1/24. Fatal anaphylactic shock during a fluorescein angiography.The Authors describe an extremely rare fatal case (sixth case in the literature) of anaphylactic shock following a fluorescein angiography. This is the first report in which the diagnosis of anaphylactic reaction to the dye was made through laboratory analyses. The diagnosis of fatal shock due to sodium fluorescein was made based on clinical, laboratory and immunohistochemical data. Mast-cell tryptase was dosed in serum and a pulmonary immunohistochemical evaluation was performed. Tryptase, a neutral protease of human mast-cells is a potentially important indicator of mast-cell involvement in anaphylactic events.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
2/24. vancomycin anaphylaxis and successful desensitization in a patient with end stage renal disease on hemodialysis by maintaining steady antibiotic levels.BACKGROUND: vancomycin anaphylaxis is a major management problem in patients with methicillin-resistant staphylococcus aureus (MRSA) sepsis. Lerner et al in 1984 have described a protocol for desensitization to vancomycin; however, antibiotic blood levels have never been used as a guide in this process. CASE REPORT: A 46-year-old female with ESRD on hemodialysis who developed a dialysis-catheter related MRSA sepsis was found to have anaphylaxis to vancomycin. She underwent successful desensitization to vancomycin using Lerner's protocol. Periodic antibiotic blood levels were used to guide the amount and frequency of vancomycin infusion to successfully maintain desensitization thereafter. DISCUSSION: Lerner described loss of desensitization to vancomycin when antibiotic infusion was stopped after 18 hours followed by successful desensitization to the same drug via the same protocol. This observation points out that desensitization to vancomycin appears to be dependent on some minimal drug level. In our case report, we have for the first time used the concept of blood levels to maintain successful desensitization to an antibiotic. CONCLUSION: We hypothesize that desensitization to vancomycin can be induced and maintained by keeping a minimum antibiotic blood level. Further studies are needed to quantify this.- - - - - - - - - - ranking = 4keywords = tea (Clic here for more details about this article) |
3/24. Fatal anaphylactic reaction to protamine after femoropopliteal by-pass surgery.BACKGROUND AND AIMS: Administration of protamine might cause serious complications especially in patients treated preoperatively with NPH insulin. MATERIAL AND methods: A case report. RESULTS AND CONCLUSION: Administration of protamine sulphate caused fatal anaphylactic reaction to a diabetic patient undergoing femoropopliteal by-pass surgery. Care should be taken when administering protamine to a patient treated preoperatively with NPH insulin and the possibility of an anaphylactid reaction to protamine have to be kept in mind.- - - - - - - - - - ranking = 5keywords = tea (Clic here for more details about this article) |
4/24. Effects of losartan on blood pressure and humoral factors in a patient who suffered from anaphylactoid reactions when treated with ACE inhibitors during LDL apheresis.In a patient who was taking an angiotensin-converting-enzyme inhibitor, low-density lipoprotein (LDL) apheresis with dextran-sulfate cellulose provoked hypotension accompanied by lacrimation and blurred vision. hypotension was eliminated by changing the anticoagulant from heparin to a protease inhibitor, nafamostat mesilate. A study was undertaken to clarify whether an antagonist of angiotensin type 1-receptor, losartan, could be safely used in the same patient during LDL apheresis treatment. blood pressure and humoral factors were compared between the apheresis sessions with losartan and those without. Although angiotensin ii and bradykinin plasma levels during LDL apheresis were significantly greater with losartan than without, blood pressure reduction by losartan was mild and unpleasant symptoms were not induced. losartan was thus safely used for this patient during treatment by LDL apheresis. The greater rise in bradykinin levels during apheresis with losartan might be ascribable to angiotensin type 2-receptor stimulation.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
5/24. atrial fibrillation associated with anaphylaxis during venom and pollen immunotherapy.BACKGROUND: Electrographic changes after insect stings have been reported both with and without systemic symptoms. To our knowledge, however, there have been no reported cases of arrhythmias in the maintenance phase of venom or pollen immunotherapy. OBJECTIVE: We report a case of a patient who developed paroxysmal atrial fibrillation after receiving venom and pollen immunotherapy. This patient was initially evaluated in an outpatient setting, and the events described occurred at an allergist's private office. We believe this is an atypical presentation and would be very pertinent to the practicing allergist. methods: This patient was under the care of a clinical allergist in a private practice with associations to a teaching hospital. Interventions were as described in the body of the paper, more specifically venom and pollen maintenance immunotherapy followed by two doses of 0.3 mL of 1:1,000 concentration epinephrine intramuscularly. RESULTS: Patient was found to be in atrial fibrillation along with systemic symptoms immediately after administration of immunotherapy. After epinephrine administration, patient converted back to normal sinus rhythm and systemic symptoms resolved. CONCLUSIONS: atrial fibrillation is an atypical presentation of a systemic reaction to immunotherapy.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
6/24. Immediate systemic hypersensitivity reaction associated with topical application of Australian tea tree oil.Australian tea tree oil has been used as a veterinary antiseptic for many years and, more recently, has been extended into human use. There have been many reports of allergic contact dermatitis and toxicity reactions, but it has never been implicated in immediate systemic hypersensitivity reactions. A 38-year-old man experienced immediate flushing, pruritus, throat constriction, and lightheadedness after topical application of tea tree oil. Our purpose was to determine whether this represented an immunoglobulin e (IgE)--mediated reaction. skin-prick and intradermal testing was performed, as well as enzyme-linked immunosorbent assays for specific IgG and IgE against tea tree oil. The patient had a positive wheal and flare reaction on intradermal testing with tea tree oil. All five patient controls were negative on skin testing. No specific IgG or IgE was detected. We present the first reported case of an immediate systemic hypersensitivity reaction occurring after topical application of Australian tea tree oil, confirmed by positive wheal and flare reaction on skin testing.- - - - - - - - - - ranking = 9keywords = tea (Clic here for more details about this article) |
7/24. Anaphylactic reaction to a dietary supplement containing willow bark.OBJECTIVE: To report a case of anaphylaxis resulting from the use of a willow bark-containing dietary supplement in a patient with a history of an aspirin allergy. CASE SUMMARY: A 25-year-old white woman presented to the emergency department of a community teaching hospital with anaphylaxis requiring epinephrine, diphenhydramine, methylprednisolone, and volume resuscitation to which she responded favorably. Medication history revealed that she had ingested 2 capsules of Stacker 2 (NVE Pharmaceuticals, Newton, NJ), a dietary supplement promoted for weight loss, prior to experiencing her initial symptoms. Among other active ingredients, this product contains willow bark. Of significance is that this patient also reported a history of allergy to acetylsalicylic acid. No other causes for anaphylaxis were identified. She continued to receive routine supportive care and the remaining hospital course was uncomplicated. DISCUSSION: dietary supplements, including herbal products, are used by many individuals who consider them to be inherently safe despite limited regulatory oversight by the food and Drug Administration. While there may be value to specific botanical ingredients, a potential for adverse effects also exists. The popular product consumed by our patient is used for weight loss and contains willow bark, a source of salicylates. Based on the Naranjo probability scale, it is probable that this case of anaphylaxis was due to this dietary supplement. CONCLUSIONS: The use of any willow bark-containing dietary supplement may present a risk of anaphylactic reaction to patients with a history of allergy to salicylates. Clinicians need to recognize the potential for adverse effects from dietary supplements.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
8/24. Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review.OBJECTIVE: Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to progesterone produced during the luteal phase of a woman's menstrual cycle with a variety of presentations including erythema multiforme, eczema, urticaria, angioedema, and progesterone-induced anaphylaxis. We present a case of progesterone-induced anaphylaxis and a review of literature focusing on its diagnosis and therapy. DATA SOURCES: We surveyed all the literature in English back to 1921 when the first case was published. First, we researched the terms progesterone anaphylaxis, autoimmune progesterone dermatitis, cyclic urticaria, using the pubmed resource. Then we included articles found within these publications' reference sections. STUDY SELECTION: We selected articles based on whether the cases described appeared to fit the description of the entity autoimmune progesterone dermatitis. All cases included had dermatologic reactions occurring during the luteal phase of the menstrual period, positive skin or intramuscular reactions to progesterone, and treatment amenable to anovulatory agents and/or hysterectomy with bilateral salpingo-oophorectomy. RESULTS: We found approximately 50 published cases of autoimmune progesterone dermatitis, and only nine known cases of its manifestation as anaphylaxis. These cases, including the case described by us, are summarized, and successful diagnostic and therapeutic approaches in the literature are reviewed. CONCLUSIONS: Autoimmune progesterone dermatitis is a rare entity associated with progesterone production of the luteal phase of a woman's menstrual cycle. It can be diagnosed using intradermal or intramuscular progesterone tests and can be treated by disrupting the ovulation cycle using specific medications or by oopherectomy.- - - - - - - - - - ranking = 3keywords = tea (Clic here for more details about this article) |
9/24. Fatal cases of gabexate mesilate-induced anaphylaxis.gabexate mesilate, ethyl-4-(6-guanidinohexanoyloxy) benzoate monomethanesulfonate (C16H23N3 O4CH4O3S: M.W. 417.48), is a synthetic protease inhibitor and was introduced for clinical use in 1978. It rarely induces anaphylaxis, and patients with gabexate mesilate-induced shock had been reported to survive with appropriate treatments including respiratory support. However, there were increasing reports on fatal cases in recent years: 6 cases have been reported to develop fatal anaphylaxis following dripping infusions of gabexate mesilate. All the fatal cases rapidly developed anaphylaxis (within 5 minutes), whereas 7 out of 11 in recovered cases developed it 5 or more minutes after the injection. Venous access should be kept for at least 30 minutes to prepare for and to treat this fatal reaction in patients receiving gabexate mesilate repeatedly.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
10/24. Managing childhood food allergies and anaphylaxis.BACKGROUND: food allergies in children are becoming more common causing concern for parents, child carers, teachers and school principals. OBJECTIVE: This article aims to provide practical information on childhood food allergies and their ongoing management including assessment, prescription of self or carer administered adrenaline, emergency action plans, patient education, school based strategies, and family support. DISCUSSION: With most schools, preschools and child care centres having at least one child with food allergies, general practitioners are increasingly likely to be involved in school liaison and education, as well as caring for families with food allergic children.- - - - - - - - - - ranking = 1keywords = tea (Clic here for more details about this article) |
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