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1.
Chinese Journal of Pediatrics ; (12): 447-451, 2022.
Article in Chinese | WPRIM | ID: wpr-935718

ABSTRACT

Objective: To analyze the clinical features of IgE-mediated cow's milk protein allergy (CMPA) in children aged 0-5 years. Methods: This cross-sectional study collected the data on children diagnosed with CMPA in the Department of Allergy at the Children's Hospital of the Capital Institute of Pediatrics from October 2019 to November 2020 and improved peripheral blood routine,total IgE defection, milk specific IgE (sIgE) defection,SPT and milk component defection,diagnosis of severe anaphylaxis based on clinical manifestations. Rank-sum test and chi-square test are used for statistical analysis of clinical characteristics between groups. Results: A total of 106 children (67 boys and 39 girls) were enrolled with the age of 15 (8, 34) months, including 42 cases (≤ 1 year of age), 39 cases (>1-<3 years of age) and 25 cases(≥3 years of age), the onset age of 6 (5, 8) months. Among them, 95 cases (89.6%) were reacted after consuming milk or its products, 42 cases (39.6%) had reaction due to skin contact and 11 cases (10.4%) reacted after exclusive breastfeeding. The onset time of milk product consumption was 45 (1, 120) min, skin contact pathway was 10 (5, 30) min and symptoms in breastfeeding pathway was 121 (61, 180) min. There was statistical difference among the time of symptoms (χ2=77.01, P<0.001).The cutaneous reaction was most common (100 cases, 94.3%), followed by digestive (20 cases, 18.9%) and respiratory (16 cases, 15.1%), and the nervous symptoms (1 case, 0.9%) were uncommon and 24 cases (22.6%) had at least one episode of anaphylaxis. There were 87 cases (82.1%) also diagnosed with other food allergies, 94 cases (88.7%) with previous eczema, 57 cases (53.8%) with history of rhinitis, and 23 cases (21.7%) with history of wheezing. The total IgE level was 191.01 (64.71, 506.80) kU/L, and the cow's milk sIgE level was 3.03 (1.11, 15.24) kU/L. The maximum diameter of the wheal in SPT was 8.2 (4.0, 12.0) mm. Component resolved diagnosis showed that 77 cases (81.9%) were sensitized to at least one out of 4 main components, including casein, α lactalbumin, β lactoglobulin and bovine serum albumin.The possibility of anaphylaxis in children with milk sIgE grade Ⅳ-Ⅵ was higher than that in children with grade 0-Ⅲ (57.7% (15/26) vs. 12.5% (10/80), OR=9.545, 95%CI 3.435-26.523). Children with milk SPT ≥+++ had a higher probability of anaphylaxis than those with milk SPT ≤++ (34.4% (11/32) vs. 11.5% (3/26), OR=4.016, 95%CI 0.983-16.400). Anaphylaxis were more common in α lactalbumin positive children than in negative children (34.3% (13/38) vs. 14.2% (8/56), χ2=1.23,P=0.042). Conclusions: CMPA in children has early onset and diversified clinical manifestations, which are mainly cutaneous symptoms. Most children are sensitized to at least one allergen component. Serum sIgE level, SPT reaction and allergen components play important roles in the diagnosis and evaluation of CMPA, and higher milk sIgE level may predict a higher risk of anaphylaxis.


Subject(s)
Allergens , Anaphylaxis/etiology , Animals , Cattle , Child , Cross-Sectional Studies , Female , Humans , Immunoglobulin E , Lactalbumin , Male , Milk Hypersensitivity/diagnosis , Skin Tests
2.
Rev. bras. anestesiol ; 70(6): 642-661, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155771

ABSTRACT

Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.


Resumo Este segundo documento, escrito por especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória, tem por objetivo revisar os mecanismos fisiopatológicos, agentes desencadeantes (em adultos e crianças), assim como a abordagem diagnóstica durante e após o episódio. Por se tratar de uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados, e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.


Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as Topic
3.
Rev. bras. anestesiol ; 70(5): 534-548, Sept.-Oct. 2020. tab
Article in English | LILACS | ID: biblio-1143957

ABSTRACT

Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.


Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.


Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as Topic
4.
Einstein (Säo Paulo) ; 18: eRC5478, 2020. graf
Article in English | LILACS | ID: biblio-1142868

ABSTRACT

ABSTRACT A 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.


RESUMO Paciente do sexo masculino, 33 anos, com asma e rinite alérgica desencadeadas por ácaros, relatou episódio de angioedema facial e labial, dispneia, tosse e disfagia aos 25 anos, minutos após a ingestão de uma pizza de cogumelo ( Agaricus bisporus ). O paciente negou consumo de medicamentos, picadas de himenópteros, ou quaisquer outros possíveis desencadeadores ou cofatores que pudessem estar presentes. Desde então, evita todos os tipos de cogumelos, até a ocorrência de um contato acidental com molho de cogumelo, que resultou em angioedema labial minutos após. O estudo imunoalergológico incluiu doseamento de IgE total e específica para cogumelos, testes cutâneos para aeroalérgenos, possíveis alérgenos alimentares e extrato de cogumelos, teste prick to prick com A. bisporus cru e cozido e teste de SDS-PAGE immunoblotting . O estudo revelou IgE específica para cogumelos de 0,76kUA/L, teste cutâneo positivo para extrato de cogumelos e teste prick to prick positivo para A. bisporus branco e castanho (cru e cozido). O immunoblotting identificou duas proteínas de ligação de IgE, de 10kDa e 27kDa. Relatamos, assim, um caso de anafilaxia por ingestão de A. bisporus , provavelmente explicado por sensibilização primária a cogumelos. Detectamos duas proteínas IgE-reativas de 10kDa e 27kDa como os possíveis alérgenos responsáveis.


Subject(s)
Humans , Animals , Male , Adult , Cats , Agaricus , Deglutition Disorders/etiology , Cough/etiology , Dyspnea/etiology , Food Hypersensitivity/immunology , Anaphylaxis/etiology , Angioedema/etiology , Immunoglobulin E/blood , Skin Tests , Allergens , Alternaria , Flour , Anaphylaxis/chemically induced
5.
Rev. bras. oftalmol ; 78(6): 399-402, nov.-dez. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1057915

ABSTRACT

Resumo A síndrome de Marfan é uma doença de herança autossômica dominante e que afeta o tecido conjuntivo com manifestações fenotípicas que envolvem os sistemas esquelético, cardiovascular e ocular. As principais manifestações oculares são a subluxação do cristalino, a miopia e o descolamento da retina. O objetivo deste artigo foi relatar a conduta clínico-cirúrgica de um paciente portador da síndrome de Marfan com cristalino luxado para a cavidade vítrea e que evoluiu com severa reação facoanafilática caracterizada por um glaucoma secundário severo e descompensação corneana.


Abstract Marfan syndrome is an autosomal dominant inheritance disease that affects connective tissue with phenotypic manifestations involving the skeletal, cardiovascular and ocular systems. The main ocular manifestations are the subluxation of the lens, myopia and retinal detachment. The aim of this article was to report the clinical and surgical management of a patient with Marfan syndrome with luxated lens for the vitreous cavity and who developed a severe phacoanaphylactic reaction characterized by severe secondary glaucoma and corneal decompensation.


Subject(s)
Humans , Male , Middle Aged , Lens Subluxation/complications , Lens Subluxation/etiology , Anaphylaxis/etiology , Marfan Syndrome/complications , Vitrectomy/methods , Vitreous Body/surgery , Visual Acuity , Corneal Edema/etiology , Glaucoma/etiology , Lens Subluxation/surgery , Lens Subluxation/diagnosis , Vision, Low , Ultrasonography , Lens Implantation, Intraocular/methods , Eye Pain , Slit Lamp Microscopy , Intraocular Pressure
6.
Säo Paulo med. j ; 137(3): 295-297, May-June 2019. tab
Article in English | LILACS | ID: biblio-1020953

ABSTRACT

ABSTRACT CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.


Subject(s)
Humans , Female , Adult , Skin Tests/methods , Latex Hypersensitivity/diagnosis , Anaphylaxis/etiology , Occupational Diseases/etiology , Latex Hypersensitivity/complications , Anaphylaxis/diagnosis , Occupational Diseases/diagnosis
8.
Rev. Soc. Bras. Med. Trop ; 51(1): 115-117, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-897045

ABSTRACT

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.


Subject(s)
Humans , Animals , Female , Bites and Stings/complications , Cnidaria/classification , Cnidarian Venoms , Anaphylaxis/etiology , Angioedema/etiology , Anaphylaxis/diagnosis , Angioedema/diagnosis
9.
Rev. chil. enferm. respir ; 34(1): 48-54, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959407

ABSTRACT

Resumen Las reacciones de hipersensibilidad a corticoides son raras en la población general, se dividen en dos categorías: Inmediatas, típicamente mediadas por Inmunoglobulina E (IgE), donde se incluye la anafilaxia luego de la administración de un fármaco en un corto período. Su prevalencia descrita es de 0,3-0,5%. Otra reacción es la 'no inmediata', que se manifiesta en un tiempo mayor de una hora después de la administración del fármaco. Se revisó la literatura con el objetivo de mejorar y aclarar el tratamiento en pacientes asmáticos que poseen esta condición. Se encontró que las vías posibles para generar estas reacciones son intranasal, aerosol por inhalador, oral y parenteral. Frente a esta condición se requiere una evaluación estrecha y detallada de la historia clínica, síntomas y reacciones secundarias al fármaco sospechoso. Finalmente, al momento de elegir tipo de corticoide a usar es primordial la seguridad del paciente logrando, además, el control de la enfermedad.


Hypersensitivity reactions to corticosteroids are rare in the general population, they fall into two categories: 'immediate', typically mediated by immunoglobulin E (IgE), which includes anaphylaxis after administration of a drug in a short period of time. Its reported prevalence is 0.3-0.5%. Another reaction is 'not immediate', which manifests itself in a time longer than one hour after the administration of the drug. We reviewed the literature with the aim of improving and clarifying the treatment in asthmatic patients with this condition. It was found that the possible routes to generate these reactions are intranasal, aerosol by inhaler, oral and parenteral. Facing this condition requires a close and detailed evaluation of the clinical history, symptoms and side reactions to the suspected drug. Finally, when choosing which corticosteroid to use, the patient's safety is paramount, and control of the disease is also essential.


Subject(s)
Humans , Female , Aged , Asthma/physiopathology , Nebulizers and Vaporizers , Hypersensitivity/diagnosis , Anaphylaxis/diagnosis , Anaphylaxis/therapy , Immunoglobulin E/immunology , Immunoglobulin E/blood , Adrenal Cortex Hormones/deficiency , Albuterol/administration & dosage , Anaphylaxis/etiology
10.
Medicina (B.Aires) ; 77(5): 382-387, oct. 2017. tab
Article in Spanish | LILACS | ID: biblio-894504

ABSTRACT

Las reacciones anafilácticas intraoperatorias son impredecibles, infrecuentes y pueden poner en riesgo al paciente. Tienen una incidencia de 1/10 000 a 1/20 000 produciéndose en la mayoría de los casos por bloqueantes musculares, látex y antibióticos. No hay estadística de las reacciones alérgicas sistémicas durante otros procedimientos médicos. El estudio diagnóstico posterior a una reacción es complejo debiendo incluir toda la medicación utilizada en el procedimiento. En este estudio retrospectivo describimos 15 pacientes, de los cuales 10 tuvieron reacciones anafilácticas en un procedimiento quirúrgico, 2 en endoscopías y 1 en una ecografía transvaginal. Los dos pacientes restantes presentaron una reacción alérgica sistémica durante una ecografía transvaginal y un procedimiento odontológico. Estudiamos los pacientes con toda la medicación utilizada, incluimos látex y, eventualmente, los detergentes y desinfectantes, de haber sido empleados. Tres de las 10 cirugías no pudieron realizarse por desarrollarse la reacción durante la inducción anestésica, en cinco casos debieron interrumpirse y solo en dos se terminaron. Las reacciones posteriores a endoscopías fueron severas, requiriendo internación en terapia intensiva; las reacciones en ecografías transvaginales y procedimientos odontológicos fueron asistidas en emergencias. Los agentes causales en las cirugías incluyeron bloqueantes musculares, látex, cefalosporina, azul patente y ranitidina; en endoscopías el agente causal fue el orto-ftalaldehído (OPA), en las ecografías transvaginales el látex y en el procedimiento odontológico la amoxicilina. El objetivo de este artículo es describir la etiología de las reacciones alérgicas sistémicas y anafilácticas intraoperatorias y en procedimientos médicos, recalcando su gravedad y la necesidad de su identificación.


Anaphylaxis during anesthesia is an unpredictable, severe, and rare reaction. It has an incidence of 1/10 000 to 1/20 000 surgeries. In most series, the responsible drugs include neuromuscular blocking agents, latex, or antibiotics. The frequency and etiology of systemic allergic reactions in other medical procedures are largely unknown. The identification of responsible drugs of anaphylaxis is a complex task, requiring testing of all medications and substances used during surgery. We describe our experience in a retrospective study of 15 patients. Ten subjects developed anaphylaxis during surgery, two in endoscopic studies and one in a trans-vaginal ultrasound. The remaining two subjects, one in a trans-vaginal ultrasound and another during a dental procedure had a systemic allergic reaction. We studied all patients with all medications administered during the procedures, including latex and detergents and disinfectants. Three surgeries had to be suspended at induction of anesthesia, five were stopped incomplete and two were completed. Both patients that presented a reaction during endoscopy required intensive care unit admission and the rest were observed in a Hospital. The responsible drugs during surgery anaphylaxis were neuromuscular blocking agents, latex, patent blue, and ranitidine. Ortho-phthalaldehyde (OPA) was identified during endoscopic studies; latex was responsible in transvaginal ultrasounds; and amoxicillin in the dental procedure. The aim of the present article is to review our experience studying allergic systemic reactions and anaphylaxis during general anesthesia and medical procedures, emphasizing the severity of these reactions and the need for causative drug identification.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Echocardiography, Transesophageal/adverse effects , Endosonography/adverse effects , Endoscopy/adverse effects , Hypersensitivity/etiology , Anaphylaxis/etiology , Intraoperative Complications/etiology , Surgical Procedures, Operative/adverse effects , Retrospective Studies
11.
Arch. argent. pediatr ; 115(2): e89-e91, abr. 2017.
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838344

ABSTRACT

La alergia al huevo es una de las alergias alimentarias más frecuentes durante la niñez, junto con la alergia a la leche de vaca. La vacuna triple viral (VTV), contra el sarampión, la rubéola y las paperas, es parte del calendario de vacunación pediátrica y contiene proteína de huevo. La recomendación aceptada en la actualidad es que la VTV debe administrarse en una sola dosis y bajo supervisión médica en los pacientes con alergia al huevo. Si bien se ha informado que la VTV es segura para estos pacientes, algunos tuvieron anafilaxia. En general, la anafilaxia después de una vacunación previa se considera una contraindicación. En este artículo, presentamos el caso de la administración satisfactoria de la VTV mediante el incremento gradual de la dosis a una paciente que tuvo anafilaxia después de una vacunación previa.


Egg allergy is one of the most common food allergies during childhood along with cow's milk allergy. The measles-mumps-rubella (MMR) vaccine is included in the pediatric immunization schedule and contains egg protein. The currently accepted opinion is that the MMR vaccination should be done in a single dose under medical observation in patients with egg allergy. Although it is reported that the MMR vaccine is safe for that patients, there are some patients who developed anaphylaxis. Generally, the development of anaphylaxis after the previous vaccination is reported as a contraindication. We present a successful administration of MMR vaccine by gradually increased doses for a patient who developed anaphylaxis after the previous vaccination.


Subject(s)
Humans , Female , Infant , Measles-Mumps-Rubella Vaccine/administration & dosage , Anaphylaxis/etiology , Measles-Mumps-Rubella Vaccine/adverse effects , Egg Hypersensitivity/complications
13.
J. pediatr. (Rio J.) ; 93(supl.1): 53-59, 2017. tab
Article in English | LILACS | ID: biblio-894081

ABSTRACT

Abstract 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. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Conclusion: Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.


Resumo Objetivos: Abordar o manejo diagnóstico e terapêutico das formas graves de alergia alimentar. Fontes dos dados: Busca ativa na base de dados Medline dos termos severe food allergies, anaphylaxis and food allergy e food protein-induced enterocolitis nos últimos dez anos e com busca nos campos título, resumo ou palavra-chave. Síntese dos dados: A alergia alimentar pode ser grave e ameaçadora à vida. Leite, ovo, amendoim, castanha, noz, trigo, gergelim, crustáceo, peixe e frutas podem precipitar emergências alérgicas. A gravidade das reações vai depender de fatores associados, tais como idade, uso de medicamentos no início da reação, persistência de asma e/ou rinite alérgica grave, história de prévia anafilaxia, exercício e doenças intercorrentes. Para anafilaxia, a adrenalina intramuscular é uma indicação bem estabelecida. Para o tratamento da síndrome da enterocolite induzida pela proteína alimentar na fase aguda no setor de emergência, fazem-se necessárias a pronta reposição hidroeletrolítica e a administração de metilprednisolona e odansetrona IV. Importante recomendar ao paciente com o diagnóstico de alergia alimentar grave que mantenha a dieta de exclusão, procure acompanhamento especializado e, naqueles que apresentaram anafilaxia, enfatizar a necessidade de portar adrenalina. Conclusão: Alergia alimentar grave pode se manifestar como anafilaxia ou síndrome da enterocolite induzida por proteína alimentar em fase aguda, as quais, por serem condições cada vez mais presentes e reconhecidas no setor de emergência pediátrica, demandam diagnóstico e tratamento imediatos.


Subject(s)
Humans , Enterocolitis/etiology , Food Hypersensitivity/diagnosis , Food Hypersensitivity/physiopathology , Food Hypersensitivity/therapy , Anaphylaxis/etiology , Syndrome , Severity of Illness Index , Enterocolitis/diagnosis , Enterocolitis/therapy , Anaphylaxis/diagnosis , Anaphylaxis/therapy
14.
Arch. argent. pediatr ; 114(3): e195-e198, jun. 2016. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838226

ABSTRACT

La anafilaxia es una reacción de hipersensibilidad sistemica y grave, de inicio rápido y potencialmente mortal. En los recién nacidos prematuros, el sistema inmunitario aún no ha madurado y, por lo tanto, tienen menos probabilidades de presentar anafilaxia. La administración de amikacina, que contenía metabisulfito de sodio, a un prematuro de 3 días de vida le indujo anafilaxia casi mortal. Debido a que se sospechaba un caso de anafilaxia, se inició la administración de amikacina en el bebé. Una vez comenzado el tratamiento, se observó una mejoría clínica. Al tercer día de tratamiento con amikacina, el recién nacido tuvo, repentinamente, taquipnea, taquicardia, angioedema y cianosis. Se le diagnosticó anafilaxia y se inició el tratamiento. Una hora después de la mejoría clínica, se produjo una reacción tardía. Inmediatamente, se intubó al recién nacido. La anafilaxia es una emergencia médica; por lo tanto, los médicos deben realizar una evaluación rápida y atenta para detectar esta reacción potencialmente mortal. Incluso después del tratamiento satisfactorio de la anafilaxia, el paciente debe permanecer bajo observación durante 72 horas dada la posibilidad de una reacción bifásica.


Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction.


Subject(s)
Humans , Male , Infant, Newborn , Sulfites/adverse effects , Amikacin/adverse effects , Anaphylaxis/etiology , Anti-Bacterial Agents/adverse effects , Infant, Premature
15.
Rev. bras. cir. cardiovasc ; 31(3): 226-231, May.-June 2016. tab, graf
Article in English | LILACS | ID: lil-796123

ABSTRACT

ABSTRACT Objective: To examine if methylene blue (MB) can counteract or prevent protamine (P) cardiovascular effects. Methods: The protocol included five heparinized pig groups: Group Sham -without any drug; Group MB - MB 3 mg/kg infusion; Group P - protamine; Group P/MB - MB after protamine; Group MB/P - MB before protamine. Nitric oxide levels were obtained by the nitric oxide/ozone chemiluminescence method, performed using the Nitric Oxide Analizer 280i (Sievers, Boulder, CO, USA). Malondialdehyde plasma levels were estimated using the thiobarbiturate technique. Results: 1) Groups Sham and MB presented unchanged parameters; 2) Group P - a) Intravenous protamine infusion caused mean arterial pressure decrease and recovery trend after 25-30 minutes, b) Cardiac output decreased and remained stable until the end of protamine injection, and c) Sustained systemic vascular resistance increased until the end of protamine injection; 3) Methylene blue infusion after protamine (Group P/MB) - a) Marked mean arterial pressure decreased after protamine, but recovery after methylene blue injection, b) Cardiac output decreased after protamine infusion, recovering after methylene blue infusion, and c) Sustained systemic vascular resistance increased after protamine infusion and methylene blue injections; 4) Methylene blue infusion before protamine (Group MB/P) - a) Mean arterial pressure decrease was less severe with rapid recovery, b) After methylene blue, there was a progressive cardiac output increase up to protamine injection, when cardiac output decreased, and c) Sustained systemic vascular resistance decreased after protamine, followed by immediate Sustained systemic vascular resistance increase; 5) Plasma nitrite/nitrate and malondialdehyde values did not differ among the experimental groups. Conclusion: Reviewing these experimental results and our clinical experience, we suggest methylene blue safely prevents and treats hemodynamic protamine complications, from the endothelium function point of view.


Subject(s)
Animals , Female , Protamines/antagonists & inhibitors , Enzyme Inhibitors/pharmacology , Hemodynamics/drug effects , Heparin Antagonists/administration & dosage , Methylene Blue/pharmacology , Swine , Endothelium, Vascular/drug effects , Protamines/adverse effects , Central Venous Pressure/drug effects , Models, Animal , Heparin Antagonists/adverse effects , Anaphylaxis/etiology , Anaphylaxis/prevention & control , Malondialdehyde/blood , Nitric Oxide/blood
16.
Rev. bras. anestesiol ; 65(4): 292-297, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-755137

ABSTRACT

BACKGROUND AND OBJECTIVE:

Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.

CONTENT:

The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.

CONCLUSION:

The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

.

ANTECEDENTES E OBJETIVO:

A anafilaxia continua sendo uma das causas potenciais de morte perioperatória, pois geralmente não é prevista e evolui rapidamente para uma situação ameaçadora da vida. Uma revisão da anafilaxia perioperatória é feita.

CONTEÚDO:

O exames diagnósticos são importantes principalmente para evitar eventos posteriores. Os pilares do tratamento são a adrenalina e os líquidos intravenosos.

CONCLUSÃO:

O anestesiologista deve estar familiarizado com o diagnóstico oportuno, manejo e monitoramento da anafilaxia perioperatória.

.

ANTECEDENTES Y OBJETIVO:

La anafilaxia sigue siendo una de las causas potenciales de muerte perioperatoria por ser generalmente no anticipada, y progresar rápidamente a una situación amenazante de la vida. Se realiza una revisión de la anafilaxia perioperatoria.

CONTENIDO:

Las pruebas diagnósticas son importantes principalmente para evitar eventos posteriores. Los pilares del tratamiento son la adrenalina y los líquidos intravenosos.

CONCLUSIÓN:

El anestesista debe estar familiarizado con el diagnóstico oportuno, manejo y seguimiento de la anafilaxia perioperatoria.

.


Subject(s)
Humans , Hypersensitivity, Immediate/epidemiology , Anaphylaxis/epidemiology , Intraoperative Complications/epidemiology , Epinephrine/administration & dosage , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Drug Hypersensitivity/epidemiology , Fluid Therapy/methods , Hypersensitivity, Immediate/diagnosis , Hypersensitivity, Immediate/etiology , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Intraoperative Complications/diagnosis , Anesthesiology/methods
17.
An. bras. dermatol ; 90(3,supl.1): 22-25, May-June 2015. ilus
Article in English | LILACS | ID: lil-755782

ABSTRACT

Abstract

Ants are social insects with species of medical interest, such as the fi re ants (Solenopsis sp.). The sting causes inflammation, vesicles and sterile pustules, which may cause allergic phenomena and even anaphylactic shock. We describe a patient who suffered a large number of stings and an episode of syncope with fall in blood pressure and complete regression of symptoms after resuscitation and medication for anaphylaxis. Considering the clinical manifestations and images of wheals and blisters on the patient’s feet at the time of syncope, this report should serve as a warning for the diagnosis and treatment of this condition and even for counseling and prevention regarding patients exposed to this risk.

.


Subject(s)
Adult , Animals , Female , Humans , Ants , Anaphylaxis/etiology , Ant Venoms/poisoning , Insect Bites and Stings/complications , Anaphylaxis/physiopathology , Insect Bites and Stings/physiopathology , Syncope/etiology , Time Factors
18.
Ann Card Anaesth ; 2015 Apr; 18(2): 261-264
Article in English | IMSEAR | ID: sea-158192

ABSTRACT

Anaphylactic shock is a life‑threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine‑containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm‑induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance.


Subject(s)
Anaphylaxis/etiology , Amiodarone/etiology , Angina Pectoris, Variant/epidemiology , Defibrillators/etiology , Epinephrine/etiology , Heart-Assist Devices/etiology , Myocardial Infarction/epidemiology
19.
Annals of Thoracic Medicine. 2014; 9 (1): 42-44
in English | IMEMR | ID: emr-139570

ABSTRACT

Food-dependent exercise-induced anaphylaxis [FDEIA] is one of the severe allergic reactions in which symptoms develop only if exercise takes place within a few hours of eating a specific food. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food [s]. We herein report the first two cases of FDEIA in the Middle East. The first one is induced by wheat, while the other by peanut. The pathophysiology, predisposing factors, diagnosis, and treatment of FDEIA are also summarized here


Subject(s)
Humans , Male , Female , Anaphylaxis/etiology , Allergens/adverse effects , Hypersensitivity , Review Literature as Topic , Exercise , Radioallergosorbent Test , Skin Tests
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