RESUMEN
BACKGROUND: Ten percent of the population claims an allergy to penicillin, but 90% of these individuals are not allergic. Patients labeled as penicillin-allergic have higher medical costs, longer hospital stays, are more likely to be treated with broad-spectrum antibiotics, and develop drug-resistant bacterial infections. Most penicillin skin test reagents are not approved by the Food and drug Administration or readily available to evaluate patients labeled penicillin-allergic. OBJECTIVE: To determine the negative predictive value (NPV) of the Penicillin Skin Test Kit containing the major allergenic determinant (penicilloyl polylysine), a minor determinant mixture (penicillin G, penicilloate, penilloate), and amoxicillin, produced according to Food and Drug Administration standards. METHODS: This was a prospective, multicenter, open-label investigation of penicillin skin testing using the Penicillin Skin Test Kit. Skin test-negative subjects were challenged with 250 mg amoxicillin, whereas skin test-positive patients were not challenged. The primary end point was NPV of the Penicillin Skin Test Kit, defined as the percentage of subjects with negative skin test results who did not experience an IgE-dependent reaction within 72 hours of amoxicillin challenge. RESULTS: In total, 455 patients with a history of penicillin allergy underwent skin testing and 63 (13.8%) had 1 or more positive test results; 65% of the positive test results were to the minor determinant mixture and/or amoxicillin alone. In the per protocol group of 373 skin test-negative subjects, 8 developed potential IgE-dependent reactions following oral amoxicillin challenge, translating to an NPV of 97.9% (95% CI, 95.8-99.1; P < .0001). All but 1 of the reactions was mild or moderate, and most subjects who required treatment received only antihistamines. CONCLUSIONS: The Penicillin Skin Test Kit, containing all relevant penicillin allergenic determinants, demonstrated very high NPV. Removal of a penicillin allergy label in a large majority of currently mislabeled patients has substantial personal and public health implications.
Asunto(s)
Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Penicilinas/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pruebas Cutáneas , Adulto JovenRESUMEN
BACKGROUND: Food allergy and anaphylaxis appear to be increasing in the United States, especially in young children, and preparedness is paramount to successful emergency management in the community. Although the treatment of choice for anaphylaxis is epinephrine delivered by autoinjection, some devices are challenged by less user-friendly designs or pose the risk of injury, especially in young patients. Human factors engineering has played a larger role in the development of more recent epinephrine autoinjector technologies and will continue to play a role in the evolution and future design of epinephrine autoinjectors. OBJECTIVE: To discuss contemporary issues related to the identification and management of anaphylaxis, current and future epinephrine autoinjector design, and unmet needs for the treatment of special populations, namely, young children weighing less than 15 kg. METHODS: The literature was reviewed and select articles retrieved to support expert clinical opinions on the need for improved recognition of anaphylaxis, epinephrine autoinjector design, and unmet needs in special populations. RESULTS: Anaphylaxis may be underrecognized and poorly defined in infant- and toddler-aged children, current devices may not be adequate to safely treat these patients (ie, inappropriate needle length), and health care professionals may not be aware of these issues. CONCLUSION: As epinephrine autoinjector technology continues to evolve, device characteristics that promote safe, user-friendly experiences and give clinicians and their patients confidence to successfully treat anaphylaxis during an emergency, without injury, will be favored.
Asunto(s)
Anafilaxia/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Epinefrina/uso terapéutico , Inyecciones/instrumentación , Adulto , Anafilaxia/diagnóstico , Anafilaxia/fisiopatología , Niño , Preescolar , Femenino , Humanos , Lactante , Inyecciones Intramusculares/instrumentación , Masculino , AgujasRESUMEN
BACKGROUND: Case series of anaphylaxis can vary regarding causes, treatments, and follow-up of patients. Unfortunately, case series that are specific to the pediatric population are few. OBJECTIVE: To describe confirmed cases of pediatric anaphylaxis in patients presenting to a pediatric hospital emergency department (ED). METHODS: We identified all ED visits with the International Classification of Diseases, Ninth Revision (ICD-9) codes 995.XX (allergic reactions) and 989.5 (sting or venom reaction) for 1 calendar year (January 1, 2014, through December 31, 2014). Cases were reviewed by an allergist and an emergency medicine physician to identify true anaphylaxis cases using National Institute of Health/National Institute of Allergy and Infectious Diseases criteria. Any questionable or debatable cases were evaluated and adjudicated by a second allergist. RESULTS: We identified 927 unique ED visits. Of these visits, 40 were determined to definitively meet anaphylaxis criteria. Median age of the patients was 6.5 years. A total of 70% of patients were male, and 80% were African American. Causes included foods (65%), venom or insect sting (12.5%), and medications (5%), and 17.5% were idiopathic. All patients had multiorgan involvement, with 98% having skin involvement, 78% having lower respiratory tract symptoms, and 40% having gastrointestinal symptoms. There were no deaths. Only 33% of patients received epinephrine at some point in their care. Only 12 patients were referred to an allergist, and only 4 of these were actually seen by an allergist. CONCLUSION: At our center, foods are the most common trigger for pediatric anaphylaxis. Patients continue to be undertreated, and referral to an allergist from the ED is rare.
Asunto(s)
Anafilaxia/epidemiología , Anafilaxia/etiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Adolescente , Alérgenos/inmunología , Anafilaxia/diagnóstico , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Fenotipo , Estudios RetrospectivosAsunto(s)
Anafilaxia/inducido químicamente , Antialérgicos/efectos adversos , Antiasmáticos/efectos adversos , Omalizumab/efectos adversos , Adulto , Antialérgicos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Omalizumab/uso terapéuticoRESUMEN
Chronic nonallergic rhinitis (NAR) is a syndrome rather than a specific disease. A lack of understanding of the pathogenesis of this condition has led to imprecise terminology with several alternate names for the condition, including vasomotor rhinitis, nonallergic rhinopathy, and idiopathic rhinitis. The therapy for NAR is best based on the underlying pathology, which typically exists in a form whereby an abnormality of the autonomic nervous system is dominant or a form in which inflammation seems to be the cause of symptoms. In general the most effective therapy is the combination of an intranasal antihistamine and an intranasal corticosteroid.
Asunto(s)
Rinitis/terapia , Administración Intranasal , Corticoesteroides/uso terapéutico , Sistema Nervioso Autónomo/patología , Humanos , Hipersensibilidad , Rinitis/patologíaAsunto(s)
Anafilaxia/inducido químicamente , Hipersensibilidad a las Drogas/diagnóstico , Bloqueantes Neuromusculares/efectos adversos , Atención Perioperativa/efectos adversos , Agonistas alfa-Adrenérgicos/uso terapéutico , Adulto , Anafilaxia/tratamiento farmacológico , Anafilaxia/inmunología , Antiinflamatorios/uso terapéutico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/inmunología , Epinefrina/uso terapéutico , Femenino , Humanos , Hidrocortisona/uso terapéutico , Masculino , Persona de Mediana Edad , Bloqueantes Neuromusculares/inmunología , Succinilcolina/efectos adversosAsunto(s)
Dermatitis Atópica/inducido químicamente , Leche/efectos adversos , Prurito/inducido químicamente , Agonistas alfa-Adrenérgicos/uso terapéutico , Animales , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/inmunología , Epinefrina/uso terapéutico , Humanos , Lactante , Masculino , Leche/inmunología , Prurito/tratamiento farmacológico , Prurito/inmunologíaAsunto(s)
Anafilaxia/etiología , Cistoscopía/efectos adversos , Neoplasias de la Vejiga Urinaria/patología , Anciano de 80 o más Años , Anafilaxia/sangre , Anafilaxia/diagnóstico , Anafilaxia/tratamiento farmacológico , Anafilaxia/inmunología , Anestésicos Locales/efectos adversos , Antialérgicos/uso terapéutico , Biomarcadores/sangre , Hipersensibilidad a las Drogas/sangre , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/inmunología , Humanos , Derivados de la Hipromelosa/efectos adversos , Inmunoglobulina E/sangre , Hipersensibilidad al Látex/sangre , Hipersensibilidad al Látex/diagnóstico , Hipersensibilidad al Látex/inmunología , Lidocaína/efectos adversos , Masculino , Valor Predictivo de las Pruebas , Factores de Riesgo , Pruebas SerológicasAsunto(s)
Síndromes Periódicos Asociados a Criopirina/diagnóstico , Adulto , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Proteínas Portadoras/genética , Síndromes Periódicos Asociados a Criopirina/sangre , Síndromes Periódicos Asociados a Criopirina/genética , Femenino , Humanos , Mutación , Proteína con Dominio Pirina 3 de la Familia NLR , Adulto JovenAsunto(s)
Artroplastia de Reemplazo de Rodilla , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis por Contacto/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Pruebas Cutáneas/métodos , Anciano , Alérgenos/efectos adversos , Alérgenos/inmunología , Cementos para Huesos/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Dermatitis por Contacto/etiología , Diagnóstico Diferencial , Testimonio de Experto , Humanos , Masculino , Níquel/efectos adversos , Níquel/inmunología , Prótesis e Implantes/efectos adversosRESUMEN
Idiopathic anaphylaxis is a perplexing problem that accounts for approximately 30% to 60% of cases of anaphylaxis in ambulatory adults and perhaps 10% of cases in children. Advances in our knowledge of idiopathic anaphylaxis have occurred over the past decade with the elucidation of mast cell activating disorders and the discovery of episodes of anaphylaxis caused by galactose-alpha-1,3-galactose. Most patients do well because fatalities can usually be prevented with proper therapy, and many individuals, for reasons not understood, undergo spontaneous remission.