First study of pattern of anaphylaxis in a large tertiary care hospital in Saudi Arabia

BACKGROUND: Anaphylaxis is a serious allergic reaction that may cause death. The signs and symptoms of anaphylaxis have not been examined in the Saudi population before. OBJECTIVE: The present study examined the signs, symptoms, triggers, and demographic patterns of patients treated for anaphylaxis at a large tertiary care hospital in Riyadh, Saudi Arabia. METHODS: All the patients who were prescribed new prescriptions of adrenaline auto-injectors (AAs) between February 1, 2010 and December 31, 2011 were included in this study. Information was collected using a standardized form. RESULTS: There were 238 patients who were analyzed. The median age at the time of first AA prescription was 15.5 years. Female to male ratio was 52:48 and 54% of the subjects were more than 18 years of age. There were some differences in the presenting signs and symptoms observed in our study compared with similar studies from around the world. Urticaria and angioedema were the most common at about 70% across all ages, followed by shortness of breath at 28%. Some triggers were found to be more common in our region. Food was the commonest trigger for anaphylaxis including tree nuts, egg, and sesame. Drug allergy was also a common trigger, with penicillins and nonsteroidal anti-inflammatory drugs being the commonest. Regarding insect allergy, samsam ant was the commonest trigger in our study. CONCLUSION: To our knowledge, this is the first study on anaphylaxis in Saudi Arabia. Some of the manifestations of anaphylaxis are significantly different in our population study compared to previously published data from other parts of the world. While managing anaphylaxis, we should be mindful of these differences. This improved understanding should help reduce the morbidity and mortality associated with anaphylaxis in our region.

Mycobacterium tuberculosis in the A1 Ain Medical District - Epidemiological and DNA evidence for indigenous strains

Oil rich Arabian Gulf countries, including the United Arab Emirates [UAE], have unique population demographics, where expatriate workers represent the majority [>60% in the UAE]. Tuberculosis transmission in these countries is attributed to this influx of foreign labour, especially from neighboring tuberculosis endemic countries, and control measures aim largely at eliminating this foreign source. However, this has not resulted in an elimination of transmission. We have used two, IS 6110 insertion element based, PCR-DNA analysis systems to identify patterns of transmission among citizen and expatriate patients in the UAE. In PCR system 1, intervening DNA sequences between the PGRS repeat and IS6110 was used. In the second, IS6110 was analyzed with respect to the ipl locus [EMBL X59799]. Conventional restriction fragment length polymorphism analysis was also used. Our data show that M. tuberculosis strains isolated from UAE citizen patients were different from those of expatriate workers. We conclude that the primary source of infection in UAE citizen tuberculosis patients in not the expatriate workers, but M. tuberculosis strains indigenous to the region