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epinephrine in anaphylaxis

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https://www.readbyqxmd.com/read/29040433/low-end-tidal-co2-as-a-real-time-severity-marker-of-intra-anaesthetic-acute-hypersensitivity-reactions
#1
A Gouel-Chéron, L de Chaisemartin, F Jönsson, P Nicaise-Roland, V Granger, A Sabahov, M-T Guinnepain, S Chollet-Martin, P Bruhns, C Neukirch, D Longrois
Background: Prompt diagnosis of intra-anaesthetic acute hypersensitivity reactions (AHR) is challenging because of the possible absence and/or difficulty in detecting the usual clinical signs and because of the higher prevalence of alternative diagnoses. Delayed epinephrine administration during AHR, because of incorrect/delayed diagnosis, can be associated with poor prognosis. Low end-tidal CO2 (etCO2) is known to be linked to low cardiac output. Yet, its clinical utility during suspected intra-anaesthetic AHR is not well documented...
October 10, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29017902/small-percentage-of-anaphylactic-reactions-treated-with-epinephrine-during-food-challenges-in-dutch-children
#2
Johanna P M van der Valk, Irene Berends, Roy Gerth van Wijk, Nicolette J T Arends, Maurits S van Maaren, Hans de Groot, Harry J Wichers, Joyce A M Emons, Anthony E J Dubois, Nicolette W de Jong
BACKGROUND: Severe allergic reactions, including anaphylaxis, occur during oral food challenges (OFCs) and the first-line treatment of anaphylaxis is epinephrine. OBJECTIVE: To evaluate the percentage of anaphylactic reactions treated with epinephrine during OFCs and to identify associated factors for the administration of epinephrine. METHODS: Children who underwent an OFC with peanut, hazelnut, cow's milk, hen's egg, or cashew nut from 2005 through 2015 in the Netherlands were evaluated...
October 7, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28965631/drug-induced-anaphylaxis
#3
REVIEW
Marcelo Vivolo Aun, Jorge Kalil, Pedro Giavina-Bianchi
Drugs are among the main triggers of anaphylaxis, but identification of the culprit drug is frequently difficult. To confirm diagnosis of the causative agent, medical records and clinical history are fundamental. There are a few in vitro tests available in clinical practice, such as serum-specific IgE and basophil activation test. Skin tests are often useful for the diagnosis, although drug challenge is indicated in patients with inconclusive clinical history or to provide safe alternatives. Treatment of anaphylaxis is standard and intramuscular epinephrine is the main agent to prevent morbidity and mortality...
November 2017: Immunology and Allergy Clinics of North America
https://www.readbyqxmd.com/read/28958374/contemporary-issues-in-anaphylaxis-and-the-evolution-of-epinephrine-autoinjectors-what-will-the-future-bring
#4
Paul A Greenberger, Dana V Wallace, Phillip L Lieberman, Sean M Gregory
BACKGROUND: Food allergy and anaphylaxis appear to be increasing in the United States, especially in young children, and preparedness is paramount to successful emergency management in the community. Although the treatment of choice for anaphylaxis is epinephrine delivered by autoinjection, some devices are challenged by less user-friendly designs or pose the risk of injury, especially in young patients. Human factors engineering has played a larger role in the development of more recent epinephrine autoinjector technologies and will continue to play a role in the evolution and future design of epinephrine autoinjectors...
October 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28956131/biphasic-and-protracted-anaphylaxis-to-iodinated-contrast-media
#5
Tae-Hyung Kim, Soon Ho Yoon, Suh-Young Lee, Young Hun Choi, Chang Min Park, Hye-Ryun Kang, Sang-Heon Cho
OBJECTIVES: To investigate the prevalence of biphasic and protracted anaphylaxis to iodinated contrast media (ICM), their risk factors and practical observation duration for detecting biphasic reaction. METHODS: 145 patients with ICM anaphylaxis from January 2005-February 2016 were retrospectively categorised into uniphasic, biphasic (anaphylaxis recurrence within 72 h after resolution of initial anaphylaxis) and protracted (anaphylaxis >5 h) reaction groups...
September 27, 2017: European Radiology
https://www.readbyqxmd.com/read/28941390/severe-forms-of-food-allergy
#6
REVIEW
Emanuel Sarinho, Maria das Graças Moura Lins
OBJECTIVES: To guide the diagnostic and therapeutic management of severe forms of food allergy. DATA SOURCES: Search in the Medline database using the terms "severe food allergy," "anaphylaxis and food allergy," "generalized urticaria and food allergy," and "food protein-induced enterocolitis syndrome" in the last ten years, searching in the title, abstract, or keyword fields. SUMMARY OF DATA: Food allergy can be serious and life-threatening...
September 21, 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28941221/how-well-do-rheumatology-fellows-manage-acute-infusion-reactions-a-pilot-curricular-intervention
#7
Jason J Weiner, Amanda M Eudy, Lisa G Criscione-Schreiber
BACKGROUND: Infusible DMARDs are commonly prescribed in rheumatology and other fields. There are no published formal educational curricula rheumatology fellowship programs can use to teach infusion reaction management skills to fellows. We aimed to better understand this educational gap, and implement and assess the effectiveness of an experiential curriculum on acute infusion reaction management. METHODS: We included current rheumatology fellows and recent graduates from five fellowship programs...
September 21, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28938839/needle-length-for-epinephrine-prefilled-syringes-in-children-and-adolescents-is-it-one-inch
#8
Wiparat Manuyakorn, Buntita Bamrungchaowkasem, Nichanan Ruangwattanapaisarn, Wasu Kamchaisatian, Suwat Benjaponpitak
BACKGROUND: Intramuscular epinephrine is the first line drug in the treatment of anaphylaxis. This study was to identify the appropriateness of 1 inch needle length for epinephrine prefilled syringes in children. METHODS: Children aged 1 month to 18 years were enrolled. Skin to muscle depth (STMD) and skin to bone depth (STBD) were measured using an ultrasonography at the mid-anterolateral thigh. A 1 inch needle was considered as being appropriate if the STBD was more than 1 inch and the STMD was less than 1 inch...
September 17, 2017: Asian Pacific Journal of Allergy and Immunology
https://www.readbyqxmd.com/read/28928989/an-unusual-case-of-recurrent-hypersensitivity-reaction-associated-with-kounis-like-acute-coronary-syndrome
#9
Shanker Kundumadam, Vivek Reddy, Sagar Mallikethi Reddy, Pradeep Kathi, Aiden Abidov
There have been multiple reports of allergic reactions associated with acute coronary syndromes. This has been classically described as Kounis syndrome. We present an unusual case of 70-year-old male with multiple prior hypersensitivity reactions and history of coronary artery bypass grafting who presented recurrent episode of severe angioedema and anaphylaxis. He responded to epinephrine but subsequently developed a non-ST elevation myocardial infarction with worsening heart failure. Our case is unique in that, unlike classic Kounis syndrome, the acute coronary event in this case did not present concurrently with the allergic reaction; rather it took nearly 48 hours to present...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28916424/predictors-of-epinephrine-dispensing-and-allergy-follow-up-after-emergency-department-visit-for-anaphylaxis
#10
Megan Motosue, M Fernanda Bellolio, Holly K Van Houten, Nilay D Shah, Ronna L Campbell
BACKGROUND: National guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (EAI) and referred to an allergy/immunology (A/I) specialist. OBJECTIVE: To evaluate guideline concordance and identify predictors of EAI dispensing and A/I follow-up in patients with anaphylaxis treated in the emergency department (ED). METHODS: We identified patients seen in the ED for anaphylaxis from 2010 through 2014 from an administrative claims database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm...
September 12, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28890861/idiopathic-anaphylaxis
#11
REVIEW
Bright I Nwaru, Sangeeta Dhami, Aziz Sheikh
Idiopathic anaphylaxis is a rare life-threatening disorder with symptoms similar to other forms of anaphylaxis. There is lack of a robust evidence base underpinning the treatment of anaphylaxis and even less so for idiopathic anaphylaxis. Much of the evidence therefore comes from relatively small case series and expert opinion. Idiopathic anaphylaxis is a diagnosis of exclusion, requiring a thorough history and careful diagnostic work-up investigating possible triggers and underlying predisposing factors. Key diagnostic tests include skin-prick testing, tests for specific-IgE, component-resolved diagnostics, and in some cases for allergen challenge tests...
2017: Current Treatment Options in Allergy
https://www.readbyqxmd.com/read/28888253/further-evaluation-of-factors-that-may-predict-biphasic-reactions-in-emergency-department-anaphylaxis-patients
#12
Sangil Lee, Alexa Peterson, Christine M Lohse, Erik P Hess, Ronna L Campbell
BACKGROUND: Anaphylaxis is a systemic allergic reaction that is commonly treated in the emergency department (ED). The risk of a biphasic reaction is the rationale for observation. OBJECTIVE: To derive a prediction rule to stratify ED anaphylaxis patients at risk of a biphasic reaction. METHODS: We conducted an observational study of a cohort of patients presenting to an academic ED with signs and symptoms of anaphylaxis. We collected clinical data on biphasic reactions meeting National Institutes of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network diagnostic criteria...
September 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28888249/do-corticosteroids-prevent-biphasic-anaphylaxis
#13
Waleed Alqurashi, Anne K Ellis
Anaphylaxis is a severe hypersensitivity reaction that is rapid in onset and can result in death. The pattern of an anaphylactic reaction can be uniphasic (or monophasic), biphasic (also called delayed or late phase), or refractory in nature. The most widely cited definition of biphasic anaphylaxis is a recurrence of anaphylactic symptoms after initial resolution despite no further exposure to the trigger. Corticosteroids are thought by some to prevent the development of biphasic symptoms and, therefore, commonly used in the emergency treatment of anaphylaxis but this has not been systemtically analyzed...
September 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28888248/epinephrine-autoinjectors-new-data-new%C3%A2-problems
#14
Susan Waserman, Ernie Avilla, Moshe Ben-Shoshan, Lana Rosenfield, Andrea Burke Adcock, Matthew Greenhawt
Epinephrine is the first-line treatment for anaphylaxis. Despite this, there have been identified gaps in the management of anaphylaxis including infrequent or delayed use of epinephrine for acute allergic reactions, as well as inadequate epinephrine autoinjector (EAI) training, and prescription rates of these devices for patients at risk. This paper reviews new data, and new problems in recently published literature on EAIs. A database search was conducted for publications between January 2015 and February 2017 using keywords related to EAIs including their functionality and features, carriage, prescription rates, barriers, and side effects...
September 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28888247/fatal-anaphylaxis-mortality-rate-and-risk-factors
#15
Paul J Turner, Elina Jerschow, Thisanayagam Umasunthar, Robert Lin, Dianne E Campbell, Robert J Boyle
Up to 5% of the US population has suffered anaphylaxis. Fatal outcome is rare, such that even for people with known venom or food allergy, fatal anaphylaxis constitutes less than 1% of total mortality risk. The incidence of fatal anaphylaxis has not increased in line with hospital admissions for anaphylaxis. Fatal drug anaphylaxis may be increasing, but rates of fatal anaphylaxis to venom and food are stable. Risk factors for fatal anaphylaxis vary according to cause. For fatal drug anaphylaxis, previous cardiovascular morbidity and older age are risk factors, with beta-lactam antibiotics, general anesthetic agents, and radiocontrast injections the commonest triggers...
September 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28884986/corticosteroids-in-management-of-anaphylaxis-a-systematic-review-of-evidence
#16
C K Liyanage, P Galappatthy, S L Seneviratne
As anaphylaxis is a medical emergency, there are no randomized controlled clinical trials on its emergency management. Therefore, current guidelines are mostly based on data from observational studies, animal and laboratory studies. Although epinephrine is the mainstay of recommended treatment, corticosteroids are also frequently used. This review evaluates the evidence on the use of corticosteroids in emergency management of anaphylaxis from published human and animal or laboratories studies. Thirty original research papers were found with 22 human studies and eight animal or laboratory studies...
September 2017: European Annals of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28870153/myocardial-infarction-during-anaphylaxis-in-a-young-healthy-male-with-normal-coronary-arteries-is-epinephrine-the-culprit
#17
W D Jayamali, H M M T B Herath, Aruna Kulathunga
BACKGROUND: Anaphylaxis is an acute, potentially fatal medical emergency. Myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis syndrome or it can also be due to the effect of epinephrine treatment. Epinephrine is considered as the cornerstone in management of anaphylaxis. Myocardial infarction secondary to therapeutic doses of adrenaline is a rare occurrence and only a few cases have been reported in literature...
September 4, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28845100/determination-of-the-enantiomeric-purity-of-epinephrine-by-hplc-with-circular-dichroism-detection
#18
Douglas Kirkpatrick, Jingyue Yang, Michael Trehy
Several hundred drug substances approved by the U.S. Food and Drug Administration are chiral molecules. For the enantiomeric purity assessment, current practice is to develop separation techniques using chiral columns or mobile phase modifiers to separate enantiomers before detection. An alternative approach is to use currently accepted HPLC assay methods and use chiral-specific detectors to confirm whether the correct enantiomer is present. In this paper, adding a circular dichroism (CD) detector to an achiral HPLC method from the US Pharmacopeia (USP) is shown to be amenable for the determination of the enantiomeric purity of epinephrine, a substance used to treat anaphylaxis...
2017: Journal of Liquid Chromatography & related Technologies
https://www.readbyqxmd.com/read/28818177/angioedema
#19
Janina Hahn, Thomas K Hoffmann, Bastian Bock, Melanie Nordmann-Kleiner, Susanne Trainotti, Jens Greve
BACKGROUND: Acute angioedema of the upper airways can be life-threatening. An important distinction is drawn between mast-cell-mediated angioedema and bradykinin-mediated angioedema; the treatment of these two entities is fundamentally different. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed and on guidelines concerning the treatment of angioedema. The authors draw on their own clinical experience in their assessment of the literature...
July 24, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28800865/anaphylaxis
#20
REVIEW
Daniel LoVerde, Onyinye I Iweala, Ariana Eginli, Guha Krishnaswamy
Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting; however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU...
August 8, 2017: Chest
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