Reports Of Allergic Reactions Research Articles

A hidden allergen of anaphylaxis: Beetroot

Allergy to beetroot, a member of the Chenopodiaceae family, has been rarely reported. Most reports are associated with beet pollen exposure and respiratory symptoms. There have been two reports of allergic reactions after ingestion. We present a patient with anaphylaxis after the first ingestion of beetroot, supported by evidence of hypersensitivity on skin prick testing. In cases of idiopathic anaphylaxis, in which the cause of the reaction is unknown, uncommon allergens should be considered.

Is Allergy to Titanium Bone Fixation Plates a Problem?

Open reduction and internal fixation (ORIF) with titanium fixation plates is the gold standard for maxillofacial fracture treatment. Titanium is considered a fully compatible material. However, reports of allergic reactions to titanium implants do occur. The aim of this work is to answer the question whether titanium devices used in the treatment of fractures in the craniofacial region can cause allergic reactions. The study comprised 50 subjects treated surgically for maxillofacial injuries with the use of titanium composite devices. Allergic tests were performed by the patch method. The control group consisted of 20 healthy people who did not have any titanium elements. There were no skin changes to titanium and its compounds in both the test and control groups. Only one patient had a positive skin test which showed an allergic reaction to silver nitrate. Titanium fixing elements, as well as titanium dental implants, according to our research, do not show allergic skin reactions.

A Cost-Effectiveness Evaluation of Hospitalizations, Fatalities, and Economic Outcomes Associated with Universal Versus Anaphylaxis Risk-Stratified COVID-19 Vaccination Strategies

BackgroundVaccine-associated anaphylaxis is a rare event (1.34 events/million doses; 0.00017% occurrence over 26 years). Several reports of allergic reactions concerning for anaphylaxis have been reported early into the Pfizer-BioNTech and Moderna coronavirus disease 2019 (COVID-19) vaccine campaign in the United States, Canada, and the United Kingdom.ObjectiveTo perform a cost-effectiveness analysis characterizing the risks of COVID-19 versus vaccine anaphylaxis, comparing universal COVID-19 vaccination versus risk-stratified vaccination approaches.MethodsCohort analysis models were created to evaluate the cost-effectiveness of universal vaccination versus risk-stratified vaccination (eg, contraindicated in persons with a history of any previous episode of anaphylaxis) with a threshold for cost-effective care at $10,000,000 per death prevented. In the base case, risk of anaphylaxis was estimated at 0.1%, with case-fatality estimated at 0.3%.ResultsOn a population level (n = 300,000,000 simulated persons), universal vaccination was associated with a cost-savings of $503,596,316 and saved 7,607 lives, but the cost-savings was sensitive to increasing rates of vaccine-associated anaphylaxis. The universal strategy dominated at higher rates of COVID-19 infection and low rates of vaccine-associated anaphylaxis in both the health care and societal perspectives. When the risk of vaccine-associated anaphylaxis exceeded 0.8%, the risk-stratified approach to vaccination was the most cost-effective strategy. There was also an interaction between anaphylaxis risk and anaphylaxis fatality, with a risk-stratified approach becoming cost-effective as each risk increased concurrently. Stratified observation time by anaphylaxis history (15 minutes vs 30 minutes) was not cost-effective until a 1% anaphylaxis case-fatality was assumed and risk of vaccine anaphylaxis exceeded 6%.ConclusionsThis study demonstrates that unless vaccine anaphylaxis rates exceed 0.8%, a universal vaccination approach dominates a risk-stratified approach where persons with any history of anaphylaxis would be contraindicated from vaccination, with lower cost and superior health outcomes.

Hyaluronidase in Neuroplasty: A Review

Background: Neuroplasty, also known as percutaneous adhesiolysis, is an effective treatment for persistent axial and radicular pain. Objectives: One issue of concern is whether hyaluronidase should be used when performing neuroplasty. The objective of this narrative review is to evaluate the current literature relating to hyaluronidase and its role in neuroplasty. Methods: The literature relating to hyaluronidase was examined via a search of PubMed and Google Scholar until April 2019, review of the citations of relevant literature, and the authors’ knowledge of the literature and activity in the field. The literature was reviewed in light of hyaluronidase’s physiologic role, allergenicity, medical uses, and evaluation specifically for neuroplasty. Results: Hyaluronidase facilitates the spread of medications in the extracellular matrix by breaking down polysaccharides in the interstitial space. While allergic reactions to hyaluronidase have been reported, these reactions occurred with animal-derived preparations. The current human recombinant hyaluronidase does not have any reports of allergic reactions. Laboratory studies show that it does not evoke an immune response. Hyaluronidase has been extensively used in a variety of medical applications, including intrathecal treatment of arachnoiditis. There have been multiple studies reporting benefit from the use of hyaluronidase in interventional procedures. One randomized trial specifically looking at the use of hyaluronidase in neuroplasty found that the addition of hyaluronidase improved pain ratings at 12 months compared to other techniques and decreased the number of procedures needed to gain effect. Limitations: There have been limited studies examining the enhanced efficacy of neuroplasty when hyaluronidase is added. Conclusions: Because of enhanced efficacy and safety, and because of the decrease in the number of procedures needed to be performed, hyaluronidase should be considered when deciding which medications to use when performing neuroplasty. Key words: Neuroplasty, adhesiolysis, hyaluronidase, spinal stenosis, failed back surgery synderome, post lumbar surgery syndrome

Essure© Sterilization: Experience and Outcomes with 1024 Patients in a Solo Practice Over 8 Years

Objective: The aim of this research was to evaluate the experiences and outcomes of patients undergoing attempted Essure© sterilization, including successful and unsuccessful procedures, pregnancy, and need for additional procedures. Design: This was a retrospective longitudinal cohort study. Materials and Methods: Records of all patients who underwent attempted Essure sterilization from 2006 to 2014 by a single physician were reviewed for placement outcomes; follow-up imaging results; reliance rates; and long-term outcomes, including perforations, expulsions, and hysterectomy rates. Results: Records for 1024 patients intending to undergo Essure were identified. Of these, 1013 patients underwent attempted bilateral placement, with 1004 (99.1%) of these placements being successful. The intent-to-treat reliance rate was 94.4%, with 967 patients relying, with 1732 women-years of follow-up with an average of 1.7 years. Also, 778 (77.5%) patients had postprocedure hysterosalpingograms (HSGs), while an additional 170 (16.9%) had transvaginal ultrasound (TVUS) testing to confirm proper positioning and locations. Of these, 723 (92.9%) HSG-evaluated patients had satisfactory location and bilateral occlusion, and relied on their devices. Other findings were 9 (1.2%) perforations, 6 (0.8%) expulsions, 0 reports of allergic reactions or autoimmune symptoms, and 71 (6.9%) hysterectomies, while 46 (4.5%) were lost to follow-up and 11 (1.1%) were not relying. Zero pregnancies resulting from device failure were reported. Two luteal-phase pregnancies were diagnosed. One (0.1%) patient requested and underwent device removal because of pain. Conclusions: Within this cohort, there was a high rate of successful bilateral placement and reliance, while rates of pregnancy and malplaced devices were low. Long-term review revealed that only 1 patient requested Essure removal because of device-related pain. (J GYNECOL SURG 32:173)

Abstract WP73: Potentially Fatal Adverse Allergic Events to Intravenous Thrombolytics: An analysis from Adverse Event Reporting System

Objective: Adverse events including intracerebral hemorrhage (ICH) and reperfusion arrythmias are known to occur with thrombolytic therapy. Due to limited data, our goal is to describe the types of allergic adverse events directly attributable to IV thrombolytics. Methods: Adverse Event Reporting System (AERS) is a database that contains information on adverse event and medication error reports submitted to FDA. A systematic review of AERS database was performed for allergic adverse events occurring in conjunction with IV thrombolytics, including alteplase, tenecteplase, urokinase and reteplase. Allergic reaction was defined as any non-hemorrhagic sensitivity reaction which occurred as a direct result of administration of IV thrombolytic. We reviewed 924 adverse events which occurred between 2004-2010 associated with thrombolytics and further requested 33 detailed ISR reports of allergic reactions. Results: Out of the 33 reports, there were 12 cases (age range 57 to 93 years) of adverse allergic reaction directly attributable to IV thrombolytics. Allergic reactions included angioedema, facial swelling, urticaria, skin rash, cutaneous hypesthesia, hypotension, seizure, anaphylactic shock and death. Of the patients who were reported to suffer from allergic adverse events 11 received IV alteplase, and 1 received IV reteplase. Four of these patients were taking ACE inhibitors at the time of allergic reaction. In the remaining 21 events, the IV thrombolytics remained as a possible secondary cause of allergic reaction, but concomitantly administered medications made this difficult to ascertain. Most reactions associated with IV alteplase resolved with withdrawal of medication and treatment with diphenhydramine and steroids +/- epinephrine. There was 1 death directly attributable to allergic reaction in a patient who received IV reteplase for MI. Conclusion: Although IV alteplase is identical to endogenous tissue plasminogen activator, it appears to be the most common cause of allergic reaction amongst currently used thrombolytics, with or without concomitant administration of ACE inhibitors. A greater awareness among physicians may result in prompt recognition and treatment.

A Rare Case of Anaphylaxis to Bowel Prep: A Case Report and Review of the Literature

Polyethylene glycols (PEGs) are commonly utilized as a bowel prep prior to colonoscopy. They are generally well-tolerated, and reports of allergic reactions are rare. A recent search of the literature reveals only 4 prior reported cases of allergic reactions and only 1 other case of anaphylaxis. We report a second case of anaphylaxis following the ingestion of PEG solution, making this the fifth reported case of an allergic reaction to PEG bowel prep.

Chlorhexidine Impregnated Central Venous Catheter Inducing an Anaphylatic Shock in the Intensive Care Unit

Chlorhexidine, a bisbiguanide, is widely used as an antiseptic agent in medical practice as it has the greatest residual antimicrobial activity. Central venous catheters coated extraluminally with chlorhexidine have been made to reduce extraluminal contamination. By using both the chlorhexidine-alchohol skin preparation and antimicrobial-coated catheters during vascular cannulation, it can reduce catheter related bloodstream significantly [1]. The reduction in infection rate is especially vital in critically ill patients who require long-term vascular access. Adverse reactions to chlorhexidine are rare and uncommon, and have been under-recognised as a cause of anaphylaxis. There are several reports of allergic reactions following exposure to chlorhexidine. We report of a case of anaphylaxis shock requiring cardiopulmonary resuscitation during the placement of a chlorhexidine impregnated central venous catheters.

A mouse model of lupin allergy

Lupin has been introduced as a new food ingredient in an increasing number of European countries, resulting in reports of allergic reactions mostly due to cross-reactions in peanut-allergic individuals. Some cases of primary lupin allergy have also been reported. The aim of our study was to develop a food allergy model of lupin in mice with anaphylaxis as the endpoint and further, to develop an approach to estimate the allergen dose inducing maximal sensitization using a statistical design requiring a limited number of animals. Mice were immunized by intragastric gavage using cholera toxin as an adjuvant. A two-compartment response surface design with IgE as the main variable was used to estimate the maximal sensitizing dose of lupin in the model. This estimated dose was further used to evaluate the model. The mice were challenged with a high dose of lupin and signs of an anaphylactic reaction were observed. Antibody reactions (IgE and IgG2a), serum mast cell protease [mouse mast cell protease-1 (MMCP-1)] and ex vivo production of cytokines (IL-4, IL-5 and IFN-gamma) by spleen cells were measured. An immunoblot with regard to IgE binding was also performed. The dose that elicited the maximal sensitization measured as IgE was 5.7 mg lupin protein per immunization. Mice that received this dose developed anaphylactic reactions upon challenge, IgE against several proteins in the lupin extract, and high levels of MMCP-1, and showed a general shift towards a T-helper type 2 response. Post-challenge serum MMCP-1 levels corresponded to the seriousness of the anaphylactic reactions. We have established a mouse model with clinical symptoms of lupin allergy, with an optimized dose of lupin protein. A statistical design that can be used to determine an optimal immunization dose with the use of a minimum of laboratory animals is described.

Allergic reactions to patent blue dye V – the ALMANAC and NEW START experience (on behalf of the ALMANAC study group).

Abstract Abstract #1001 Background and methods
 Single reports of allergic reactions following injection of patent blue dye V - an isomer of isosulfan blue - as part of the sentinel node procedure have been well documented in small series. We report analysis from the systematic and prospective data collection of 5853 sentinel node biopsies as part of the ALMANAC trial (J Natl Cancer Inst 2006; 98(9):599-609) and NEW START sentinel node training program that has subsequently been rolled out in the UK. Prospective data collection includes documentation of side-effects after injection of patent blue dye V. The participating surgeon can specify the reaction in a free-text box. We summarised the specified reactions into local skin, allergic and cardiovascular reactions. We also charted whether the reactions necessitated any drug treatment (histamine antagonist, steroids or adrenaline / ephedrine) or triggered admission to the intensive care unit or a change of the procedure. Allergic reactions were classified into grade I (urticaria, blue hives +/- generalised rash), grade II (transient hypotension not requiring vasopressor support) and grade III (severe hypotension requiring vasopressor support).
 Results
 51 of 5853 (0.9 %) patients experienced 77 reactions to patent blue dye V. In 16 patients the type of reaction was not further specified. 5 patients were noted to have intense localised skin staining. Interestingly, 3 surgeons independently noted blue wheals distal to the blood pressure cuff. 21 patients experienced minor (grade I) allergic skin reactions. One was treated with hydrocortisone only, one with a histamine antagonist only, 6 with hydrocortison and a histamine antagonist. Grade II allergic reactions – transient hypotension not requiring vasopressor support – occurred in 4 patients, one of whom developed bronchospasm. 2 patients experienced grade III allergic reactions – severe hypotension treated with vasopressors. In 2 further patients the severity of the allergic reaction led to a change of the proposed procedure. In one patient who developed severe hypotension immediately after administration of patent blue dye V the procedure was abandoned. The patient was admitted to the intensive care unit for observation overnight but recovered without any sequelae. Another patient – who was in the ALMANAC audit phase where the sentinel node procedure was followed by the unit's conventional surgery - developed arrhythmias. The patient was meant to undergo an axillary node clearance but this was changed to axillary sampling as the final staging procedure.
 Conclusion
 Minor reactions after patent blue dye V injection are uncommon and were noted in 51 of 5853 (0.9 %) sentinel node biopsies. Severe allergic reactions requiring either vasopressor support or a change / abandoning of the procedure are even rarer - 4 of 5853 (0.07 %) procedures. It is, however, important that surgeon, anaesthetist and the unit are prepared for this eventuality. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1001.

Insektenallergie – Millionen von Arten als Auslöser?

Allergic reactions to insects are elicited by venom, saliva, other secretions or body parts (e.g. shed hairs) of these animals. Immediate type reactions (particularly contact urticaria, rhinoconjunctivitis, asthma, anaphylaxis) and delayed-type reactions are clinically most important. The best characterized allergic diseases due to insects are anaphylaxis caused by stings of Hymenoptera (particularly apids, vespids, ants) and asthma elicited by allergens from cockroaches. Mosquitoes, lice, bed bugs or fleas mainly cause skin disease. Reactions to butterflies, moths, or caterpillars (lepidopterism), e.g. elicited by the oak processionary moth, are due to toxic or allergic mechanisms. There have been reports of allergic reactions to many other insects, e.g. lady bugs or flies. Insect stings and intense exposure to insects frequently induce sensitization. Presumably, under appropriate circumstances, any insect species can induce allergic reactions.

HIT Happens: Diagnosing and Evaluating the Patient with Heparin-Induced Thrombocytopenia

HIT Happens: Diagnosing and Evaluating the Patient with Heparin-Induced Thrombocytopenia

A modified prescription‐event monitoring study to assess the introduction of Flixotide EvohalerTM into general practice in England: an example of pharmacovigilance planning and risk monitoring

A modified prescription-event monitoring (PEM) study was conducted to examine the safety of the introduction of the metered dose inhaler (MDI) Flixotide Evohaler (fluticasone with the propellant HFA 134a). Patients were identified from the first NHS prescriptions dispensed in England for Flixotide Evohaler. Postal questionnaires were sent to the prescribing doctor, requesting information including: demographic characteristics, severity of indication, concomitant medication, event data 3 months prior to and 3 months after the first prescription, and any reasons for stopping Flixotide. Pregnancies, deaths and selected events were followed up. Incidence density ratios (IDRs) were calculated to compare event rates 3 months before and 3 months after the introduction of Flixotide Evohaler. The cohort comprised 13 413 patients that were prescribed Flixotide Evohaler. The response rate was 64.0%. When the pre- and post-exposure periods were compared fewer patients had events in the post-exposure period, and there was no significant difference in the length of courses of oral steroid use. Eighteen patients experienced an event within 1 hour of using Flixotide Evohaler; these were minor with the exception of one case of angioneurotic facial oedema. Six of these events were assessed as possibly related to Flixotide Evohaler. During the study period there were an additional 13 patients with events assessed as possibly related to Flixotide Evohaler, including two reports of allergic reactions. The results suggest that the transition to Flixotide Evohaler was generally well tolerated. The modified methodology has contributed to the risk management of the introduction of this product.

Absence of contact sensitization to Aloe vera (L.) Burm. f.

Aloe vera has been used as a cosmetic and medical remedy since ancient times and has gained increasing popularity in recent years. Despite its widespread use, reports of allergic reactions are rare. We patch tested 702 consecutive patients with an oily extract from the leaves, Aloe pulvis from the entire plant and concentrated Aloe vera gel. A specially designed questionnaire was used for the use of Aloe vera, reasons and location of application, adverse reactions, occupation, hobbies and atopy. None of the subjects showed any reaction to one of the preparations. 2 components of the plant have to be distinguished: the bark of the leaves contains anthrachinones with pro-peristaltic and potential antibiotic and anticancer properties. Constraints have been imposed due to their considerable toxic potential. Today, mostly the Aloe gel from the center of the leaves is processed. It almost exclusively consists of carbohydrates to which also many medical effects have been attributed. Carbohydrates are not likely to induce contact sensitization, which might explain the outcome of our study. However, this does not justify unrestrained promotion of Aloe products, as scientific studies investigating the claims on its constitutional effects are few in number, and the majority of them have been unable to diminish the intuitive scepticism against miracle cures, like Aloe seems to be.

Acute Renal Failure Induced by a Brazilian Variety of Propolis

Propolis is a resinous substance collected by honeybees and used in hive construction and maintenance. Cumulative evidence suggests that propolis may have anti-inflammatory, antibiotic, antioxidant, antihepatotoxic, and antitumor properties. In addition to topical applications, products containing propolis have been used increasingly as dietary supplements. Although reports of allergic reactions are not uncommon, propolis is reputed to be relatively nontoxic. Its systemic toxicity is rarely reported and hence may be underestimated. This is the first report of propolis-induced acute renal failure. A 59-year-old man required hemodialysis for acute renal failure. The patient had cholangiocarcinoma and had ingested propolis for 2 weeks before presentation. Renal function improved after propolis withdrawal, deteriorated again after reexposure, and then returned to a normal level after the second propolis withdrawal. This case indicates that propolis can induce acute renal failure and emphasizes the need for vigilance and care when propolis is used as a medicine or dietary supplement.

The role of natural color additives in food allergy

A critical evaluation of the available information demonstrates that reactions to natural color additives are rare. Studies of turmeric and carotenoid pigments administered in mixtures with other food colorings failed to definitely identify reactions to either color additive. For carotenoids, the one case report of an adverse reaction was not conclusive. An anaphylactic reaction to saffron does suggest an IgE-mediated reaction, but the high use of saffron as compared with this single report of an adverse reaction suggests that sensitivity to saffron is extremely rare. Numerous reports of reactions to grapes or grape products have been reported in the literature, but no reports of sensitivities to grape skin extract or grape color extract were found. In rare cases, annatto dye may provoke a severe, adverse reaction in individuals with an uncommon hypersensitivity, and may aggravate the symptoms of patients suffering from recurrent urticaria. In its long history of use, there has been only one reported case of anaphylaxis resulting from the ingestion of annatto. Studies designed to investigate the role of annatto in recurrent urticaria sufferers were limited due to the absence of double-blind challenge and placebo controls. A number of cases of adverse reactions to carmine following ingestion have been reported in the literature. These adverse reactions suggest an IgE-mediated hypersensitivity. In many of the reported cases, the cause of sensitization to carmine was topical exposure from the use of carmine-containing cosmetics or occupational exposure to carmine and not from ingestion of carmine-containing foods and beverages. Following sensitization, affected individuals would be sensitive to carmine and the amounts present in foods and beverages could elicit allergic reactions. It is not known whether all individuals with carmine sensitivity induced through topical use are sensitive to the ingestion of carmine in foods. However, reactions to carmine solely because of ingestion are likely to be exceedingly rare due to the low use levels of carmine in foods and beverages. Despite their widespread use in food products, few reports of allergic reactions following ingestion have been reported for the majority of natural color additives. It is concluded that the ingestion of natural color additives presents a very low risk of provoking adverse reactions.

Change in gelatin content of vaccines associated with reduction in reports of allergic reactions

Anaphylactic reactions after administration of measles, mumps, and rubella combined vaccine were first identified as gelatin allergy by Kelso et al.1 Beginning in 1993, anaphylactic reactions were increasingly reported after administration with gelatin-containing vaccines in Japan.2-4 IgE antibodies against gelatin were detected most frequently from patients with anaphylactic reactions and less frequently from those with urticarial eruptions.4 We analyzed the prior immunization history of acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) among patients with gelatin allergy and suggested that the gelatin-containing DTaP may have a causal relationship to the development of gelatin allergy.

Review of the biological properties and toxicity of bee propolis (propolis)

Propolis is a multifunctional material used by bees in the construction and maintenance of their hives. Use of propolis by humans has a long history, predated only by the discovery of honey. Use of products containing propolis have resulted in extensive dermal contact and it is now increasingly being used a dietary supplement. Unlike many ‘natural’ remedies, there is a substantive database on the biological activity and toxicity of propolis indicating it may have many antibiotic, antifungal, antiviral and antitumour properties, among other attributes. Although reports of allergic reactions are not uncommon, propolis is relatively non-toxic, with a no-effect level (NOEL) in a 90-mouse study of 1400 mg/kg body weight/day

Health Agencies Update

Latex Allergy Alert Concerned about the substantial numbers of people employed in the health care industry who have work-related allergic reactions to natural rubber latex, the National Institute for Occupational Safety and Health (NIOSH) has issued an alert that spells out guidelines for reducing the risk such reactions pose to workers. Reports of allergic reactions triggered by job-related exposures to latexin gloves and other products have increased in recent years, particularly among the 7.7 million or more people employed in the health care industry. An estimated 8% to 12% of health care workers regularly exposed to latex are sensitized, compared with 1% to 6% of the general population, and some experience reactions severe enough to interfere with their ability to continue working in their current jobs. The NIOSH alert advises health care workers and employers that if latex gloves are designated as appropriate protection for handling infectious materials, reduced-protein, powder-free

第7回日本自動化健診学会講演抄録 (その2) 自動化健診時における胆のう造影剤アレルギーについての報告

第7回日本自動化健診学会講演抄録 (その2) 自動化健診時における胆のう造影剤アレルギーについての報告