Retrospective study on the use of epinephrine in patients with drug-induced anaphylactic shock in Chongqing from 2015 to 2022 / 中国药房

OBJECTIVE To evaluate the rationality of epinephrine in the treatment of drug-induced anaphylactic shock， and to provide a reference for further standardizing the treatment measures of anaphylactic shock. METHODS According to the relevant data of the reports of severe adverse drug reaction （ADR） of drug-induced anaphylactic shock provided by Chongqing ADR Monitoring Center from 2015 to 2022， the selection of treatment drugs， and the application of epinephrine in anaphylactic shock were analyzed retrospectively； the clinical outcomes of anaphylactic shock with different epinephrine administration methods were investigated. RESULTS A total of 1 415 cases of severe ADR related to drug-induced anaphylactic shock were reported， with a male-to-female ratio of 1.04∶1； the drugs that caused allergic shock mainly included anti-infective drugs （47.92%）， TCM injections （9.12%）； the patients who suffered from drug-induced anaphylactic shock within 10 min after medication accounted for 43.96%； 97.24% of patients were cured or improved， and 2.76% of patients died or did not been improved. Among 1 415 patients， 63.39% of patients were treated with epinephrine， and the patients who preferred epinephrine treatment accounted for 53.14%； the intramuscular injection， subcutaneous injection， intravenous injection and intravenous drip accounted for 33.78%， 30.32%， 25.75% and 1.23%， respectively. The initial dose range of epinephrine was 0.01-10 mg， and the most frequent single dose was 1 mg （44.70%）. Excessive single doses of intramuscular injection， subcutaneous injection and intravenous injection accounted for 51.03% （148 cases）， 53.13% （136 cases） and 91.47% （193 cases） respectively， and the risk of overdose in intravenous injection was higher （P＜0.05）. The patients receiving initial treatment with epinephrine had a higher improvement rate/cure rate than those who did not use epinephrine （98.14% vs. 96.23%， P＝0.029）； the patients who preferred epinephrine had a higher improvement rate/cure rate than those who did not preferred epinephrine （98.14% vs. 95.17%， P＝0.031）； the improvement rate/cure rate of patients receiving intramuscular injection of epinephrine was higher than those without intramuscular injection （99.01% vs. 96.69%， P＝0.038）. CONCLUSIONS There are some unreasonable phenomena in the treatment of drug-induced anaphylactic shock， such as inappropriate selection of drugs， insufficient use of epinephrine， delay of administration， inappropriate route of administration and excessive single dose.

Reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos en dos hospitales de Guinea Bissau

RESUMEN Introducción: la seguridad durante los procedimientos médicos o quirúrgicos se ve amenazada por la anafilaxia. Objetivo: evaluar el cuadro clínico, método de estudio y eventual resultado de la reexposición en pacientes con reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en 11 pacientes con diagnóstico de anafilaxia en el curso de una intervención quirúrgica o proceder médico, en los hospitales Militar Principal y Nacional Simão Méndes, de Guinea Bissau, entre 2018 y 2020. Se evaluaron las variables: edad, sexo, procedimiento, método anestésico, antecedentes alérgicos, gravedad de la anafilaxia y agente causal. Resultados: de los 11 pacientes estudiados, 10 tuvieron reacciones en procedimientos quirúrgicos. La media de edad fue de 46,09 años, con una relación por sexo de 0,57 casos masculinos por cada caso femenino. Cinco pacientes (45,45 %) desarrollaron el grado máximo de severidad de la anafilaxia. Los agentes anestésicos fueron la causa de la anafilaxia en dos de los cuatro pacientes sometidos al método de anestesia general y en dos de los cinco sometidos al método de anestesia regional. Por su parte, el látex resultó ser el agente causal en el 45,45 % de los pacientes. Conclusiones: la apropiada identificación de las reacciones anafilácticas durante su aparición, constituye la piedra angular de la actuación médica. En cualquier caso, conllevará estudios alergoanestésicos posteriores que definan el agente causal.

ABSTRACT Introduction: safety during medical or surgical procedures is threatened by anaphylaxis. Objective: to evaluate the clinical characteristics, study method and eventual outcome of re-exposure in patients with anaphylactic and allergic reactions during medical or surgical procedures. Materials and methods: a quantitative, observational and descriptive study was carried out in 11 patients with a diagnosis of anaphylaxis in the course of a surgical intervention or medical procedure, in the Main Military Hospital and the National Hospital Simão Méndes, of Guinea Bissau between 2018 and 2020. The evaluated variables were: age, sex, procedure, anesthetic method, allergic history, severity of anaphylaxis and causal agent. Results: of the 11 patients studied, 10 had reactions in surgical procedures. The mean age was 46.09 years with a sex ratio of 0.57 male cases for each female case. Five patients (45.45 %) developed the maximum degree of anaphylaxis severity. Anesthetic agents were the cause of anaphylaxis in two of the four patients who underwent the general anesthesia method, and in two of the five who underwent the regional anesthesia method. Latex was found to be the causal agent in 45.45 % of the patients. Conclusions: the proper identification of anaphylactic reactions during their appearance is the cornerstone of medical action. In any case, subsequent allergo-anesthetic studies would be needed to define the causative agent.

Indigo Carmine Hemodynamic Studies to Treat Vasoplegia Induced by Compound 48/80 in a Swine Model of Anaphylaxis

Abstract Introduction: There are many reasons to believe that the nitric oxide/guanosine 3'5' - cyclic monophosphate (or NO/cGMP) pathway on vasoplegic states is underestimated. To study indigo carmine (IC) as an alternative to methylene blue was the investigation rationale. Methods: The IC (3mg/kg intravenous infusion) study protocol included five experimental groups; 1) Control group — saline was injected at 0 and 10 minutes; 2) IC group — IC was injected at 0 and saline at 10 minutes; 3) compound 48/80 (C48/80) group — C48/80 was injected at 0 minute and saline at 10 minutes; 4) C48/80 + IC group — C48/80 was injected at 0 minute and IC at 10 minutes; and 5) IC + C48/80 group — IC was injected at 0 minute and C48/80 at 10 minutes. The studies were carried out by registering and measuring hemodynamic and blood gasometric parameters, including continuous cardiac output. Results: 1) The effects of the drugs (IC and C48/80) were more evident in the first 20 minutes of recording; 2) hypotensive responses were more pronounced in the C48/80 groups; 3) IC isolated or applied before C48/80 caused transient pulmonary hypertension; and 4) after the first 20 minutes, the pressure responses showed stability with apparent hypotension more pronounced in the C48/80 groups. Clinical observations showed significant hemodynamic instability and catastrophic anaphylactic reactions (agitation, pulmonary hypertension, severe bronchospasm, urticaria, high-intensity cyanosis, violent gastric hypersecretion, and ascites). Conclusion: A global results analysis showed differences between groups only in the first 20 minutes of the experiments.

Investigation and management of an anaphylactic shock case after inoculation with COVID-19 vaccine / 上海预防医学

Anaphylactic shock is a serious and rare adverse reaction， which can be life-threatening if not treated in time. COVID-19 vaccine is a newly marketed vaccine， and people pay high attention to its adverse reactions. This report summarized the investigation and management process of a case of anaphylactic shock after inoculation with COVID-19 vaccine， in order to provide reference for standardizing the diagnosis and management of anaphylactic shock after vaccination.

Reacción de hipersensibilidad secundaria al uso de bloqueadores neuromusculares / Hypersensitivity reaction secondary to the use of neuromuscular blockers

Resumen: Introducción: La anafilaxia perioperatoria constituye una condición clínica potencialmente letal. La causa más frecuente se atribuye a los bloqueadores neuromusculares. Objetivo: Identificar la incidencia de reacciones anafilácticas secundarias al uso de bloqueadores neuromusculares. Material y métodos: Se realizó una investigación descriptiva, observacional, de corte transversal para evaluar la incidencia de reacciones anafilácticas secundarias al uso de bloqueantes neuromusculares. El estudio se realizó en el Hospital «Hermanos Ameijeiras¼ en el período comprendido entre enero de 2016 y diciembre de 2018. Resultados: Del total de intervenciones quirúrgicas electivas, 3,431 requirieron anestesia general y el uso de bloqueadores neuromusculares. Predominó el sexo femenino en 75% de los casos, el grupo etario de 60 años y más con 68 pacientes (32.7%), el estado físico ASA II, 98 pacientes (41.1%). La media del IMC fue de 22.7 ± 1.14. La media del tiempo quirúrgico fue de 190 ± 42.5 min. De todos los fármacos el más utilizado fue el atracurio en 90 pacientes (43.3%) seguido del vecuronio 79 (38.0%) y el rocuronio 39 (18.8%). El número de eventos adversos fue escaso. Sólo se encontraron cuatro, dos con atracurio (50%), uno con rocuronio y uno con vecuronio 25% respectivamente. Conclusiones: Se constató la presencia de reacciones anafilácticas por el uso de bloqueadores neuromusculares, mismas que se manifestaron en un corto período al inicio de la inducción. El atracurio presentó la mayor frecuencia y todas fueron de intensidad leve.

Abstract: Introduction: Perioperative anaphylaxis is a potentially lethal clinical condition. The most frequent cause is attributed to neuromuscular blockers. Objective: To identify the incidence of anaphylactic reactions secondary to the use of neuromuscular blockers. Material and methods: A descriptive, observational, cross-sectional investigation was conducted to assess the incidence of anaphylactic reactions secondary to the use of neuromuscular blockers. The study was carried out at the «Hermanos Ameijeiras¼ Hospital, in the period between january 2016 and december 2018. Results: Of the total elective surgical interventions, 3,431 required general anesthesia and the use of neuromuscular blockers. The female sex predominated with 75%, the age group of 60 years and over with 68 patients (32.7%), ASA II physical condition, 98 patients (41.1%). The average BMI was 22.7 ± 1.14. The mean surgical time was 190 ± 42.5 min. Of all the drugs the most used was atracurium in 90 patients (43.3%), followed by vecuronium 79 (38.0%) and rocuronium 39 (18.8%). The number of adverse events was low. Only four were found, two with atracurium (50%), one with rocuronium and one with 25% vecuronium respectively. Conclusions: The presence of anaphylactic reactions was observed with the use of neuromuscular blockers, which occurred in a short period at the beginning of induction. The atracurium presented the highest frequency and all were of mild intensity.

Analysis of a Rare Case of Cerebral Infarction Secondary to Anaphylactic Shock Caused by Nicotinic Acid Injection / 中国药房

OBJECTIVE：To provide reference for safe use of Nicotinic acid injection in the clinic. METHODS ：The clinical pharmacist introduced the occurrence and treatment of cerebral infarction secondary to anaphylactic shock caused by Nicotinic acid injection in a patient with hypertension in the cardiovascular medicine department of our hospital. By consulting the relevant drug instructions and searching the relevant literatures ，the inducement and severity of ADR were evaluated ，and the rational drug use suggestions of Nicotinic acid injection were put forward. RESULTS & CONCLUSIONS ：According to the Management Measures for ADR Reporting and Monitoring ，the correlation between anaphylactic shock and Nicotinic acid injection was analyzed and evaluated as “very likely ”. Secondary cerebral infarction was mainly associated with a variety of risk factors （hypertension， hyperlipidemia，etc.），among which there was a greater possibility of secondary cerebral infarction due to insufficient cerebral perfusion caused by anaphylactic shock and sharp drop of blood pressure. The above symptoms could be life-threatening if not rescued in time ，which was defined as “severe ADR ”. Clinical pharmacists suggest that when using Nicotinic acid injection ，the patient’s allergy history should be inquired in detail ，the use should be started from a small dose ，and the patient ’s reaction should be closely monitored in the early stage of medication. For patients with high-risk factors of cerebrovascular diseases （hypertension， hyperlipidemia，etc.），if anaphylactic shock occurs ，the effective circulating blood volume should be restored as soon as possible. After the blood pressure rises ，drugs such as improving microcirculation can be used to prevent secondary cerebral infarction. Clinical pharmacists should timely carry out medication education for such patients ，and warn patients to inform doctors of the related drugs with severe ADR in the later stage of treatment ，so as to prevent the recurrence of anaphylactic shock and severe complications. At the same time ，when antihypertensive drugs and statins are combined ，the blood pressure monitoring and the monitoring of ADR such as muscle toxicity should be strengthened，so as to ensure the medication safety of patients.

Anti-anaphylactic potential of benzoylpaeoniflorin through inhibiting HDC and MAPKs from Paeonia lactiflora / 中国天然药物

Guided by cell-based anti-anaphylactic assay, eighteen cage-like monoterpenoid glycosides (1-18) were obtained from the bioactive fraction of P. lactiflora extract. Among these, compounds 1, 5, 6, 11, 12, 15, and 17 significantly reduced the release rate of β-HEX and HIS without or with less cytotoxicity. Furthermore, the most potent inhibitor benzoylpaeoniflorin (5) was selected as the prioritized compound for the study of action of mechanism, and its anti-anaphylactic activity was medicated by dual-inhibiting HDC and MAPK signal pathway. Moreover, molecular docking simulation explained that benzoylpaeoniflorin (5) blocked the conversion of L-histidine to HIS by occupying the HDC active site. Finally, in vivo on PCA using BALB/c mice, benzoylpaeoniflorin (5) suppressed the IgE-mediated PCA reaction in antigen-challenged mice. These findings indicated that cage-like monoterpenoid glycosides, especially benzoylpaeoniflorin (5), mainly contribute to the anti-anaphylactic activity of P. lactiflora by dual-inhibiting HDC and MAPK signal pathway. Therefore, benzoylpaeoniflorin (5) may be considered as a novel drug candidate for the treatment of anaphylactic diseases.

Piperacillin and Its Compound Preparation-induced Anaphylactic Shock ：A Case Report and Literature Analysis / 中国药房

OBJECTIVE：To i nvestigate the clini cal ch aracteristics of anaphylactic shock induced by piperacillin and its compound preparation ，and to provide reference for prevention and treatment of the severe ADR. METHODS ：A case of anaphylactic shock induced by piperacillin and sulbactam were analyzed in our hospital ，meanwhile ADR literatures about piperacillin alone and its compound preparation-induced anaphylactic shock were collected from Medline ，CNKI，Wanfang database and VIP during the inception to Jul. 2020. Gender and age of patients ，allergic history ，primary disease and treatment ，skin test ， administration route and dosage of piperacillin and its compound preparation ，occurrence time and main manifestations of anaphylactic shock ，treatment measure and prognosis were analyzed ，then prevention and treatment suggestions were put forward. RESULTS：The patient in this case was transferred to the ICU after partial hepatectomy. The use of piperacillin and sulbactam to prevent postoperative infection caused anaphylactic shock. A total of 28 literatures about anaphylactic shock induced by piperacillin and its compound preparations were collected from the database （involving 28 patients）. Among totally 29 patients，there were 12 male and 17 female；the majority of patients were 50-59 years old （6 cases，20.69％）. Three patients had allergic history （food， latex gloves ，etc.），and most of the primary diseases were infectious diseases or the drug used in perioperative period. Skin tests were carried out in 22 patients（75.86％）before medication and the results were negative. The possible allergenic drugs of 27 cases which were administered by intravenous route included piperacillin ，piperacillin sulbactam and piperacillin tazobactam. The dosage was different according to the primary disease and severity. 14 patients（55.56％）developed anaphylactic shock within 5 minutes after drug exposure. The main symptoms were systemic allergic reaction ，mainly involving the circulatory system. Except for two death cases ，the other patients ’symptoms were relieved after treatment. CONCLUSIONS ：Allergic history and skin test results may have limitation in predicting anaphylactic shock induced by piperacillin and its compound preparation. Close monitoring needs to be taken in patients during these medications. Rescue therapy should be prepared in advance and countermeasures need to be carried out promptly in case of anaphylactic shock.

Anafilaxia y anafiláctico / Anaphilactic shock and anaphilaxis

Anaphylaxis is a life-threatening clinical condition that results from the activation of mast cells/basophils, inflammatory pathways, or both. It can be specific (allergic), or non-specific (non-allergic). Most anaphylaxis are mediated by IgE, but there are also some mediated by IgM and complement activation. Incidence is about 1:10,000 anesthesia. Recent studies show that the drugs or substances mostly implicated in producing perioperative anaphylaxis are: neuromuscular blockers (60.6%), antibiotics (18.2%), patent blue dye (5.4%) and latex (5.2%). However, all drugs and substances used during anesthesia and surgery, perhaps with the sole exception of inhalation agents and crystalloids, have been reported as potentially causes of anaphylaxis. The clinical presentation is multisystemic, producing signs and symptoms mainly on skin, respiratory, cardiovascular, gastrointestinal and central nervous systems. In its advanced phase, it may evolve to anaphylactic shock, causing tissue hypoperfusion and leading to altered cell integrity and multiple organ failure, associated with high mortality. Diagnosis is based on clinical presentation (history and clinical manifestations), biological evidence (serum tryptase levels, serum histamine levels and search for specific IgE) and allergological evidence (skin tests, provocation test, mediator release tests and tests of activation of basophils). Treatment include 3 stages: general measures, first-line or primary treatment and second-line or secondary treatment. General measures consist of: Trendelenburg position, invasive monitoring (according to the severity of the clinical presentation), 100% oxygen administration, discontinuation of drugs and/or suspected agents and asking for help. The primary treatment is epinephrine in doses proportional to the clinical manifestations, airway support, 100% oxygen and aggressive resuscitation with intravenous fluids. Secondary treatment includesadministration of bronchialodilators, corticosteroids, and antihistamines.

Una anafilaxia es una condición clínica potencialmente mortal que resulta de la activación específica (alérgica), o no específica (no alérgica) de mastocitos/ basófilos, vías inflamatorias o ambos. La mayoría de las anafilaxias son mediadas por IgE, pero también las hay por IgM y activación del complemento. Su incidencia es de 1:10.000 anestesias. En los últimos estudios, los fármacos o sustancias más implicadas en producir anafilaxia perioperatoria son los bloqueadores neuromusculares (60,6%), los antibióticos (18,2%), las tinturas azules (5,4%) y el látex (5,2%), sin embargo, todas las drogas y sustancias usadas durante la anestesia y la cirugía, tal vez con la única excepción de los agentes inhalatorios y los cristaloides, han sido reportadas como potencialmente causantes de anafilaxia. El cuadro clínico es multisistémico, originando signos y síntomas centrados en la piel y los sistemas respiratorio, cardiovascular, gastrointestinal y nervioso central. En su fase avanzada puede evolucionar a anafiláctico, causando hipoperfusión tisular y llevando a alteración en la integridad celular y falla de múltiples órganos, con alta mortalidad asociada. El diagnóstico se basa en evidencias clínicas (historia y manifestaciones clínicas), evidencias biológicas (niveles de triptasa sérica, de histamina sérica y búsqueda de IgE específicas) y evidencias alergológicas (pruebas cutáneas, test de provocación, pruebas de liberación de mediadores y pruebas de activación de basófilos. El tratamiento incluye 3 etapas: medidas generales, tratamiento de primera línea o primario y tratamiento de segunda línea o secundario. Las medidas generales consisten en poner al paciente en posición de Trendelemburg, iniciar monitorización invasiva según la intensidad del cuadro clínico, administración de oxígeno al 100%, discontinuación de drogas y/o agentes posiblemente incriminados y pedir ayuda. El tratamiento primario es la adrenalina, en dosis proporcionales a las manifestaciones clínicas, el soporte de la vía aérea manteniendo el oxígeno ql 100% y la reanimación agresiva con fluidos endovenosos. El tratamiento secundario incluye la administración de broncodilatadores, corticoesteroides y antihistamínicos.

Manejo anestésico de paciente con mastocitosis cutánea / Anaesthetic managemet of cutaneous mastocytosis

Mastocytosis consists of a heterogeneous group of disorders characterized by an abnormal increase of mast cell in one or more organs or tissues. The degranulation of mast cells with subsequent clinical symptoms can be triggered by psychological, chemical or traumatic agents. The main challenge of these patients is to avoid these triggers in order to prevent an anaphylactic shock. We report a case of a patient diagnosed with cutaneous mastocytoses who underwent urgent appendicectomy. Their perioperative management involves a multidisciniplinary approach. We report the anaesthetic management in this disease.

Las mastocitosis son un grupo heterogéneo de enfermedades que se caracterizan por la proliferación de mastocitos y su posterior acumulación. La degranulación de los mastocitos puede desencadenarse por diferentes agentes como la cirugía, el estrés o los fármacos histaminoliberadores. El principal reto que plantea a un anestesiólogo un paciente con mastocitosis es la posibilidad de que se desencadene una reacción anafiláctica. Se describe el manejo anestésico de un paciente con mastocitosis cutánea. El desconocimiento de esta entidad puede suponer un aumento de la morbimortalidad de estos pacientes.

DNA Methylation Differences in Peripheral Blood of Patients with Anaphylaxis / 法医学杂志

Objective To study the DNA methylation of nucleated cells in peripheral blood of patients died from anaphylactic shock caused by cephalosporin drugs and to provide a new research direction and basis for the forensic diagnosis of shock caused by drug hypersensitiveness. Methods Methylation microarray was used to detect DNA methylation of nucleated cells in peripheral blood of patients died from anaphylactic shock caused by cephalosporin drugs and normal subjects. Sequencing data and chip data were analyzed for differences in DNA methylation using R language methylkit, ChAMP package. Random forest algorithm was used to evaluate the importance of the DNA methylation differential sites. Results Differential sites of DNA methylation highly associated with anaphylaxis caused by cephalosporin drugs were obtained at loci such as ETS1, PRR23B and GNAS. Conclusion Cephalosporin allergy is associated with DNA methylation, and DNA methylation may be a new strategy for forensic identification of anaphylactic shock and death.

Evaluation of Diagnosis and Management of Anaphylactic shock in Emergency Room

Background: Anaphylaxis is the most severe form of an allergic reaction. The incidence rate of anaphylaxisenhanced during the last decade. Death may happen in fatal anaphylactic shocks within minutes of the reaction.Hence, it is needed to highlight the significance of effective emergency management. Objective: In thisinvestigation, we aimed to discuss the important aspects of anaphylaxis shock diagnosis and management in theemergency room. Method: PubMed database was used for article selection, and the following keywords wereused in the mesh: "anaphylaxis management in emergency room"[Mesh] and “anaphylactic shock managementin emergency room"[Mesh]. A total of 20 papers were reviewed and included in the research. Conclusion: Theessential manifestations of anaphylactic reactions are on the skin, in the gastrointestinal tract, respiratory tract,and cardiovascular system. The symptoms may begin and progress very quickly, in which the condition candeteriorate dramatically into death within a few minutes. Then, a physician should be skilled and prepared forsuch cases. The most noteworthy drug in the acute remedy of anaphylaxis is adrenaline as it is a lifesaving drugin cases of anaphylaxis.

Vitamin K induced anaphylactic reaction in a child: a case report

Vitamin-K is commonly indicated in pediatric patients with coagulation disorders, hepatic disease, warfarin toxicity, sepsis-induced disseminated reaction. Minor complications are very well known, but anaphylactic reactions are rarely reported in children. We present a case of a 13-year-old child who developed anaphylactic reaction following intravenous administration of Vitamin-K. He was managed with Inj. Adrenaline 0.35mg IM, Inj. Avil 22mg IV slowly over 20 mins, Nebulization with salbutamol 1mg. The reaction was most probably due to an anaphylactic reaction to Vitamin-K.

Systematic Retrospective and Review of Anaphylactic Shock Induced by Cefazolin Sodium with Negative Skin Test / 中国药学杂志

OBJECTIVE: To systematicly review and analyse the clinical characteristics of anaphylactic shock induced by cefazolin sodium with negative skin test, and provide a basis for the safe and reasonable application of cefazolin sodium. METHODS: Databases of PUBMED, EMBASE, CBM, CNKI, VIP and WANFANG data(from built to October 2017)were conducted for case reports published in English or Chinese involving anaphylactic shock induced by cefazolin sodium. Literatures were screened, extracted and statistic analysed by two authors independently. RESULTS: A total of 1 358 literatures were searched out and 18 were included involving 20 patients, the median age was 39.0 years, 60.0% of the patients had no history of penicillin or drug allergy, and 30.0% of the patients had used penicillin or cephalosporin antibiotics, and intravenous infusion was the main route of administration. Anaphylactic shock occurred within 30 min accouted for 47.6%, and the longest time occurred on the 7th day of medication. The clinical manifestations were mainly circulatory system damage, and the rescue measures included discontinuation of medicine immediately, prostration, establishment of intravenous channels, oxygen uptake, administration of vasoactive drugs and glucocorticoids, etc., all of which were eventually successfully rescued.The correlation evaluation of ADR was definite and probable in 1 and 19 cases, respectively. CONCLUSION: High attention should be put on anaphylactic shock induced by cefazolin sodium with negative skin test. The proportion of young people and immediate anaphylactic shock were high.The cefazolin sodium skin test is of little value in predicting anaphylaxis. History of medication and allergies of patients should be taken in detail before medication, and the whole-process of medication, especially within 30 min should be closely monitored. Emergency rescue measures of anaphylactic shock should be prepared in advance.

Glucocorticoid use in amniotic fluid embolism / 中国实用妇科与产科杂志

This paper discussed the use of glucocorticoids in amniotic fluid embolism treatment by analyzing the pathophysiological basis of amniotic fluid embolism and the pharmacological effects of glucocorticoids,and expounded the viewpoints and controversial issues supporting the application of glucocorticoids in amniotic fluid embolism.The conclusion is that there is no evidence to support the conventional use of glucocorticoids in the treatment of amniotic fluid embolism,although there is theoretical basis.It is controversial to use or not use large doses of glucocorticoids.

Anaphylactic shock after sugammadex administration, induced by formation of a sugammadex-rocuronium complex: a case report / 대한마취과학회지

BACKGROUND: Sugammadex is a reversal agent for non-depolarizing neuromuscular blockers and widely used worldwide on account of its rapid and effective reversal from neuromuscular blockade, despite its advantages, multiple cases of sugammadex-induced anaphylactic shock have been reported. CASE: A 42-year-old man developed anaphylactic shock in the postanesthesia care unit. Initially, sugammadex was suspected as the causative agent, but an intradermal skin test revealed negative results. A further skin test was performed with sugammadex-rocuronium complex that yielded positive results. CONCLUSIONS: Anesthesiologists and healthcare providers should be aware of the possibility of anaphylaxis from the sugammadex-rocuronium complex, as well as from sugammadex or rocuronium alone.

Anafilaxia em serviços de emergência: constante desafio para clínicos e equipe de saúde / Anaphylaxis in emergency services: a constant challenge for clinicians and health staff

Introdução: a anafilaxia é uma reação alérgica sistêmica grave, de início rápido e potencialmente fatal. A despeito da gravidade e da intensidade das reações anafiláticas, os sinais e sintomas desta síndrome são subestimados e não são reconhecidos por pacientes e por médicos. Objetivo: revisar os aspectos principais da epidemiologia, diagnóstico e tratamento da anafilaxia em sala de emergências. Metodologia: foi realizada busca de estudos publicados na língua inglesa, nas bases de dados PUBMED/ MEDLINE que discorressem sobre o tema anafilaxia. Os estudos foram selecionados após a definição dos DeCS e MeSH: alergia, hipersensibilidade, choque anafilático, emergência e morte. Estes termos foram cruzados por meio do chaveador boleano (AND). Os dados foram coletados no período de maio de 2017 a agosto de 2017. Conclusão: a anafilaxia caracteriza-se por ser uma síndrome sistêmica, multiorgânica, potencialmente fatal porem ainda de difícil diagnóstico. Epinefrina constitui-se o tratamento de escolha na emergência.

Introduction: anaphylaxis is a serious, early-onset and potentially fatal systemic allergic reaction. Despite the severity and intensity of anaphylactic reactions, the signs and symptoms of this syndrome are underestimated and are not recognized by patients and physicians. Objective: to review the main aspects of epidemiology, diagnosis and treatment of anaphylaxis in an emergency room. Methodology: a search was made for studies published in the English language, in PUBMED / MEDLINE databases that discuss the topic of anaphylaxis. The studies were selected after the definition of DeCS and MeSH: allergy, hypersensitivity, anaphylactic shock, emergency and death. These terms were crossed by the boolean switch (AND). The data were collected from May 2017 to August 2017. Conclusion: anaphylaxis is characterized by a systemic, multiorganic syndrome, potentially fatal but difficult to diagnose. Epinephrine is the treatment of choice in the emergency room.

Anaphylactic reaction/angioedema associated with jellyfish sting

Abstract The most frequent jellyfish in Southern Brazil causes mainly local pain and skin plaques. A 3-year-old female bather presented an erythematous, irregular plaque on the left forearm after contact with a jellyfish and intense facial angioedema with facial flushing. The lungs had vesicular murmur, wheezes, and snorts, and pink and spumous secretion in the airways with intercostal retraction. She was administered subcutaneous adrenaline (0.1mg/kg) and hydrocortisone intravenous (10mg/kg) with total recovery in a few minutes. The manifestations of anaphylactic reactions are distinct from those of envenomations, and prompt and adequate care is fundamental in these situations.

Epinephrine combined with acupuncture therapy can treat anaphylactic shock mice through nuclear factor-κB signaling pathway: a rat experimental result / 中华危重病急救医学

Objective To explore the therapeutic effect of epinephrine combined with acupuncture on anaphylactic shock and its mechanism. Methods Sixty male Kunming mice were randomly divided into normal saline (NS) group, anaphylactic shock model group, and integrated traditional Chinese and Western medicine treatment group with 20 mice in each group. The anaphylactic shock model was reproduced by egg albumin infusion: intraperitoneal injection of 0.25 mL egg albumin (0.01 mmol/L), repeated injection 1 week later, and intravenous injection of 0.5 mL egg albumin through caudal vein on the 3rd week to induce anaphylactic shock. The mice in the NS group were injected with NS. The mice in the treatment group were immediately subcutaneously injected with 0.2 μg of 0.1% epinephrine, and intraperitoneally injected with aminophylline 0.2 mg, combined with acupuncture at Shuigou, Neiguan and Hegu points. Number of died mice in each group were observed at 1, 6, and 12 hours after model reproduction. The mice were sacrificed at 12 hours, the blood was harvested, and the serum tryptase, immunoglobulin E (IgE), tumor necrosis factor-α (TNF-α), interleukins (IL-1 and IL-6) were determined by enzyme linked immunosorbent assay (ELISA). The lung tissues were harvested, and the protein expressions of p65, phosphorylation of p65 (p-p65), and phosphorylation of nuclear factor-κB inhibitor α (p-IκBα) were determined by Western Blot. Results No mice died in the NS control group at 12 hours. In the treatment group, the mortality at 12 hours was significantly lower than that in the model group (10% vs. 80%, P < 0.01). The levels of tryptase and IgE in the model group were significantly higher than those in the NS control group [tryptase (μg/L): 1.53±0.28 vs. 0.91±0.23, IgE (μg/L): 33.3±3.1 vs. 21.3±1.9, both P < 0.01], both levels in the treatment group were significantly lower than those in the model group [tryptase (μg/L): 1.31±0.26 vs. 1.53±0.28, IgE (μg/L): 25.6±2.2 vs. 33.3±3.1, both P < 0.05]. The levels of TNF-α, IL-1 and IL-6 in the model group were significantly higher than those in the NS control group [TNF-α (ng/L): 35.3±4.7 vs. 16.4±3.5, IL-1 (ng/L): 13.8±3.3 vs. 4.2±1.8, IL-6 (ng/L): 15.3±4.8 vs. 5.5±2.1, all P < 0.01]. The serum inflammatory factors of the treatment group were significantly higher than those of the model group [TNF-α (ng/L): 26.1±4.3 vs. 35.3±4.7, IL-1 (ng/L): 7.2±2.7 vs. 13.8±3.3, IL-6 (ng/L): 8.8±3.8 vs. 15.3±4.8, all P < 0.05]. It was shown by Western Blot results that there was no significant difference in p65 protein expression of the lung tissue among the three groups. In the NS control group, the expression of p-p65 protein in the nucleus of the lung tissue was extremely low but was significantly increased in the model group, and p-p65 protein in the treatment group was significantly decreased as compared with that in the model group. The expression tendency of p-IκBα protein was consistent with that of p-p65. Conclusion Epinephrine combined with acupuncture plays a therapeutic role in mice with anaphylactic shock by inhibiting the activation of NF-κB signaling pathway.

A pediatric case of anaphylactic shock induced by tipepidine hibenzate (Asverin)

Tipepidine hibenzate (Asverin) is commonly used as an antitussive drug for acute and chronic cough in various age groups and is generally safe and well-tolerated. However, we experienced a case of tipepidine hibenzate-induced anaphylactic shock in a 1-year-old boy. After ingesting cold medication including tipepidine hibenzate, the patient presented with generalized erythema and urticaria, swollen face, coughing, wheezing and vomiting, together with hypotension and a decreased level of consciousness. To identify the culprit drug, we performed skin prick tests (SPTs) and oral drug provocation tests (DPTs). SPTs revealed a negative reaction for all drugs, but DPTs caused a positive reaction only for a full therapeutic dose of tipepidine hibenzate. Physicians need to consider tipepidine hibezate as a culprit drug when anaphylaxis occurs after taking anticough or common cold medication.