History Of Anaphylactic Shock Research Articles

Myocardial infarction in combination with anaphylactic shock (Kounis syndrome): a case report

Introduction. Allergic reactions and side effects are a common consequence of drug use and account for ~5% of all hospital admissions. The co-occurrence of ana phylactic shock and acute myocardial infarction (AMI) is called Kounis synd rome (KS).Brief description. The article analyzes the case of ceftriaxone-induced KS in a 56-year-old female patient with a history of anaphylactic shock after ampicillin therapy. The patient was treated on an outpatient basis due to an acute upper respiratory infection. The patient was diagnosed with acute bronchitis, in connection with which antibiotic therapy with azithromycin was started. Due to inefficiency the drug was canceled and ceftriaxone 1 g in 3,5 ml of 1% lidocaine solution 2 times a day was prescribed. After the first intramuscular injection, the patient developed anaphylactic shock, which was stopped by intravenous administration of prednisolone 120 mg, dexamethasone 8 mg and adrenaline hydrochloride 1,0 ml. Almost immediately, the ST segment elevation was recorded, in connection with which thrombolytic therapy with fortelyzin 15 mg was performed. Coronary angiography revealed thrombotic occlusion of the left anterior descending artery in the upper segment. Further examination verified AMI in the patient.Discussion. This case of AMI is pathogenetically associated with anaphylactic shock. However, the available data on the state of patient coronary system and no data on the morphologic characteristics of thrombus do not make it possibelr to define a type of KS.Conclusion. This clinical case indicates the need for a thorough allergic anamnesis collection by physicians of any specialty and prescribing medications taking it into account.

Hypersensitivity reactions to iodinated radiocontrast media: Cluster analysis reveals distinct clinical phenotypes

BackgroundDrug hypersensitivity reaction (DHR) to iodinated radiocontrast media (iRCM) is reported in 1%–3% of injections. Risk assessment of patients with suspicion of DHR to iRCM relies solely on clinical phenotyping and drug allergy workup. Using a novel unsupervised TwoStep cluster analysis, we aimed to identify prototypic patterns within a large cohort of patients evaluated for a potential iRCM DHR. MethodsA retrospective study was conducted using data from the Drug Allergy and Hypersensitivity Database of the Allergy Unit, University Hospital of Montpellier, Montpellier, France. All referred patients during February 2001 to December 2019 with suspicion of iRCM DHR with either confirmed positive or confirmed negative skin tests were included in the analysis. ResultsA total of 1439 patients were evaluated. The chronology of the index reaction was immediate and nonimmediate in 77.1% and 22.4%, respectively. Cluster analysis categorized the total study population in 5 clusters. Cluster 1 compiled all nonimmediate and cluster 2–5 almost all immediate reactors. Cluster 1 and 2 had recent reactions (<1 y) with mostly known iRCMs and the highest iRCM allergy prevalence (16–17%). In the other clusters, more remote reactions, unknown iRCMs and a lower allergy prevalence (3–8%) was observed. Chronology and semiology of the index reaction were the factors most strongly differentiated among clusters. History of anaphylactic shock and chronology of immediate hypersensitivity reactions were shown to be independent predictors of allergy with adjusted OR (aOR) of 4.68 (95%CI: 3.01–7.27, p < 0.001) and 2.51 (95%CI: 1.67–3.78, p < 0.001), respectively. ConclusionsUnsupervised cluster analysis identified 5 prototypic patterns within patients with a suspected DHR to iRCMs. Well-phenotyped patients cluster together in 2 groups in which the prevalence of allergy is approximately 1 in 6. However, this value decreases for patients with reactions dating back to more than a decade.

Abstract 17057: Long Term Outcomes in Coronary Artery Disease Patients With Acetylsalicylic Acid Sensitivity Undergoing a Novel Desensitization Protocol

Purpose: Aspirin therapy is the cornerstone of treatment in patients (pts) with coronary artery disease, particularly those undergoing percutaneous coronary intervention (PCI). The aim of this study was to test the safety and efficacy of a new standard desensitization procedure, using escalating low doses of aspirin in pts with acetylsalicylic acid sensitivity. Methods: Out of 3080 pts undergoing coronary angiography, seventy-seven had a history of aspirin sensitivity (2.5%). A history of cutaneous reactions (urticaria and/or angioedema) was reported in 76% of pts, respiratory sensitivity (asthma and/or rhinitis) in 21.5%, whereas 2.5% had a history of anaphylactic shock. All pts underwent the desensitization procedure: six sequential doses of aspirin (1, 5, 10, 20, 40, and 100 mg) administered orally at predefined intervals, with the procedure lasting 5.5 hours. None received pretreatment with antihistamines or corticosteroids. Blood pressure, pulse, cutaneous, nasoocular, or pulmonary reactions were monitored until 4 hours after the procedure. Pts were followed-up for 18.1± 6.3 months. Major adverse cardiac events (MACE), defined as death, repeat revascularization and stroke were recorded. Results: The desensitization procedure was successful in 71 pts (92.2%). No serious adverse reactions occurred: 3 pts with history of idiopathic urticaria developed cutaneous reaction, 2 pts (with frequent asthma attacks) experienced shortness of breath associated with bronchospasm, and 1 pt had shortness of breath without bronchospasm. All reactions were immediately resolved with corticosteroids and antihistamines. All pts but 15 (19.4%) underwent PCI (1.8 stent/pt, DES 75.5%, multivessel PCI 31.4%) and were discharged on dual antiplatelet therapy. At follow-up, aspirin was maintained in 92.9% pts. None of the discontinuations were due to allergic reaction. The incidence of MACE was 6.5% (1 non-cardiac death and 4 repeat revascularizations). None of the pts experienced stent thrombosis. Conclusions: This novel desensitization procedure seems to be safe and effective. Complex PCI procedures can be performed also in such pts, without increasing the risk of stent thrombosis.

Drug provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction.

Drug hypersensitivity reactions are common and can be life-threatening. Confirmation of the diagnosis should be rigorous and based on clinical history and a physical examination, possibly followed by skin tests and drug provocation tests. To describe the outcome of drug provocation tests in evaluating patients with histories suggesting drug allergy. Retrospective analysis of clinic case series. The department for drug allergy at a university hospital. 898 consecutive patients with suspected immediate drug allergy referred to the clinic between September 1996 and August 2001. Patients with severe skin reactions and those with positive results on skin tests for beta-lactams were excluded. Single-blinded administration of increasing doses of the suspected drug, up to the usual daily dose, under strict hospital surveillance. 1372 drug provocation tests were performed using various drugs, including beta-lactams (30.3%), aspirin (14.5%), other nonsteroidal anti-inflammatory drugs (11.7%), paracetamol (8.9%), macrolides (7.4%), and quinolones (2.4%). There were 241 (17.6%) positive drug provocation test results. Drug provocation reproduced the same symptoms, albeit milder and of a shorter duration, in the following patients: 13 (5.4%) with a history of anaphylactic shock, 17 (7.0%) with a history of anaphylaxis without shock, 10 (4.1%) with a history of laryngeal edema, 19 (7.9%) with a history of bronchospasm, 160 (66.4%) with a history of urticaria, and 22 (9.1%) with a history of maculopapular eruption. All adverse reactions were completely reversed by prednisolone, H(1)-antihistamines, and epinephrine as needed. Falsely negative results on drug provocation tests may have occurred because of loss of sensitization, rare cofactors not included in the diagnostic procedure, and tolerance induction during provocation. Drug provocation tests in individuals with suspected drug allergy performed in carefully controlled settings can confirm drug hypersensitivity.