Adherence to Anaphylaxis Guidelines: Real-World Data From the Emergency Department of a Tertiary Hospital.

BACKGROUND AND OBJECTIVE: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. METHODS: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. RESULTS: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). CONCLUSIONS: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions.

Adherence to anaphylaxis guidelines: real-world data from the emergency department of a tertiary hospital

Background: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. Methods: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). Conclusion: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions

Antecedentes: Pocos estudios han evaluado el cumplimiento de las recomendaciones de las guías clínicas de anafilaxia en los servicios de urgencias. Objetivo: El objetivo de este estudio fue conocer el cumplimiento de las guías de anafilaxia en el servicio de urgencias (SU) de un hospital terciario. Métodos: Se revisaron los informes de los pacientes atendidos en el SU del Hospital Universitario de Salamanca durante un año y se seleccionaron los que cumplían los criterios de anafilaxia propuestos por el NIAID/FAAN. Resultados: Se identificaron 89 pacientes, 74 adultos y 15 niños. El 65% de los adultos presentó una reacción moderada, el 34% grave y el 1% muy grave; en todos los niños la gravedad fue moderada. Menos de la mitad de los pacientes (42%) fueron tratados con adrenalina, solo el 19% por vía intramuscular. El 65% de las reacciones moderadas y el 42% de las graves no recibieron adrenalina. Al alta, se recomendó un auto-inyector de adrenalina al 5,6% de los pacientes, se remitió al Servicio de Alergia al 52% (57% adultos frente a 27% niños, p=0,047), se dieron indicaciones para evitar posibles desencadenantes al 29% (31% adultos frente a 20% niños, p=.5) e instrucciones para reconocer los signos de alarma de una reacción anafiláctica al 51% (41% adultos frente a 100% niños, P<0,001). Conclusión: Los resultados del estudio muestran importantes discrepancias entre las recomendaciones de las guías clínicas y el manejo de la anafilaxia en un SU hospitalario. Es necesario un mayor esfuerzo en educación para mejorar el tratamiento de los pacientes con anafilaxia

Alimentos transgénicos y alergia / Transgenic foods and allergy

La biotecnología consiste en la aplicación de técnicas de biología molecular y/o DNA recombinante, o la transferencia in vitro de genes (bioingeniería), para el desarrollo de nuevos productos o para dotar de nuevas características a organismos ya existentes. A pesar de los beneficios potenciales que entrañan esos métodos, han surgido elementos de preocupación tanto en lo que respecta a su repercusión para la salud como para el medio ambiente. Desde un punto de vista alergológico, esos riesgos potenciales incluyen tanto la adicción de alérgenos conocidos a alimentos previamente no alergénicos, como la formación de nuevos alérgenos y la consiguiente posibilidad de sensibilización en la población expuesta susceptible. En el conocido como Protocolo de Cartagena sobre Bioseguridad se establecieron los criterios de evaluación de los riesgos que suponen los organismos modificados genéticamente. Por otra parte, la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO), de forma conjunta con la Organización Mundial de la Salud (OMS), han advertido también desde un punto de vista científico sobre la necesidad de evaluar la seguridad de los alimentos derivados de animales o plantas modificados genéticamente. En la presente revisión hemos querido hacer un repaso de los métodos utilizados para evaluar los potenciales riesgos de alergenicidad de los alimentos modificados genéticamente, así como de la actual legislación europea a este respecto

Biotecnology is the application of the techniques of molecular biology and/or recombinant DNA technology, or in vitro gene transfer (bioengineering), to develop products or impart specific capabilities to organisms. Despite potential benefits of such techniques, concerns have been raised about the potential consequences on health or environment. From an allergic stanpoint, potential risks include the transfer of a known allergen from a crop into a non- allergenic crop, and the creation of neo-allergens that leads the appearance of the novo sensitizaions in the allergic population. In the Cartagena Protocol on Biosafety standards for risks assessment of genetically modified organisms have been set. On the other hand, the Food and Agriculture Organization of the United Nations (FAO) joined to the World Health Organization (WHO) have provided scientific advice on the safety assessment of foods derived from genetically modified animals or plants. This review presents an overview of the methods used for the assessment of the potential allergenic risk of genetically modified foods and the current European legislation on this issue

Reacciones de hipersensibilidad a fármacos quimioterápicos / No disponible

No disponible

Pollen calendar of the city of Salamanca (Spain). Aeropalynological analysis for 1981-1982 and 1991-1992.

We report a study on the contents of airborne pollen in the city of Salamanca (Spain) aimed at establishing a pollen calendar for the city for the yearly periods of maximum concentrations, relating these with quantifiable atmospheric variables over two two-year periods with an interval of 10 years between them: 1981-82 and 1991-92. The pollen was captured with Burkard spore-traps, based on Hirst's volumetric method. Determinations were made daily and were used to make preparations, previously stained with basic fuscin, for study under light microscopy at x 1,000 magnification. 946 preparations were analyzed, corresponding to the same number of days distributed over 150 weeks of the periods studied. The results afforded the identification of 48 different types of pollen grain: Grasses (Poaceae), Olea europea (olive), Quercus rotundifolia (Holm-oak), other Quercus spp. (Q. pyrenaica, Q. suber, Q. faginea, etc.), Cupressaceae (Cupressus sempervivens, C. arizonica, Juniperus communis etc.), Plantago (Plantago lanceolata, Plantago media, etc.), Pinaceae (Pinus communis, Abies alba, etc.), Rumex sp. (osier), Urtica dioica (nettle), Parietaria (Parietaria officinalis, P. judaica), Chenopodio-Amaranthaceae (Chenopodium sp., Amaranthus sp., Salsola kali, etc.), Artemisia vulgaris (Artemisia), other Compositae (Taraxacum officinalis, Hellianthus sp. etc.), Castanea sativa (Chestnut), Ligustrum sp. (privet), Betula sp. (birch), Alnus sp. (common alder), Fraxinus sp (ash), Populus sp. (poplar), Salix sp. (willow), Ulmus sp. (elm), Platanus sp. (plantain, plane), Carex sp. (sweet flag), Erica sp. (common heather), Leguminosae or Fabaceae:--Papillionaceae (Medicago sp.; Cercis sp., Robina sp.)--Cesalpinoideae Acacia sp. (Acacia),--Mimosoideae: Sophora japonica, Umbelliferae (Foeniculum sp., Cirsium sp., etc.), Centaurea sp., Cistus sp. (rock rose), Typha sp (bulrush), Mirtaceae (Myrtus communis), Juglans regia (Walnut), Galium verum, Filipendula sp. (spirea/drop wort), Rosaceae (Pyrus sp., Prunus sp., etc.), Tilia sp. (Linden), Morus sp. (mulberry), Taxus baccata (yew), Papaveraceae (Papaver rhoeas etc.), Labiata (Lavandula sp.), Cannabaceae (Humulus sp. etc.), Liliaceae (Lilium sp.), Echium sp. (viper's bugloss). The most abundant taxa, detected in the highest quantities (grains/m3 air), by order of counting were as follows: holm-oak, olive, grasses, Plantago and Parietaria. With the data obtained we have established a pollen calendar for Salamanca and report the period in which each type of pollen is found along the years and the periods with the highest airborne concentrations of such pollens. The diversity and the spectrum of the pollen in the city of Salamanca correspond to the typical plant communities found on the dehesas (large ranges of grasslands) of Castile, where Salamanca is located, although the wind directions and the peculiar climatic characteristics of the area govern the peaks of maximum presence of the different taxa. As examples, in the case of olive, which is cultivated at some distance from the city, its maximum presence coincides with south-westerly winds; in the case of grasses, the peaks of maximum counts coincide with a sharp rise in mean temperature, close to or higher than 20 degrees C and between five and six weeks after rainfall equal to or greater than 5 L/m2.