Diagnosis Of Anaphylaxis Research Articles

Chemiluminescence-Based IgE Dot-Blot Assay in the Diagnosis of Anaphylaxis Caused by Prontosan.

Chemiluminescence-Based IgE Dot-Blot Assay in the Diagnosis of Anaphylaxis Caused by Prontosan.

Prevention of Anaphylaxis Episodes in Idiopathic Anaphylaxis by Omalizumab

Introduction: In 15–35 percent of patients with anaphylaxis, the triggering allergen cannot be found; therefore, a diagnosis of idiopathic anaphylaxis (IA) is made. We report on the outcomes in patients with IA treated with omalizumab. Methods: We included consequent omalizumab-treated IA adult patients treated with omalizumab 300 mg every 4 weeks. Results: Out of 7 patients, 6 were female, median age 40 years with the frequency of anaphylaxis episodes from 3 in 2 years to 5 in 4 months. Baseline tryptase ranged from 1.71 to 12.0 μg/L. An increase in tryptase during anaphylaxis was documented in 6 patients. Activating KIT p.D816V variant was detected in 2 patients. One patient also had hereditary alpha-tryptasemia (HαT). The duration of omalizumab treatment was 0.5–7.5 years. None of the patients have experienced an anaphylactic reaction since the start of treatment. Mild systemic reactions were reported in 6 patients (86%). The presence of underlying cMCD had no impact on the treatment outcome. Conclusion: All patients in our study had complete responses to omalizumab. The presence of KIT p.D816V and HαT did not influence the response to omalizumab treatment.

El pediatra de Atención Primaria y la anafilaxia

Anaphylaxis is a severe, rapid and potentially fatal allergic reaction. The diagnosis of anaphylaxis is clinical and must be early. It appears in the first 2 hours after exposure to the allergen, in the first 30 minutes in food allergy and earlier with intravenous drugs or hymenoptera stings. Cutaneous symptoms are generally the first to appear and are present in most cases, more than 80%. They may be mild or transitory, or absent in 18% of cases. If the cardio-circulatory system is affected, an anaphylactic shock occurs. The most frequent cause in pediatrics is nutrition. There are several cofactors whose presence increases the likelihood of anaphylaxis; the most important are: exercise, medication, fever and stress. The treatment of choice is intramuscular adrenaline. Parents and children should be able to identify the signs and/or symptoms of anaphylaxis in order to implement the treatment prescribed in the written action plan.

Simulation training for medical emergencies: Evaluation of dentists' long-term learning skills and confidence.

As the population ages and more patients experience medical emergencies during dental treatments, dentists must competently and confidently manage these situations. We developed a simulation training course for medical emergencies in the dental setting using an inexpensive vital sign simulation app for smartphones/tablets without the need for an expensive simulator. However, the duration for which this effect is maintained is unclear. This study was performed to evaluate the long-term educational effect at 3, 6, and 12 months after taking the course. Thirty-nine dental residents participated in this course. Scenarios included vasovagal syncope, anaphylaxis, hyperventilation syndrome, and acute coronary syndrome, each of which the participants had to diagnose and treat. The participants were evaluated using a checklist for anaphylaxis diagnosis and treatment skills immediately after and 3, 6, and 12 months after the course. The participants were also surveyed about their confidence in diagnosing and treating these conditions by questionnaire before, immediately after, and 3, 6, and 12 months after the course. The checklist scores for anaphylaxis were significantly lower at 3, 6, and 12 months after the course than immediately after the course. The percentage of participants who provided a correct diagnosis and appropriate treatment for vasovagal syncope, hyperventilation syndrome, and acute coronary syndrome was lower at all reassessments than immediately after the course. Because medical emergency management skills and confidence declined within 3 months, it would be useful to introduce a refresher course approximately 3 months after the initial course to maintain skills and confidence.

Anafilaksiye Güncel Yaklaşım

Anaphylaxis is the most important acute systemic allergic reaction. The incidence of anaphylaxis has been increasing in recent years. Therefore, all healthcare providers should know the diagnosis and management of anaphylaxis. In this article, the current approach to anaphylaxis is presented, considering the criteria accepted by the World Allergy Organization (WAO) and the European Academy of Allergy and Clinical Immunology (EACCI). Intramuscular epinephrine is the first-line treatment for anaphylaxis. However, it is still not used at the desired level. Children at risk of anaphylaxis should be trained to use adrenaline autoinjectors. After anaphylaxis develops, children should be referred to an allergist to investigate the underlying causes.

Allergic Acute Coronary Syndrome: A Case Report and Literature Review

Introduction: Kounis Syndrome was first described in 1991 by Kounis and Zavras as “the concurrence of chest pain during an allergic reaction, accompanied by clinical laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult” [1].
 The mechanism of Kounis Syndrome most likely involves the release of cytokines through mast-cell degranulation, which leads to coronary vasospasm and atheromatous plaque erosion or rupture following the allergic reaction to an allergen.[2]
 The treatment is specific to acute coronary syndrome and anaphylaxis, with the added complication that the drugs used, while indicated in each of the two disorders separately, may present contradictions when administered jointly in one patient.[3]
 The purpose of this review is to briefly revise the existing literature regarding its overlooked diagnosis and contradictory joint management of anaphylaxis and acute coronary syndrome.
 We will conduct a brief review of the current literature on Kounis Syndrome while describing a suspected case of a female patient presented with both anaphylaxis symptoms and angina pectoris.
 Conclusions: Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic reaction. Treatment of allergic reactions may be sufficient in type I KS. In contrast, coronary intervention is needed in the other two types, accompanied by vasodilator drugs, including nitrates and calcium antagonists, each of which may have contradictory effects.

Frequency of cardiotoxicity following intramuscular administration of epinephrine in emergency department patients with anaphylaxis.

Epinephrine can be a life-saving treatment for patients with anaphylaxis. Potential cardiovascular side effects of epinephrine may contribute to clinician hesitancy to use it. However, the frequency of cardiotoxicity resulting from epinephrine treatment for anaphylaxis is not well described. We sought to describe the frequency of cardiotoxicity following intramuscular (IM) administration of epinephrine in adult emergency department (ED) patients with anaphylaxis. We conducted a retrospective observational study at a single, quaternary care academic ED in Tennessee. We identified consecutive ED visits with the diagnosis of anaphylaxis from 2017 to 2021 who received at least one intramuscular (IM) dose of epinephrine in the ED. Analysis was primarily descriptive. The primary outcome was cardiotoxicity, the occurrence of any of the following after epinephrine administration: ischemic electrocardiogram changes, systolic blood pressure>200mmHg, or cardiac arrest ≤4h; elevated troponin ≤12h; or percutaneous coronary intervention or depressed ejection fraction ≤72h. Among 338 included patients, 16 (4.7%; 95%CI: 2.8-7.6%) experienced cardiotoxicity. Cardiotoxic events included eight (2.4%) ischemic electrocardiogram changes, six (1.8%) episodes of elevated troponin, five (1.5%) atrial arrhythmias, one (0.3%) ventricular arrythmia, and one (0.3%) depressed ejection fraction. Patients with cardiotoxicity were significantly older, had more comorbidities, and were more likely to have received multiple doses of epinephrine or an epinephrine infusion compared with a single IM dose of epinephrine. Among 338 consecutive adult ED patients who received IM epinephrine for anaphylaxis during a recent 4-year period, cardiotoxic side effects were observed in approximately 5% of patients.

Сучасні аспекти діагностики та лікування анафілаксії. Частина 1

Abstract. The aim of this review is to characterize the epidemiology, determine the phenotypes and endotypes of anaphylaxis, pathogenetic mechanisms of its development, systematize on their basis of clinical manifestations and degrees of severity of this condition, evaluate possible biomarkers of anaphylaxis for their wider implementation in clinical practice. Anaphylaxis is the most severe of allergic reactions, putting patients at high risk of losing their lives and requiring prompt recognition and immediate treatment. However, since its symptoms mimic the manifestations of other diseases, such as asthma and urticaria, the diagnosis of anaphylaxis is often insufficiently effective due to the very rare determination of the tryptase level, so the treatment of patients is delayed, and epinephrine (adrenaline) is used late. The main causes of anaphylaxis are poorly understood, and death due to anaphylaxis is often difficult to investigate due to misdiagnosis of the condition. Key words: anaphylaxis, phenotypes and endotypes of anaphylaxis, anaphylactic shock, immediate-type hypersensitivity reactions, IgE, monoclonal antibodies, epinephrine.

Serum MRGPRX2 as a Long-term Biomarker for Iodinated Contrast Media-Induced Anaphylaxis.

The diagnosis of anaphylaxis is based on the clinical history. The utility of tryptase measurements in clinical setting is limited. Mas-related G protein-coupled receptor-X2 (MRGPRX2) is expressed in mast cells and is involved in the degranulation of these cells. We evaluated the potential of MRGPRX2 as a diagnostic biomarker in patients with iodinated contrast media (ICM)-induced immediate hypersensitivity reactions (IHRs). A total of 173 patients with documented ICM-induced IHR within 4 months from registration were enrolled and skin tests for the culprit ICM were performed. The time interval was evaluated as the duration between the onset of ICM-induced IHR and the measurement of serum MRGPRX2 levels. Serum MRGPRX2 concentration was determined using an enzyme-linked immunosorbent assay kit. Of the 173 patients, 33 and 140 were included in the anaphylaxis and non-anaphylaxis groups, respectively. Serum MRGPRX2 levels were significantly higher in the anaphylaxis than in the non-anaphylaxis group (29.9 ± 24.1 vs. 20.7±17.5, P = 0.044). Serum MRGPRX2 showed a moderate predictive ability for anaphylaxis, with an area under the curve of 0.61 (P = 0.058). When groups were classified based on the time interval, T1(0-2months) and T2 (2-4months), patients with anaphylaxis had higher MRGPRX2 levels compared to the non-anaphylaxis group in the T2 group (36.5±19.2 vs. 20.5±19.0, P = 0.035). This pilot study shows that serum MRGPRX2 is a potential long-term biomarker for predicting anaphylaxis, particularly ICM-induced anaphylaxis. Further studies are needed to determine the role of MRGPRX2 in anaphylaxis in a larger population of patients with various drug-induced IHRs.

Anaphylaxis and Cardiac Arrest in a Patient during the 14th Transarterial Chemo-embolization for Hepatocellular Carcinoma

Transarterial chemo-embolization (TACE) is a valid and recommended treatment for patients with Barcelona Clinic Liver Cancer (BCLC) Stage B hepatocellular carcinoma (HCC). It is considered a safe procedure and the treatment-related mortality rate is less than 1%, mostly associated with acute liver failure, sepsis, renal failure or liver abscess. We reported a rare case of anaphylaxis and cardiac arrest during TACE, followed by successful cardiopulmonary resuscitation (CPR) and the management per anaphylaxis guideline, including epinephrine injection and glucagon infusion. The patient recovered well from this event and continued his treatment for HCC. The diagnosis, management and laboratory analysis of anaphylaxis is also reviewed in discussion. To our knowledge, it is the first case report of anaphylaxis-related cardiac arrest during TACE.

An Appy That Needs Epi: An Atypical Presentation of Anaphylaxis.

An Appy That Needs Epi: An Atypical Presentation of Anaphylaxis.

Use of in vitro and in vivo tests in the diagnosis of food-induced anaphylaxis – a case study

Food allergy is a chronic disease that affects both children and adults. Systemic allergic reactions in children are most commonly caused by foods, especially nuts, milk, and eggs. A conventional diagnostic work-up for allergy typically pinpoints the allergen source, while component-resolved diagnostics is an approach that identifies the allergen molecules responsible for causing anaphylaxis. In some cases, determining the causative agent of anaphylaxis requires the use of various diagnostic tests. In the following paper, we want to highlight the importance of a critical approach to allergy tests results and caution in the diagnosis of idiopathic anaphylaxis. Based on a case report of food-induced anaphylaxis, we discuss the diagnostic methods that can be applied following a negative IgE test result for allergens obtained with a multiplex platform.

Death Due to Anaphylactic Reaction: The Role of the Forensic Pathologist in an Accurate Postmortem Diagnosis.

Background and Objectives: The diagnosis of anaphylaxis comprehensively depends on both situational information and laboratory investigations. For this purpose, serum tryptase concentration is examined as an indicator of systemic mast cell mediator release, linked to an underlying anaphylactic process. Increased levels of tryptase may occur in some events different from anaphylaxis, but usually information from crime scene investigations is lacking and autoptic findings are not specific. For legal reasons, it is required to achieve a definite diagnosis of mast cell degranulation that can lead to a certain diagnosis of death from anaphylaxis. Immunohistochemistry seems to be a relatively simple, reliable, and easily repeatable method that can assist the forensic pathologist in the differential diagnosis of death from anaphylaxis. Materials and Methods: This work provides an overview of the current literature on immunohistochemical methods useful in the determination process of anaphylactic-related deaths. A systematic search, according to the PRISMA statement, was performed in databases to identify studies investigating immunohistochemical targets related to anaphylaxis death. Results: This work underscores the importance of anaphylaxis mediators such as tryptase, CD117, and chymase in the immunohistochemical analysis of anaphylactic deaths. Conclusions: According to the reviewed literature, the diagnosis of death due to anaphylaxis should depend not just on the suspicion of an anaphylactic reaction but also on confirming mast cell degranulation through the identification of IHC positivity for inflammatory mediators, particularly in the respiratory tract.

Examination of Pediatric Nurses’ Knowledge of Anaphylaxis: A Descriptive Study

ABSTRACT Anaphylaxis is a vital systemic allergic reaction. A rapid diagnosis of anaphylaxis is lifesaving. In most cases, nurses are the first to encounter and intervene in anaphylaxis. Therefore, they have a vital responsibility in such cases. The aim of this study is to create a questionnaire and evaluate the anaphylaxis knowledge levels of pediatric nurses. This is a descriptive type of study. The study took place in Turkey. 80 pediatric nurses who work in pediatric intensive care, neonatal intensive care, child service, and pediatric emergency service participated in the study. The sociodemographic data collection form and the anaphylaxis knowledge level assessment form was used for the study. ANOVA and t-test are used to evaluate the data. The average anaphylaxis knowledge score of the pediatric nurses was found 12.61 ± 2.61, therefore it’s moderate. The reliability of the questionnaire was high. Knowledge levels were moderately sufficient in diagnoses and insufficient in treatment and follow-up. Considering how critical anaphylaxis is, the moderately sufficient and insufficient knowledge levels are not substantial and should be increased advancedly. The questionnaire created for this study can be used in future studies. Health institutions should plan training regarding anaphylaxis and recompose anaphylaxis training in general, elaborate treatment and follow-up, and assess pediatric nurses’ knowledge periodically.

Kounis syndrome: an underestimated emergency.

Background. Kounis syndrome (KS) is defined as a rare cause of an acute coronary syndrome associated with systemic allergic reactions. To establish the prevalence of KS among the patients with diagnosis of anaphylaxis, we described clinical features, cardiological and allergological outcomes of patients evaluated in our allergy outpatient clinic. Methods. A retrospective study was carried out in the Allergy Unit of Novara hospital, from January 2008 to March 2020. Skin tests and in vitro tests were performed with suspected etiological agents. Results. We found 9 adults with KS (2%) out of 444 subjects who had experienced anaphylactic reactions (4/9 to Hymenoptera stings, 5/9 to drugs). Conclusions. The present study highlights the importance of suspicion of KS that appears not so uncommon in patients with anaphylaxis. KS seems to be a rare disease because unrecognized in diagnosis of anaphylaxis.

Short-term biological variation of serum tryptase.

Serum tryptase is a biomarker of mast cell activation. Among others, it is used in the diagnosis of anaphylaxis where a significant increase during the acute phase supports the diagnosis. When evaluating changes in biomarker levels, it is of utmost importance to consider the biological variation of the marker. Therefore, the aim of this study was to evaluate the short-term biological variation of serum tryptase. Blood samples were drawn at 9 AM three days in a row from apparently healthy subjects. On day two, additional blood samples were drawn every third hour for 12 h. The tryptase concentration was measured in serum using a fluoroenzyme immunoassay (ImmunoCAP™, Thermo Fisher Scientific). Linear mixed-effects models were used to calculate components of biological variation. In 32 subjects, the overall mean concentration of tryptase was 4.0 ng/mL (range, 1.3-8.0 ng/mL). The within-subject variation was 3.7 % (95 % confidence interval (CI) 3.0-4.4 %), the between-subject variation was 31.5 % (95 % CI 23.1-39.8 %), and the analytical variation was 3.4 % (95 % CI 2.9-4.1 %). The reference change value was 13.3 % for an increase in tryptase at a 95 % level of significance. No significant day-to-day variation was observed (p=0.77), while a minute decrease in the serum concentration was observed during the day (p<0.0001). Serum tryptase is a tightly regulated biomarker with very low within-subject variation, no significant day-to-day variation, and only minor semidiurnal variation. In contrast, a considerable between-subject variation exists. This establishes serum tryptase as a well-suited biomarker for monitoring.

Global disparities in availability of epinephrine auto-injectors

BackgroundAnaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. MethodsThe World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. ResultsResponses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. ConclusionThis survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.

Knowledge on anaphylaxis, its associated factors and self-perceived confidence on its management among medical officers attached to the Teaching Hospital Karapitiya

Introduction: Knowledge on anaphylaxis management is paramount in saving lives. The main objective of this study was to assess the knowledge on anaphylaxis, its associated factors and self-perceived confidence on its management among medical officers practising at Teaching Hospital, Karapitiya. Methods: This cross-sectional study included all medical officers (n=531) working in Teaching Hospital Karapitiya. The data were collected within three months via a self-administered questionnaire. The questionnaire consisted of 3 main parts. Part A for demographic data, part B on knowledge on diagnosis and management of anaphylaxis generated from case scenarios and part C on self-perceived confidence on diagnosis and management of anaphylaxis.Results: The response rate was 79% (n=395). Of the respondents, only 9.36% doctors diagnosed all case scenarios correctly. Nearly a quarter (25.8%) identified all anaphylaxis triggers and 25% identified all the amplifying factors. Majority (91.9%) of doctors identified adrenaline as the first line treatment. More than 80% correctly mentioned the second line treatment with more than 90% scored for correct initial management. The score of knowledge on treatment doses of adrenaline in the paediatric age group was poor (60%). Importance of adrenaline auto-injector was identified by 69.1% but knowledge on further follow up of anaphylaxis was sub-optimal. Self-perceived confidence in diagnosis of anaphylaxis 87.6% and the self-perceived confidence in management of anaphylaxis was 83.9%. Conclusions &amp; recommendations: Even though the self-perceived confidence in diagnosis and management of anaphylaxis was satisfactory among the doctors, the knowledge on triggers and amplifying factors were sub-optimal. Novel educational and training strategies must be implemented to overcome the identified deficiencies.

Simulation Training in Teaching Pediatricians the Skills of Providing Emergency Care for Anaphylaxis Using the ABCDE Algorithm

Anaphylaxis is the most severe, potentially life-threatening systemic hypersensitivity reaction, which in children ranges from 10.5 to 70 cases per 100,000 person-years, with the highest incidence at the age of 5-17 years. As before, late diagnosis remains in pediatrics — in 50% of cases, the diagnosis of anaphylaxis is not actually made, which makes it necessary to develop skills in diagnosis and treatment tactics. The results of the training on one of the life-threatening conditions on the basis of the Multidisciplinary Simulation Center of the Tyumen State Medical University for five years are described.

Precise diagnosis and management of anaphylaxis based on phenotypes and endotypes

Anaphylaxis is the most severe allergic reaction, demanding immediate management by health care providers, which is currently underdiagnosed and undertreated in China. In addition to the classic IgE-mediated pathway, non-IgE dependent pathway has also been extensively studied in the pathogenesis of anaphylaxis. Recently, the atypical symptoms induced by widespread used monoclonal antibodies and biologics have been reported. The goal of this article is to recognize the phenotypes (triggers and presentation) and understand its characteristics through endotypes (mechanisms) of anaphylaxis. Ultimately, the aim is to help allergists and health care providers guide a precision approach to diagnose and manage of anaphylaxis.