Cases reported "Anaphylaxis"

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1/16. Cerebral perfusion monitored using transcranial Doppler during acute anaphylaxis.

    We present a case of severe acute anaphylaxis that occurred during preparation of a patient for carotid endarterectomy. Intra-arterial blood pressure and transcranial Doppler monitoring had been established before the anaphylactic reaction began and therefore the changes in arterial blood pressure and middle cerebral artery blood-flow velocity could be observed as they happened. This made it possible to assess directly the effectiveness of our management, which followed the resuscitation guidelines issued by the association of Anaesthetists. In particular, this was a rare opportunity to confirm whether the recommended management is effective in restoring cerebral blood flow, and not just blood pressure, in a 'real life' situation, as most resuscitation information is based on laboratory-based animal studies. Evidence is presented which suggests that the administration of adrenaline in this setting is associated with increases in cerebral blood flow that are independent of arterial blood pressure.
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2/16. anaphylaxis to deer dander in a child: a case report.

    BACKGROUND: hypersensitivity to deer dander is rarely reported, with only 26 cases in the literature. Ours is the youngest reported case and the first reported case of anaphylaxis on exposure to a live deer. OBJECTIVE: Evaluation of a case of anaphylaxis in a young boy upon exposure to a deer. methods AND RESULTS: A 4-year-old boy experienced hives, swelling, and shortness of breath requiring epinephrine following a deer exposure. He had one mild reaction 5 days prior to his anaphylaxis with an indirect exposure. A deer dander extract was made from fur supplied by the patient's mother. IgE-mediated reactivity was positive for deer and cattle by both selective skin prick method and RAST results. CONCLUSION: hypersensitivity to wild animals can lead to life threatening anaphylaxis, even in children. Passive transfer of antigen may occur, but needs further investigation.
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3/16. Occupational acute anaphylactic reaction to assault by perfume spray in the face.

    BACKGROUND: Perfumes have been associated with rashes in employees exposed to scented soaps or with allergic conditions, such as rhinitis or asthma, in employees exposed to perfumes or fragrances in the air. methods: Reported here is a case of an anaphylactic reaction and respiratory distress as a result of a deliberate assault with a perfume spray. The medical literature was searched using the key words "fragrances," "respiratory distress," "assault," and "health care workers." RESULTS: A female medical assistant with no history of asthma or reactions to fragrances was assaulted by a patient, who pumped three sprays of a perfume into her face. The employee experienced an acute anaphylactic reaction with shortness of breath, a suffocating sensation, wheezes, and generalized urticaria, and required aggressive medical treatment, a long period of oral bronchodilator therapy, and, finally, weaning from the medications. CONCLUSIONS: Perfumes are complex mixtures of more than 4,000 vegetable and animal extracts and organic and nonorganic compounds. Fragrances have been found to cause exacerbations of symptoms and airway obstruction in asthmatic patients, including chest tightening and wheezing, and are a common cause of cosmetic allergic contact dermatitis. In many work settings the use of fragrances is limited. Assault is becoming more common among workers in the health care setting. Workers should be prepared to take immediate steps should an employee go into anaphylactic shock.
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4/16. Level of exhaled nitric oxide during human anaphylaxis.

    BACKGROUND: nitric oxide (NO) seems to play an important pathophysiologic role in modulating the systemic changes associated with anaphylaxis. Even if some effects of NO may be protective, animal models of anaphylaxis have shown that the summation effects of NO are deleterious, resulting in hypotension and loss of intravascular volume. There are no studies of NO production during anaphylaxis in humans. OBJECTIVE: To measure the level of exhaled NO during anaphylaxis induced by bee venom cluster immunotherapy in a 34-year-old beekeeper. methods: Exhaled NO was measured using a chemiluminescence analyzer at different flow rates, and alveolar NO concentration and airway NO production were calculated. RESULTS: We measured a high level of exhaled NO (78 ppb at 50 mL/s, with increased alveolar concentration and airway production) during anaphylaxis induced by bee venom immunotherapy in this patient. Normal values of exhaled NO were measured in the same patient 1 week later before and after a modified regimen of desensitization. CONCLUSIONS: nitric oxide production was increased in the respiratory tract during anaphylaxis. Having excluded all the common causes of increased exhaled NO levels, these resultssupport the hypothesis that NO plays an important role in anaphylaxis.
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5/16. Proteins: chymopapain and insulin.

    We studied clinical and immunologic aspects of the reactions to two newly introduced drugs, chymopapain and human recombinant deoxyribonucleic acid insulin (HI), in patients demonstrating allergies to one of these two drugs. We then used this information to improve our ability to diagnose and prevent chymopapain allergy and to further our understanding of systemic insulin allergy and its management. Of the patients who were sensitive to chymopapain, one had severe anaphylaxis to intradisc injection while the other had rhinitis, asthma, and urticaria with occupational exposure. The latter demonstrated cutaneous reactivity to papain; the former refused skin testing. Both demonstrated immunoglobulin (Ig) E and IgG to chymopapain as measured by enzyme-linked immunosorbent assay. We have prospectively skin tested 61 patients with chymopapain. Sixty-one patients have had negative skin tests and have tolerated the intradisc injection of chymopapain without incident. We are continuing our prospective skin test study in order to identify a population at risk for allergy to chymopapain. Two patients with systemic allergic reactions to animal insulin have at least as much cutaneous reactivity and IgE and IgG antibodies to HI as to porcine insulin. A large local reaction occurred during an attempt to desensitize one of them to HI; the patient was subsequently desensitized without difficulty to porcine insulin, to which she was less skin reactive. We conclude that HI will not eliminate insulin allergy in patients with systemic allergy to animal insulin and that such patients will continue to require the usual therapeutic measures for insulin allergy.
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6/16. Severe anaphylactic reaction to bovine serum albumin at the first attempt of artificial insemination.

    A 33-year-old woman without history of previous atopic diseases or drug allergies developed a severe anaphylactic reaction with asthma, vomiting, itching, generalized urticaria, and angioedema during artificial insemination with her husband's sperm. The sperm-processing medium contained bovine serum albumin (BSA). Skin prick test and RAST demonstrated an IgE-mediated hypersensitivity to BSA as well as a polyvalent atopic sensitization to pollens, animal danders, cow's milk, beef, pork, and mutton. SDS-PAGE studies indicated serum albumin to be the appropriate allergen with a high degree of cross-reactivity between serum albumin from different animal species. Artificial insemination with fluid containing potential allergens can, therefore, represent an unnecessary risk for atopic females, even in the absence of prior clinical symptoms of allergic diseases. Preoperative testing with the medium is recommended.
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7/16. anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gelatin.

    BACKGROUND: Allergic reactions to measles, mumps, and rubella (MMR) vaccine are rare; some have been attributed to allergy to trace quantities of egg proteins. We report a 17-year-old female who had an anaphylactic reaction to MMR vaccine. A primary vaccination with MMR at age 15 months had been uneventful. She is not allergic to eggs; however, ear and throat pruritus and tongue swelling develop after she eats gelatin. MMR vaccine contains gelatin as a stabilizer. methods AND RESULTS: Prick skin tests were positive to 1:10 wt/vol dilutions of MMR vaccine and gelatin but negative to egg. By immunoassay, her serum IgE antibodies were elevated to both MMR vaccine and gelatin, but not to isolated MMR antigens. IgE binding to the gelatin carrier could be inhibited in a dose-dependent fashion by addition of not only MMR vaccine but also gelatin from a variety of animal sources. immunoblotting confirmed the presence of IgE antibodies to multiple gelatin components as well as to MMR vaccine components. CONCLUSIONS: We conclude that the patient has an anaphylactic sensitivity to gelatin, and that her anaphylaxis to MMR vaccine was caused by the gelatin component. This sensitivity may explain other cases of MMR anaphylaxis.
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8/16. Study of complement-mediated anaphylaxis in humans. The role of IgG subclasses (IgG1 and/or IgG4) in the complement-activating capacity of immune complexes.

    The role of Ig classes and subclasses in complement activation has been investigated both in vitro and in experimental animals, but not in humans. This study was conducted to determine the immunologic events of post-transfusion anaphylaxis in humans, and the effects of immune complexes of different IgG subclass compositions on complement activation. The ability of immune complexes containing mixed IgG1 and IgG4 or IgG4 Ab only to activate complement was investigated in two patients with von Willebrand's disease (a congenital bleeding disorder). This disease was complicated by precipitating IgG alloantibodies to von willebrand factor (vWF), which triggered complement-mediated anaphylaxis after infusion of vWF-containing preparations. complement activation was greater in the presence of mixed IgG1- and IgG4-vWF complexes than with IgG4-vWF alone. In one patient, the generation of large amounts of C4a, C3a, and terminal complement complexes following the formation of mixed IgG1- and IgG4-vWF was associated with life-threatening anaphylaxis. In this patient, IgG4 appeared to have no inhibitory effect on antigen-bound IgG1-mediated complement activation. In the other patient, formation of IgG4-vWF led to a lesser degree of complement activation and was associated with moderately severe anaphylaxis. Since neither patient showed any biochemical alterations indicating the involvement of mast cells or the contact phase of coagulation at any time, it is probable that the pathogenetic mechanism of the clinical syndrome was a direct effect of complement anaphylatoxins on vascular permeability and smooth muscle contraction. In both patients, IgG-vWF bound C4 and C3 (IgG4-vWF to a lesser extent than mixed IgG1- and IgG4-vWF), and this probably prevented serum sickness as a complication.
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9/16. Nucleus pulposus pulmonary embolism. A case report.

    STUDY DESIGN. This postmortem case report describes nucleus pulposus pulmonary embolism occurring in a human. OBJECTIVES. Clinical, pathologic, and pathogenetic features of the case are discussed. Reference is made to warnings in the literature stressing the importance of avoiding, during radiologic procedures, any possibility of intrathecal ingress of iodinated, ionic, hyperosmolar contrast material. SUMMARY OF BACKGROUND DATA. Various tissues have been implicated as pulmonary emboli in humans. Nucleus pulposus has been reported to embolize to spinal cord vessels in animals and humans and to embolize to the lungs in two animal species. This is the first report of nucleus pulposus pulmonary embolism in a human. methods. A patient with refractory low back pain was admitted for lumbar discography using diatrizoate meglumine, 52%, and diatrizoate sodium, 8%. Afterward, an ultimately fatal systemic reaction began, among the symptoms of which were spasmodic extensions of the lower back and legs. Postmortem examination was performed. RESULTS. Nucleus pulposus pulmonary emboli were seen microscopically on random lung sections. The lumbar vertebral column grossly featured acute herniations of disc material into vertebral marrow spaces; nucleus pulposus was identified microscopically in these areas. CONCLUSIONS. We speculate that the spasmodic back extensions imposed compressive forces on vertebrae, causing nucleus pulposus to be extruded into vertebral marrow sinusoids (thus creating emboli) and possibly causing these emboli to flow anteriorly into the anterior external vertebral plexus, which resulted in pulmonary emboli exclusively with no spinal cord emboli.
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10/16. anaphylaxis after laboratory rat bite: an occupational hazard.

    Workers exposed to laboratory animals are at risk of developing asthma, rhinitis, angioedema, conjunctivitis, and urticaria. Approximately one in five scientists and technicians handling small animals will develop laboratory animal allergy symptoms within three years of employment, many of whom will have severe symptoms requiring a change of occupation. Individuals suffering from allergy to environmental allergens, such as pollen and ragweed, are more likely to develop allergic reactions to animals, and are more likely to develop asthma. We report a case of life-threatening anaphylaxis secondary to a rat bite in a laboratory research director with known allergies to rat urinary protein. While rodent bites are common in research settings, such severe reactions are extremely rare.
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