Acute Anaphylactic Reaction Research Articles

Acute hypersensitivity reactions to chemotherapy

To provide a review of the immune system response involved in acute hypersensitivity reactions (HSRs) and anaphylactic reactions to chemotherapy. Professional experience, published articles, and book chapters. Acute HSRs from chemotherapy administration can be a rare to moderate occurrence, depending on the chemotherapy agents involved. It is of vital importance for nurses caring for patients receiving chemotherapy to take steps to prevent HSRs when possible and/or to minimize the potentially fatal effects of those reactions. Nurses caring for patients receiving chemotherapy should understand the risk of HSRs as well as the pathophysiology involved to ensure utilization of preventive measures when appropriate and early recognition and intervention in the event of an acute HSR.

"Not so immediate" hypersensitivity--the danger of biphasic anaphylactic reactions.

OBJECTIVE: To assess how commonly clinically significant biphasic anaphylactic reactions occur after apparently successful treatment of an anaphylactic reaction. Cases were analysed to determine whether there were any markers that...

Drug points: Intranasal chlorhexidine resulting in anaphylactic circulatory arrest

Acute anaphylaxis due to chlorhexidine has been reported, especially in Japan.1 2 3 4 Most of the cases have presented with cutaneous eruptions, bronchospasm, tachycardia, and mild hypotension. We report...

Effects of triazolodiazepine on the production of interleukin-6 from murine spleen cells and rabbit synovial cells in vitro

Interleukin-6 (IL-6) is a multifunctional cytokine that regulates the immune response, acute phase anaphylactic reaction, and haematopoiesis. Lipopolysaccharide (6–24 μg/ml) significantly induced IL-6 release from murine spleen cells. In cultured rabbit synovial cells interleukin-1 (IL-1, 1–10 U/ml) induced IL-6 production in a concentration-dependent manner. Triazolodiazepine (Tri) is a hetrazepine platelet-activating factor antagonist. In this study we found that Tri (0.1–10 μmol/l) exerted strong inhibitory effects on LPS stimulated IL-6 production in murine spleen cells. Kinetic studies showed that the inhibition of IL-6 release was time-independent. In rabbit synovial cells Tri also reduced IL-6 release induced by IL-1 and tumour necrosis factor. Inhibition of cytokine production by Tri may partially explain its wide and strong anti-inflammatory effects.

Intensive Care Management of Acute Asthma in Children

To the Editor.— In the article by Stein et al1 it was stated that three deaths occurred. The death of the 17-year-old boy working in the restaurant was reported as due to the acute onset of respiratory distress followed by respiratory arrest. Asthma usually occurs gradually, with prodromal symptoms 24 to 48 hours before an attack. In a few patients, the prodrome can occur less than 6 hours before the respiratory symptoms.2 The time course of the asthma in the 17-year-old boy is more consistent with an acute anaphylactic reaction, most likely from food ingestion.

Fruit allergy: Demonstration of IgE antibodies to a 30 kd protein present in several fruits

A patient who had experienced allergic responses to various fruits developed an acute anaphylactic reaction after the ingestion of a local strain of cling peaches. The patient's serum, but not control sera, contained IgE antibodies reactive to extracts from peaches, guavas, bananas, mandarins, and strawberries in an ELlSA. The patient's serum, however, did not demonstrate elevated levels of IgE antibodies to extracts from apples, pears, and nectarines. Adsorption of the patient's serum with extracts from peaches, strawberries, and mandarins resulted in a decline of detectable IgE antibodies to these fruits. Adsorption with extracts from apples and pears had no such effect. These results demonstrate the specificity of the patient's IgE antibodies to selected fruits only. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by Western blotting revealed a 30 kda of protein that was recognized by the IgE antibodies in the patient's serum. This protein was not present in extracts from pears or apples. Our results highlight the importance of specific allergens in considering acute allergic reactions to individuals exhibiting sensitivity to various foods or fruits.

Acute anaphylactic reactions

Anaphylactic shock may be provoked by a diverse group of substances and stimuli, which range from large molecular weight proteins and small drug molecules to some colloids, emulsions and even exercise. The underlying mechanism may be immunological or non-immunological but, regardless of the mechanism, the physiological effects and the observable symptoms of anaphylaxis are due to the release of potent pharmacologically-active mediators, including histamine. Although a number of predisposing factors are recognized, the appearance of most of the reactions cannot be predicted. Reactions occur suddenly and dramatically and progress rapidly. Cardiovascular collapse is the most common life-threatening clinical feature, while bronchospasm is the most difficult to treat. The primary aim of treatment should be to treat the underlying cause and to improve cellular oxygenation. The pharmacological agent of choice for treatment is adrenaline. It is direct-acting and is effective for both bronchospasm and cardiovascular collapse. It is imperative that the provoking substance or stimulus be identified in patients and there is no substitute for a carefully-gathered and detailed case history in the diagnosis of anaphylaxis. Patients should be issued with some form of warning identification together with written details concerning their reaction.

Characterization of an antigen in acute anaphylactic dialysis reactions: Ethylene oxide-altered human serum albumin

Anaphylactic reactions to dialysis have been associated with antibody to human serum albumin (HSA) that has been reacted with ethylene oxide (ETO). ETO, an agent used to sterilize dialyzers, is a potent alkylator of proteins. We have studied the antigenic characteristics of ETO-HSA. By use of immunoelectrophoresis we have demonstrated differences in electrophoretic mobility between HSA and ETO-HSA. By gel chromatography we have observed an apparent increase in the molecular weight of ETO-HSA as compared to HSA. Antigenic activity of ETO-HSA as determined by the technique of Lidd and Farr is found in all molecular weight fractions. Cutaneous reactivity to ETO-HSA can be transferred to subhuman primates. That reactivity is lost if the sera are heated to 56 °C for 4 hours. Antibody activity to ETO-HSA cannot be inhibited by ETO-glycine or HSA but can partially be inhibited by ETO-polylysine or ETO-ovalbumin. This suggests that antibody is directed against a new antigenic determinant on the ETO-protein moiety, probably an ETO-amino acid determinant like lysine.

Anaphylaxis Following the Use of Bacitracin Ointment

A 52-year-old woman suffered an acute anaphylactic reaction to topically applied bacitracin. An investigation disclosed the presence of concurrent type I and IV hypersensitivity to bacitracin. We review five other cases of anaphylactic reactions to topical medications and describe the clinical characteristics common to all six cases.

A study of 100 infants and young children with cow's milk allergy.

Although CMA may be readily recognized in infancy when acute anaphylactic reactions are most prevalent, clinical features in older children may be frequently nonspecific and insidious in onset. This study has identified three populations of children with separate clinical features. Their existence needs to be confirmed by others and by undertaking prospective studies based on the information generated by this investigation. Given the broad spectrum of clinical manifestations of CMA, it is not surprising that there is no single test on which to base its diagnosis other than the demonstration of a reproducible response to cow’s milk challenge under controlled clinical conditions. The recognition of different patterns of clinical diseases that are now all regarded as CMA should lead to a finer appreciation of the value of separate immunological tests in the diagnosis of this complex disorder.

Intradermal testing after anaphylactoid reaction to anaesthetic drugs: practical aspects of performance and interpretation.

A detailed description of an intradermal test for the diagnosis of the drug responsible for acute anaphylactoid or anaphylactic reactions to anaesthetic drugs is presented. If intradermal testing is performed according to this protocol the drug responsible for the reaction can be determined in the majority of reactions.

Allergic reactions to local anesthetics.

The majority of adverse reactions to local anesthetics are due to high plasma levels from excessive quantities of a drug. These are often blamed on idiosyncrasy, sensitivity, or allergy. The incidence of reactions due to allergy to local anesthetics is low compared to that with other drugs. Allergic reactions may be systemic or local. More than 80% of reactions are cell mediated, resulting in contact dermatitis. The remainder are caused by circulating antibodies that give rise to systemic anaphylaxis. Acute anaphylactic reactions are rare but invariably fatal unless promptly treated. Localized systemic anaphylactic reactions manifested by urticaria, laryngeal edema, and extrinsic asthma are less serious and amenable to treatment. There is no foolproof test for screening of susceptible persons. The intradermal test is of no value for detecting possible systemic sensitivity. The patch test is useful for detecting contact allergy. Systemic reactions are treated with epinephrine, antihistamines, and steroids. Contact dermatitis responds to topical steroids.

Anaphylactic reaction to penicillin (or penicillin-like substance) in a soft drink

An acute anaphylactic reaction occurred in a patient known to be highly sensitive to penicillin following ingestion of the soft drink Wink. Bacteriologic studies showed the presence of penicillin or a penicillin-like substance in the Wink, suggesting it as the cause of the anaphylaxis. The source of this contaminant could not be identified.

Cow's milk intolerance presenting as necrotizing enterocolitis: E. de Peyer and J. Walker-Smith. Helv Paediatr Acta 32:509–515, 1977

Case history is reported of an infant who was changed from breast to bottle feeding at fourth day of life, who on ninth day developed bilious vomiting and bloody diarrhoea. Later gas was found in colonic wall on X-ray. Necrotizing enterocolitis was diagnosed and infant managed with total intravenous alimentation. On recovery although she tolerated breast milk, return to cow's milk formula lead to return of bloody diarrhoea. Subsequently she thrived on a cow's milk-free diet based on chicken meat formula. At four months after total of 15 ml cow's milk she had an acute anaphylactic reaction. She recovered and is well on milk-free diet. Thus, this infant has recovered from necrotizing enterocolitis but has evidence of persistent cow's milk protein intolerance. The hypothesis is put forward that in this child cow's milk protein played a major role in the pathogenesis of necrotizing enterocolitis.

Intradermal Testing in the Diagnosis of Acute Anaphylaxis during Anaesthesia — Results of Five Years Experience

Intradermal testing has been used in the diagnosis of acute anaphylactic reactions during anaesthesia in 51 patients. Positive results occurred in 32 patients and confirmation was possible in 26. Only in one case did a combination of history and intradermal testing not give a diagnosis. Nine of the negative results were confirmed. Intradermal testing is of no value in the diagnosis of reactions to local anaesthetics or colloids but has great value in determining the cause of reactions due to induction agents or muscle relaxants if performed under controlled conditions. It is safe, and requires no expertise in performance or interpretation.

Chemotherapy of hydatid disease (Echinococcus granulosus) in mice with mebendazole and bithionol.

We treated female Swiss Webster mice with heavy, long standing infections of Echinococcus granulosus with mebendazole, 50 mg/kg body weight daily for 10 days and bithionol, 70 mg/kg every other day for four doses. Necropsy performed 6 weeks after completion of therapy showed no gross or histologic differences between untreated controls and bithionol-treated mice or their cysts. Mebendazole-treated mice had a significant decrease in the total number of cysts (15 vs. 100), with many of those present being ruptured. Electron microscopy of intact, mebendazole-treated cysts revealed a marked increase in vacuolization and disarray of the distal cytoplasm, dilated and degenerating microtubules, increase in the size and number of lysosomes, a decrease in the number of normal appearing golgi, and increased density of mitochondria. Several mice died shortly after the termination of mebendazole therapy, all with ruptured cysts. Due to the large volume of the cysts, the presumed cause of death was acute volume overload, but toxic or anaphylactic reactions could not be excluded. We suggest that any proposed chemotherapy of humans with hydatid disease be done cautiously, with careful monitoring.

Acute anaphylactic reactions and aspirin allergy.

The subject of anaphylaxis immediately brings to mind penicillin, and for good reasons. Still, any of a long list of diagnostic and therapeutic agents and foods can be the cause of this life-threatening event. Every physician and even some patients should be prepared to deal with this emergency. For some asthmatic patients, even taking aspirin can precipitate a severe attack of asthma. In particular, the combination of asthma and nasal polyps should raise suspicion of this type of aspirin allergy.

Anaphylaxis in Young Calves Inoculated with Heat-inactivated Mycoplasma mycoides

Intravenous inoculation of a concentrated, heat-inactivated suspension of Mycoplasma mycoides in calves induced formation of circulating complement fixing (CF) antibody only in animals over 8 weeks old. However, younger calves showed sensitization to inactivated M. mycoides, manifested by an acute anaphylactic reaction following reinoculation 14 days after the primary inoculation. Anaphylaxis occurred in the absence of detectable circulating antibody and of cutaneous hypersensitivity.

Peripheral Neuropathy Following Tetanus Toxoid Administration

THE INCIDENCE of anaphylaxis to horse serum administration is estimated to be one in 50,000 and that of serum sickness one in 20.¹This significant risk has served to emphasize the superiority of active immunization against tetanus with toxoid over passive immunization with heterologous antitoxin. Significant local and systemic reactions to tetanus toxoid were not uncommon with the cruder preparations of yesteryear but have become less frequent with those currently available. In 1940, Cooke²reported cases of urticaria following booster injections of tetanus toxoid. This was shown to be due to the Berna peptone used in the culture media. A review of reactions to tetanus toxoid by Whittingham in 1940³indicated that acute anaphylactic reactions occurred in two of 61,000 inoculations or 0.003%. The incidence of constitutional and significant local reactions in the same series was 1%. The sensitizing agent in most of these cases was considered

Horse Serum and Horse Sense

An article appearing in one of our sister journals points up the promiscuous use of tetanus antitoxin.* A survey showed that approximately 50% of ophthalmologists would give antitoxin to patients who had perforating wounds of the cornea and who were not known to have had toxoid. The motivation for this liberal use of antitoxin was, according to the author, as much to cover the doctor from medicolegal liability as to cover the patient from tetanus. Yet antitoxin and other components of the serum are not without their own hazards. They may give rise to an acute anaphylactic reaction (rarely) or some form of serum sickness (commonly). Nor is the usual dose of 1,500 units a certain preventive of tetanus, possibly less effective than a few days of treatment with penicillin or tetracycline. A study some years ago showed that tetanus resulting from eye injuries was a great rarity even before