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PubMedDate not supplied

Edema test for assessing ocular anaphylaxis.

A technique for measuring the increase in conjunctival thickness which accompanies a clinically relevant, topically induced model of ocular anaphylaxis was developed and was compared with the determination of an increase in percent of degranulated mast cells in affected tissue. Twenty rats immunized with egg albumin were topically challenged with egg albumin solution applied to one eye and with phosphate-buffered saline applied to the other eye. Clinical signs of edema and erythema were not seen in ocular tissues undergoing anaphylaxis. However, both conjunctival thickness and percent of degranulated mast cells were significantly greater in antigen-challenged tissues than in buffer-challenged tissues. Amount of edema correlated significantly with amount of mast cell degranulation. Conjunctival thickness served as a reliable indicator of anaphylaxis. The measurement of topically induced anaphylaxis by evaluating the increase in conjunctival thickness was simpler, faster, and less expensive than the evaluation of anaphylaxis by the increase in the percent of degranulated mast cells in the same tissues.

Anaphylaxis↗
PubMed2005

Specific IgE determination to epitope peptides of omega-5 gliadin and high molecular weight glutenin subunit is a useful tool for diagnosis of wheat-dependent exercise-induced anaphylaxis.

Wheat omega-5 gliadin and a high m.w. glutenin subunit (HMW-glutenin) have been reported as major allergens in wheat-dependent exercise-induced anaphylaxis. A simultaneous detection of specific IgE to epitope sequences of both proteins is considered to be a reliable method for diagnosis of wheat-dependent exercise-induced anaphylaxis. However, the IgE-binding epitope of HMW-glutenin remains unknown. The aim of this study was to determine the IgE-binding epitopes of HMW-glutenin to establish a useful system of identifying patients with wheat-dependent exercise-induced anaphylaxis. For determination of IgE-binding epitopes of HMW-glutenin overlapping peptides were synthesized and reactivities of IgE Abs in the sera of patients to those peptides were analyzed. Three IgE-binding epitopes, QQPGQ, QQPGQGQQ, and QQSGQGQ, were identified within primary sequence of HMW-glutenin. Epitope peptides, which include IgE-binding sequences of omega-5 gliadin and a HMW-glutenin, were synthesized and peptide-specific IgE Abs were measured by CAP-System fluorescent enzyme immunoassay. Twenty-nine of 30 patients with wheat-dependent exercise-induced anaphylaxis had specific IgE Abs to these epitope peptides. None of the 25 sera from healthy subjects reacted to both epitope peptides. Twenty-five patients with atopic dermatitis who had specific IgE to wheat and/or gluten had very low or nonexistent levels of epitope peptide-specific IgE Abs. These results indicated that measurement of IgE levels specific to epitope peptides of omega-5 gliadin and HMW-glutenin is useful as an in vitro diagnostic method for the assessment of patients with wheat-dependent exercise-induced anaphylaxis.

Allergens↗
PubMed2006

Anaphylaxis: diagnosis and management.

Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. Anaphylaxis in children is most often caused by food. Bronchospasm is a common symptom, and there is usually a background of atopy and asthma. Venom- and drug-induced anaphylaxis are more common in adults, in whom hypotension is more likely to occur. Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. The cornerstones of initial management are putting the patient in the supine position, administering intramuscular adrenaline into the lateral thigh, resuscitation with intravenous fluid, support of the airway and ventilation, and giving supplementary oxygen. If the response to initial management is inadequate, intravenous infusion of adrenaline should be commenced. Use of vasopressors should be considered if hypotension persists. The patient should be observed for at least 4 hours after symptom resolution and referred to an allergist to assist with diagnosis, allergen avoidance measures, risk assessment, preparation of an action plan and education on the use of self-injectable adrenaline. Provision of a MedicAlert bracelet should also be arranged.

Airway Obstruction↗
PubMed2003

Anaphylaxis and emergency treatment.

Food anaphylaxis is now the leading known cause of anaphylactic reactions treated in emergency departments in the United States. It is estimated that there are 30 000 anaphylactic reactions to foods treated in emergency departments and 150 to 200 deaths each year. Peanuts, tree nuts, fish, and shellfish account for most severe food anaphylactic reactions. Although clearly a form of immunoglobulin E-mediated hypersensitivity, the mechanistic details responsible for symptoms of food-induced anaphylaxis are not completely understood, and in some cases, symptoms are not seen unless the patient exercises within a few hours of the ingestion. At the present time, the mainstays of therapy include educating patients and their caregivers to strictly avoid food allergens, to recognize early symptoms of anaphylaxis, and to self-administer injectable epinephrine. However, clinical trials are now under way for the treatment of patients with peanut anaphylaxis using recombinant humanized anti-immunoglobulin E antibody therapy, and novel immunomodulatory therapies are being tested in animal models of peanut-induced anaphylaxis.

Anaphylaxis↗
PubMed2004

[Idiopathic anaphylaxis].

Idiopathic anaphylaxis (IA) has been described as a clinical entity by North America authors. The symptoms are brisk and relapsing episodes of angioedema, urticaria, bronchospasm, digestive symptoms, cardio-vascular collapse. Adults, females more than males, are mainly concerned. The seriousness is linked to laryngeal angioedema or to hypotension. Nevertheless lethality is rare. The first step of the procedure is aimed at the detection of several rare pathologies mimicking IA: the paroxystic capillary leak syndrome induced by a monoclonal gammapathy or by a release of cytokines, a carcinoid syndrome, cutaneous or visceral mastocytosis, hereditary or acquired deficiency of C1 esterase inhibitor, relapsing benign flushes and factitious anaphylaxis. These diseases being excluded, the diagnosis of anaphylaxis is established, and the diagnostic process searches for exceptional causes: food allergy elicited by unusual trophallergens, exercise-induced anaphylaxis, allergy to parasitic antigens, to inhalants, or hormonal allergy. The negativity of thorough investigations establishes the plausibility of IA. Several unconfirmed pathogenic hypotheses have been put forward: abnormal easiness to non specific release of mediators from mast cells and/or basophils, anti-IgE antibodies as a specific kind of auto-immunity, angiotensin II deficiency. Treatment of emergency relies on self-administration of epinephrine. A daily therapeutic regimen using corticosteroids and anti-H1 drugs is currently prescribed and can be efficient, but no randomized studies have asserted the validity of this management. The lack of immunological studies, contrasting with numerous clinical reports, questions whether IA is really an entity or solely anaphylaxis in search of unknown eliciting allergenic agents.

Adrenal Cortex Hormones↗
PubMed2004

Effector cells of anaphylaxis: mast cells and basophils.

Systemic anaphylaxis arises when mast cells, possibly along with other cell types, are provoked to secrete mediators that evoke a systemic response. Mast cells in perivascular, respiratory, gastrointestinal and cutaneous tissues are likely involved, regardless of whether IgE or non-IgE-dependent pathways are invoked. Alpha/beta tryptases are selectively and abundantly produced by mast cells. Tryptase levels in the circulation provide a precise indicator of mast cell involvement. Mature beta tryptase is stored in secretory granules and is released when the cells are activated to degranulate, as occurs in anaphylaxis. Alpha/beta pro/pro' tryptases are spontaneously secreted by mast cells. Consequently, mature tryptase levels in serum (normally 1 ng/ml) are elevated in systemic anaphylaxis. Total tryptase levels (mature plus precursor forms), normally 1-15 ng/ml in baseline serum samples, are elevated in patients with systemic mastocytosis (> 20 ng/ml), a disease that also predisposes one to anaphylactic reactions. The assessment of basophils in systemic anaphylactic reactions has been problematic, because an assay for a specific releasable marker from this cell type has not been developed. Nevertheless, in cases of anaphylaxis in which elevations of histamine, but not tryptase, have been detected, it is enticing to speculate that basophil-dependent anaphylaxis may have occurred.

Allergens↗
PubMed2006

[A case of "late-onset" anaphylaxis caused by fermented soybeans; Natto].

Natto is a Japanese traditional food made from fermented soybeans. We report a case of anaphylaxis caused by natto and review the literature. The patient was a 22-year-old man who showed systemic eruption with itching and pectoralgia about 10 hours after eating a meal containing natto. Results of skin tests for soybean allergen were negative, and the allergen remained unidentified. We then used a food elimination trial to confirm the allergy. However the patient did not refrain from eating natto, and he had three anaphylactic reactions might have been caused by natto. Each event occurred 10 to 14 hours after he ate a meal containing natto. We performed detailed examinations to determine the allergen. First, the prick-by-prick tests with natto and its characteristic viscous yarn-like surface were done and yielded positive results. Next, a provocation test with commercial natto (50 g) was performed and caused systemic eruption and pectoralgia about 9 hours after ingestion of the natto. The patients'plasma histamine level was elevated during the anaphylactic event. Anaphylaxis caused by natto was diagnosed. Recent studies have shown that the anaphylaxis caused by natto is of late-onset. Late-onset anaphylaxis can be considered one of IgE-mediated allergic reactions. The viscous surface of natto contains poly-gamma-glutamic acid (PGA). The hypothesized mechanism of late-onset anaphylaxis is delayed absorption or release of PGA into the bowel. In our case, the patient ate heated natto, we therefore speculate that suspect allergens were heat resistant. Patients with natto allergy must not eat natto, whether or not it is cooked or heated. Natto may induce allergic reactions up to a half-day after ingestion; thus, the clinical course and patient's diet must be considered during medical examination. Natto has recently gained popularity as a health food in foreign countries. The existence or natto allergy should be more widely recognized.

Adult↗
PubMed1990

Characterization of cardiovascular events mediated by platelet activating factor during systemic anaphylaxis.

Previous studies have shown that an anaphylactic reaction in the isolated perfused heart is characterized by drastic coronary constriction, arrhythmias, and severe impairment of contractility. In vivo anaphylaxis is associated with myocardial ischemia and rapid cardiovascular failure. Recently, not only histamine but also platelet activating factor (PAF) has been implicated in cardiac manifestation of anaphylaxis. The present study was designed to separate the effects of PAF from those of histamine on cardiovascular function during systemic anaphylaxis. In guinea pigs, sensitization was produced by subcutaneous (s.c.) application of ovalbumin. Fourteen days after sensitization, the effects of an intravenous (i.v.) infusion of ovalbumin were tested in anesthetized artificially ventilated guinea pigs. The renewed application of the antigen induced severe cardiac dysfunction. Within 3 min, cardiac output (CO) had already decreased by 90% and left ventricular end-diastolic pressure (LVEDP) increased significantly, indicating left ventricular pump failure. Concurrently, ECG recordings uniformly showed signs of acute myocardial ischemia. In addition, arrhythmias occurred in terms of atrioventricular block. After 4 min, blood pressure (BP) rapidly decreased. All animals died within 10 min. Pretreatment with the H1-receptor antagonist mepyramine (1 mg/kg i.v.) in combination with the H2-receptor antagonist cimetidine (10 mg/kg i.v.) delayed onset of myocardial ischemia, arrhythmias and cardiac pump failure. After 10 min, however, LV contractility and BP steadily decreased, leading to severe hypotension within 30 min. If the selective PAF antagonist WEB 2086 (1 mg/kg i.v.) was administered in addition to cimetidine and mepyramine, myocardial ischemia and LV contractile failure were markedly inhibited further. In contrast, pretreatment with WEB 2086 alone had no beneficial effects on the anaphylactic cardiovascular changes. Therefore, we conclude that histamine is the predominant mediator during the early phase of systemic anaphylaxis whereas PAF-mediated effects are involved in cardiac dysfunction during the protracted late phase of anaphylaxis.

Anaphylaxis↗
PubMed2006

Anaphylaxis to cefazolin during labor secondary to prophylaxis for group B Streptococcus: a case report.

BACKGROUND: Anaphylaxis is an uncommon event during pregnancy, but if it does arise, it can lead to serious fetal consequences even if there are no serious long-term maternal complications. CASE: A parturient developed anaphylaxis in the labor unit shortly after intravenous cefazolin chemoprophylaxis had begun for perinatal group B streptococcal disease. Prompt treatment for anaphylaxis commenced, involving the administration of epinephrine and glucocorticoids, and an emergency cesarean section spared the mother serious morbidity, with a favorable perinatal outcome for the fetus. CONCLUSION: To the best of our knowledge, this case is the first reported one of anaphylaxis to cefazolin in pregnancy secondary to prophylaxis against for B Streptococcus. The case demonstrates that a life-threatening anaphylactic reaction can occur at any time during pregnancy and that all staff in a maternal unit should be familiar with the management of perinatal anaphylaxis.

Adult↗
PubMed1991

Efficacy of ketotifen in corticosteroid-dependent idiopathic anaphylaxis.

To assess the potential benefit of ketotifen in the treatment of patients with corticosteroid-dependent idiopathic anaphylaxis, ketotifen was administered in an open trial to nine patients with idiopathic anaphylaxis who required maintenance prednisone for control of their disease. A double-blind trial was not done for reasons of patient safety. After a period of management with prednisone and establishment of the minimal dose of prednisone that controlled idiopathic anaphylaxis, ketotifen was initiated and cautious reduction of prednisone was attempted. The prednisone requirement was not altered in two patients, but prednisone was either substantially reduced or terminated in seven patients. Of these seven, three patients developed recurrent symptoms of idiopathic anaphylaxis after tapering and discontinuation of ketotifen, and ketotifen had to be resumed. The statistical analysis of prednisone reduction was highly significant (P less than .004) and we conclude ketotifen was of significant benefit in seven of nine patients with corticosteroid-dependent idiopathic anaphylaxis.

Adult↗
PubMed1991

Anaphylaxis and asthma in a scrimshander due to deer bone dust.

A boilermaker who engraved deer bone (scrimshaw) as his artistic vocation developed recurrent anaphylaxis while scraping deer bones. These bones has been boiled in NaClO and dried, leaving residual NaOH and altered deer protein. He had recurrent episodes of anaphylaxis when exposed to the bone dust. The anaphylaxis appears to be the result of exposure of traumatized skin to NaOH and antigen with sufficient absorption of antigen to result in anaphylaxis, although inhalation may have been contributory. The most severe, near fatal episode of anaphylaxis may have been worsened by captopril. The patient's reaction by prick test to protein extracted in buffered saline from the deer bones boiled in NaClO and NaOH but not to natural deer protein suggested IgE antibody against deer protein altered by boiling in alkali. The scrimshander is now working with deer bone after prophylactic therapy and control of exposure.

Anaphylaxis↗
PubMed1987

Prevention of chymopapain anaphylaxis by screening chemonucleolysis candidates with cutaneous chymopapain testing. A preliminary report.

The risk of anaphylaxis in candidates for chemonucleolysis for herniated lumbar discs is approximately 1%. An investigation was designed to eliminate or reduce the incidence of chymopapain anaphylaxis. The procedure was to restrict chemonucleolysis to patients who are prick test-negative to chymopapain at a concentration of 10 mg/ml. The authors skin-tested 292 chemonucleolysis candidates; five were positive and 287 were negative. None of the positive patients were injected with chymopapain. There were no instances of unequivocal chymopapain anaphylaxis in the skin test-negative group. This 0% incidence of anaphylaxis in skin test-negative patients was compared with a population estimate of 1%, based on historical data. The resulting value of p = 0.08 value fell short of the conventional level of significance of 0.05. The p value will reach 0.05 when the series of skin test-negative patients without anaphylaxis reaches 360. It is important that this information is readily available to physicians concerned about anaphylactic reactions to chymopapain.

Adult↗
PubMed1980

Acute systemic anaphylaxis in adult domestic fowl: evidence for the protective role of H2-histaminergic and beta 2-adrenergic receptors.

Pentobarbital-anesthetized and spontaneously breathing, bovine albumin (BA)-sensitized adult domestic fowl showed acute systemic anaphylaxis to IV injection of antigen (BA), which was characterized by arterial hypotension, central venous hypertension, and bradycardia. Large doses of pyrilamine maleate (/1-receptor antagonist) partially inhibited acute systemic anaphylaxis. On the other hand, metiamide (a specific H2-antagonist) and propranolol (beta-adrenergic antagonist) markedly enhanced the anaphylactic response. Terbutaline (beta 2-agonist), dimaprit (a highly selective H2-agonist), and compound FPL 55712 (a slow-reacting substance of anaphylaxis receptor antagonist) either significantly inhibited or reversed the anaphylactic response. Cimetidine (a newer H2-antagonist) enhanced only central venous pressor response to BA. This investigation appears to suggest a minor role of histamine and a major role of slow-reacting substance of anaphylaxis as chemical mediatiors of anaphylaxis. A protective role of beta 2-adrenergic and H2-histaminergic receptors seem to operate in immediate hypersensitivity reactions in adult domestic fowl.

Anaphylaxis↗
PubMed1984

Anaphylaxis: managing and preventing a true emergency.

Anaphylaxis is the sudden, life-threatening reaction to an antigen. It generally results from the injection of a potent antigen. However, it may be caused by the inhalation or ingestion of any antigen or allergen as well. Although anaphylaxis may occur after a single exposure to an antigen, it usually occurs after repeated exposures. There is general agreement that the sooner it occurs after exposure to the antigen, the more likely it is that the reaction will be severe. The focus of this article will be on the management and prevention of immediate hypersensitivity (anaphylaxis) induced by immunoglobulin E(IgE) or type I. Since anaphylaxis is often iatrogenic, every practitioner has a responsibility to prevent this hypersensitive state from occurring. When it does happen, prompt recognition and treatment can be lifesaving. Management needs to be initiated quickly whenever anaphylaxis seems imminent.

Anaphylaxis↗
PubMed1980

Participation of ocular tissues in systemic anaphylaxis.

The participation of ocular tissues was examined in two models of systemic anaphylaxis in the rat. Increased retention of radiolabeled rat serum albumin, which accompanies anaphylaxis, was the parameter measured. The production of IgE antibodies to egg albumin or worm antigen was stimulated by immunization with minute amounts of egg albumin and alum or by infection with Nippostrongylus brasiliensis. Intravenous administration of egg albumin or worm extract produced clinical signs of systemic anaphylaxis in the correspondingly immunized rats. Systemic anaphylaxis was accompanied by increased retention of radiolabeled rat serum albumin in the small intestine in both groups of rats. Significantly increased retention occurred in rat lid-conjunctivaorbital tissues of both groups and in globe tissues of the rats immunized with egg albumin. We concluded that the ocular tissues participated in systemic anaphylaxis.

Albumins↗
PubMedDate not supplied

Odor-associated idiopathic anaphylaxis. A case report.

A 44 year old woman is described who appears to have idiopathic anaphylaxis triggered by chemical odors. Her case and a general discussion of anaphylaxis are presented. The known causes of anaphylaxis and a discourse on idiopathic anaphylaxis are given. The treatment of idiopathic anaphylaxis is discussed.

Adult↗
PubMed1994

Intraoperative vecuronium anaphylaxis compounded by latex hypersensitivity.

BACKGROUND: Anaphylaxis to latex or muscle relaxant drugs has been demonstrated in the perioperative period but there are no reports of a patient with anaphylaxis to both of these substances. METHODS: We report a patient with meningomyelocele who was initially thought to have anaphylaxis to latex during induction of anesthesia. After recurrence of anaphylaxis following removal of latex as the suspected agent, the muscle relaxant vecuronium was found to be the actual etiology. RESULTS: Skin testing to several muscle relaxants and other anesthetic medications confirmed a hypersensitivity to vecuronium. Skin testing and subsequent physical contact with latex also established a hypersensitivity to this substance. CONCLUSIONS: This report demonstrates the need to scrutinize closely every notation in the anesthesia record when evaluating perioperative anaphylaxis and to consider that hypersensitivity to more than one substance may be present.

Anaphylaxis↗
PubMedDate not supplied

Systemic anaphylaxis due to hepatic hydatid disease.

Hydatidosis can be a cause of anaphylaxis; it has been clearly established that the accidental rupture of a cyst during surgery can provoke severe anaphylactic reactions. Spontaneous anaphylaxis secondary to hydatid disease is much less frequent. We report three patients who presented with spontaneous anaphylaxis without apparent cause. Serological and ultrasonographic studies showed hepatic hydatid disease. Two years after surgical resection of cysts, no new episodes of anaphylaxis have occurred. Hydatidosis is a cause of apparently spontaneous anaphylaxis and this is likely due to an IgE-mediated mechanism.

Adolescent↗