Case Of Severe Allergic Reaction Research Articles

Increasing Cefazolin Use for Perioperative Antibiotic Prophylaxis in Penicillin-Allergic Children.

Cefazolin, a first-generation cephalosporin, is the most commonly recommended antibiotic for perioperative prophylaxis to reduce surgical site infections. Children with a reported penicillin allergy often receive an alternative antibiotic because of a common misunderstanding of the cross-reactivity between these antibiotics. This use of alternative antibiotics in surgical populations have been associated with increased infections, antibiotic resistance, and health care costs. We aimed to increase the percentage of patients with nonsevere penicillin-class allergies who receive cefazolin for antibiotic prophylaxis. A multidisciplinary team conducted this quality improvement initiative, with a series of 3 plan-do-study-act cycles aimed at children with nonsevere penicillin-class allergies undergoing surgical procedures that require antibiotic prophylaxis. The primary outcome measure was the percentage of surgical encounters among patients with nonsevere penicillin-class allergies who received cefazolin as antibiotic prophylaxis. Statistical process control charts were used to measure improvement over time. Approximately 400 children were involved in this project. There was special cause variation and a shift in the center line from 60% to 80% of eligible patients receiving cefazolin for antibiotic prophylaxis, which was sustained for the duration of the project. In the last month, 90% of eligible patient received cefazolin, surpassing our goal of 85%. This improvement has been sustained in the 5 months after project completion. We had no cases of severe allergic reactions in the operating room. Our multidisciplinary education-focused interventions were associated with a significant increase in the use of cefazolin for perioperative antibiotic prophylaxis in patient with penicillin allergies.

Vaccine allergy: evidence to consider for COVID-19 vaccines.

Purpose of reviewWhereas the COVID-19 pandemic has changed our lives worldwide, we hope that vaccination can combat the disease. We propose how to evaluate suspected severe allergic reactions to the vaccines so that as many as possible may be safely vaccinated.Recent findingsRare cases of severe allergic reactions after COVID-19 vaccination have been observed, seemingly at a higher frequency than for other vaccines. Few excipients are likely to have caused these reactions. IgE-mediated reactions to polyethylene glycol (PEG) and its derivatives are the most suspected, albeit hitherto unproven, causes. We suggest to make a diagnosis based on skin tests with PEG and PEG derivatives and that these be considered in relation to the decisions required before the first and the second vaccine dose. A vaccine without these excipients is available, but published data about its side effects are limited.SummaryThe underlying immunological mechanisms of the rare severe allergic reactions to the COVID-19 vaccines are poorly understood and need to be clarified. Identifying those who have an undiagnosed allergy to PEG and PEG derivatives is crucial before vaccination, and these substances are found in laxatives, cosmetics and in 30% of all our medications today.

The Importance of a Timely Second Dose of the 2021 COVID-19 mRNA Vaccine Depends on the Protection Afforded by a First Dose and Subsequent Risk of Anaphylaxis

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents our greatest hope to combat the devastating coronavirus disease 2019 (COVID-19) pandemic. Amid ongoing global vaccination efforts, rare cases of severe allergic reactions to COVID-19 mRNA vaccines have received significant attention. Although the exact nature of these reactions may be heterogeneous, various approaches exist to engage with patients, communities, public health departments, primary care providers, and other clinicians in a multidisciplinary approach to advance population health. Whereas it is optimal for patients to receive COVID-19 vaccination as outlined in emergency use authorizations, second-dose deferral of mRNA vaccines may be a consideration within a shared decision-making paradigm of care in select circumstances characterized by high durable first-vaccine–dose protection and significant elevations of vaccine anaphylaxis risk. Still, the durability of protection afforded by a single dose of a COVID-19 mRNA vaccine is uncertain, and alternative approaches to complete vaccination, including precautionary use of a COVID-19 viral vector vaccine, also remain patient-preference–sensitive options. There is an urgent need to define correlates of COVID-19 immunity and the level of longer-term protection afforded by COVID-19 vaccination.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine - United States, December 21, 2020-January 10, 2021.

As of January 20, 2021, a total of 24,135,690 cases of coronavirus disease 2019 (COVID-19) and 400,306 associated deaths had been reported in the United States (https://covid.cdc.gov/covid-data-tracker/#cases_casesper100klast7days). On December 18, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Moderna COVID-19 vaccine administered as 2 doses, 1 month apart to prevent COVID-19. On December 19, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of Moderna COVID-19 vaccine (1). As of January 10, 2021, a reported 4,041,396 first doses of Moderna COVID-19 vaccine had been administered in the United States, and reports of 1,266 (0.03%) adverse events after receipt of Moderna COVID-19 vaccine were submitted to the Vaccine Adverse Event Reporting System (VAERS). Among these, 108 case reports were identified for further review as possible cases of severe allergic reaction, including anaphylaxis. Anaphylaxis is a life-threatening allergic reaction that occurs rarely after vaccination, with onset typically within minutes to hours (2). Among these case reports, 10 cases were determined to be anaphylaxis (a rate of 2.5 anaphylaxis cases per million Moderna COVID-19 vaccine doses administered), including nine in persons with a documented history of allergies or allergic reactions, five of whom had a previous history of anaphylaxis. The median interval from vaccine receipt to symptom onset was 7.5 minutes (range=1-45 minutes). Among eight persons with follow-up information available, all had recovered or been discharged home. Among the remaining case reports that were determined not to be anaphylaxis, 47 were assessed to be nonanaphylaxis allergic reactions, and 47 were considered nonallergic adverse events. For four case reports, investigators have been unable to obtain sufficient information to assess the likelihood of anaphylaxis. This report summarizes the clinical and epidemiologic characteristics of case reports of allergic reactions, including anaphylaxis and nonanaphylaxis allergic reactions, after receipt of the first dose of Moderna COVID-19 vaccine during December 21, 2020-January 10, 2021, in the United States. CDC has issued updated interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States (3) and interim considerations for preparing for the potential management of anaphylaxis (4).

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine - United States, December 14-23, 2020.

As of January 3, 2021, a total of 20,346,372 cases of coronavirus disease 2019 (COVID-19) and 349,246 associated deaths have been reported in the United States. Long-term sequalae of COVID-19 over the course of a lifetime currently are unknown; however, persistent symptoms and serious complications are being reported among COVID-19 survivors, including persons who initially experience a mild acute illness.* On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for Pfizer-BioNTech COVID-19 vaccine to prevent COVID-19, administered as 2 doses separated by 21 days. On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine (1); initial doses were recommended for health care personnel and long-term care facility residents (2). As of December 23, 2020, a reported 1,893,360 first doses of Pfizer-BioNTech COVID-19 vaccine had been administered in the United States, and reports of 4,393 (0.2%) adverse events after receipt of Pfizer BioNTech COVID-19 vaccine had been submitted to the Vaccine Adverse Event Reporting System (VAERS). Among these, 175 case reports were identified for further review as possible cases of severe allergic reaction, including anaphylaxis. Anaphylaxis is a life-threatening allergic reaction that does occur rarely after vaccination, with onset typically within minutes to hours (3). Twenty-one cases were determined to be anaphylaxis (a rate of 11.1 per million doses administered), including 17 in persons with a documented history of allergies or allergic reactions, seven of whom had a history of anaphylaxis. The median interval from vaccine receipt to symptom onset was 13 minutes (range=2-150 minutes). Among 20 persons with follow-up information available, all had recovered or been discharged home. Of the remaining case reports that were determined not to be anaphylaxis, 86 were judged to be nonanaphylaxis allergic reactions, and 61 were considered nonallergic adverse events. Seven case reports were still under investigation. This report summarizes the clinical and epidemiologic characteristics of case reports of allergic reactions, including anaphylaxis and nonanaphylaxis allergic reactions, after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine during December 14-23, 2020, in the United States. CDC has issued updated interim clinical considerations for use of mRNA COVID-19 vaccines currently authorized in the United States (4) and interim considerations for preparing for the potential management of anaphylaxis (5). In addition to screening for contraindications and precautions before administering COVID-19 vaccines, vaccine locations should have the necessary supplies available to manage anaphylaxis, should implement postvaccination observation periods, and should immediately treat persons experiencing anaphylaxis signs and symptoms with intramuscular injection of epinephrine (4,5).

HORSEFLY-WASP SYNDROME

Introduction We present a 67 year old male who developed anaphylaxis after being bitten by a horsefly; likely a more common diagnosis than previously documented. Case Description 67 year old male farmer presented to ED with symptoms of anaphylaxis. He had eaten crab and ten minutes later was bitten by a horsefly on his left hand. He became lightheaded, developed left arm swelling, and itchy hands. Symptoms progressed to peri-oral numbness, neck erythema, emesis and loss of consciousness. His evaluation revealed positive specific IgE by serology to HB, WA, YH, YJ, WFH, horsefly and crab. Six weeks later, patient successfully passed crab challenge. Probable horsefly-wasp syndrome suspected and patient decided to undergo VIT to mixed vespids, wasp, and honeybee. Discussion At least 30 cases of severe allergic reactions to horsefly allergy (family Tabanidae) have been recorded; however, this is thought to be underreported secondary to poor diagnostics and lack of awareness. Clinically, a co-existence of anaphylaxis to horsefly and hymenoptera has been reported. Tab y 2 (a hyaluronidase) and Tab y 5 (antigen 5) have been identified as potential allergen proteins from the saliva of the horsefly as well as wasp venom which supports evidence of horsefly-wasp syndrome. Given the patient's occupational risk, lack of specific immunotherapy for horsefly allergy, and suspected cross reactivity between the wasp and horsefly, VIT for wasp should be considered as a scientifically plausible but limited treatment option for horsefly allergy. We present a 67 year old male who developed anaphylaxis after being bitten by a horsefly; likely a more common diagnosis than previously documented. 67 year old male farmer presented to ED with symptoms of anaphylaxis. He had eaten crab and ten minutes later was bitten by a horsefly on his left hand. He became lightheaded, developed left arm swelling, and itchy hands. Symptoms progressed to peri-oral numbness, neck erythema, emesis and loss of consciousness. His evaluation revealed positive specific IgE by serology to HB, WA, YH, YJ, WFH, horsefly and crab. Six weeks later, patient successfully passed crab challenge. Probable horsefly-wasp syndrome suspected and patient decided to undergo VIT to mixed vespids, wasp, and honeybee. At least 30 cases of severe allergic reactions to horsefly allergy (family Tabanidae) have been recorded; however, this is thought to be underreported secondary to poor diagnostics and lack of awareness. Clinically, a co-existence of anaphylaxis to horsefly and hymenoptera has been reported. Tab y 2 (a hyaluronidase) and Tab y 5 (antigen 5) have been identified as potential allergen proteins from the saliva of the horsefly as well as wasp venom which supports evidence of horsefly-wasp syndrome. Given the patient's occupational risk, lack of specific immunotherapy for horsefly allergy, and suspected cross reactivity between the wasp and horsefly, VIT for wasp should be considered as a scientifically plausible but limited treatment option for horsefly allergy.

Elicitors of severe allergic reactions - reports from allergists and emergency doctors.

Data from the anaphylaxis registry of German-speaking countries indicate that food is the most frequent elicitor of severe allergic reactions in children, insect venom is the most frequent elicitor in adults. The anaphylaxis registry considers data from patients of allergy centers. The aim of the present study was to collect data regarding elicitors, cofactors and the medical care of patients with severe allergic reactions seen by private practice allergists but also patients seen by emergency doctors. From June 2008 to December 2009 70 cases of severe allergic reactions from private practice allergists and 154 from emergency doctors in Berlin were registered. Our data show that the profile of elicitors differs among the reporting groups. The reported causes from allergists were severe reactions to food, insect venom and subcutaneous immunotherapy, the emergency doctors reported insect venom as the most frequent elicitor. Our data show that a systematic evaluation of severe allergic reactions can provide important data about elicitors and circumstances of anaphylaxis. Through a comparison with data from the anaphylaxis registry the analysis of the data from the emergency doctors will allow to determine how many patients with severe allergic reactions are seen by an allergist for further diagnostic work-up and subsequent therapy.

Enzymatic hydrolysis of gluten proteins changes the dose-response of oral sensitization, but not the gluten epitopes

Background Wheat gluten proteins are very complex proteins containing hundreds of components present as monomers, oligomers and polymers that by definition are not soluble in water. To improve utilization, gluten proteins can be hydrolyzed by enzymes or acid. This increases solubility and provide proteins with new functional properties. During the last decade, cases of severe allergic reaction to hydrolyzed wheat proteins have been reported in subjects tolerant to wheat.

A case of severe allergic reaction to cooked potato

White potato is a very common ingredient in the diet of infants in Mediterranean countries, and in its cooked form, it is one of the first solid foods introduced, usually around the age of 4-6 months. Allergy to potato is uncommon, and allergic reactions to cooked potato have been reported only in children. We report a case of severe potato-induced allergic reaction in an 8-month-old infant with atopic dermatitis and multiple food allergies that raises questions about differential diagnosis between anaphylaxis and food protein-induced enterocolitis syndrome (FPIES). Allergy to cooked potatoes could be a cause of severe although rare allergic reactions; it could be very difficult, in some cases, to make a differential diagnosis between anaphylaxis and FPIES. Moreover, the diagnosis appears to be very important for the choice of therapy and long-term allergologic management.

Efficacy of teicoplanin for the prevention of surgical site infections after total hip or knee arthroplasty: a prospective, open-label study

A prospective randomised study was conducted in three centres to evaluate the efficacy of teicoplanin as antimicrobial prophylaxis for arthroplasties. From a total of 616 patients undergoing total hip or knee arthroplasty, 278 patients operated on in one centre were administered a single dose of 10mg/kg teicoplanin upon introduction of anaesthesia and the remaining 338 patients operated on in the other two centres were administered multiple doses of comparators for 4–6 days as decided by the attending physicians. Follow-up was done for 24 months. No differences were found between the two groups regarding gender, underlying diseases and duration of the operation. Surgical site infections (SSIs) were present in two patients in the teicoplanin arm (0.78%) and in 11 patients in the comparator arm (3.53%) (P=0.025 between groups). These were deep SSIs in four patients (two in each arm). Two cases of severe allergic reaction occurred, one in the teicoplanin arm and another in the comparator arm. It is concluded that single-dose teicoplanin was more effective as prophylaxis for total hip or knee arthroplasty compared with multiple doses of broad-spectrum antimicrobials.

Eight Years of Severe Allergic Reactions in Finland: A Register-Based Report

Background No data have been available on severe allergic reactions in Finland.Materials and Methods We summarize the data accumulated from 2000 to 2007 in the national register established at the Skin and Allergy Hospital of the Helsinki University Central Hospital, where physicians voluntarily report on patients with severe allergic reactions.Results During the period, the 530 reported cases of severe allergic reactions represented an annual frequency of 0.001%. Of the patients, 66% were adults and 56% were female, with a median age of 27 years. Food was the causative agent in 53% of the cases, drugs in 26%, allergen preparations in 12%, and insects in 8%. Dermatologic symptoms were reported in 85%, respiratory in 76%, cardiovascular in 50%, gastrointestinal in 33%, and eye/nose symptoms in 18%. The reaction was a life-threatening anaphylactic shock in 26% of the cases, with no deaths reported. Patients were treated with intramuscular adrenaline in 75% of the cases. Not only nuts and seeds, but also fruit and vegetables were the most important allergens for the adults. Nuts were also important allergens for children, along with milk, egg, and wheat. In addition, many "exotic" allergens were identified: patent blue, carmine dye, yeast, buckwheat, and macrogol.Conclusions Severe allergic reactions are underreported, but a register reflects the real-life situation and helps to identify new causative agents. It also contributes to improvements in first aid treatment practice.

Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer)

BackgroundFirst-line chemotherapy regimens suitable for elderly advanced breast cancer patients are still not defined. Patients and methodsWomen with stage III or IV breast cancer aged ≥70 years were enrolled in a phase II study aimed to evaluate both activity and toxicity of weekly paclitaxel. Among 46 planned patients, at least 18 responses and not more than seven unacceptable toxic events are required for a favourable conclusion. Paclitaxel 80mg/m2 was administered weekly for 3 weeks every 28 days. ResultsUnacceptable toxicity occurred in seven out of 46 patients evaluated for toxicity [15.2%; exact 95% confidence interval (CI) 7.6% to 28.2%] and was represented by one case of febrile neutropenia, one case of severe allergic reaction and five cases of cardiac toxicity. Among 41 patients evaluated for response, a complete response occurred in two (4.9%) patients and a partial response in 20 (48.8%), with an overall response rate of 53.7% (exact 95% CI 38.7% to 67.9%). The median progression-free survival was 9.7 months (95% CI 8.5–18.7) and median survival was 35.8 months (95% CI 19–not defined). ConclusionsWeekly paclitaxel is highly active in elderly advanced breast cancer patients. Data on cardiovascular complications, however, indicate the need for a careful monitoring of cardiac function before and during chemotherapy.

Cross-reactivity between coconut and hazelnut proteins in a patient with coconut anaphylaxis

The medical literature reports few cases of severe allergic reactions to coconut. We encountered a patient with anaphylaxis to coconut and oral symptoms to tree nuts. To identify cross-reactive antibodies between coconut and other tree nuts. We performed commercial radioallergosorbent tests to coconut and various tree nuts using the patient's serum. Skin prick testing was performed to fresh coconut and commercial extracts of coconut, almond, Brazil nut, cashew, pecan, walnut, and hazelnut. Proteins from fresh coconut, commercial coconut extract, and tree nuts were extracted. Immunoblot and inhibition assays were performed to evaluate for cross-reacting IgE antibodies between similar-sized allergens in coconut and hazelnut. Positive skin test results occurred to the coconut and multiple tree nut extracts. In vitro serum specific IgE was present for coconut, hazelnut, Brazil nut, and cashew. Immunoblots demonstrated IgE binding to 35- and 50-kDa protein bands in the coconut and hazelnut extracts. Inhibition assays using coconut demonstrated complete inhibition of hazelnut specific IgE, but inhibition assays using hazelnut showed only partial inhibition of coconut specific IgE. Our study demonstrates the presence of cross-reactive allergens between hazelnut (a tree nut) and coconut (a distantly related palm family member). Because there are many potentially cross-reactive allergens among the tree nuts, we recommend patients with coconut hypersensitivity be investigated for further tree nut allergies.

A case of severe allergic reaction that was caused by oral administration of diclofenac sodium

A case of severe allergic reaction that was caused by oral administration of diclofenac sodium

Ammoniated mercury ointment: outdated but still in use

Although severe mercury-associated side effects, such as poisoning and high irritant and allergic potential, as well as the weak potency of mercury as an antiseptic or antipsoriatic agent, are well-known, topical mercury preparations are still listed in several pharmacopoeias, including that of the United States, UK and several other European countries. Thus, topical mercurials are still in use, even though more effective and less toxic drugs are now available. We report 2 cases of severe allergic reaction to ammoniated mercury and hope, in agreement with the pertinent literature, to contribute to its removal, and that of most other mercurials, from the therapeutic armamentarium.

A case of severe allergic reaction to monomycin in the treatment of sinusitis

The antibiotic monomycin has a wide spectrum of action, therefore it is often used in medical practice. The nephrotoxic effect of monomycin is mainly observed with prolonged parenteral administration and increased dosage. We observed a case of severe allergic reaction to parenteral administration of monomycin at an average therapeutic dose.