged from 2.57 to 21.19 ng/mL (mean 5.17 ng/mL), with no significant differences in patients with anaphylaxis due to different triggers. Mean levels were 4.93; 5.2; 5.41, and 5.24 ng/mL for patients who had anaphylaxis due to Hymenoptera venom (n = 17), foods (n = 13), drugs (n = 13), and idiopathic disease (n = 14), respectively. Significantly higher sBT levels were observed in patients with severe anaphylaxis (grade IV) than in patients with mild-moderate disease (grades II/III) (mean levels 6.61 vs. 4.71 ng/mL, respectively). CONCLUSION: High sBT levels may help to identify patients at increased risk of more severe anaphylaxis, prompting physicians to initiate immediate therapy to avoid further acute episodes.


Assuntos
Anafilaxia/sangue , Triptases/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anafilaxia/terapia , Animais , Biomarcadores/sangue , Criança , Hipersensibilidade a Drogas/sangue , Hipersensibilidade a Drogas/terapia , Feminino , Hipersensibilidade Alimentar/sangue , Hipersensibilidade Alimentar/terapia , Humanos , Himenópteros/imunologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
13.
Br J Anaesth ; 123(1): e104-e109, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30916025

RESUMO

Simulation-based education is often highlighted as a method to prepare health personnel to handle clinical emergencies through repeated training and the design of supports. As one of the most common clinical emergencies in anaesthesia, anaphylaxis is often included in simulation scenarios at both graduate and postgraduate levels. Case reviews of anaphylaxis management continue to identify deficiencies in clinical responses. We evaluated the evidence to support the use of simulation to address these deficiencies. We undertook a comprehensive review of the MEDLINE and Embase databases with MESH terms 'Anaphylaxis', 'Anaesthesia', 'Simulation training', and variations of these terms. Articles were also searched from reference lists in the identified papers. A total of 39 articles on perioperative anaphylaxis simulation were identified, with most focusing on the clinical skills of individuals. However, anaphylaxis scenarios are also being used in assessment of teams and in the evaluation of broader system performance. Many countries mandate simulation training and competency assessment at graduate and postgraduate levels: despite this, none of the articles linked simulation training or assessment with improved patient management or outcomes. We found evidence that in situ simulation and use of cognitive aids lead to improved teamwork and task performace. Quantitative and qualitative evidence for simulation-based perioperative training is limited. Future studies should investigate whether simulation training in perioperative anaphylaxis, particularly in situ simulation, translates into improved patient management and outcomes.


Assuntos
Anafilaxia/terapia , Anestesiologia/educação , Competência Clínica , Complicações Intraoperatórias/terapia , Simulação de Paciente , Complicações Pós-Operatórias/terapia , Educação em Enfermagem , Humanos
15.
PLoS One ; 14(2): e0211949, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730977

RESUMO

OBJECTIVE: Opportunity exists to reduce unnecessary hospitalizations for children with anaphylaxis given wide variation in admission rates across U.S. emergency departments (EDs). We sought to identify children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies, as these patients may be candidates for ED discharge rather than inpatient hospitalization. METHODS: We conducted a single-center retrospective cohort study of children 1-21 years of age hospitalized with anaphylaxis from 2009 to 2016. Acute inpatient therapies included intramuscular (IM) or racemic epinephrine, bronchodilators, fluid boluses, vasopressors, non-invasive ventilation, or intubation. We derived age-specific (pre-verbal [<36 months] vs. verbal [≥ 36 months]) prediction rules using recursive partitioning to identify children at low risk of receiving acute inpatient therapies. RESULTS: During the study period 665 children were hospitalized for anaphylaxis, of whom 108 (16.2%) received acute inpatient therapies. The prediction rule for patients < 36 months (no wheezing, no cardiac involvement [hypotension or wide pulse pressure]) had a sensitivity of 90.5% (CI 69.6-98.8%) and a negative predictive value of 98.3% (CI 94.1-99.8%) for identifying children at low risk of receipt of acute inpatient therapies during hospitalization. For children ≥ 36 months, the prediction rule (no wheezing, no cardiac involvement, presence of gastrointestinal symptoms) had a sensitivity of 90.8% (CI 82.7-96.0%) and a negative predictive value of 92.4% (CI 85.6-96.7%). CONCLUSIONS: We derived age specific prediction rules for children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies. These children may be candidates for ED discharge rather than inpatient hospitalization.


Assuntos
Manuseio das Vias Aéreas/métodos , Anafilaxia/terapia , Broncodilatadores/administração & dosagem , Epinefrina/administração & dosagem , Vasoconstritores/administração & dosagem , Adolescente , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Feminino , Hospitalização , Humanos , Lactente , Injeções Intramusculares , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Vasoconstritores/uso terapêutico , Adulto Jovem
16.
Pediatr Allergy Immunol ; 30(3): 269-276, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30734362

RESUMO

Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life-threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug-induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non-steroidal anti-inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate-onset drug-induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children.


Assuntos
Anafilaxia/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Anafilaxia/induzido quimicamente , Anafilaxia/terapia , Criança , Pré-Escolar , Dessensibilização Imunológica/métodos , Diagnóstico Diferencial , Hipersensibilidade a Drogas/terapia , Humanos , Fatores de Risco , Testes Cutâneos/métodos
17.
Arch Dis Child ; 104(1): 83-90, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29909382

RESUMO

Anaphylaxis is a serious systemic allergic reaction that is rapid in onset and may cause death. Despite numerous national and international guidelines and consensus statements, common misconceptions still persist in terms of diagnosis and appropriate management, both among healthcare professionals and patient/carers. We address some of these misconceptions and highlight the optimal approach for patients who experience potentially life-threatening allergic reactions.


Assuntos
Anafilaxia , Administração dos Cuidados ao Paciente , Pediatria , Anafilaxia/etiologia , Anafilaxia/terapia , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Pediatria/métodos , Pediatria/normas
19.
Pediatr Emerg Care ; 35(1): 28-31, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28398938

RESUMO

OBJECTIVES: The objective of this study was to describe the quality of emergency department (ED) care for pediatric patients with anaphylaxis. The secondary objectives were to describe (1) the clinical presentation of pediatric patients with anaphylaxis including the proportion of patients meeting each of the National Institute of Allergy and Infectious Diseases (NIAID) consensus criteria and subcriteria and (2) the Interrater reliability (IRR) for applying the NIAID criteria. METHODS: We conducted a retrospective cross-sectional chart review of patients seen in a pediatric ED during a 2-year period. All charts were reviewed by a trained chart reviewer with 10% abstracted by a second reviewer. Data were analyzed using descriptive statistics including proportions, medians, and interquartile range. Interrater reliability was calculated using Cohen unweighted κ or percent agreement. RESULTS: Of the 250 charts reviewed, 84% (211) met the NIAID criteria for anaphylaxis (IRR, 1.0). Only 68% of patients received epinephrine in the ED or within 3 hours of the ED visit. Adherence was poor and IRR was variable, for measures reflecting documentation of discharge instructions and follow-up with a specialist. The IRR of reviewers for determining which patients met the NIAID criteria overall and for each subcriterion was high. CONCLUSIONS: Our findings highlight a gap between best practice and ED care. In addition, our results suggest that the NIAID criteria can reliably be used to retrospectively identify pediatric patients with anaphylaxis. Accurately identifying cases is a prerequisite for measuring gaps in management and developing interventions to improve care.


Assuntos
Anafilaxia/diagnóstico , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Anafilaxia/terapia , Criança , Pré-Escolar , Consenso , Estudos Transversais , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA