Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics

Perioperative anaphylactic reactions are immediate, hypersensitive reactions that are potentially life-threatening resulting from a sudden release of mediators from mast cells and basophiles, due to either immune (IgE or non-IgE mediated) or non-immune mechanisms. The most frequent causing agents are neuromuscular blocking agents (NMBAs), latex and antibiotics, with latex being the first cause in paediatrics. With regard to perioperative anaphylactic reactions, the usual early signs and symptoms of an anaphylactic reaction could be overlooked or erroneously interpreted and non-severe anaphylaxis could go undetected, with a risk of more severe reactions in the future. Using the data registered on the anaesthesia sheet, it is essential to establish a chronological relationship between drugs and/or substances administered and the reaction observed. An elevated level of tryptase confirms an anaphylactic reaction, but this does not usually increase in the absence of compromised circulation. An allergy study should be carried out preferably between 4 and 6 weeks after the reaction, using a combination of specific IgE, skin and controlled exposure tests (if indicated). Test sensitivity is good for NMBAs, latex, antibiotics, chlorhexidine, gelatine and povidone, and poor for barbiturates, opiates (these can give false positives since they are histamine releasers) and benzodiazepines. Special preventive measures should be taken, especially in the case of latex. We present the maximum concentrations recommended for skin tests, the recommended dosage to treat anaphylactic reactions in paediatrics and a procedure algorithm for the allergological study of these reactions

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Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics.

Perioperative anaphylactic reactions are immediate, hypersensitive reactions that are potentially life-threatening resulting from a sudden release of mediators from mast cells and basophiles, due to either immune (IgE or non-IgE mediated) or non-immune mechanisms. The most frequent causing agents are neuromuscular blocking agents (NMBAs), latex and antibiotics, with latex being the first cause in paediatrics. With regard to perioperative anaphylactic reactions, the usual early signs and symptoms of an anaphylactic reaction could be overlooked or erroneously interpreted and non-severe anaphylaxis could go undetected, with a risk of more severe reactions in the future. Using the data registered on the anaesthesia sheet, it is essential to establish a chronological relationship between drugs and/or substances administered and the reaction observed. An elevated level of tryptase confirms an anaphylactic reaction, but this does not usually increase in the absence of compromised circulation. An allergy study should be carried out preferably between 4 and 6 weeks after the reaction, using a combination of specific IgE, skin and controlled exposure tests (if indicated). Test sensitivity is good for NMBAs, latex, antibiotics, chlorhexidine, gelatine and povidone, and poor for barbiturates, opiates (these can give false positives since they are histamine releasers) and benzodiazepines. Special preventive measures should be taken, especially in the case of latex. We present the maximum concentrations recommended for skin tests, the recommended dosage to treat anaphylactic reactions in paediatrics and a procedure algorithm for the allergological study of these reactions.

Macrolide antibiotics in the treatment of asthma. An update

It seems clear that certain macrolide antibiotics exert anti-inflammatory and immune modulating effects beyond their purely antibacterial action, as has been demonstrated in a number of bronchial inflammatory disorders such as diffuse panbronchiolitis. Randomised, controlled clinical trials involving larger patient samples are needed to confirm whether these actions are of clinical relevance in application to asthma. On the other hand, the macrolide antibiotics have a long half-life, with a prolonged elimination interval, which appears to favour the development of resistances that persist over the long term, as in the case of azithromycin. Would the risk/benefit ratio of sustained low-dose macrolide use be justified, considering the risk of selecting resistant strains?A number of questions must be answered before these drugs can be recommended in application to asthmatic patients: In which patients should they be used? Which drug or drugs would be most appropriate? What would the recommended dose be, and for how long should treatment be administered? What adverse effects can be expected?

Macrolide antibiotics in the treatment of asthma. An update.

It seems clear that certain macrolide antibiotics exert anti-inflammatory and immune modulating effects beyond their purely antibacterial action, as has been demonstrated in a number of bronchial inflammatory disorders such as diffuse panbronchiolitis. Randomised, controlled clinical trials involving larger patient samples are needed to confirm whether these actions are of clinical relevance in application to asthma. On the other hand, the macrolide antibiotics have a long half-life, with a prolonged elimination interval, which appears to favour the development of resistances that persist over the long term, as in the case of azithromycin. Would the risk/benefit ratio of sustained low-dose macrolide use be justified, considering the risk of selecting resistant strains? A number of questions must be answered before these drugs can be recommended in application to asthmatic patients: In which patients should they be used? Which drug or drugs would be most appropriate? What would the recommended dose be, and for how long should treatment be administered? What adverse effects can be expected?

Factores de riesgo no genéticos en el desarrollo de asma bronquial / No disponible

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Aspectos epidemiológicos del asma en la edad pediátrica / Epidemiological aspects of asthma in the pediatric age

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No disponible

Vacuna antineumocócica conjugada heptavalente en un caso de meningitis recurrente por neumococo / The heptavalent pneumococcal conjugate vaccine in a case of recurrent pneumococcal meningitis

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[Peak expiratory flow rate in 4- to 15-year-old children. Comparison of 3 measuring models]. / Pico de flujo espiratorio en escolares de 4 a 15 años de edad. Comparación de tres modelos de medidor.

OBJECTIVE: a) To establish the possible differences between three different models of PEF-meter, including PF-Control for the first time; b) to build a normogram for each of the three models, as a function of different variables (age, height, and inspiratory and espiratory thoracic circumference); c) to search for differences between both sexes, and d) to study the mathematical correlation between the results yielded by the different models. METHODS: PEF was measured in a sample of 476 school-children, in the range of 4 and 15 years (233 boys, 243 girls), with a mean age of 9,3 years and a height range between 96,8 cm and 178,8 cm (mean 137,9). PEF value was recorded as the best of three attempts when the difference them was less than 10%. Three devices of each model were used (Vitalograph, Mini-Wright, PF-Control). The utilisation was always done in a rotatory fashion at school time (15-17 hours) in the children's school. RESULTS: We found significant differences between the three models (p < 0,0004). The best predictive variable for PEF is height, with an r = 0,90-0,92 (depending on the model) when the exponential model is considered. Independently of the device, there were significant differences between sexes. CONCLUSIONS: a) The variable that expresses PEF the better is height; b) PEF values are different between girls and boys; c) there were significant differences between the various models; d) Monitoring of a given child must be done with the same model of PEF-meter, and e) The best correlation is obtained with the exponential model, although differences with the lineal model were not statistically significant.

Pico de flujo espiratorio en escolares de 4 a 15 años de edad. Comparación de tres modelos de medidor / Peak espiratory flow rate in school-children 4-15 years old. Comparison between three different devices

OBJETIVO: a) Establecer las posibles diferencias entre tres modelos de medidor, incluyendo por vez primera el PF-Control; b) determinar el normograma del pico de flujo espiratorio (PEF) para cada modelo de medidor, en función de la edad, talla, perímetro torácico inspiratorio y espiratorio; c) establecer las posibles diferencias en razón del sexo, y d) estudiar la correlación matemática entre los resultados obtenidos con los distintos modelos de medidor. MÉTODOS: Se midió el PEF en una muestra de 476 escolares, de edades comprendidas entre 4 y 15 años (233 varones y 243 mujeres), con una media de 9,3 años. La talla menor fue 96,8 cm y la mayor 178,8 cm, con una media de 137,95 cm. Se consideró como valor de PEF al mejor de tres intentos, con una diferencia menor del 10 por ciento entre ellos. Se utilizaron 3 aparatos de cada modelo (Vitalograph, Mini-Wright, PF-Control). Su uso fue siempre rotatorio, y el horario de 15 a 17 horas, en el propio centro escolar. RESULTADOS: Existen diferencias significativas en razón del modelo de medidor. La variable que mejor se ajusta al PEF es la talla, con una r = 0,90-0,92 (según el modelo considerado) para el modelo exponencial. El factor sexo establece diferencias significativas en los valores del PEF, con los tres modelos de medidor. CONCLUSIÓN: a) La variable que mejor expresa los resultados del PEF es la talla; b) los valores del PEF de varones y mujeres son distintos, con significación estadística; c) existen diferencias significativas en razón del modelo de medidor utilizado; d) la monitorización del PEF en un sujeto determinado debe hacerse con el mismo modelo de medidor, y e) el modelo de regresión exponencial consigue un mejor ajuste (AU)