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Anafilaxia , Vesículas Extracelulares , Hipersensibilidad a los Alimentos , MicroARNs , Humanos , Vesículas Extracelulares/metabolismo , Anafilaxia/diagnóstico , MicroARNs/genética , Niño , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Masculino , Femenino , Preescolar , AdolescenteRESUMEN
BACKGROUND: Kounis syndrome is defined as the concurrence of acute coronary syndromes in the setting of allergic or anaphylactic reactions. It primarily affects men aged 40-70 years and is often associated with chest pain. This syndrome is often unrecognized and undiagnosed in clinical practice due to a low level of awareness. Herein, we present a case of type I Kounis syndrome in a young woman without chest pain. CASE PRESENTATION: A 28-year-old Japanese woman with a history of atopic dermatitis received a glycyrrhizin, glutathione, and neurotropin preparation (a preparation of inflamed skin extract from rabbits inoculated with vaccinia virus) at a dermatology clinic to treat pruritus caused by atopic dermatitis. Immediately after the administration, the patient developed abdominal pain and generalized body wheals. The patient was diagnosed with anaphylaxis and was transported to our hospital. She had no chest pain on arrival at our hospital; however, a 12-lead electrocardiogram showed ST elevation in leads I, aVL, V2, and V3, and an echocardiogram showed decreased wall motion in the anterior and lateral walls of the left ventricle. Sublingual nitroglycerin administration improved ST-segment elevation and left ventricular wall motion abnormalities. The patient underwent emergency coronary angiography, which revealed no significant stenosis, and was diagnosed with type I Kounis syndrome. CONCLUSION: Kounis syndrome without chest pain is rare in young women. Since it can be fatal in cases with severe allergic symptoms such as anaphylaxis, the possibility of concurrent acute coronary syndrome should be considered when treating systemic allergic reactions, regardless of age, sex, or the presence or absence of chest symptoms.
Asunto(s)
Síndrome de Kounis , Femenino , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/etiología , Síndrome de Kounis/fisiopatología , Síndrome de Kounis/tratamiento farmacológico , Adulto , Angiografía Coronaria , Resultado del Tratamiento , Electrocardiografía , Vasodilatadores/administración & dosificación , Nitroglicerina/administración & dosificación , Anafilaxia/diagnóstico , Anafilaxia/inducido químicamente , Anafilaxia/tratamiento farmacológico , Administración SublingualRESUMEN
Hypersensitivity reactions represent one of the most common causes of hesitancy for adherence to national vaccination programs. The majority of hypersensitivity reactions after vaccination are mild, and anaphylaxis is reported to be rare, although it remains challenging to estimate the frequency attributed to each single vaccine, either because of the lower number of administered doses of less common vaccines, or the administration of simultaneous vaccine in most of the vaccination programs. Although literature remains scattered, international consensus guides clinicians in identifying patients who might need the administration of vaccines in protected environments due to demonstrated hypersensitivity to vaccine components or adjuvants. Here we provide the current guidance on hypersensitivity reactions to vaccines and on vaccination of children with allergy disorders.
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Hipersensibilidad , Vacunación , Vacunas , Humanos , Vacunas/efectos adversos , Vacunas/administración & dosificación , Vacunación/efectos adversos , Niño , Anafilaxia/prevención & control , Guías de Práctica Clínica como AsuntoRESUMEN
Neuromuscular blocking agents (NMBAs) relax skeletal muscles to facilitate surgeries and ease intubation but can lead to adverse reactions, including complications because of postoperative residual neuromuscular blockade (rNMB) and, in rare cases, anaphylaxis. Both adverse reactions vary between types of NMBAs, with rocuronium, a widely used nondepolarizing NMBA, inducing one of the longest rNMB durations and highest anaphylaxis incidences. rNMB induced by rocuronium can be reversed by the synthetic γ-cyclodextrin sugammadex. However, in rare cases, sugammadex can provoke anaphylaxis. Thus, additional therapeutic options are needed. Rocuronium-induced anaphylaxis is proposed to rely on preexisting rocuronium-binding antibodies. To understand the pathogenesis of rocuronium-induced anaphylaxis and to identify potential therapeutics, we investigated the memory B cell antibody repertoire of patients with suspected hypersensitivity to rocuronium. We identified polyclonal antibody repertoires with a high diversity among V(D)J genes without evidence of clonal groups. When recombinantly expressed, these antibodies demonstrated specificity and low affinity for rocuronium without cross-reactivity for other NMBAs. Moreover, when these antibodies were expressed as human immunoglobulin E (IgE), they triggered human mast cell activation and passive systemic anaphylaxis in transgenic mice, although their affinities were insufficient to serve as reversal agents. Rocuronium-specific, high-affinity antibodies were thus isolated from rocuronium-immunized mice. The highest-affinity antibody was able to reverse rocuronium-induced neuromuscular blockade in nonhuman primates with kinetics comparable to that of sugammadex. Together, these data support the hypothesis that antibodies cause anaphylactic reactions to rocuronium and pave the way for improved diagnostics and neuromuscular blockade reversal agents.
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Anafilaxia , Rocuronio , Rocuronio/efectos adversos , Animales , Humanos , Anafilaxia/inmunología , Anticuerpos , Ratones , Periodo Perioperatorio , Androstanoles/efectos adversos , Sugammadex/efectos adversos , Inmunoglobulina E/inmunología , Especificidad de Anticuerpos , Femenino , Modelos Animales de Enfermedad , MasculinoRESUMEN
α-Gal syndrome (AGS) is an allergic reaction to galactose-α-1,3-galactose (α-gal) found in the salivary glands of ticks, mammalian meat excluding primates, and some antibody preparations, such as cetuximab. We report two cases of AGS diagnosed after ingestion of wild boar meat. Patient 1, a male in his 70s, developed anaphylactic shock about 3 h after eating wild boar meat. He was transported to our acute and critical care center in Nagasaki University Hospital because he had difficulty in moving. Patient 2, a female in her 60s, developed a skin rash about 2.5 h after ingesting wild boar meat. After visiting our department to investigate the cause of the disease, the sera of both patients were found to be positive for α-gal specific IgE antibody and were diagnosed with AGS caused by ingestion of wild boar meat. Reports of AGS diagnosed after ingestion of wild boar meat are rare in Japan. Compared with other prefectures, the consumption of wild boar meat in Nagasaki is relatively high in Japan. In the past 10 years, four cases of AGS were diagnosed at our department, half of which were caused by the ingestion of wild boar meat, the ratio is possibly higher than that in other prefectures in Japan.
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Hipersensibilidad a los Alimentos , Carne , Animales , Femenino , Humanos , Masculino , Hipersensibilidad a los Alimentos/etiología , Hipersensibilidad a los Alimentos/inmunología , Anciano , Carne/efectos adversos , Persona de Mediana Edad , Sus scrofa , Anafilaxia/etiología , Anafilaxia/inmunología , SíndromeRESUMEN
BACKGROUND: Anaphylaxis is a severe systemic hypersensitivity reaction that usually has a rapid onset and can be fatal. Presentations of childhood anaphylaxis vary widely in accordance with the triggers and the patient's age, geographical region and dietary and lifestyle habits. METHODS: The medical records of 177 paediatric patients diagnosed with anaphylaxis between January 2021 and January 2024, whose disease progression was monitored at a single tertiary care centre, were reviewed retrospectively. RESULTS: The study included 177 patients diagnosed with anaphylaxis (107 males and 70 females with a median age of 48 months). The most common allergen responsible was food (53.7%). Egg allergy was the most common source of anaphylaxis, afflicting 35 patients (19.3%), while beta-lactam provoked the most common drug allergy, affecting 24 patients (13.6%). The most common organ involved was the skin (92.7%). When the patients were analysed by age group, there were more males in the infancy, preschool and school age groups, while there were more females in the adolescent group (p = 0.44). Food-induced anaphylaxis became less common with increasing age, whereas the rate of drug-induced anaphylaxis increased (p = 0.01 and p = 0.01, respectively). Cardiovascular system findings were observed more frequently in adolescents compared to other age groups (p = 0.003). Most cases stemming from a food allergy were mild, whereas most drug-induced cases were moderate or severe (p < 0.05). When severity was analysed by age group, mild cases in infants were more common than moderate to severe cases. CONCLUSION: The aetiological and clinical manifestations of childhood anaphylaxis vary among different age groups.
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Anafilaxia , Hipersensibilidad a los Alimentos , Humanos , Anafilaxia/epidemiología , Anafilaxia/etiología , Anafilaxia/diagnóstico , Femenino , Masculino , Preescolar , Niño , Estudios Retrospectivos , Adolescente , Lactante , Hipersensibilidad a los Alimentos/epidemiología , Hipersensibilidad a los Alimentos/complicaciones , Factores de Edad , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/diagnóstico , Alérgenos/inmunología , Alérgenos/efectos adversos , Hipersensibilidad al Huevo/epidemiología , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad al Huevo/complicaciones , Hipersensibilidad al Huevo/diagnósticoRESUMEN
Systemic mastocytosis (SM) is a clonal mast cell disorder that can lead to potentially severe anaphylactic reactions. Hymenoptera sting is one of the most frequent triggers of anaphylaxis in these patients, and diagnosis of indolent SM (ISM) without skin involvement (ISMs) is not rare. In this subgroup of patients, venom immunotherapy (VIT) is an effective treatment decreasing subsequent systemic reactions, and lifelong administration is recommended. An individualized diagnosis is necessary to offer the most adequate VIT, and molecular diagnosis (MD) may be useful to discriminate between primary sensitization and cross-reactivity. Nevertheless, other techniques such as ImmunoCAP inhibition assays may be necessary to identify the genuine sensitization to offer the most suitable VIT. We present a male patient with an anaphylactic reaction following several wasp stings. The patient was diagnosed with ISM, and allergy to both Polistes dominula and Vespula sp venom was confirmed. In this scenario, MD did not discriminate between a genuine double sensitization and venom cross-reactivity between both vespids. Thus, CAP-inhibition assay was performed. This case indicated the importance of an accurate diagnosis of hymenoptera venom allergy (HVA). It also highlights the usefulness of CAP-inhibition assays when MD fails to distinguish between genuine double Polistes-Vespula sensitization and cross-reactivity.
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Anafilaxia , Reacciones Cruzadas , Mordeduras y Picaduras de Insectos , Mastocitosis Sistémica , Venenos de Avispas , Avispas , Humanos , Masculino , Venenos de Avispas/inmunología , Mastocitosis Sistémica/diagnóstico , Mastocitosis Sistémica/inmunología , Mastocitosis Sistémica/complicaciones , Animales , Anafilaxia/diagnóstico , Anafilaxia/inmunología , Anafilaxia/etiología , Mordeduras y Picaduras de Insectos/inmunología , Mordeduras y Picaduras de Insectos/diagnóstico , Mordeduras y Picaduras de Insectos/complicaciones , Avispas/inmunología , Reacciones Cruzadas/inmunología , Desensibilización Inmunológica/métodos , Alérgenos/inmunología , Alérgenos/administración & dosificación , Triptasas/sangre , Inmunoglobulina E/inmunología , Inmunoglobulina E/sangreAsunto(s)
Anafilaxia , Frío , Urticaria , Humanos , Anafilaxia/etiología , Anafilaxia/diagnóstico , Urticaria/diagnóstico , Urticaria/etiología , Urticaria/inmunología , Frío/efectos adversos , Femenino , Masculino , AdultoAsunto(s)
Anafilaxia , Citrus sinensis , Hipersensibilidad a los Alimentos , Giberelinas , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/inmunología , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/diagnóstico , Citrus sinensis/inmunología , Citrus sinensis/efectos adversos , Giberelinas/efectos adversos , Inmunoglobulina E/inmunología , Inmunoglobulina E/sangre , Proteínas de Plantas/inmunología , Proteínas de Plantas/efectos adversos , Femenino , Masculino , Alérgenos/inmunología , Alérgenos/efectos adversos , Antígenos de Plantas/inmunología , Pruebas CutáneasRESUMEN
In this cross-sectional, descriptive, and observational study conducted at Fundación Valle del Lili in Colombia, the clinical and sociodemographic characteristics of anaphylaxis were investigated in a cohort of 80 patients who sought medical care between January 2021 and December 2022. With a median age of 16 years and a notable prevalence among individuals aged below 18 years, the study revealed that 63.8% of patients had concomitant allergic diseases. Medications emerged as the primary triggers for anaphylaxis, followed by food. The mucocutaneous system was predominantly affected in 55% of cases, with respiratory involvement observed in 37.5%. Alarmingly, anaphylactic shock occurred in 17.5%, and 7.5% experienced biphasic anaphylaxis. Intramuscular adrenaline was administered in 88.8% of cases, with 75% of patients not receiving an allergy consultation upon discharge, and 52.5% lacking follow-up for allergy care. Considering that in Colombia epidemiological data on the clinical and sociodemographic aspects of anaphylaxis remain largely unknown, this study documents the features of anaphylaxis in both adult and pediatric populations and highlights the urgent need for improved awareness, timely evaluation by allergists, and comprehensive follow-up care for individuals experiencing anaphylaxis.
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Anafilaxia , Humanos , Anafilaxia/epidemiología , Colombia/epidemiología , Masculino , Femenino , Adolescente , Adulto , Estudios Transversales , Adulto Joven , Niño , Persona de Mediana Edad , Preescolar , Prevalencia , Epinefrina/administración & dosificación , Hipersensibilidad a los Alimentos/epidemiología , Lactante , AncianoRESUMEN
RATIONALE: Anaphylactic shock, a severe and rapid systemic allergic reaction, poses significant treatment challenges. Epinephrine, the first-line treatment, effectively reverses symptoms but can complicate the clinical picture by elevating lactate levels, blurring the distinction between shock-induced hypoperfusion and drug-induced metabolic effects. PATIENT CONCERNS: A 26-year-old female presented with anaphylactic shock following an antibiotic infusion, experiencing chest tightness, hypotension, and pulmonary edema, without significant past medical history apart from a noted allergy to fish and shrimp. DIAGNOSES: Anaphylaxis was diagnosed based on clinical presentation and supported by imaging that revealed pulmonary edema, despite normal troponin levels and electrocardiogram. INTERVENTIONS: Treatment included 0.5 mg of intramuscular epinephrine and 5 mg of intravenous dexamethasone, with subsequent intubation and mechanical ventilation in the intensive care unit. An intravenous epinephrine infusion was also administered for hemodynamic support. OUTCOMES: While epinephrine resolved the pulmonary edema and stabilized circulation, it led to a significant, albeit transient, increase in lactate levels, which normalized following discontinuation of epinephrine, indicating the metabolic effect of the drug rather than ongoing tissue hypoperfusion. LESSONS: This case illustrates the importance of recognizing epinephrine-induced lactate elevation in anaphylactic shock, necessitating a nuanced interpretation of lactate dynamics. Clinicians must differentiate between lactate elevations due to tissue hypoperfusion and those arising from epinephrine's pharmacologic effects to optimize patient care.
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Anafilaxia , Epinefrina , Ácido Láctico , Humanos , Anafilaxia/tratamiento farmacológico , Anafilaxia/sangre , Femenino , Adulto , Epinefrina/administración & dosificación , Ácido Láctico/sangre , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Edema Pulmonar/inducido químicamente , Edema Pulmonar/tratamiento farmacológico , Antibacterianos/efectos adversos , Antibacterianos/administración & dosificaciónRESUMEN
Allergy is a medical condition of frequent occurrence. In the Netherlands approximately 20% of the population has some kind of respiratory allergy, due to pollen and dust mites. The occurrence of allergy on foods, antibiotics, other medications, contrast fluid and insect poison is estimated to be 2% in the adult population. Because of this large and diverse group of allergy triggers it is very likely that physicians, regardless of background or medical specialty, will come across questions regarding allergy at some point in their career. The severity of an allergic reaction can vary, with anaphylaxis as one of the most severe and potentially life-threatening reactions (among DRESS, SJS, TEN and acute FPIES). This article describes the backgrounds of IgE-mediated allergy and anaphylaxis, like pathophysiology, diagnostics and treatment.
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Anafilaxia , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/terapia , Hipersensibilidad/diagnóstico , Inmunoglobulina E/sangre , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE OF REVIEW: This review will identify and summarize the published existing data pertaining specifically to Hymenoptera venom allergy in children and adolescents, highlighting the major studies currently available on venom immunotherapy (VIT) and its prognosis in children. RECENT FINDINGS: The current review covers the incidence and prevalence of Hymenoptera venom allergy (HVA) in children, factors influencing occurrence and severity of reactions (age, sex, comorbidities, etc.), indications to perform diagnostic tests and start VIT in children, different existing VIT protocols and their safety and efficacy. SUMMARY: Hymenoptera venom allergy is the second most common cause of anaphylaxis in children and it considerably affects quality of life. Cutaneous reactions are the most prevalent clinical presentation in children who usually have a more favourable prognosis than adult patients. However, studies on HVA in children and adolescents are still limited. Currently VIT is the only treatment able to modify the natural history of HVA in adults as well as in children, and to protect patients from systemic reactions after subsequent stings.
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Anafilaxia , Venenos de Artrópodos , Desensibilización Inmunológica , Himenópteros , Mordeduras y Picaduras de Insectos , Humanos , Niño , Adolescente , Animales , Himenópteros/inmunología , Desensibilización Inmunológica/métodos , Venenos de Artrópodos/inmunología , Venenos de Artrópodos/efectos adversos , Mordeduras y Picaduras de Insectos/inmunología , Mordeduras y Picaduras de Insectos/terapia , Mordeduras y Picaduras de Insectos/epidemiología , Mordeduras y Picaduras de Insectos/diagnóstico , Anafilaxia/epidemiología , Anafilaxia/inmunología , Anafilaxia/prevención & control , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/terapia , Hipersensibilidad/inmunología , Hipersensibilidad/terapia , Hipersensibilidad/epidemiología , Hipersensibilidad/diagnóstico , Alérgenos/inmunología , Incidencia , Prevalencia , Calidad de VidaRESUMEN
PURPOSE OF REVIEW: The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations. RECENT FINDINGS: A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis. SUMMARY: This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i.e., travels, outdoor activities and eating out). Moreover, it underlines the need for a further allergological education in these cases, in order to prepare allergic patients to avoid and manage undesired situations.
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Anafilaxia , Vacaciones y Feriados , Anafilaxia/epidemiología , Anafilaxia/etiología , Humanos , Viaje , Animales , Alérgenos/inmunología , Alérgenos/efectos adversos , Factores de Riesgo , Riesgo , Hipersensibilidad a los Alimentos/epidemiología , Hipersensibilidad a los Alimentos/inmunología , Artrópodos/inmunologíaRESUMEN
Idiopathic anaphylaxis (IA) remains a frustrating challenge for both patients and physicians. The aim of this paper is to focus on IA in pediatric ages and suggest possible diagnostic algorithms according to specific age ranges (infants, children, and adolescents). In fact, in a variable percentage of patients, despite extensive diagnostic tests, the cause of anaphylactic episodes cannot be identified. Moreover, the lack of a unanimous IA definition requires a careful and detailed diagnostic workup. Prompt recognition of signs and symptoms, especially in younger children, and an accurate clinical history often allow a choice of the most appropriate diagnostic tests and a correct differential diagnosis.
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Anafilaxia , Humanos , Anafilaxia/diagnóstico , Anafilaxia/terapia , Anafilaxia/etiología , Anafilaxia/tratamiento farmacológico , Niño , Adolescente , Lactante , Diagnóstico Diferencial , Preescolar , AlgoritmosRESUMEN
Human fibrinogen (FIB) has been clinically proven to be considerably effective for the treatment of postoperative bleeding, with reported cases of allergic reactions to human FIB being rare. Here, we report a case of an anaphylactic shock in 27-year-old patients with rheumatic heart valve disease who received a human FIB infusion during mitral valve replacement, aortic valve replacement, and tricuspid valve-shaping surgery. The patients showed generalised profuse sweating, a barely noticeable skin rash, faint pulse, systolic pressure < 50 mmHg, and a heart rate of 71 beats/min. We share insights from a case of severe allergy to human FIB infusion during cardiac surgery, through which we have gained experience in the processes of diagnosing and treating. This report aims to provide a preliminary summary of the characteristics of this case to serve as a reference for fellow clinicians.
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Anafilaxia , Fibrinógeno , Humanos , Anafilaxia/inducido químicamente , Anafilaxia/diagnóstico , Fibrinógeno/uso terapéutico , Fibrinógeno/administración & dosificación , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Masculino , Femenino , Cardiopatía Reumática/cirugíaRESUMEN
Immunoglobulin E (IgE) plays pivotal roles in allergic diseases through interaction with a high-affinity receptor (FcεRI). We established that Fab fragments of anti-IgE antibodies (HMK-12 Fab) rapidly dissociate preformed IgE-FcεRI complexes in a temperature-dependent manner and inhibit IgE-mediated anaphylactic reactions, even after allergen challenge. X-ray crystallographic studies revealed that HMK-12 Fab interacts with each of two equivalent epitopes on the Cε2 homodimer domain involved in IgE F(ab')2. Consequently, HMK-12 Fab-mediated targeting of Cε2 reduced the binding affinity of Fc domains and resulted in rapid removal of IgE from the receptor complex. This unexpected finding of allosteric inhibition of IgE-FcεRI interactions by simultaneous targeting of two epitope sites on the Cε2 homodimer domain of IgE F(ab')2 may have implications for the development of novel therapies for allergic disease.