RESUMO
Clinical diagnosis of intraoperative transfusion anaphylaxis using clinical symptoms is challenging and should be made carefully, as an incorrect clinical diagnosis can exacerbate surgical bleeding secondary to stopping a clinically indicated blood transfusion. The timing of onset of anaphylaxis to start of transfusion may be the key to correctly diagnosing intraoperative transfusion anaphylaxis clinically. However, the reliability of this measure remains unknown. A literature search was conducted using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to June 29, 2021. No language restriction was applied. Two pairs of review authors independently reviewed intraoperative transfusion anaphylaxis cases and extracted data on the timing of onset of anaphylaxis to start of transfusion. A total of 8,918 articles were reviewed, the full texts of 186 articles were assessed, and 20 intraoperative transfusion anaphylaxis cases were included in this study. The 20 intraoperative transfusion anaphylaxis cases included a precise timing of onset. With nine cases, cardiovascular surgery was the most prevalent, and one case was fatal. Fifteen cases had a timing of onset in minutes, and of those, 14 reported timeframes within 30 minutes of initiation of transfusion (median: 15.5, 5-30 minutes). Almost all cases of intraoperative transfusion anaphylaxis occurred within 30 minutes of the transfusion initiation. This timeframe may be helpful in the clinical diagnosis of intraoperative transfusion anaphylaxis.
Assuntos
Anafilaxia , Humanos , Anafilaxia/etiologia , Anafilaxia/diagnóstico , Fatores de Tempo , Reação Transfusional/diagnóstico , Transfusão de Sangue , Complicações Intraoperatórias/etiologia , Perda Sanguínea CirúrgicaRESUMO
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.
Assuntos
Anafilaxia , Hipersensibilidade Alimentar , Humanos , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Anafilaxia/diagnóstico , Feminino , Masculino , Pré-Escolar , Criança , Estudos Retrospectivos , Adolescente , Lactente , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/complicações , Fatores Etários , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/diagnóstico , Alérgenos/imunologia , Alérgenos/efeitos adversos , Hipersensibilidade a Ovo/epidemiologia , Hipersensibilidade a Ovo/imunologia , Hipersensibilidade a Ovo/complicações , Hipersensibilidade a Ovo/diagnósticoRESUMO
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.
Assuntos
Anafilaxia , Reações Cruzadas , Mordeduras e Picadas de Insetos , Mastocitose Sistêmica , Venenos de Vespas , Vespas , Humanos , Masculino , Venenos de Vespas/imunologia , Mastocitose Sistêmica/diagnóstico , Mastocitose Sistêmica/imunologia , Mastocitose Sistêmica/complicações , Animais , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Anafilaxia/etiologia , Mordeduras e Picadas de Insetos/imunologia , Mordeduras e Picadas de Insetos/diagnóstico , Mordeduras e Picadas de Insetos/complicações , Vespas/imunologia , Reações Cruzadas/imunologia , Dessensibilização Imunológica/métodos , Alérgenos/imunologia , Alérgenos/administração & dosagem , Triptases/sangue , Imunoglobulina E/imunologia , Imunoglobulina E/sangueAssuntos
Anafilaxia , Citrus sinensis , Hipersensibilidade Alimentar , Giberelinas , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Anafilaxia/imunologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/diagnóstico , Citrus sinensis/imunologia , Citrus sinensis/efeitos adversos , Giberelinas/efeitos adversos , Imunoglobulina E/imunologia , Imunoglobulina E/sangue , Proteínas de Plantas/imunologia , Proteínas de Plantas/efeitos adversos , Feminino , Masculino , Alérgenos/imunologia , Alérgenos/efeitos adversos , Antígenos de Plantas/imunologia , Testes CutâneosRESUMO
Introduction: Tryptase is an important biomarker widely used in the laboratory confirmation of severe hypersensitivity reactions, especially anaphylaxis. It also plays a crucial role in the diagnosis, risk stratification, management and prognostic evaluation of many other mast cell-related conditions. Aim: This paper aims to highlight the role of serum tryptase, both in allergic disorders and other mast cell-related conditions. Two clinical cases regarding timely serum tryptase acquisition (in drug hypersensitivity reactions during the imaging procedure and perioperative anaphylaxis) are meant to emphasize the clinical potential of this protease. Method: We performed a comprehensive literature search of the PubMed/Medline and Scopus databases. From a total of 640 subject related publications, dating from 1940 to 2024, 45 articles written in English were selected. Literature search results: Total serum tryptase is a simple, cost-effective analysis with a normal baseline tryptase (sBT) level below 8.4 µg/L. Elevated sBT can indicate hereditary alpha-tryptasemia (HαT), mastocytosis and other non-allergic disorders. Patients with higher sBT levels, especially with insect venom allergy, have an increased risk of severe reactions and thereby require a prolonged treatment. All immediate systemic hypersensitivity reactions require a correlation between serum acute tryptase (sAT) and sBT. According to the guidelines, measuring sAT 30 min to 2 h after the symptom onset and sBT 24 h after the resolution, using the 20 + 2 rule and an sAT/sBT ratio of 1.685, improves the diagnostic accuracy in anaphylaxis. Conclusions: Tryptase levels should be acquired in all cases with clinical suspicion of MC degranulation. Given the increasing clinical relevance, elevated baseline serum tryptase levels require a multidisciplinary approach and further investigation.
Assuntos
Anafilaxia , Biomarcadores , Triptases , Humanos , Triptases/sangue , Anafilaxia/diagnóstico , Biomarcadores/sangue , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/sangue , Masculino , Feminino , Pessoa de Meia-IdadeAssuntos
Anafilaxia , Vesículas Extracelulares , Hipersensibilidade Alimentar , MicroRNAs , Humanos , Vesículas Extracelulares/metabolismo , Anafilaxia/diagnóstico , MicroRNAs/genética , Criança , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/imunologia , Masculino , Feminino , Pré-Escolar , AdolescenteRESUMO
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.
Assuntos
Síndrome de Kounis , Feminino , Humanos , Síndrome de Kounis/diagnóstico , Síndrome de Kounis/etiologia , Síndrome de Kounis/fisiopatologia , Síndrome de Kounis/tratamento farmacológico , Adulto , Angiografia Coronária , Resultado do Tratamento , Eletrocardiografia , Vasodilatadores/administração & dosagem , Nitroglicerina/administração & dosagem , Anafilaxia/diagnóstico , Anafilaxia/induzido quimicamente , Anafilaxia/tratamento farmacológico , Administração SublingualRESUMO
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.
Assuntos
Anafilaxia , Fibrinogênio , Humanos , Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Fibrinogênio/uso terapêutico , Fibrinogênio/administração & dosagem , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Masculino , Feminino , Cardiopatia Reumática/cirurgiaAssuntos
Anafilaxia , Antibacterianos , Combinação Piperacilina e Tazobactam , Testes Cutâneos , Humanos , Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Combinação Piperacilina e Tazobactam/efeitos adversos , Antibacterianos/efeitos adversos , Piperacilina/efeitos adversos , Masculino , Feminino , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/efeitos adversos , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Anafilaxia , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Anafilaxia/terapia , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Índice de Gravidade de DoençaRESUMO
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.
Assuntos
Anafilaxia , Venenos de Artrópodes , Dessensibilização Imunológica , Himenópteros , Mordeduras e Picadas de Insetos , Humanos , Criança , Adolescente , Animais , Himenópteros/imunologia , Dessensibilização Imunológica/métodos , Venenos de Artrópodes/imunologia , Venenos de Artrópodes/efeitos adversos , Mordeduras e Picadas de Insetos/imunologia , Mordeduras e Picadas de Insetos/terapia , Mordeduras e Picadas de Insetos/epidemiologia , Mordeduras e Picadas de Insetos/diagnóstico , Anafilaxia/epidemiologia , Anafilaxia/imunologia , Anafilaxia/prevenção & controle , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Anafilaxia/terapia , Hipersensibilidade/imunologia , Hipersensibilidade/terapia , Hipersensibilidade/epidemiologia , Hipersensibilidade/diagnóstico , Alérgenos/imunologia , Incidência , Prevalência , Qualidade de VidaAssuntos
Anafilaxia , Humanos , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Anafilaxia/diagnóstico , Ásia/epidemiologia , Criança , Pré-EscolarRESUMO
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.
Assuntos
Anafilaxia , Humanos , Anafilaxia/diagnóstico , Anafilaxia/terapia , Anafilaxia/etiologia , Anafilaxia/tratamento farmacológico , Criança , Adolescente , Lactente , Diagnóstico Diferencial , Pré-Escolar , AlgoritmosAssuntos
Anafilaxia , Humanos , Anafilaxia/epidemiologia , Anafilaxia/diagnóstico , Anafilaxia/imunologiaRESUMO
PURPOSE OF REVIEW: Anaphylaxis is a severe, and potentially life-threatening hypersensitivity reaction whose diagnosis is based on clinical signs and symptoms and their prompt recognition. The presence of mimics and unusual presentations necessitate a careful evaluation and expertise in the field, due to potential diagnostic errors and hence a delay in the treatment.The aim of this review is to analyze and make an overview of the potential differential diagnosis of anaphylaxis, focusing on the clinical challenges of recognizing these conditions effectively among similar others. RECENT FINDINGS: The presence of mimics and unusual presentations of anaphylaxis necessitate a careful evaluation, emphasizing the importance of a comprehensive diagnostic approach.Tryptase is well known marker of mast cells activation, and a useful tool assisting the diagnosis of anaphylaxis, helping to differentiate it from atypical mimickers. SUMMARY: The differential diagnosis of anaphylaxis comprises a very wide setting, and a systematic approach assessing different categories of cardiovascular, skin, respiratory airway, neuropsychiatric, and hematologic systems, can facilitate recognition of the correct diagnosis of this complex and life-threatening condition.
Assuntos
Anafilaxia , Triptases , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Humanos , Diagnóstico Diferencial , Triptases/sangue , Mastócitos/imunologia , BiomarcadoresRESUMO
PURPOSE OF REVIEW: Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children. RECENT FINDINGS: Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others. Reactions to natto, fermented soybeans, are currently mainly reported in Japan, but changing dietary practices and an increase in plant-based eating mean natto, other forms of soy and other legumes are increasingly linked to anaphylaxis in Western countries. Anaphylaxis to red meat, caused by sensitization to galactose-α-1,3-galactose and first reported in North America, is now a more world-wide concern. Co-factor induced anaphylaxis is increasingly associated with both wheat allergy and lipid transfer protein allergy. SUMMARY: More research is urgently needed to characterize adult food allergy, its triggers and symptom severity. Unusual food triggers and potential co-factors should be considered, so that anaphylaxis in adults can be correctly managed, not merely labelled as idiopathic.
Assuntos
Anafilaxia , Hipersensibilidade Alimentar , Humanos , Anafilaxia/etiologia , Anafilaxia/epidemiologia , Anafilaxia/imunologia , Anafilaxia/diagnóstico , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/diagnóstico , Adulto , Alérgenos/imunologia , Alérgenos/efeitos adversos , Japão/epidemiologia , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/epidemiologia , Fabaceae/efeitos adversos , Fabaceae/imunologia , Glycine max/efeitos adversos , Glycine max/imunologiaRESUMO
PURPOSE OF REVIEW: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires rapid identification and intervention. Current management includes early recognition, prompt administration of epinephrine, and immediate medical attention. However, challenges remain in accurate diagnosis, timely treatment, and personalized care. This article reviews the integration of artificial intelligence and machine learning in enhancing anaphylaxis management. RECENT FINDINGS: Artificial intelligence and machine learning can analyze vast datasets to identify patterns and predict anaphylactic episodes, improve diagnostic accuracy through image and biomarker analysis, and personalize treatment plans. Artificial intelligence-powered wearable devices and decision support systems can facilitate real-time monitoring and early intervention. The ethical considerations of artificial intelligence use, including data privacy, transparency, and bias mitigation, are also discussed. SUMMARY: Future directions include the development of predictive models, enhanced diagnostic tools, and artificial intelligence-driven educational resources. By leveraging artificial intelligence and machine learning, healthcare providers can improve the management of anaphylaxis, ensuring better patient outcomes and advancing personalized medicine.
Assuntos
Algoritmos , Anafilaxia , Inteligência Artificial , Aprendizado de Máquina , Humanos , Anafilaxia/diagnóstico , Medicina de Precisão/métodos , Epinefrina/uso terapêutico , Epinefrina/administração & dosagemRESUMO
PURPOSE OF REVIEW: The purpose of this narrative review was to summarize data and official recommendations purporting to paired tryptase determination in patients experiencing drug-induced anaphylaxis, published between January 1, 2023 and June 1, 2024. RECENT FINDINGS: Three main lines of evidence obtained through paired acute and baseline tryptase determination were identified: diagnostic criterion for hypersensitivity reactions involving systemic mast cell activation; differential diagnostic criterion for hypersensitivity reactions involving other mechanisms of immediate reactions; and added value of acute and baseline tryptase levels for personalized management following drug-induced anaphylaxis: cause, risk of recurrence, underlying mast cell conditions including hereditary α-tryptasemia, familial clusters. SUMMARY: The implementation of existing guidelines which consensually recommend paired tryptase measurement is a persistent unmet need hampering optimal diagnosis of drug-induced anaphylaxis and patient management. Another major unmet need is the lack of standardized recommendations for hereditary α-tryptasemia testing and counselling. Progress in this field is seen at a rapid pace, requiring significant efforts of continued medical education for practicing clinicians and laboratory specialists worldwide.
Assuntos
Anafilaxia , Hipersensibilidade a Drogas , Triptases , Humanos , Anafilaxia/diagnóstico , Anafilaxia/sangue , Anafilaxia/imunologia , Triptases/sangue , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/sangue , Mastócitos/imunologia , Guias de Prática Clínica como AssuntoRESUMO
PURPOSE OF REVIEW: Buckwheat (BW) allergy is a significant issue in Asia. This review delves into three types of BW allergy: immediate food allergy; food-dependent, exercise-induced anaphylaxis (FDEIA) as a subset of immediate food allergy; and food protein-induced enterocolitis syndrome (FPIES); by comparing data from Asian and non-Asian countries. RECENT FINDINGS: Most studies on BW have been published in Japan and Korea, and only a few studies on the topic have been done outside Asia. To date, seven components of common BW (Fagopyrum esculentum) and four components of Tartary BW (Fagopyrum tartaricum) have been implicated in BW allergy. Although BW-sIgE has limited utility for evaluating immediate BW allergy, Fag e 3-specific IgE, one of the components of common BW, and the skin prick test are diagnostically useful. The present review aims to shed light on the current state of knowledge, highlight research gaps, and suggest future directions in the management and understanding of BW allergy.