Rapid Aspirin Desensitization is Safe and Feasible in Patients With Stable and Unstable Coronary Artery Disease: A Single-Center Experience.

AIMS: There are limited data on aspirin (ASA) desensitization for patients with coronary disease. We present our experience with a rapid nurse-led oral desensitization regimen in patients with aspirin sensitivity undergoing coronary angiography. METHODS: This single-center retrospective observational study includes patients with a history of ASA sensitivity undergoing coronary angiography with intent to perform percutaneous coronary intervention (PCI). RESULTS: Between January 2012 and January 2017, 24 patients undergoing coronary angiography for stable coronary disease (7 cases) or acute coronary syndromes (non-ST-segment myocardial infarction [NSTEMI; 8 cases], STEMI [9 cases]) underwent aspirin desensitization having reported previous reactions to aspirin. At initial presentation, previous sensitivity reactions were reported as: mucocutaneous reactions in 17 patients (urticaria in 3 [13%], nonurticarial rash in 6 [25%], angio-oedema in 8 [33%]), respiratory sensitivity in 4 (17%), and systemic anaphylactoid reactions in 3 (13%). Seventeen (71%) patients underwent PCI. Desensitization was acutely successful in 22 (92%) patients and unsuccessful in 2 (8%) patients who both had a single short-lived episode of acute bronchospasm treated successfully with nebulized salbutamol. Fifteen successfully desensitized patients completed 12 months of aspirin; no patient had recurrent hypersensitivity reaction. Aspirin was stopped prior to 12 months in 7 patients (replaced by warfarin [1 case], no antiplatelet or single antiplatelet clinically indicated and clopidogrel chosen [4 cases], patient choice without evidence of recurrent hypersensitivity [1 case], and death due to cardiogenic shock following STEMI [1 case]). CONCLUSION: A rapid aspirin desensitization protocol is safe and effective across a broad spectrum of hypersensitivity reactions and clinical presentations.

Resultados de la inmnoadsorción en el trasplante ABOi y el rechazo humoral en una unidad de hemodiáisis hospitalaria / Results of immunoadsorption in the ABOi kidney transplantation and humoral rejection in a hospital hemodialysis unit

Introducción: El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos. Objetivo: Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria. Material y Método: Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral. Resultados: Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos. En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos. Conclusiones: El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto

Introduction: The non-selective immunoadsorption treatment was introduced in our hospital hemodialysis unit with the aim of allowing desensitization prior to a kidney transplant with blood group incompatibility and the treatment of antibody-mediated rejection. Aim: To analyze the results of the non-selective immunoadsorption technique in a hospital hemodialysis unit. Material and methods: Retrospective descriptive study of the first 18 patients treated in our center with non-selective immunoadsorption (years 2012-2017) in the indications for ABOi transplant conditioning and treatment of humoral rejection. Results: During a period of 5 years, 128 non-selective immunoadsorption sessions were analyzed. 38.9% (n= 7) of cases for desensitization prior to renal transplantation with incompatibility of blood group and 61.1% (n=11) remaining for the treatment of antibody-mediated rejection. In the first case, an average of 8±0.6 sessions of immunoadsorption prior to kidney transplantation were performed and 57.1% were complemented by 2 subsequent sessions. The concomitant treatment was protocolled with rituximab and immunoglobulins, 57.1% requiring plasma exchanges. In the second case, an average of 5.9±2 immunoadsorption sessions were carried out. The concomitant treatment was the same and 27.3% performed plasma exchanges. Conclusions: Kidney transplantation from ABOi living donor after desensitization was possible in 100% of patients. 72.7% of patients treated for antibody-mediated rejection currently maintain graft functionality

Nursing Care of Patients Undergoing Chemotherapy Desensitization: Part II.

Chemotherapy desensitization protocols are safe, but labor-intensive, processes that allow patients with cancer to receive medications even if they initially experienced severe hypersensitivity reactions. Part I of this column discussed the pathophysiology of hypersensitivity reactions and described the development of desensitization protocols in oncology settings. Part II incorporates the experiences of an academic medical center and provides a practical guide for the nursing care of patients undergoing chemotherapy desensitization.
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Inmunoterapia alérgica desde Atención Primaria de Salud / Allergen immunotherapy from Primary Health Care

La vacuna o inmunoterapia es el único tratamiento etiológico y específico de las enfermedades alérgicas capaz de modificar su curso natural.El objetivo de este artículo es mostrar una actualización en la administración de la inmunoterapia alérgica (subcutánea y sublingual) en el ámbito de la Atención Primaria de Salud, así como en las recomendaciones generales para el paciente con alergia. Para ello se llevó a cabo una revisión de la literatura.No se han encontrado diferencias sobre la modificación de pautas y la actuación en caso de reacciones adversas. Además se ha de valorar la inmunoterapia sublingual, la cual se está posicionando como forma segura y eficaz en el tratamiento de la enfermedad alérgica. Esta vía de administración presenta una buena tolerancia, comodidad de administración y escasez de efectos secundarios en los pacientes alérgicos (AU)

Vaccines or immunotherapy is the only causal and specific treatment of allergic diseases able to modify the natural course of allergic disease.The aim of this paper is to show an update on the administration of allergenim munotherapy (subcutaneous and sublingual) in the field of PrimaryHealth Care, as well as general recommendations for patients with allergy. To this end a review of the literature was carried out.No differences were found on the modification of regimen patterns or actions to be taken in adverse reactions. In addition, sublingual immunotherapy has to be assessed, which is positioning it self as a safe and effective method in the treatment of allergic disease. This route of administration affords a good tolerance, ease of administration and lack of side effects in allergic patients (AU)

Alergia e inmunoterapia: actuación enfermera / Allergy and immunotherapy: nursing intervention

La inmunoterapia se basa en la aplicación sucesiva de extractosalergénicos a un paciente sensibilizado al mismo, que es lo que lep rovoca la enfermedad-alergia, con el objetivo final de pro d u c i runa hiposensibilización. En la actualidad, esta técnica cada vez esmás frecuente en las consultas de Atención Primaria debido al aumentode la incidencia del número de personas alérgicas. Es unatécnica invasiva no exenta de riesgo que comporta una serie decuidados que la enfermera debe aplicar y que van desde la informacióny educación hasta la correcta administración y aplicaciónde medidas eficaces en caso de reacción adversa. Es necesario tenerconocimientos sobre esta técnica, sus indicaciones y contraindicaciones,así como el mecanismo de producción de la alergia

Immunotherapy is based on the successive application of allergenicdrugs to a patient previously sensitised to it, which is what causesthe disease-allergy, with the final objective of causing hypersensitivitation.At present, this technique is more and more frequent inprimary care consultations due to an increased incidence in thenumber of allergic people. It is an invasive technique that is notrisk free and that involves a sort of care that the nurse must apply,ranging from patient information and education to the correct administrationand application of effective measures in case of adversereactions. It is necessary to have the necessary knowledge onthis technique, its indications and contraindications, as well as themechanisms that cause the allergy

Relief for patients with severe allergies.

For patients with severe allergies, allergen immunotherapy can lessen or eliminate reactions, reduce the need for medication, and improve quality of life. Here's what you need to know to provide this treatment safely and minimize its risks.

Perils of childhood. Immunization against measles, mumps, and rubella.

Some children with a positive history and skin test for egg allergy require a unique desensitization protocol for the measles, mumps and rubella (MMR) vaccine. The pathophysiology of food allergies, skin testing and the MMR desensitization protocol are described. Strategies appropriate to the children's developmental stage are suggested to enhance the nurse's supportive role throughout the desensitization process.