Anaphylaxis Research Articles

Parenteral Iron Therapy for Pediatric Patients

Iron deficiency (ID) is by far the most common nutritional disorder in developing and developed countries. When left untreated, ID leads to anemia. Although the usually recommended treatment for iron deficiency anemia (IDA) is oral iron therapy with countless products, such therapy necessitates administration for >3–6 months with questionable patient compliance since most oral iron products have an unpleasant metallic aftertaste and cause intestinal side effects. In addition, in certain gastrointestinal conditions, such as inflammatory bowel diseases or untreated gluten-sensitive enteropathy, oral iron therapy is contraindicated or unsuccessful. Intravenous iron is considered safe in adults, where adverse events are mild and easily managed. The experience with parenteral iron in children is much more limited, and many pediatricians appear reluctant to use it because of uncorroborated fears of serious anaphylactic reactions. In the current article, we thoroughly review the available pediatric literature on the use of all commercially available parenteral iron products except ferumoxytol, which was recently removed from the market. We conclude that parenteral iron appears to be safe in children; it works faster than oral iron, and the newer third-generation products allow replacement of the total iron deficit in a single sitting.

Investigating heat exchanger tube performance: second law efficiency analysis of a novel combination of two heat transfer enhancement techniques

AbstractIn the study, the focus was on evaluating the second law efficiency of a heat exchanger tube operating under continuous heat flux and turbulent flow conditions. The evaluation involved the use of a hybrid GnP and Fe3O4 and modified coiled wire as passive heat transfer enhancement techniques. The primary objective was to investigate the impact of these combined techniques on thermal and hydraulic performance, entropy generation number, Bejan number and second law efficiency. To achieve this, different mass fractions of GnP and Fe3O4 nanoparticles were used in the hybrid nanofluid, along with two forms of modified coiled wire: barrel type and hourglass type. The experimental results indicated that the utilization of hybrid nanofluids and modified helical inserts led to a noticeable improvement in the second law efficiency of the heat exchanger tube. However, it was observed that the differences in entropy generation number and Bejan number between the barrel and hourglass types were not significant, mainly due to higher frictional losses associated with the latter. The highest recorded second law efficiency was 0.416, while the lowest entropy generation number was 0.118. These values were achieved through the combined use of GnP and Fe3O4 with a mass fraction of 0.4% and a barrel-type coiled wire insert with a pitch ratio of 0.5.

Electrochemically assisted DNA and thioaromatic assembly as sensing and antifouling interface for food allergens.

Food allergies have become a global issue and are estimated to affect approximately 220 million people worldwide. Allergy to peanuts can easily become life-threatening and induce anaphylactic reactions. Mislabeling and cross-contamination during food processing can occur in the frame of world population growth and pose a serious health issue. As the mandatory allergen list is not uniform worldwide, the development of routine analytical strategies with high specificity and sensitivity is a demanding task to aid in the rapid identification of allergenic foods. In this work, an electrochemical aptasensor for Ara h1 peanut allergen was developed by immobilizing the specific aptamer by the inserting method. First, a layer of p-aminothiophenol (p-ATP) was immobilized on the gold surface of screen-printed electrodes (GSPE) to improve the aptamer insertion and reduce the fouling effects at the electrode surface. The grafting of the p-ATP and Ara h1 aptamer on the GSPE surface was monitored by cyclic voltammetry (CV), differential pulse voltammetry (DPV), and electrochemical impedance spectroscopy (EIS). The resulting disposable aptasensor allowed for indirect electrochemical detection of Ara h1 protein in the presence of 5 mM ferro/ferricyanide as a redox probe. The electrochemical response upon aptamer-target interaction was monitored in the concentration range 1-250 nM, and two limits of detection in the nanomolar range were estimated based on DPV (2.78 nM Ara h1) and EIS (0.82 nM Ara h1) measurements. The aptasensor was successfully applied to real sample analysis.

Effectiveness of Advanced Platelet-Rich Fibrin on Postoperative Sequelae for Impacted Mandibular Third Molar Surgery: A Prospective Study.

Introduction Impacted third molar extraction is frequently removed surgically by maxillofacial surgeons, which is mostly associated with postoperative sequelae like pain and swelling. It is essential to minimize the complications and enhance wound healing in the extracted socket of the third molar. Hence, this study aimed to assess the efficiency of advanced platelet-rich fibrin (A-PRF) in wound healing and reducing pain after surgical extraction of the impacted mandibular third molar (IMTM). Materials and methods Thirtyhealthy patients who have been diagnosed with Pell and Gregory class II IMTM were included in this study. In the study group, which comprises 15 patients, extraction sockets were filled with A-PRF extract. In the control group, no material was placed in the extraction sockets. The pain was assessed preoperative and on the third and seventh postoperative days using a visual analog scale (VAS). Wound healing was assessed on the third and seventh postoperative days using a modified laundry scale. SPSS for Windows was used for data analysis. Categorical data was compared between the groups using the Chi-square test. P-value less than 0.05 was considered as statistically significant. Results The study population's mean age was 25.67 ± 2.4 years. Nineteen patients were male, and 11 patients were female. Differences in mean pain scores between the groups were not statistically significant both on the third postoperative day (p=0.59)and the seventh postoperative day (p=0.33). During the seventh day postoperative day, the study group exhibited better wound healing compared to the control group and the results were statistically significant (p=0.01). Conclusion A-PRF is a simple and effective method of reducing postoperative sequela by promoting wound healing after surgical extraction of IMTM. Ithas the advantage of less chance of allergic and anaphylactic reactions, unlike their predecessor platelet concentrates.

Veal calves management in Québec, Canada: Part I. Association between passive immunity transfer at arrival and health disorders

Morbidity and mortality remain important concerns for veal production which traditionally involves very young calves being transported directly from dairy farms to calf-raising facilities or sold through auction markets from dairy farms. There are few studies that examine the relationship between transfer of passive immunity and health outcomes in veal production in Québec. The objective of this study was to investigate the risk factors associated with morbidity and mortality in milk and grain-fed veal facilities in Québec. Between October 2017 and December 2018, a prospective cohort study was conducted on 59 batches of milk- and grain-fed veal calves from Montérégie and Centre du Québec regions in Québec, Canada. A total of 30 calves per batch were randomly sampled for the transfer of passive immunity (TPI) status using the Brix refractometer (serum threshold ≥ 8.4%). Throughout the production cycle, arrival, treatment, mortality, and slaughter records of each batch of calves were extracted and used to quantify individual- and group-level risk factors. Morbidity and mortality were modelled through generalized linear mixed models (GLMMs) using a logit link, as function of categorical variables (individual inadequate TPI, arrival season, purchasing sites, and arrival weights) and a continuous variable (proportion of inadequate TPI in the batch). Given that the health and performance data are usually collected retrospectively under commercial settings, incomplete data was recognized as a potential issue. Thus, multiple imputation models were used. From 59 batches where 1729 calves were sampled for measuring TPI, 1084 calves had a serum Brix% < 8.4% giving a prevalence of 62.7% of inadequate TPI. The prevalence of morbidity and mortality in those 59 batches were not associated with the batch-level inadequate TPI prevalence. On the other hand, individual calves with inadequate TPI had higher odds of morbidity (OR: 1.56; 95% CI: 1.2–2.05, P = 0.001) compared to those calves with adequate TPI. Odds of mortality, on the other hand, were not significantly affected by inadequate TPI (OR:1.27; 95% CI: 0.74–2.18, P = 0.3). Calves arriving to the facility during the winter season had lower odds of mortality than those arriving in fall (OR:0.16; 95% CI: 0.03–0.78, P = 0.02). In conclusion, this study suggests that inadequate TPI, as assessed upon arrival in veal farms, remains an important concern for negative health outcomes in veal calves.

Bovine serum albumin nanoparticles containing Poly (I:C) can enhance the neutralizing antibody response induced by envelope protein of Orthoflavivirus zikaense

Since the Orthoflavivirus zikaense (ZIKV) has been considered a risk for Zika congenital syndrome development, developing a safe and effective vaccine has become a high priority. Numerous research groups have developed strategies to prevent ZIKV infection and have identified the domain III of the ZIKV envelope protein (zEDIII) as a promising target. Subunit antigens are often poorly immunogenic, necessitating the use of adjuvants and/or delivery systems to induce optimal immune responses. The subject of nanotechnology has substantial expansion in recent years in terms of research and applications. Nanoparticles could be used as drug delivery systems and to increase the immunogenicity and stability of a given antigen. This work aims to characterize and validate the potential of a vaccine formulation composed of domain zEDIII and bovine serum albumin nanoparticles containing polyinosinic-polycytidylic acid (NPPI). NPPI were uptake in vitro by immature bone marrow dendritic cells and histological analysis of the skin of mice treated with NPPI showed an increase in cellularity. Immunization assay showed that mice immunized with zEDIII in the presence of NPPI produced neutralizing antibodies. Through the passive transfer of sera from immunized mice to ZIKV-infected neonatal mice, it was demonstrated that these antibodies provide protection, mitigating weight loss, clinical or neurological signs induced by infection, and significantly increased survival rates. Protection was further substantiated by the reduction in the number of viable infectious ZIKV, as well as a decrease in inflammatory cytokines and tissue alterations in the brains of infected mice. Taken together, data presented in this study shows that NPPI + zEDIII is a promising vaccine candidate for ZIKV.

Concerted synergy between viral-specific IgG and CD8 + T cells is critical for clearance of an HCV-related rodent hepacivirus.

Evidence assessing the role of B cells and their antibodies, or lack thereof, in the spontaneous resolution of acute HCV infection is conflicting. Utilization of a strictly hepatotropic, HCV-related rodent hepacivirus (RHV) model circumvents many of the challenges facing the field in characterizing the immunological correlates of dichotomous infection outcomes. This study seeks to elucidate the importance of B cells in the clearance of acute RHV infection. µMT mice were infected i.v. with RHV and found to develop chronic infection for over a year. Wild-type (WT) mice depleted of B cells also exhibited persistent viremia that resolved only upon B cell resurgence. The persistent infection developed by B1-8i and AID cre/cre mice revealed that antigen-specific, class-switched B cells or their antibodies were crucial for viral resolution. Virus-specific CD8 + and CD4 + T cells were characterized in these mice using newly developed major histocompatibility complex class I and II tetramers and ex vivo peptide stimulation. Immunoglobulin G (IgG) was purified from the serum of RHV- or lymphocytic choriomeningitis virus Armstrong-infected mice after viral clearance and passively transferred to AID cre/cre recipients, revealing viral clearance only in αRHV IgG recipients. Further, the transfer of αRHV IgG into B cell-depleted recipients also induced viral resolution. This ability of RHV-specific IgG to induce viral clearance was found to require the concomitant presence of CD8 + T cells. Our findings demonstrate a cooperative interdependence between immunoglobulins and the T cell compartment that is required for RHV resolution. Thus, HCV vaccine regimens should aim to simultaneously elicit robust HCV-specific antibody and T cell responses for optimal protective efficacy.

Erythrokinetic mechanism(s) causing the "late anemia" of hemolytic disease of the fetus and newborn.

A transfusion-requiring "late anemia" can complicate the management of neonates convalescing from hemolytic disease of the fetus and newborn (HDFN). This anemia can occur in any neonate after HDFN but is particularly prominent in those who received intrauterine transfusions and/or double-volume exchange transfusions. Various reports describe this condition as occurring based on ongoing hemolysis, either due to passive transfer of alloantibody through breast milk or persistence of antibody not removed by exchange transfusion. However, other reports describe this condition as the result of inadequate erythrocyte production. Both hypotheses might have merit, because perhaps; (1) some cases are primarily due to continued hemolysis, (2) others are primarily hypoproductive, and (3) yet others result from a mixture of these two mechanisms. We propose prospective collaborative studies that will resolve this issue by serially quantifying end-tidal carbon monoxide. Doing this will better inform the assessment and treatment of neonates recovering from HDFN.

Possible modulating functions of probiotic Lactiplantibacillus plantarum in particulate matter-associated pulmonary inflammation.

Pulmonary disease represents a substantial global health burden. Increased air pollution, especially fine particulate matter (PM2.5) is the most concerned proportion of air pollutants to respiratory health. PM2.5 may carry or combine with other toxic allergens and heavy metals, resulting in serious respiratory allergies and anaphylactic reactions in the host. Available treatment options such as antihistamines, steroids, and avoiding allergens/dust/pollutants could be limited due to certain side effects and immense exposure to air pollutants, especially in most polluted countries. In this mini-review, we summarized how PM2.5 triggers respiratory hyperresponsiveness and inflammation, and the probiotic Lactiplantibacillus plantarum supplementation could minimize the risk of the same. L. plantarum may confer beneficial effects in PM2.5-associated pulmonary inflammation due to significant antioxidant potential. We discussed L. plantarum's effect on PM2.5-induced reactive oxygen species (ROS), inflammatory cytokines, lipid peroxidation, and DNA damage. Available preclinical evidence shows L. plantarum induces gut-lung axis, SCFA, GABA, and other neurotransmitter signaling via gut microbiota modulation. SCFA signals are important in maintaining lung homeostasis and regulating intracellular defense mechanisms in alveolar cells. However, significant research is needed in this direction to contemplate L. plantarum's therapeutic potential in pulmonary allergies.

Pilot study on the use of basophil activation tests and skin tests for the prevention of allergic transfusion reactions.

Management of severe allergic transfusion reactions (ATR) is challenging. In this study, we investigate the usefulness of skin tests and basophil activation tests (BAT) in chronically transfused patients for the prevention of future ATR. BAT and skin tests were carried with the supernatant of red blood cell (RBC) units for a sickle-cell disease patient under chronic exchange transfusion who has presented a severe ATR, in order to prevent potential future ATR. If the results for both BAT and skin tests were negative, the RBC units could be transfused to the patient. If either one of the results was positive, the tested RBC unit was discarded for the patient. 192 RBC units were tested with both tests. The level of results concordance between the two tests was 95%. Out of the 169 negative units with both tests, 118 units were transfused to the patient for which he presented no ATR. In our study, combining both BAT and skin tests was associated with a good negative predictive value since we were able to safely transfuse our patient. Further studies are still necessary to confirm this result but this pilot study indicates that skin tests and BAT might help prevent ATR. When BAT is not available, skin tests may also be useful in preventing ATR.

Preparation of poly(caffeic acid)-coated epitope molecularly imprinted polymers and investigation of adsorption performance toward ovalbumin

Food allergy can lead to severe allergic reactions that are potentially fatal for human, hence the detection of food allergens such as ovalbumin (OVA) is important. In this study, a poly(caffeic acid)-coated epitope molecularly imprinted polymer (EMIP) was prepared by chelation and autoxidation of caffeic acid with hexamethylenediamine. EMIP has not only imprinted cavities highly matched with OVA in size and spatial structure, but also externally abundant hydrophilic groups, resulting in few non-specific binding and good hydrophilicity. With high specificity, significant paramagnetism, and great reusability, EMIP can distinguish OVA from other proteins and selectively enrich OVA in egg white samples, which opens up a promising route to the determination of allergens in food products.

Chromosome-level genome of Ambrosia trifida provides insights into adaptation and the evolution of pollen allergens

Ambrosia trifida (giant ragweed) is an invasive plant that can cause serious damage to natural ecosystems and severe respiratory allergies. However, the genomic basis of invasive adaptation and pollen allergens in Ambrosia species remain largely unknown. Here, we present a 1.66 Gb chromosome-scale reference genome for giant ragweed and identified multiple types of genome duplications, which are responsible for its rapid environmental adaptation and pollen development. The largest copies number and species-specific expansions of resistance-related gene families compared to Heliantheae alliance might contribute to resist stresses, pathogens and rapid adaptation. To extend the knowledge of evolutionary process of allergic pollen proteins, we predicted 26 and 168 potential pollen allergen candidates for giant ragweed and other Asteraceae plant species by combining machine learning and identity screening. Interestingly, we observed a specific tandemly repeated array for potential allergenic pectate lyases among Ambrosia species. Rapid evolutionary rates on putative pectate lyase allergens may imply a crucial role of nonsynonymous mutations on amino acid residues for plant biological function and allergenicity. Altogether, this study provides insight into the molecular ecological adaptation and putative pollen allergens prediction that will be helpful in promoting invasion genomic research and evolution of putative pollen allergy in giant ragweed.

Evaluation of Colostrum Quality and Passive Transfer Immunity in Terms of Heat Stress and Disease Incidence in Central Anatolia

The effects of heat stress on colostrum quality, passive transfer failure and disease incidence experienced by cows and calves raised in the Central Anatolian region, where temperature differences are very high, were investigated in a large population in order to prevent calf deaths and yield losses. Cow's daily temperature humidity index, 7-day average temperature humidity index, average temperature and humidity index (p

Anaphylaxis onboard commercial aircraft: what can we learn from post event safety reports?

This letter details a review of safety reports submitted to the UK Civil Aviation Authority over a 5 year period relating to severe allergic reactions. No trend of seasonality and evidence of aerosolisation was found. Reports were 4.8 times more likely to be submitted on an inbound flight than an outbound flight.

Infant Whole-Cell Versus Acellular Pertussis Vaccination in 1997 to 1999 and Risk of Childhood Hospitalization for Food-Induced Anaphylaxis: Linked Administrative Databases Cohort Study

Evidence suggests that children who had received an initial priming dose of whole-cell pertussis (wP) vaccine, rather than acellular pertussis (aP) vaccine, had a lower risk of developing IgE-mediated food allergy, the most common cause of anaphylaxis-related hospital presentations ofchildhood. To assess the association between wP versus aP vaccination in infancy and subsequent hospital presentations for anaphylaxis. This study was preregistered under PMID 34874968. Perinatal records for a cohort of New South Wales-born children (1997-1999) receiving their first dose of pertussis-containing vaccine before age 4 months were probabilistically linked to hospital and immunization records. We used adjusted Cox models to estimate hazard ratios (aHRs) and 95% CIs for anaphylaxis-coded hospitalizations. There were 218,093 New South Wales-born children who received a first dose of wP or aP before age 4 months. Among these children, 86 experienced at least one hospitalization for food-induced anaphylaxis at age 5-15 years (range of events per patient, one to three). The person-time of follow-up was 1,476,969 years, and 665,519 years for children vaccinated with wP as a first dose (wP-1 children) and aP as a first dose (aP-1 children), respectively. The incidence rates for first hospitalization for food anaphylaxis were 3.5 (95% CI, 2.6-4.6) and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among wP-1 children and aP-1 children, respectively (aHR for wP vs aP= 0.47; 95% CI, 0.26-0.83). For first admission for venom anaphylaxis, the incidence rate was 4.9 (95% CI, 3.9-6.2) per 100,000 child-years among wP-1 children and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among aP-1 children (aHR for wP vs aP= 0.92; 95% CI, 0.53-1.60), and for all-cause anaphylaxis, the incidence rate was 10.6 (95% CI, 9.0-12.4) per 100,000 child-years among wP-1 children and 12.8 (95% CI, 10.2-15.8) per 100,000 child-years among aP-1 children (aHR for wP vs aP= 0.92; 95% CI, 0.53-1.60). Vaccination with wP in infancy was associated with a lower risk of hospitalizations for food-induced anaphylaxis (and therefore severe IgE-mediated food allergy) occurring in childhood.

Characteristics of failure of passive transfer at the herd level using the serum immunoglobulin G concentration as an indicator on dairy farms in eastern Hokkaido, Japan.

The objectives of this study were to conduct a survey of failure-of-passive-transfer (FPT) in eastern Hokkaido Japan, to evaluate the association between herd-level FPT and death and culling or treatment, and to test the effectiveness of monitoring using herd-level FPT. A total of 4,411 Holstein and Holstein-Wagyu crossbreds calves born from Holstein dams during the year beginning April 2, 2019 on 39 dairy farms were included in the study to investigate death-and-culling and the treatment rate during the first month of life, as well as rearing management up to 3 weeks of age. A subset of Holsteins (n=381) was included in the study for passive transfer and farms were diagnosed as having FPT if more than 20% of newborn calves had serum IgG levels below 10 g/L at the herd level. The prevalence of FPT (<IgG 10 g/L) on farms was significantly correlated (r=0.27, P<0.05) with the death-and-culling rate. Binomial logistic regression analysis showed that FPT farms had a significantly higher risk of being high death-and-culling farms than non-FPT farms (odds ratio: 5.20, P<0.05), emphasizing the importance of colostrum feeding. Farms not using frozen stored colostrum had a significantly higher risk of being FPT farms than those that did (odds ratio: 4.13, P<0.05), emphasizing the importance of feeding colostrum from the dam. Monitoring herd-level FPT was useful in assessing whether the problem of calf death and culling lies in passive transfer.

A Long-Term Follow-up Study of Asthmatic Children Discontinued Allergen-Specific Immunotherapy

AbstractOur objective was to explore the factors associated with the prognosis of allergic asthmatic children with poor compliance with subcutaneous immunotherapy (SCIT). A telephonic follow-up was conducted in 616 asthmatic children who received SCIT treatment from June 2005 to October 2010. The status of asthmatic controlled was based on their level of asthma symptom control when they were followed-up. Seven factors, including sex, age, family history of allergic disease, severity of mite allergy, times of SCIT, whether inhaled corticosteroids regularly, and with rhinitis or not, were analyzed. In total, 322 asthmatic children discontinued the 3-year course of SCIT. Of the 127 children included in the final analysis, 85 (66.9%) were asthmatic controlled patients and 42 (33.1%) were asthmatic uncontrolled patients. The median (interquartile range) age of the 127 asthmatic children was 7.1 ± 4.8 years. The proportion of male and female was 87/40. In the seven factors, family history of allergic diseases (p = 0.035), whether inhaling corticosteroids regularly (p = 0.007), were significantly related to the level of asthma symptom control, whereas the age of these asthmatic children, severity of mite allergy, times of SCIT, and asthma with rhinitis or not had no relation to the level of asthma symptom control. Our findings revealed that the family history of allergic diseases was an important factor affecting the prognosis of childhood asthma, and inhaling corticosteroids regularly after discontinuing SCIT could significantly improve their prognosis. These results could provide value in clinical asthma treatment.

Hen's egg ladder: Therapy option for the gradual introduction of hen's eggs in cases of hen's egg allergy.

More than 10 years ago, the British Society for Allergy and Clinical Immunology (BSACI) published guidelines for the management of egg allergy [1]. For the first time, these included a stepwise plan for the reintroduction of egg for egg-allergic children who could already tolerate well-cooked egg, such as cakes and cookies. Since then, various egg ladders have been developed [2, 3, 4, 5, 6, 7, 8, 9]. In the past 3 years, several studies have been published suggesting that a gradual introduction of highly processed to less processed egg containing foods contribute to the acceleration of tolerance development [2, 3, 4, 5]. However, depending on the study and egg ladder, the egg products vary in their level of processing (wheat matrix, degree, and location of heating (e.g., oven, pan, pot), egg quantity, and egg protein). In the UK, the introduction of the egg ladder is recommended at the age of 12 months or if the last reaction occurred 6 months before. The benefits of introducing egg at home include an early increase in the variety of foods, reduction of food fears, improved nutrient intake, and the avoidance of hospitalization fears in children [10]. Children with mild reactions in the past can start with small amounts of baked goods at home. Food challenges in an inpatient setting to exclude or reconfirm the allergy should be conducted if the patients have previously had severe allergic reactions, i.e., anaphylaxis, or if the smallest amounts triggered an allergic reaction or if existing asthma is poorly controlled [10, 11]. The present work includes, in addition to the evaluation of study results, a presentation of the recent studies regarding egg ladders. From these, a new egg ladder as therapeutic option for the German-speaking region has been developed. As already done for the milk ladder a detailed step-by-step plan, selection criteria, a recipe collection, and also ideas for commercial prepackaged food items can be found in the appendices [11].

Severe Allergic Reaction Following Administration of Antivenom Serum for Snakebite: A Case Report from Togo

Severe Allergic Reaction Following Administration of Antivenom Serum for Snakebite: A Case Report from Togo

Multi-centre Implementation of the SNAP Protocol for Paracetamol Overdose - reducing the length of stay

Aim/Objective/Background: Paracetamol stands as one of the most prevalent drugs of overdose in the UK. The conventional treatment for Paracetamol toxicity involves intravenous administration of N-acetylcysteine (NAC), typically administered over 21 hours in UK hospitals. However, an alternative 12-hour infusion, known as the &amp;apos;SNAP&amp;apos; regimen, has shown promise in reducing anaphylactoid reactions compared to the standard treatment. This study implemented the SNAP regimen in two District General Hospital Emergency Departments within the same NHS Trust as part of a quality improvement project (QIP), aiming to assess its impact on reducing adverse reactions and inpatient length of stay. Methods/Design: Trust guidelines were revised to recommend the 12-hour SNAP regimen for adult Paracetamol overdose cases, accompanied by a pre-filled prescription chart. A retrospective analysis of patient records and electronic discharge letters was conducted before and after the guideline change to identify NAC recipients and document any adverse reactions. Length of inpatient stay was also documented. Results/Conclusions: Over a three-month period from August to November 2020 across both sites, 60 adult patients received NAC for Paracetamol overdose, with four experiencing anaphylactoid reactions. Following the introduction of the SNAP regimen, spanning from April to June 2021, 36 adult patients received NAC, none of whom experienced adverse drug reactions. Before the guideline change, adult patients admitted for Paracetamol overdose had an average inpatient stay of 48.3 hours, which decreased to an average of 44.5 hours following the adoption of the SNAP regimen. The SNAP NAC regimen demonstrated comparable safety regarding adverse drug reactions while effectively reducing the length of inpatient stay for adults with Paracetamol overdose.