Adrenaline (epinephrine) nasal spray for severe allergic reactions.

Intentional diagnostic sting challenges: an important medical issue

APhA fights potential death from anaphylaxis

Guideline on the investigation and management of acute transfusion reactions.

This is a prototype first chapter of a ten chapter Business English Video Text. It includes a student text, workbook, teacher guide and video. The materials are geared for Asians interested in trade and business. The title of this chapter is 'Greetings and Introductions'.

Editorial III: Anaphylaxis and anaesthesia—all clear now?

Reply

Emergency department visits for vaccine-related severe allergic reactions among US adults: 2006-2018

Symposium on the Definition and Management of Anaphylaxis: Summary report

Macdougall C, Cant A, Colver A. Arch Dis Child. 2002;86:236–239To evaluate the incidence of fatal and severe allergic reactions to foods in a large population of children.A retrospective search for fatalities in children 0 to 15 years old from March 1990-February 1998 and a prospective survey of fatal and severe reactions from March 1998-February 2000 were performed.Details of death certificates from the offices of national statistics were reviewed for fatal allergic food reactions via codes from the International Classification of Diseases, Ninth Revision (ICD-9), and inquiries were sent to pediatricians asking them to report on patients under 16 who died or were admitted to the hospital for an allergic reaction to food.Eight children died in a population of 13 million children, yielding an incidence of 0.006 deaths per 100 000 children. Milk caused 4 of the deaths, peanut, 2; egg white, 1; and mixed food, 1. Two children died despite receiving early epinephrine before admission, and 1 child with a mixed food reaction died from an epinephrine overdose. Over the 2-year prospective period, there were 6 near-fatal reactions, none caused by peanut, and 49 severe ones, 10 caused by peanut, yielding incidences of 0.02 and 0.19 per 100 000 children per year, respectively. All fatal cases and 5 of 6 near-fatal cases had a clear history of asthma. Those suffering the most severe reactions tended to have had severe previous reactions, but it was notable that in 2 of 3 fatal reactions and 5 of 6 near-fatal reactions, the previous event had not required urgent hospital treatment.The finding of so few deaths in such a large population should reassure parents and doctors that the risk of death is small. The child with food allergy and asthma may be at particular risk. Although a previous mild reaction may not be as reassuring as had been thought, the absence of asthma may be. Early administration of epinephrine may not prevent death, and concomitant treatment for the asthmatic component of an allergic reaction may be very important.Although the risk of death from food allergies may be small, parents and physicians should not be lulled into a false sense of security regarding the potential severity of adverse reactions to foods. Concomitant asthma places patients with food allergy at particular risk of a severe reaction. Although some foods more commonly cause severe reactions, it is important to note that any food theoretically can cause a severe life-threatening reaction, and the fact that milk caused more food-related deaths than peanut in this study emphasizes this point. The authors also mention that early epinephrine use may not prevent death, but it is still the general consensus that early and proper use of epinephrine in severe food reactions is associated with a better prognosis.

Reply

Objective: Risk of severe systemic reactions(SR) with subsequent hymenoptera stings for patients who had a large local reaction (LLR) or only cutaneous symptoms is considered to be negligible but recent studies report cases who have experienced more severe reactions.We aimed to evaluate the frequency of reactions that are more severe than previous ones after re-sting for children with hymenoptera venom hypersensitivity reactions. Materials and Methods:Children who had attended four pediatric allergy clinics for reactions due to hymenoptera sting were questioned for previous and subsequent stings by phone call.Number of stings, characteristics of reactions, type of bee were recorded.Whether they had a reaction more severe than the first reaction with subsequent stings was evaluated.Results: By phone call, 148 children who had LLR or SR were contacted.Of these 55 had a subsequent sting after LLR or SR and 49 had had reactions more than once.In 29 patients (59.1%), there was a more severe subsequent reaction.Twenty (52.6%) of 38 children with LLR had Grade II-III SR with subsequent stings.Age, gender, type of hymenoptera, living place, presence of concomitant allergic reaction in children and/or parents of patients who had or did not have a more severe reaction with subsequent stings were not different between two groups.Median number of hymenoptera stings and sequence of the subsequent sting causing the most severe reaction were higher among patients who had a more severe reaction (p<0.001,p<0.001 respectively). Conclusion:Our results show that we may be underestimating the risk of more severe reactions with subsequent stings for children.

Future therapies for food allergies

Background-Clopidogrel and ticlopidine are structurally very similar.In patients with an allergic or hematologic adverse reaction to either one of these drugs, the likelihood that an allergic or hematologic adverse effect will develop to the other is unknown.It is also unknown whether a reaction to the second thienopyridine is likely to be life threatening.Methods and Results-Medical records from 2 academic institutions were reviewed to identify patients who had an allergic or hematologic adverse reaction to either of the 2 currently commercially available thienopyridines and who were subsequently prescribed the other thienopyridine.Patient demographics, details of the adverse reactions, and subsequent clinical course were reviewed.A total of 76 patients were identified with an allergic or hematologic adverse reaction to clopidogrel or ticlopidine who had also received the other thienopyridine.Fourteen (27%; 95% CI, 16 to 41) patients who had an allergic or hematologic adverse reactions to clopidogrel had a similar reaction to ticlopidine; none developed a life-threatening reaction.The most common reaction was a rash (93%).Conclusions-In patients with an allergic or hematologic adverse reaction to one thienopyridine, there seems to be an increased frequency of such reactions to the other thienopyridine.However, no patient had a life-threatening reaction after exposure to the alternative thienopyridine.(Circ Cardiovasc Intervent.2009;2:348-351.)Key Words: platelet aggregation inhibitors Ⅲ hemorrhage Ⅲ thienopyridine Ⅲ clopidogrel Ⅲ ticlopidine Ⅲ allergy Ⅲ cross-reactivityR ecent studies demonstrate that drug-eluting stents may pose a higher risk of late stent thrombosis than bare metal stents because of delayed healing. 1 This has lead to guidelines recommending dual antiplatelet therapy for at least 1 year after the placement of drug-eluting stents. 2 Premature cessation of dual antiplatelet therapy can be catastrophic. 3 Clinical Perspective on p 351Clopidogrel, a second-generation thienopyridine structurally similar to ticlopidine, was developed to be equally efficacious to ticlopidine but with fewer adverse effects. 4,5However, allergic or hematologic reactions occur in approximately 1% of patients taking clopidogrel and, when severe, require discontinuation. 6Substituting ticlopidine for clopidogrel is the most common practice in patients who develop a severe allergic or hematologic adverse reaction to clopidogrel.However, the frequency and severity of allergic cross-reactivity between the agents are not known.

Aims: To discover the incidence of fatal and severe allergic reactions to food in a large population of children. Methods: A retrospective search for fatalities in children 0–15 years from...

Vaccination against SARS-CoV-2 is a highly effective strategy to prevent infection and severe COVID-19 outcomes. The best strategy for a second dose of vaccine among persons who had an immediate allergic reaction to their first SARS CoV-2 vaccination is unclear. To assess the risk of severe immediate allergic reactions (eg, anaphylaxis) to a second dose of SARS-CoV-2 mRNA vaccine among persons with immediate allergic reactions to their first vaccine dose. MEDLINE, Embase, Web of Science, and the World Health Organization Global Coronavirus database were searched from inception through October 4, 2021. Included studies addressed immediate allergic reactions of any severity to a second SARS-CoV-2 vaccine dose in persons with a known or suspected immediate allergic reaction (<4 hours after vaccination) after their first SARS-CoV-2 vaccine dose. Studies describing a second vaccine dose among persons reporting delayed reactions (>4 hours after vaccination) were excluded. Paired reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects models were used for meta-analysis. The GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach evaluated certainty of the evidence. Risk of severe immediate allergic reaction and repeated severe immediate allergic reactions with a second vaccine dose. Reaction severity was defined by the reporting investigator, using Brighton Collaboration Criteria, Ring and Messmer criteria, World Allergy Organization criteria, or National Institute of Allergy and Infectious Diseases criteria. Among 22 studies of SARS-CoV-2 mRNA vaccines, 1366 individuals (87.8% women; mean age, 46.1 years) had immediate allergic reactions to their first vaccination. Analysis using the pooled random-effects model found that 6 patients developed severe immediate allergic reactions after their second vaccination (absolute risk, 0.16% [95% CI, 0.01%-2.94%]), 232 developed mild symptoms (13.65% [95% CI, 7.76%-22.9%]), and, conversely, 1360 tolerated the dose (99.84% [95% CI, 97.09%-99.99%]). Among 78 persons with severe immediate allergic reactions to their first SARS-CoV-2 mRNA vaccination, 4 people (4.94% [95% CI, 0.93%-22.28%]) had a second severe immediate reaction, and 15 had nonsevere symptoms (9.54% [95% CI, 2.18%-33.34%]). There were no deaths. Graded vaccine dosing, skin testing, and premedication as risk-stratification strategies did not alter the findings. Certainty of evidence was moderate for those with any allergic reaction to the first dose and low for those with severe allergic reactions to the first dose. In this systematic review and meta-analysis of case studies and case reports, the risk of immediate allergic reactions and severe immediate reactions or anaphylaxis associated with a second dose of an SARS-CoV-2 mRNA vaccine was low among persons who experienced an immediate allergic reaction to their first dose. These findings suggest that revaccination of individuals with an immediate allergic reaction to a first SARS-CoV-2 mRNA vaccine dose in a supervised setting equipped to manage severe allergic reactions can be safe.