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PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of perioperative allergic reactions.

OBJECTIVES: To determine the incidence, risk factors, signs, symptoms and management of perioperative allergic reactions in the Thai Anesthesia Incidents Study (THAI Study). MATERIAL AND METHOD: Between February 1, 2003, and January 31, 2004, a descriptive, prospective, multicenter study was conducted in 20 hospitals across Thailand. All patients receiving anesthetic and medical agents were monitored for allergic reactions for the first 24 postoperative-hours. Signs and symptoms of suspected allergic reactions included skin reactions, wheezing and unexpected hypotension. The details of allergic reactions were reviewed and recorded. RESULTS: Allergic reactions occurred in 30 of the 163,403 patients included in this study. The reaction-incidence was approximately 1 in 5,500 cases of anesthesia. Forty-eight percent of the affected patients had a history of allergic reactions. The manifestations were skin reactions, hypotension and wheezing in 38, 22 and 19 percent of the overall symptoms, respectively. Reactions were mild, moderate and severe in 40, 23 and 37 percent of the patients, respectively. The three drugs most suspected of causing the reaction(s) were antibiotics (19%), muscle relaxants (17%) and propofol (15%). All of the affected patients recovered after treatment including the one who suffered cardiac arrest because of the allergic reaction. CONCLUSION: The incidence of perioperative allergic reactions was 1 in 5,500 cases of anesthesia. History of allergies was obtained from half of the patients and the most common sign was a skin reaction. The drugs most suspected of causing an allergic reaction were antibiotics. All of the patients responded well to rescue treatment.

Adolescent↗
PubMed1984

Pathophysiologic mechanisms of allergic and pseudo-allergic reactions to foods, food additives and drugs.

Allergic or pseudo-allergic reactions elicited by per os intake of foods, food additives or drugs may be based on one or several of the following immunopathologic mechanisms: 1) specific IgE bound to mast cells and/or basophils; 2) antigen-IgE soluble complexes hitting various target cells; 3) antigen-IgG complexes generating anaphylatoxins; 4) generation of anaphylatoxins by alternate pathway complement activation; 5) release of mast cell mediators by other direct triggering mechanisms (e.g., basic peptides, peptones); 6) effects on other target cells such as neutrophils and platelets; 7) reactions mediated by specific effector lymphocytes. While allergic reactions in a classical sense involve a sensitization process leading to the formation of specific immunologic agents such as antibodies or specific T lymphocytes, pseudo-allergic reactions appear to involve the same inflammatory mediators which are formed and/or released through different mechanisms and without the necessity for specific sensitization. The complexity of the phenomena possibly involved continues to create great difficulties in the objective diagnosis of food allergy.

Anaphylatoxins↗
PubMed2004

Immune responses to mosquito saliva in 14 individuals with acute systemic allergic reactions to mosquito bites.

BACKGROUND: Mosquito bite-induced acute systemic allergic reactions are an increasing clinical concern and have not been optimally characterized immunologically. OBJECTIVE: We wanted to study the immunologic basis of these reactions. METHODS: Sera were received from 14 individuals with a history of acute systemic allergic reactions to mosquito bites, defined as the presence of one or more of the following: urticaria, angioedema, wheezing, dyspnea, hypotension, and decrease or loss of consciousness. Ten individuals were from the United States and one each was from Canada, Germany, Japan, and Switzerland. An indirect ELISA was developed to measure specific IgE and IgG antibodies to saliva from 5 common mosquito species with different geographic distributions: Aedes aegypti, Aedes vexans, Aedes albopictus, Anopheles sinensis, and Culex quinquefasciatus. Twenty-nine individuals with negative bite test results from laboratory-reared mosquitoes served as control subjects. RESULTS: Mosquito saliva-specific IgE levels to all 5 species were significantly increased in the individuals with systemic allergic reactions compared with the control subjects ( P < .061 for Aedes vexans and P < .008 for the remaining 4 species). By using the mean of the control subjects plus 1 SD as a cut-off level, 11 individuals had positive results to Aedes albopictus and up to 4 additional species; 3 individuals had positive results to only one species. Saliva-specific IgG levels were not significantly increased in the individuals with systemic allergic reactions compared with levels seen in the control subjects ( P > .05). CONCLUSION: Acute systemic allergic reactions to mosquito bites involve mosquito saliva-specific IgE and can be characterized immunologically. Aedes albopictus is the most common species associated with systemic allergic reactions to mosquito bites.

Acute Disease↗
PubMed1995

Clinical experience with the long-term use of 1% apraclonidine. Incidence of allergic reactions.

OBJECTIVE: To identify the incidence and characteristics of allergic reactions associated with the long-term use of 1% apraclonidine hydrochloride. METHODS: We undertook a retrospective analysis of 64 patients receiving long-term 1% apraclonidine therapy at the University of California-San Francisco Glaucoma Service. Patients were excluded if the duration of treatment was less than 2 weeks. Demographic data, initial intraocular pressure response, and incidence and characteristics of allergic reactions were obtained through chart review. Student's t test and chi 2 analysis were used to analyze the demographic data, and Kaplan-Meier survival analysis was used to estimate the long-term incidence of local reactions. RESULTS: Sixty-four patients met the criteria for the study. Of these, 31 (48%) developed an allergic reaction (responders) that led to discontinuation of treatment with the medication, with a mean latency of 4.7 months. Mean follow-up was 13.3 months. Patients free of local reactions (nonresponders) for at least 10 months were able to successfully continue apraclonidine use. Responders tended to be older and female. CONCLUSIONS: Our data are specific for the 1% preparation; however, physicians prescribing apraclonidine on a long-term basis should be aware of possible allergic reactions. A substantial percentage of patients developed this side effect, but most tolerated the medication for up to 4 months, and those without a local reaction after 10 months appeared to be able to continue apraclonidine use indefinitely. This allergic reaction is likely related to the adrenergic agent itself, and not to preservatives.

Adrenergic alpha-Agonists↗
PubMed1975

[Clinical and immunological analysis of 1,047 allergic reactions to penicillin].

Of 1047 patients who had had an allergic reaction to penicillin established by clinical and laboratory findings, 224 were given penicillin therapy again later. One third of these patients developed a second allergic reaction to penicillin. In patients experiencing a second allergic reaction the most striking feature is a dramatic increase in the immediate reactions and especially of the anaphylactic type, and less markedly, an increase in the serum-sickness type of reaction. All the patients were skin tested with penicilloyl-polylysine (PPL) and benzylpenicillin (BPO). Circulating hemagglutinating antibodies were determined and in vitro stimulation of peripheral blood lymphocytes was performed in all cases. Skin tests show little change for several years. In contrast, circulating hemagglutinating antibodies disappear in half the cases within 6 months. Finally, lymphocyte stimulation with penicillin was positive in only 50% three months after onset of the allergic reaction, whereas one year later there was a 73% positive response. The best test for prediction of an allergic reaction to penicillin appears to be determination of the (high) and (low) reactors among patients with a positive skin test to PPL and BPO.

Anaphylaxis↗
PubMed2004

Isodon japonicus decreases immediate-type allergic reaction and tumor necrosis factor-alpha production.

BACKGROUND: The immediate-type allergic reaction is involved in many allergic diseases such as asthma, allergic rhinitis and sinusitis. The discovery of drugs for the treatment of immediate-type allergic disease is a very important subject in human health. Isodon japonicus Hara (Labiatae) (IJAE) has been used for centuries as a traditional medicine in Korea and is known to have an anti-inflammatory effect. However, its specific mechanism of action is still unknown. In this report, we investigated the effect of IJAE on the immediate-type allergic reaction and studied its possible mechanisms of action, focusing on the mast cell-mediated allergic reaction. METHODS: IJAE extracts were anally administered to mice for high and fast absorption. Compound 48/80-induced mortality and compound 48/80- or immunoglobulin E (IgE)-induced histamine release were measured to evaluate the antiallergic effects of IJAE. The effect of IJAE on the model of local allergic reaction in vivo, passive cutaneous anaphylaxis (PCA), was investigated. The production of tumor necrosis factor-alpha (TNF-alpha) was measured by Western blotting. RESULTS: IJAE inhibited compound 48/80-induced systemic reactions and plasma histamine release in mice. IJAE decreased the PCA reaction activated by anti-dinitrophenyl (DNP) IgE antibody. IJAE dose-dependently reduced histamine release from rat peritoneal mast cells activated by compound 48/80 or anti-DNP IgE. Furthermore, IJAE decreased the production of TNF-alpha in phorbol 12-myristate 13-acetate plus calcium ionophore A23187-stimulated human mast cells. CONCLUSION: Our findings provide evidence that IJAE inhibits mast cell-derived immediate-type allergic reactions, and also demonstrate the involvement of TNF-alpha in these effects. We propose the clinical use of IJAE in mast cell-mediated immediate-type allergic diseases.

Administration, Rectal↗
PubMed2005

Postcoital allergic reaction in a woman.

Postcoital allergic reaction to drugs is a rare condition that has not been previously described in the Emergency Medicine literature. We report a case of postcoital allergic reaction in a woman who had a history of allergy to cephalosporins, which were used by her sexual partner.

Administration, Oral↗
PubMed1989

[Allergic reactions to insect bites].

An allergic reaction to stings by insects can occur within minutes and may be fatal. The history serves to assess the severity of the reaction and may aid in the identification of the insect involved. The diagnosis is confirmed by a skin test and the presence of insect venom specific IgE. Minor allergic reactions can be treated with drugs, the more severe forms require hyposensitization therapy with pure insect venom, especially when the risk of life threatening reaction due to reexposure to insect sting is high. A protection against insect stings can be achieved within days. During the venom immunotherapy an antibody rise occurs and is followed by a suppression of specific IgE production later on. Allergy against hymenoptera venom is a suitable model for hyposensitization treatment.

Ant Venoms↗
PubMed2002

Immediate and delayed allergic reactions to Crotalidae polyvalent immune Fab (ovine) antivenom.

Allergic reactions are the most commonly reported adverse events after administration of antivenoms. Conventional horse serum-based crotalid antivenom used in the United States (Antivenin [Crotalidae] polyvalent) can lead to both immediate and delayed hypersensitivity reactions. Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) has recently been approved for use in the United States. Experience from premarketing trials of this product and in the administration of other types of Fab, such as in digoxin poisoning, has demonstrated these fragments to be safe and effective, with a low incidence of sequella; however, allergic reactions can occur when any animal-protein derivatives are administered to human subjects. We report in detail the nature and course of allergic reactions that occurred in 4 patients treated with FabAV. Cases of anaphylaxis, acute urticaria, angioedema, and delayed serum sickness are described. All reactions were easily treated with some combination of antihistamines, epinephrine, and steroids, with prompt resolution of signs and symptoms enabling further dosing of antivenom as required. Several of these cases may have resulted from batches of antivenom contaminated with Fc fragments. The overall incidence of immediate and delayed allergic reactions to this product appears so far to be lower than that reported with conventional whole-immunoglobulin G (IgG) antivenom, but postmarketing surveillance is warranted.

Adult↗
PubMedDate not supplied

Cyclosporin A inhibits eosinophilic infiltration into the conjunctiva mediated by type IV allergic reactions.

BACKGROUND: Eosinophils are important effector cells in severe allergic conjunctivitis such as vernal keratoconjunctivitis. Infiltration of eosinophils into the conjunctiva is mediated by type I and type IV allergic reactions. Cyclosporin A (CsA) eye drops are administered therapeutically for severe allergic conjunctivitis, but the mechanism by which CsA acts, that is, by inhibiting type I, type IV or both types of allergic reactions, is not known. We investigated whether CsA eye drops inhibit type I, type IV or both types of allergic reactions in the conjunctiva. METHODS: Experimental immune-mediated blepharoconjunctivitis (EC) was induced in BALB/c mice by either active immunization or passive immunization by transfer of ragweed (RW)-primed splenocytes and RW-specific IgE, followed by RW challenge to the conjunctiva. These mice were treated in eye drops with vehicle, 0.1% CsA, 0.5% CsA or 0.1% betamethasone five times (1 and 2 h before RW challenge and 1, 2 and 3 h after RW challenge). Twenty-four hours after the challenge, the conjunctivas were harvested for histological analysis to evaluate eosinophilic infiltration. To evaluate effects of CsA eye drops on systemic immune responses, sera and spleens were collected from actively immunized mice at the time of sacrifice to examine serum IgE levels and cellular immune responses, respectively. RESULTS: CsA eye drops significantly inhibited eosinophilic infiltration into the conjunctiva in actively immunized EC-developing mice compared with vehicle-treated mice. The CsA-induced inhibition was similar to inhibition induced by 0.1% betamethasone. Serum IgE levels and splenocyte responses in CsA-treated mice were equivalent to those in vehicle-treated mice. Betamethasone treatment inhibited eosinophilic infiltration into the conjunctiva induced by both splenocyte transfer and IgE transfer, while CsA treatment inhibited infiltration induced by splenocyte transfer. CONCLUSIONS: CsA eye drops inhibited eosinophilic infiltration into the conjunctiva without affecting systemic immune responses. CsA predominantly inhibits eosinophilic infiltration by interfering with the type IV allergic reaction in the conjunctiva.

Animals↗
PubMed1983

Macrophage-T lymphocyte relationships in man's contact allergic reactions.

Seventeen biopsies from contact allergic reaction sites in sensitized patients were studied by electron microscopy and immunocytochemistry. Very intimate appositions of macrophages to T lymphocytes were frequently observed in the dermis at 6, 8 and 12 hours after application of the allergen. Such juxtapositions were seen less frequently after 24, 48 and 72 hours. These appositions seem to indicate that macrophages play an antigen-presenting role in human contact allergic reactions, as Langerhans cells seem to do.

Allergens↗
PubMedDate not supplied

The effect of provoked allergic reaction and histamine on nasal mucosal blood flow in humans.

The allergic reaction in the nasal mucosa is a complex pathophysiological process with several chemical mediators involved. One of the primary mediators is histamine. This investigation was performed to study separately the effects of an allergic reaction and of histamine on the human nasal mucosal blood flow with the 133Xe wash-out method. An allergic reaction was provoked by pollen allergens and blood flow was estimated before and after provocation. In healthy subjects and in subjects with allergic rhinitis and off pollen season, the effect of histamine injected into the mucosa was studied. The allergic reaction decreased the blood flow but histamine had a converse effect in both allergic and normal subjects. This indicates that histamine alone is not responsible for the vascular effects in allergic rhinitis. Different mechanisms responsible for the decreased blood flow in the allergic reaction are discussed.

Adolescent↗
PubMed2002

Immediate allergic reactions after vaccinations--a post-marketing surveillance review.

UNLABELLED: Immediate systemic allergic reactions after vaccination with commonly used vaccines are very rare. Consequently, the risk of these reactions cannot be verified before widespread use. A data analysis of spontaneously reported suspected adverse drug reactions following the administration of 15 marketed vaccines, from 1994 to 1998, shows an average reporting rate for "allergic" reactions of one case report per 450,000 vaccine doses sold. Of these, potentially life-threatening events are extremely rare. In 31% of our case reports the reaction was reported after the first vaccination. In these cases a pre-sensitisation or a pseudo-allergic reaction can be assumed. There was no evidence for an increased risk of "allergic" reactions for patients with atopy. CONCLUSION: our data support a high level of safety for the vaccines included in the analysis. They also emphasise the importance of a careful vaccination management after occurrence of "allergic" reactions and the necessity of a post-marketing surveillance system for recording adverse drug reactions.

Adolescent↗
PubMed1988

Late systemic-allergic reactions to inhalant allergen immunotherapy.

Late systemic-allergic reactions (defined as occurring between 30 minutes and 6 hours after injection) to inhalant allergen immunotherapy were prospectively studied in four allergy treatment centers; 35,674 injections were administered to 712 patients. Twenty-nine patients (4% of all patients) experienced 33 late reactions. Fifty-six injections (0.16% of all injections) were associated with the 33 late reactions. The most common clinical manifestation of a late reaction was urticaria. However, objective respiratory airway involvement, as manifested by wheezing and/or stridor, occurred in 10 (27%) of the late reactions. Delayed reactions involving wheezing and/or stridor were only related to injections from maintenance vials, and all these more severe reactions occurred no later than 60 minutes after injection. We conclude that late systemic-allergic reactions account for a significant percent of the total number of systemic-allergic reactions to inhalant allergen immunotherapy. It is our belief that a 60-minute postinjection waiting period for injections administered from maintenance vials of extract would enhance the safety of inhalant allergen immunotherapy.

Female↗
PubMed2001

Food-allergic reactions in schools and preschools.

BACKGROUND: Food allergies may affect up to 6% of school-aged children. OBJECTIVES: To conduct a telephone survey to characterize food-allergic reactions in children (defined as those aged 3-19 years in this study) with known food allergies in schools and preschools and to determine mechanisms that are in place to prevent and treat those reactions. DESIGN: The parents of food-allergic children were contacted by telephone and asked about their child's history of food-allergic reactions in school. The schools the children attended were contacted, and the person responsible for the treatment of allergic reactions completed a telephone survey. RESULTS: Of 132 children in the study, 58% reported food-allergic reactions in the past 2 years. Eighteen percent experienced 1 or more reactions in school. The offending food was identified in 34 of 41 reactions, milk being the causative food in 11 (32%); peanut in 10 (29%); egg in 6 (18%); tree nuts in 2 (6%); and soy, wheat, celery, mango, or garlic in 1 (3%) each. In 24 reactions (59%), symptoms were limited to the skin; wheezing occurred in 13 (32%), vomiting and/or diarrhea in 4 (10%), and hypotension in 1 (2%). Also, 15 (36%) of the 41 reactions involved 2 or more organ systems, and 6 (15%) were treated with epinephrine. Fourteen percent of the children did not have a physician's orders for treatment, and 16% did not have any medications available. Of the 80 participating schools, 31 (39%) reported at least 1 food-allergic reaction within the past 2 years and 54 (67%) made at least 1 accommodation for children with a food allergy, such as peanut-free tables, a peanut ban from the classroom, or alternative meals. CONCLUSIONS: It is common for food-allergic children to experience allergic reactions in schools and preschools, with 18% of children having had at least 1 school reaction within the past 2 years. Thirty-six percent of the reactions involved 2 or more organ systems, and 32% involved wheezing. Every effort should be made to prevent, recognize, and appropriately treat food-allergic reactions in schools.

Adolescent↗
PubMed1998

Allergic reactions to oral iodinated contrast agents: reactions to oral contrast.

Allergic reactions can occur with virtually all substances used in medicine. Recently there has been increasing recognition that iodinated oral contrast agents (oral contrast) used in radiology are also capable of inducing an allergic response. Fortunately these are rarely life-threatening. This paper discusses three cases of mild reactions to oral iodinated contrast (all for computed tomography (CT) scans). The Australian experience of these agents is also reviewed.

Administration, Oral↗