Cause Of Anaphylaxis Research Articles

CULTURAL COMPETENCY IN FOOD ALLERGY: NEW FROG ALLERGY IN KNOWN FISH ALLERGIC PATIENT

<h3>Introduction</h3> Allergic reactions in response to consumption of frog are rare. In this case, we describe a patient with a previously diagnosed fish allergy that experienced an allergic reaction after consumption of frog meat. <h3>Case Description</h3> A 23-year-old female with allergic phenotype and fish allergy presented with a concern for frog allergy. Immediately after tasting frog legs, the patient experienced lip swelling and throat itching sensation. She promptly took Benadryl and symptoms resolved. Her previous history includes multiple episodes of anaphylaxis to fish involving throat swelling, hives, and vomiting requiring epinephrine. <h3>Discussion</h3> The possibility of concomitant allergy to fish and frog meat has been documented due to the presence of IgE cross reactivity of frog and fish parvalbumin, due to similarities in amino acid sequencing up to 70% between frog and various fish species. While fish allergy is well known, worldwide incidence of allergy to frog, particularly in individuals with allergy to fish, is not clearly defined. While most ingestion of frog legs occurs in Europe and East Asia and is best known for being a delicacy in French cuisine, frog meat is eaten in the Southern United States, especially in areas of historical French influence. This may impact regional counseling of patients with severe fish allergy and present an uncommon cause of anaphylaxis in fish allergic patients. Our patient highlights the importance of considering the possibility of IgE cross reactivity of frog and fish in a known fish allergic patient whose cultural diet may include frog meat.

WHAT TO GIVE NEXT? THE CHALLENGE OF SEVERE PERIOPERATIVE DRUG REACTIONS IN PEDIATRIC PATIENTS

<h3>Introduction</h3> Perioperative drug reactions (PODR) are rare, occurring in∼ 1:10,000 cases. For patients with ongoing surgical needs, it is challenging to select safe alternatives. <h3>Case Description</h3> An 11 yr old male with history of food allergy, environmental allergy, and well-controlled mild intermittent asthma required surgical reduction of a forearm fracture. Prior to presentation, he was clinically well. Anesthesia induction was performed with propofol, rocuronium, and morphine. Within minutes, the patient had severe bronchospasm, without hives/angioedema, leading to bradycardic arrest requiring intubation, resuscitation with epinephrine and ICU admission. Serum tryptase drawn at 30 minutes after the event was 62.5 ug/mL (normal: <10.9 ug/mL).. The following day, he tolerated vecuronium and rocuronium while intubated. He has tolerated multiple opiates since the event. The initial injury still requires surgical repair. <h3>Discussion</h3> His PODR was most likely triggered by a medication received during anesthesia induction, and clinically, rocuronium was most suspected. Mast cell depletion may explain his tolerance immediately after the event. Propofol is a rare cause of anaphylaxis but remains a possibility. Opioids are less likely as the patient has since tolerated multiple opioids. An underlying mast cell disorder must be considered. It was recommended the patient avoid rocuronium, vecuronium, and propofol until a full evaluation is completed. Cisacuronium was offered as an alternative agent to use for his acutely needed surgical repair due to the low cross-reactivity (5%) with rocuronium. Outpatient SPT testing was recommended when well. This case highlights the differential for perioperative anaphylaxis and the importance of further evaluation to determine the inciting agent.

Cytometric analysis reveals an association between allergen-responsive natural killer cells and human peanut allergy.

Food allergies are a leading cause of anaphylaxis, and allergen-specific immune responses in both the innate and the adaptive immune system play key roles in its pathogenesis. We conducted a comprehensive phenotypic and functional investigation of immune cell responses from nonallergic (NA) and peanut allergic (PA) participants cultured with media alone or peanut protein and found, surprisingly, that NK cell activation was strongly associated with the immune response to allergen in PA participants. Peanut-responsive NK cells manifested a distinct expression pattern in PA participants compared with NA participants. Allergen-activated NK cells expressed both Th2 and immune regulatory cytokines, hinting at a potential functional role in mediating and regulating the Th2 allergic response. Depletion of CD3+ T cells attenuated the response of NK cells to peanut-allergen stimulation, suggesting that peanut-responsive NK cells are T cell dependent. We also showed that oral immune therapy was associated with decreased NK responses to peanut allergen stimulation in vitro. These results demonstrate that NK cells are associated with the food-allergic immune response, and the magnitude of this mobilized cell population suggests that they play a functional role in allergic immunity.

Oral tolerance induction protocol to egg white – A report of three pediatric cases

Food allergies are the main cause of anaphylaxis in children. Cow’s milk and egg white are the most common agents and elimination diets are considered the current strategy for their management. Many children can tolerate increasing amounts of the known allergen, and thus, oral tolerance induction protocols seem to be a promising approach. The authors present a protocol drawn up in a pediatric allergic diseases’ outpatient clinic, at a level II hospital, with the aim of egg white oral tolerance induction. During the protocol there is an increase in the amount of egg white offered to children, at the end, tolerance is tested with the ingestion of an entire egg. The protocol was performed in three children with anaphylaxis to egg white. Two children completed the protocol successfully. Oral tolerance to egg white allows a less restrictive diet and improves the quality of life of the patients and their caregivers.

Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives.

Hymenoptera venom allergy is the most common cause of anaphylaxis in adults and the second-most frequent in children. The proper diagnosis of this life-threatening allergy remains a challenge. This review focuses on the current knowledge regarding diagnostics of Hymenoptera venom allergy. The paper includes a brief description of the representatives of Hymenoptera order and the composition of their venoms. Then, diagnostic tests for allergy to Hymenoptera venom are described. Common diagnostic problems, especially double positivity in tests for IgE antibodies specific to honeybee and wasp venom, are also discussed. Special attention is paid to the search for new diagnostic capabilities using modern methodologies. Multidimensional molecular analysis offers an opportunity to characterize changes in body fluids associated with Hymenoptera venom allergy and yields a unique insight into the cell status. Despite recent developments in the diagnostics of Hymenoptera venom allergy, new testing methodologies are still needed to answer questions and doubts we have.

Acute abdomen due to anaphylactic intestinal edema associated with systematic mastocytosis: a case report

BackgroundAmong various anaphylactic conditions resulting in acute abdomen, mast cell activation disorders, although rare, are included in the differential diagnosis.Case presentationThis report describes a 63-year-old Caucasian man who was brought to the emergency room with sudden onset abdominal pain, vomiting, and diarrhea, with breathing difficulty, and with facial swelling after quarrelling with an acquaintance. Computed tomography showed edematous and swollen intestines, consistent with splenomegaly. Physical findings included maculopapular cutaneous mastocytosis. He also had a long history of repeated episodes of anaphylaxis requiring occasional epinephrine auto-injector administration; however, the precise cause of anaphylaxis was previously undetermined. Blood tests showed high serum concentrations of soluble IL-2R and tryptase, suggesting mast cell-related disease. Subsequent biopsies of his bone marrow and cutaneous rash confirmed the diagnosis of systemic mastocytosis (SM).ConclusionSM was diagnosed in a patient with acute abdomen who visited the emergency room.

Airborne anaphylaxis: highlighting an invisible enemy.

Airborne anaphylaxis is a rare disorder defined by the occurrence of anaphylactic reactions to inhaled allergens, which may arise not only in occupational exposure but also in common settings. Foods are the most common cause of airborne anaphylaxis, even organic mixtures scents. The other important cause is represented by drugs, while in the wide range of other causes, there are often reports on unique cases. This review aims to make an overview about the potential causes of airborne anaphylaxis, by analysing what is described in literature on this topic. Concerning epidemiology, no data on specific prevalence of airborne allergy in adults are available. To date, only one study evaluated the specific prevalence of airborne allergy with anaphylaxis to foods in children, resulting in 5.9% of reactions due to exposure to aerosolized foods, compared with 78% of reactions caused by food ingestion. In addition to anaphylaxis, airborne-related reactions may also present with symptoms such as rhino-conjunctivitis, wheezing, dyspnoea and asthma. A detailed anamnesis facilitates a correct diagnosis, which allows appropriate therapeutic and preventive interventions, but, similarly to rare diseases in general, only specialized doctors are able to implement it. The assumption of the approach used in emergency medicine for other causes of anaphylaxis, that is referring the patient at discharge to an allergist who will teach the basic notions to recognize symptoms and access the appropriate therapy, would allow the patient to avoid situations of serious danger.

Incidence of Fatal Anaphylaxis: A Systematic Review of Observational Studies.

Fatal anaphylaxis is very rare, with an incidence ranging from 0.5 to 1 deaths per million person-years. Based on a systematic review, we aimed to explain differences in the reported incidence of fatal anaphylaxis based on the methodological and demographic factors addressed in the various studies. We searched PubMed/MEDLINE, EMBASE, and the Web of Science for relevant retrospective and prospective cohort studies and registry studies that had assessed the anaphylaxis mortality rate for the population of a country or for an administrative region. The research strategy was based on combining the term "anaphylaxis" with "death", "study design", and "main outcomes" (incidence). A total of 46 studies met the study criteria and included 16,541 deaths. The range of the anaphylaxis mortality rate for all causes of anaphylaxis was 0.002-2.51 deaths per million person-years. Fatal anaphylaxis due to food (range 0.002-0.29) was rarer than deaths due to drugs (range 0.004-0.56) or Hymenoptera venom (range 0.02-0.61). The frequency of deaths due to anaphylaxis by drugs increased during the study period (IRR per year, 1.02; 95%CI, 1.00-1.04). We detected considerable heterogeneity in almost all of the meta-analyses carried out. The incidence of fatal anaphylaxis is very low and differs according to the various subgroups analyzed. The studies were very heterogeneous. Fatal anaphylaxis due to food seems to be less common than fatal anaphylaxis due to drugs or Hymenoptera venom.

Allergenome profiling of Vespa orientalis venom by serum IgE in patients with anaphylactic reaction to this hornet sting

BackgroundHymenoptera stings are one of the most common causes of anaphylaxis. Vespa orientalis (red hornet) is a common and very aggressive hymenopteran endemic in central and southern areas of Iran. Allergy testing and venom immunotherapies are carried out with venom components which are expensive, have limited commercial availability, and often lack specificity. Although proteomic analysis of hymenopteran venom has been shown to be a powerful technique to identify allergens, data on the protein components of V. orientalis venom are lacking. AimThis study was designed to characterize the allergenome profile (proteome of allergenic proteins) of this local hornet venom. MethodsVenom was extracted from V. orientalis worker venom sacs. The venom constituents were separated by two-dimensional gel electrophoresis (2DE). Protein components were blotted and probed with serum from 10 allergic patients by immunoblotting. Reactive spots were isolated and characterized by liquid chromatography with tandem mass spectrometry. ResultsA total of 195 protein spots were detected on the 2DE gels. Fifteen distinct venom proteins showed reactivity to IgE in patients’ sera. Four major allergens in order of allergenicity in patients were identified as hyaluronidase, arginine kinase, phospholipase A1 (PLA1) and PLA1 magnifin. ConclusionsBroadening our knowledge of V. orientalis venom constituents can contribute to improvements in diagnostic and immunotherapeutic techniques, both of which are dependent on the major allergens in venom extract. This information is also potentially helpful to develop medical uses of major allergens in this venom to improve the diagnostic specificity and the efficacy of immunotherapy.

Emergency department childhood anaphylaxis presentations in regional/remote Australia.

AimExplore the prevalence of childhood anaphylaxis and clinical presentation of anaphylaxis in children across two regional emergency departments over a 7‐year period.MethodsRetrospective audit of all children (0–18 years) presenting to emergency from 1 January 2010 to 31 December 2016 with anaphylaxis, defined by Australasian Society of Clinical Immunology and Allergy definitions and doctor diagnosis.ResultsSeven hundred and twenty‐four patients were identified with allergic diagnosis, 60% were diagnosed with non‐anaphylaxis allergic reactions or unspecified urticaria and 40% with anaphylaxis (n = 286). Annual prevalence of anaphylaxis remained stable over the study period (M = 30.9/10 000 cases, range: 20.8–48.3/10 000). Gender distribution was equal, median age was 9.48 years (interquartile range = 4–15). Most (71%) arrived by private transport. 23% had a prior history of anaphylaxis. Food triggers (44%) were the most common cause of anaphylaxis. Insect bites/stings triggers occurred in 21%. Patients were promptly assessed (average wait time = 13 min), 16% received prior adrenaline injections. Adrenaline was administered in 26% and 20% were admitted to hospital. On discharge, 29% had a follow‐up plan, 9% received an allergy clinic referral, 6% anaphylaxis action plan, 26% adrenaline autoinjector prescriptions and allergy testing performed in 6%.ConclusionsWe found a relatively low prevalence of overall childhood anaphylaxis in a regional area. The two most common causes of anaphylaxis in this population (food and bites/stings) recorded increased prevalence providing an opportunity for further study. Significant gaps in evidence‐based care of anaphylaxis were noted, demonstrating the need for improved recognition and treatment guideline implementation in regional areas.

Characteristics of anaphylaxis patients who visited emergency departments in Korea: Results from a national emergency department information system.

BackgroundAnaphylaxis is an allergic disease with fatal respiratory or cardiovascular symptoms that require immediate emergency treatment. We aimed to understand the characteristics and frequency of emergency department (ED) visits of patients with anaphylaxis in Korea.MethodsBetween 2007 and 2013, using data from 147 ED from the National Emergency Department Information System in Korea, we retrospectively evaluated patients with a primary diagnosis of anaphylaxis.ResultsDuring the study, a total 23,313 patients visited the ED due to anaphylaxis. The number of patients with anaphylaxis who visited the ED increased from 3.0 per 100,000 population in 2007 to 11.6 per 100,000 population in 2013 (P<0.001). Overall, the frequency of anaphylaxis emergency department visits increased by 1.24 times each year (95% CI 1.23–1.25). The risk of visiting ED due to anaphylaxis by population-based age-specific group was highest in the 60–69 years old (OR 2.30, 95% CI 1.96–2.70). Deaths from anaphylaxis increased by 1.35 times per year (95% CI 1.13–1.62). The causes of anaphylaxis were unknown (80.8%; 95% CI 80.35–81.38), drugs (8.9%; 95% CI 8.47–9.24), food (4.1%; 95% CI 3.87–4.39), bees (3.2%; 95% CI 3.02–3.48) and arthropods (2.3%; 95% CI 2.11–2.48). In 2009, drugs were the most common cause of anaphylaxis in November (35.5%), followed by food in May (15.5%) (P<0.001). Between July and September, stings from insects were the most common causes (P<0.001). By age, food was the most common cause in children aged <6 years (7.6%, <12 months; 9.0%, 1–6 years) and drugs in those aged ≥7 years. The 7-year overall mortality rate was 0.104 case per 1,000,000 population; men accounted for 77.8% of the deaths. By region, the number of cases was the highest in metropolitan areas, Gyeonggi and Seoul; however, the number of anaphylaxis cases per 100,000 population was the highest in Jeju and Gangwon.ConclusionBased on ICD-10 codes, the number of ED visits due to anaphylaxis is increasing in Korea, and the incidence of anaphylaxis varies by region, season, and age.

Overcoming barriers to effective management of food-induced anaphylaxis in underserved populations through school-based interventions

Food allergy is an important public health concern in the United States, affecting an estimated 1 in 13 children and 2% to 3% of adults with evidence of increasing prevalence. Food exposure is the most common cause of anaphylaxis in children, and 40% of US children with food allergy will experience a severe reaction.1 Management of food allergy centers on avoidance of the culprit food(s) and access to epinephrine autoinjectors in case of accidental exposure. Furthermore, early recognition of anaphylaxis and administration of epinephrine are essential during severe food reactions.

A case of pediatric perioperative anaphylaxis to neuromuscular agents and its management

Background Perioperative anaphylaxis is one of the most challenging complications in anesthesiology. The key role is to determine the causative agent of the reaction. Neuromuscular agents are ones of the most common causes of anaphylaxis. Skin tests including prick and intradermal reaction tests are gold standard for definite diagnosis. Case presentation: We present a case of a child undergone several operations due to congenital esophageal atresia. Later on, attempts to perform a definitive repair failed because of perioperative anaphylaxis. Allergic skin tests were performed and rocuronium was found to be positive and atracurium – negative. The operation was successfully performed with atracurium. Conclusion: In patients who have gone through multiple surgeries the risk of anaphylaxis development is higher. The most common cause is considered to be neuromuscular blocking agents. In our case, after thorough examination of the anesthesiology cards, rocuronium and pipecuronium were defined as causes of anaphylaxis in our patient, so the surgery was done with atracurium which had been seen negative on a skin prick test. Eventually, the surgical procedure was performed successfully.

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry.

Anaphylaxis is an acute, life-threatening, multiorgan hypersensitivity reaction. Objective: The aim of this study was to identify the causes of anaphylaxis in Portugal in order to improve our knowledge of epidemiology and management. We implemented a nationwide notification system for anaphylaxis over a 10-year period, with voluntary reporting by allergists. Data on 1783 patients with anaphylaxis were included. Etiopathogenesis, manifestations, and clinical management were characterized in detail for both children and adults. The mean age was 32.7 (20.3) years, and 30% were under 18 years of age; 58% were female. The mean age at the first anaphylaxis episode was 27.5 (20.4) years (ranging from 1 month to 88 years). The main culprits of anaphylaxis were foods (48%), drugs (37%) (main trigger in adults, 48%), and hymenoptera venom (7%). The main culprit foods were shellfish (27%), fresh fruit (17%), cow's milk (16%), tree nuts (15%), fish (8%), egg (7%), and peanut (7%). The main drugs were nonsteroidal anti-inflammatory drugs (43%), antibiotics (39%), and anesthetic agents (6%). Other causes included exercise (3%), latex (2%), cold-induced anaphylaxis (2%), and idiopathic anaphylaxis (2%). Most patients (80%) were admitted to the emergency department; only 43% received adrenaline. Anaphylaxis recurred in 41% of patients (21% with ≥3 anaphylactic episodes); 7% used an adrenaline autoinjector device. Food is the leading cause of anaphylaxis in Portugal, while drugs were the main elicitors in adults. We emphasize undertreatment with adrenaline and recurrent episodes, highlighting the need to improve diagnostic and therapeutic approaches to anaphylaxis.

Anaphylaxis in Omani Patients: A Study from a Tertiary Care Center.

ObjectivesAnaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman.MethodsThis retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records.ResultsOne hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p =0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p =0.010).ConclusionsDue to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

Recurrent anaphylaxis in a chronically hospitalized pediatric patient

In-hospital anaphylaxis in the pediatric population is a life-threatening and potentially fatal problem with reported incidence of up to 761 per 100,000 person years.1 It can be difficult to elicit the cause of anaphylaxis in hospitalized patients owing to confounding factors, such as medications, meals, and concurrent infections, that patients encounter while being hospitalized. A recent study on intensive care unit pediatric anaphylaxis admissions revealed that only 42% of cases had an identifiable trigger—most often food (35%).

Анафилаксия среди детей, госпитализированных с острыми аллергическими реакциями: пятилетний ретроспективный анализ

Objective. To determine the frequency, range of triggers, features of clinical symptoms and treatment of anaphylaxis in children hospitalized with severe systemic allergic reactions in the pediatric department in Moscow. Patients and methods. We conducted a retrospective analysis of 1197 medical records of children admitted to the Z.A.Bashlyaeva Children's City Clinical Hospital with severe allergic reactions over the period from 2016 to 2020 to determine the clinical criteria for anaphylaxis. The diagnosis of anaphylaxis was made retrospectively in 86 patients based on corresponding reports of 2 independent allergy specialists. Results. The incidence of anaphylaxis among children hospitalized with severe allergic reactions was 7.18%. The use of the new WAOAG (2020) anaphylaxis criteria, compared with the previously adopted NIAID/FAAN (2006), slightly increased the coverage of patients diagnosed with anaphylaxis (7.18% vs 7.01%, respectively). Food allergens were the predominant cause of anaphylaxis in children (78%); the second most important trigger were medications (5%), and 7% of patients had idiopathic anaphylaxis. The main causes of food anaphylaxis were tree nuts (31%), cow's milk (19%), fish/seafood (16%), and chicken egg (9%); the frequency of anaphylactic reactions to peanuts did not exceed 4%. The incidence of anaphylaxis to cow's milk and chicken egg was higher in the group of children younger than 3 years (p = 0.003, p = 0.01, respectively), and the incidence of anaphylaxis to fruits was lower (p = 0.05) compared with patients aged 3-18 years. The proportion of anaphylaxis to tree nuts in children was highest and irrespective of patient age. In the development of anaphylaxis, skin/mucosal (98%) and respiratory (71%) symptoms were the most frequent, followed by gastrointestinal symptoms (29%) and laryngeal symptoms (26%). In hospital, anaphylaxis was diagnosed in 10 (12%) patients, and only 21% of children received epinephrine for the treatment of anaphylaxis. At discharge, epinephrine was recommended for 13% of patients. Conclusion. The diagnosis of anaphylaxis is to be excluded in patients with severe allergic reactions, since its incidence in this group of patients reaches 7.18%. Food allergens are the main trigger of anaphylaxis in children in the Russian Federation. The age-dependent spectrum of food anaphylaxis triggers in Russia suggests the use of diagnostic allergy panels in infants that include not only cow's milk, chicken egg, fish, but also tree nuts. Less than 1/4 of children receive epinephrine in the treatment of anaphylactic reactions; the rate of verification of the diagnosis of anaphylaxis and prescription of epinephrine is extremely low and does not exceed 13%. Key words: anaphylaxis, anaphylactic reaction, trigger, allergen, children, food allergy, infants

Causes and Diagnostic Usefulness of Tryptase Measurements for Anaphylaxis in a Korean Tertiary Care General Hospital.

The causes of anaphylaxis in a general hospital may differ from those occurring in a community setting. Underlying diseases in admitted patients and vague presenting symptoms can make the diagnosis of anaphylaxis difficult. Serum tryptase measurements may provide valuable evidence for diagnosing anaphylaxis in admitted patients. This study was designed as a retrospective study of 53 patients with an anaphylaxis episode at a Korean tertiary care general hospital. Tryptase levels were measured at baseline and different time points from the onset of anaphylaxis. Drugs (42 cases; 79.2%) and foods (10 cases; 18.9%) were the most common causes of anaphylaxis. In drug-induced anaphylaxis, antibiotics (24.5%), anticancer medications, which included monoclonal antibodies (22.6%), and contrast agents (11.3%) were the most frequent causes. The muscle relaxant eperisone (5.7%), neuromuscular blocking agent rocuronium (5.7%), and its antagonist sugammadex (3.8%) were other frequent triggering agents. Wheat-dependent exercise-induced anaphylaxis was the most common entity in food-induced anaphylaxis. Tryptase concentrations were higher in patients with higher grades of anaphylaxis, as well as in accidental anaphylaxis, compared to meticulously provoked anaphylaxis. Overall diagnostic sensitivity was higher for tryptase algorithm criteria (≥[1.2×baseline+2] µg/L: 71.4%) than for abnormal tryptase level criteria (≥11.4 µg/L: 52.8%). The triggers of anaphylaxis in a Korean tertiary care hospital were diverse, including beta-lactam antibiotics, anticancer medications, contrast medias, eperisone, nonsteroidal anti-inflammatory drugs, rocuronium, sugammadex, and wheat. Tryptase measurements provided valuable evidence for diagnosis, and the sensitivity of algorithm criteria was superior to that of the abnormal value criteria.

ANALYSIS OF DRUG-INDUCED ANAPHYLAXIS CASES USING THE JAPANESE ADVERSE DRUG EVENT REPORT DATABASE

The epidemiology of drug-induced anaphylaxis (AN) using the Japanese nationwide database has not been reported, even though drugs are a common trigger of AN. This study aimed to describe the epidemiological profile of drug-induced AN, including fatal cases, using the Japanese Adverse Drug Event Report database (JADER). We extracted data regarding drug-induced adverse events between April 2004 and February 2018 published in JADER by the Pharmaceuticals and Medical Devices Agency. We analyzed cases of anaphylaxis occurring between January 2005 and December 2017. The drug classification was based on the Japanese Standard Commodity Classification. There were 16916 cases of anaphylaxis reported during the study period. Among them, 418 fatalities were registered. The incidence of drug-induced AN and fatal cases was 1.03 cases/year per 100000 population and 0.03 cases/year, respectively. The most frequent causes of AN were diagnostic agents including X-ray contrast media (20.3%) and biological agents including human blood preparations (20.1%). In fatal cases, diagnostic agents (28.7%) and antibiotics (23.9%) were the most frequent causes. The frequency of drug-induced AN and fatalities in Japan remained unchanged over the 12-year period analyzed in this study. Diagnostic and biological agents were the most frequent causes of AN. Contrarily, fatalities were most frequently caused by diagnostic and antibiotic agents.

White potato – a rare cause of anaphylaxis in children

White potato is a very common ingredient in the diet of children in Western countries, and in its cooked form, it is one of the first solid foods introduced. Allergy to potato is uncommon, and allergic reactions to cooked potato have been reported only in children. We report a case of anaphylactic reaction to cooked potato in a 10‑months‑old infant with atopic dermatitis and with a family history of atopy.