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1.
Article in Chinese | WPRIM | ID: wpr-942066

ABSTRACT

OBJECTIVE@#To select and define the clinical questions and outcomes of Guideline for the Emergency Treatment of Anaphylaxis.@*METHODS@#A draft including clinical questions, which could be divided into foreground questions and background questions, and outcomes was drawn and revised by the secretary group for the guideline referring to the present guidelines with the guidance of a panel consisting of 7 experienced clinical medicine, pharmacy and nursing experts. Foreground questions and outcomes of the draft were voted into a final version after three rounds of counsels of 22 experienced medicine, pharmacy and nursing clinical experts using Delphi method including 3 rounds of inquiry. And the background questions were directly included in the guideline after the 22 experts' thorough revising. The research was carried out under the supervision of method ologists. Active coefficient, coefficient of variation and the frequencies of each score were calculated for quality control.@*RESULTS@#The draft of 34 foreground questions, 6 background questions and 6 outcomes was finally drawn up after thorough selecting and consulting. The 6 background questions revised by the clinical experts were all included. After three rounds of Delphi method, 28 pivotal clinical questions covering the diagnosis, preparation for the treatment, treatment and administration after the treatment, and 6 outcomes were defined and included for the guideline. The rest of the foreground questions, 4 of which were recognized as essential and 2 as important, were excluded from the guideline and left for further revising or updating. As for the outcomes, 4 of them were recognized as critical and the rest as important. The experts contributing to the research were active as the active coefficient reached 100%, and the degree of consensus was fine as the frequencies of the feedback scoring equal to or greater than 4 for all the 28 foreground questions included were greater than 75% and the result was settled in the first round. And 2 outcomes, fatality rate and severity, reached a higher degree of consensus with coefficient of variation less than 15%.@*CONCLUSION@#After thorough and rigorous selecting, the clinical questions and outcomes to be included in the Guideline for the Emergency Treatment of Anaphylaxis were finally selected and defined via Delphi method, guiding the future development of the guidelines.


Subject(s)
Anaphylaxis/therapy , Consensus , Delphi Technique , Emergency Treatment , Humans , Research Design
2.
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
3.
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
4.
Acta méd. (Porto Alegre) ; 33(1): [7], 21 dez. 2012.
Article in Portuguese | LILACS | ID: biblio-881487

ABSTRACT

O termo anafilaxia é amplamente utilizado para definir reações de hipersensibilidade graves e potencialmente fatais. As reações anafiláticas podem ser desencadeadas por diversos agentes etiológicos e apresentam sintomas de intensidade variável. A pronta suspeição e a conduta adequada, no atendimento de emergência, são imprescindíveis para a resolução favorável do quadro. Neste trabalho procuramos apresentar uma revisão atual sobre o diagnóstico e tratamento da anafilaxia, no contexto emergencial.


Anaphylaxia is defined as a serious, potentially fatal life-threatening hypersensitivity reaction. Anaphylaxis may be triggered by multiple agents and present with mild to severe intensity of symptoms. Prompt diagnosis and adequate treatment are vital to the resolution of the anaphylaxis. Here the authors review diagnosis criteria and emergency treatment of anaphylaxis.


Subject(s)
Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Epinephrine , Review
5.
Rev. méd. Minas Gerais ; 22(2)jun. 2012.
Article in Portuguese | LILACS | ID: lil-684757

ABSTRACT

Anafilaxia é uma reação de hipersensibilidade potencialmente grave, mediada por imunoglobulinas E e G, após exposição a antígeno em pessoas previamente sensibilizadas. As manifestações clínicas que provoca são multissitêmicas e inespecíficas, o que dificulta o seu diagnostico, podendo evoluir para colapso cardiovascular e insuficiência respiratória. O choque anafilático é distributivo, com importante componente hipovolêmico. A suspeição clínica imediata é fundamental, pois tem impacto no sucesso do tratamento. Este artigo objetiva rever o tema, ressaltando não apenas os sinais e sintomas clínicos e medicamentos usados, como também correlacionar a fisiopatologia com o tratamento e enfatizar a importância da prevenção adequada de novos episódios, para redução da sua incidência e morbidade.


Anaphylaxis is a potentially serious hypersensitivity reaction mediated by E and G-types immunoglobulin after exposition to antigen in previously sensitized people. It is hard to diagnose, as its clinical manifestations are unspecific and multisystemic. It can, however, progress to cardiovascular collapse and respiratory insufficiency. The anaphylactic shock is distributive, with an important hypovolemic component. Immediate clinical suspicion is crucial for treatment success. This paper aims to provide a review of the topic and highlight not only the drugs and clinical signals and symptoms, but also correlate physiopathology and treatment. It also aims to emphasize the importance of appropriate prevention of new events in order to reduce incidence and morbidity.


Subject(s)
Humans , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Diagnosis, Differential , Epinephrine/therapeutic use , Hypersensitivity
7.
Rev. Méd. Clín. Condes ; 22(3): 265-269, mayo 2011. tab
Article in Spanish | LILACS | ID: lil-600324

ABSTRACT

La anafilaxia es una reacción alérgica severa y potencialmente fatal. La mayoría de las anafilaxias son mediadas por inmunoglobulina E. El diagnóstico se basa fundamentalmente en las manifestaciones clínicas con el compromiso de múltiples sistemas (cutáneo, cardiovascular, respiratorio y gastrointestinal). La elevación de la triptasa sérica apoya el diagnóstico de anafilaxia. La epinefrina es el fármaco de elección en el tratamiento de la anafilaxia. Es fundamental su reconocimiento, oportuno tratamiento y posterior estudio etiológico para evitar nuevos episodios.


Anaphylaxis is a severe allergic reaction and potencially fatal. Most of reaction are mediated by immunoglobulin E. The diagnosis is based primarily on clinical manifestations with involvement of multiple systems (cutaneous, cardiovascular, respiratory and gastrointestinal). The increase of serum tryptase supports the diagnosis of anaphylaxis. . Epinephrine is the medication of choice in the treatment of anaphylaxis. It is essential its recognition, appropriate treatment and etiologic study to prevent further episodes.


Subject(s)
Humans , Anaphylaxis/etiology , Anaphylaxis/therapy , Epinephrine/therapeutic use , Anaphylaxis/complications
8.
Indian J Pediatr ; 2009 Mar; 76(3): 329-30
Article in English | IMSEAR | ID: sea-81000

ABSTRACT

A 15-year-old boy presented to the emergency unit complaining of dyspnea, urticaria and vomiting developed after he fell down when he was playing football. Abdominal ultrasound showed a ruptured hydatid cyst in the right lobe of the liver which was of communicating type. Echinococcus granulosus serologic tests were positive. Medical treatment was started immediately. One week later, follow up US showed no changes in the findings. Intrabdominal fluid leakage was not detected. Patient's general condition showed improvement and he was discharged 12 days later.


Subject(s)
Accidental Falls , Adolescent , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Animals , Diagnosis, Differential , Echinococcosis, Hepatic/complications , Echinococcosis, Hepatic/therapy , Echinococcosis, Hepatic/diagnostic imaging , Echinococcus granulosus , Humans , Male , Rupture/etiology , Rupture/parasitology , Rupture/diagnostic imaging , Treatment Outcome , Ultrasonography
9.
Tunisie Medicale [La]. 2009; 87 (4): 246-252
in French | IMEMR | ID: emr-103066

ABSTRACT

Anaphylaxis is a severe systemic reaction due to hypersensitivity reactions. The prognosis is threatened by the double risk of airway obstruction and collapse. The need for rapid diagnosis and early treatment represent a challenge for the medical staff. The use of a new diagnostic criteria and classification of this reaction help to standardize the treatment. This is based on the administration of epinephrine and vascular filling. The titration of epinephrine depending on the grade of gravity allows controlling the side effects


Subject(s)
Humans , Anaphylaxis/therapy , Anaphylaxis/physiopathology , Emergencies , Hypersensitivity, Immediate , Epinephrine
10.
Rev. méd. Chile ; 135(12): 1566-1571, dic. 2007. tab
Article in Spanish | LILACS | ID: lil-477987

ABSTRACT

Background: Immunotherapy can be used to treat allergic reactions to insect stings, specially bees and wasps. Aim: To report the experience with immunotherapy with aqueous extracts of hymenoptera venoms (bees and wasps). Material and methods: Ten patients aged 6 to 58 years were treated in an allergy center of a University Clinical Hospital. The medical indication for this treatment was, in all patients, anaphylactic reactions after hymenoptera stings. Immunotherapy was carried out using standardized vaccines (Aqueous extracts Venomvac LETI, Spain), applied in a traditional protocol, with subcutaneous injections. This protocol had two phases: a buildup phase (between weeks 1 and 13) and a monthly maintenance phase, from the 13th week. The monthly maintenance dose was 100 fig of hymenoptera specific venom extract. Results: Six patients had adverse reactions of different severity, during the treatment protocols and all had a good response to immediate therapeutic measures. After these events, they followed the protocol without problems. Two patients, treated with bee vaccines, suffered an accidental bee sting during the maintenance phase and they developed only local reactions. Conclusions: The lack of adverse reactions to bee stings in these two patients indicates the acquisition of clinical tolerance.


Subject(s)
Adolescent , Adult , Animals , Child , Female , Humans , Male , Middle Aged , Bee Venoms/therapeutic use , Desensitization, Immunologic/methods , Hymenoptera/immunology , Hypersensitivity, Immediate/therapy , Insect Bites and Stings/therapy , Wasp Venoms/therapeutic use , Anaphylaxis/therapy , Bee Venoms/adverse effects , Bee Venoms/immunology , Hypersensitivity, Immediate/immunology , Insect Bites and Stings/complications , Insect Bites and Stings/immunology , Wasp Venoms/adverse effects , Wasp Venoms/immunology
13.
P. R. health sci. j ; 25(2): 143-147, Jun. 2006.
Article in English | LILACS | ID: lil-472188

ABSTRACT

OBJECTIVE: To examine the clinical characteristics of patients with anaphylactic reactions evaluated at the Puerto Rico Medical Center over a ten year period. BACKGROUND: Anaphylaxis, an immunologic reaction classically initiated by the combination of an antigen and a mast cell fixed antibody (usually IgE), still carries a fatality rate of 500 to 1000 cases per year in the United States. It constitutes a medical emergency that needs to be identified promptly in order to install appropriate treatment. No studies of this condition have been conducted in Puerto Rico, specifically to assess the clinical presentation, main causes and outcome. METHODS: Eighty-three records of patients with a diagnosis of anaphylaxis were screened by retrospective and concurrent analysis. Of these, only 51 fulfilled the diagnostic criteria of anaphylaxis. Specific data gathered from those records assessed the clinical characteristics of each case, precipitating factors, severity of the reaction and outcome. A standard form was used for data gathering. A grading system was utilized to classify the severity of the clinical episodes. RESULTS: Cutaneous features were the most commonly found manifestations of anaphylactic reactions in the studied group. Only reactions graded 2 and 3 were identified. Reactions to medications were the most frequent identifiable causes of the entity. Multiple sensitivities to different allergens were not predictive of this clinical condition. CONCLUSIONS: The identification in this study that only cases with the more severe grades of anaphylaxis were evaluated and treated at our center, the inability to recognize an inciting cause in about one third of the patient sample and the fact that a minority of the treated patients received subsequent follow-up by an allergist, reflect the need to promote the training of physicians in the field of allergy in Puerto Rico and the continued education of all physicians in the Island regarding this clinical disorder.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Anaphylaxis , Anaphylaxis/chemically induced , Anaphylaxis/classification , Anaphylaxis/complications , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/immunology , Anaphylaxis/therapy , Cyanosis/etiology , Data Interpretation, Statistical , Diagnosis, Differential , Hypotension/etiology , Mast Cells/immunology , Puerto Rico , Retrospective Studies , Receptors, IgE/immunology
15.
AJAIC-Alexandria Journal of Anaesthesia and Intensive Care. 2000; 3 (Supp. 1): 7-9
in English | IMEMR | ID: emr-53231
18.
Pediatria (Säo Paulo) ; 21(1): 37-9, jan.-mar. 1999. tab
Article in Portuguese | LILACS | ID: lil-268435

ABSTRACT

Anafilaxia e bastante frequente, particularmente em criancas e adultos jovens. As causas mais comuns de anafilaxia sao alergias a alimentos, drogas, latex e picadas de insetos. A principais manifestacoes clinicas sao...


Subject(s)
Humans , Adrenal Cortex Hormones/therapeutic use , Anaphylaxis/therapy , Epinephrine/therapeutic use , Latex Hypersensitivity/etiology , Food Hypersensitivity/etiology , Hypersensitivity/etiology , Insect Bites and Stings/etiology
19.
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