MyMedR

Management of anaphylaxis

Rajakumar MK

Family Practitioner, 1977;2:6-9.

Matched MeSH terms: Anaphylaxis

Chlorhexidine hypersensitivity

Chong BS, Abdullah D, Liew AKC, Khazin SM

Br Dent J, 2021 03;230(5):273.

PMID: 33712761 DOI: 10.1038/s41415-021-2797-2

Matched MeSH terms: Anaphylaxis*

Fulltext Modulation of immune response by nanoparticle-based immunotherapy against food allergens

Krishna SS, Farhana SA, T P A, Hussain SM, Viswanad V, Nasr MH, et al.

Front Immunol, 2023;14:1229667.

PMID: 37744376 DOI: 10.3389/fimmu.2023.1229667

The increasing prevalence of food allergies worldwide and the subsequent life-threatening anaphylactic reactions often have sparse treatment options, providing only symptomatic relief. Great strides have been made in research and in clinics in recent years to offer novel therapies for the treatment of allergic disorders. However, current allergen immunotherapy has its own shortcomings in terms of long-term efficacy and safety, due to the local side effects and the possibility of anaphylaxis. Allergen-specific immunotherapy is an established therapy in treating allergic asthma, allergic rhinitis, and allergic conjunctivitis. It acts through the downregulation of T cell, and IgE-mediated reactions, as well as desensitization, a process of food tolerance without any allergic events. This would result in a protective reaction that lasts for approximately 3 years, even after the withdrawal of therapy. Furthermore, allergen-specific immunotherapy also exploits several routes such as oral, sublingual, and epicutaneous immunotherapy. As the safety and efficacy of allergen immunotherapy are still under research, the exploration of newer routes such as intra-lymphatic immunotherapy would address unfulfilled needs. In addition, the existence of nanoparticles can be exploited immensely in allergen immunotherapy, which would lead to safer and efficacious therapy. This manuscript highlights a novel drug delivery method for allergen-specific immunotherapy that involves the administration of specific allergens to the patients in gradual increasing doses, to induce desensitization and tolerance, as well as emphasizing different routes of administration, mechanism, and the application of nanoparticles in allergen-specific immunotherapy.

Matched MeSH terms: Anaphylaxis*

Fulltext Exotic food anaphylaxis and the broken heart: sago worm and takotsubo cardiomyopathy

Yew KL, Kok VS

Med J Malaysia, 2012 Oct;67(5):540-1.

PMID: 23770880 MyJurnal

There is increasing consumption of exotic food in Malaysia. Animals such as insects, worms and wild life animals also form part of the staple food of the local population. This practice may lead to more incidence of food allergy and anaphylaxis. We report a non-indigenous man who developed food anaphylaxis after consuming fried sago worms and consequently Takotsubo cardiomyopathy. We postulate that certain food allergy and anaphylaxis could be another causative trigger for Takotsubo cardiomyopathy.

Matched MeSH terms: Anaphylaxis*

Fatal anaphylaxis of ranitidine injection : have we not learnt the lesson yet?

Chuah YY, Lee YY, Lin LF, Kuo CJ

Acta Gastroenterol Belg, 2019 10 1;82(3):449-450.

PMID: 31566338

Matched MeSH terms: Anaphylaxis/chemically induced*; Anaphylaxis/diagnosis; Anaphylaxis/mortality

Fulltext Takotsubo cardiomyopathy with meperidine

Yew KL

Med J Malaysia, 2012 Feb;67(1):136.

PMID: 22582571

Matched MeSH terms: Anaphylaxis/chemically induced*

Anaphylaxis after ingestion of dust mite (Dermatophagoides farinae)-contaminated food: A case report

Rangkakulnuwat P, Sanit S, Lao-Araya M

Trop Biomed, 2020 Jun 01;37(2):318-323.

PMID: 33612801

Domestic mites have been recognized as the most common allergen responsible for respiratory allergy. Herein, we report a case of anaphylaxis due to ingestion of dust mitecontaminated food. A 14-year-old boy presented to the Emergency Department with chest discomfort, wheezing, eyelid angioedema, and urticarial rash twice in a month after eating meals, including tempura fried squids and onion fritters (containing wheat flour, eggs, squid, and onion). Anaphylaxis had been diagnosed and successfully treated. The investigations showed that the patient was sensitive to house dust mites. Positive skin prick-to-prick test response to incriminated flour and negative tests to wheat allergen extract and uncontaminated flour were demonstrated. The microscopic analysis of causative cooking flour identified the presence of Dermatophagoides farinae. During the oral food challenge test, the patient was able to eat tempura-fried squids and onion fritters, made with uncontaminated flour, without any adverse reaction. Hence, oral ingestion of dust mite-contaminated food was the culprit of this severe allergic reaction.

Matched MeSH terms: Anaphylaxis/etiology*

Fulltext Angina after anaphylaxis treatment

Leow SN, Tang WS

Malays Fam Physician, 2019;14(3):65-67.

PMID: 32175043

Anaphylaxis is a life-threatening emergency, and adrenaline is the mainstay treatment for this condition. However, there have been a few reported cases of patients experiencing cardiovascular complications, such as myocardial infarction and coronary vasospasm, after its use. We highlight such a case in a young, healthy patient and the important differentials to consider.

Matched MeSH terms: Anaphylaxis

Fulltext Life-threatening Chlorhexidine Anaphylaxis: A Case Report

Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Ng MS

Malays Orthop J, 2017 Jul;11(2):72-74.

PMID: 29021884 MyJurnal DOI: 10.5704/MOJ.1707.008

Chlorhexidine is a common antiseptic and disinfectant used in the medical field. Allergy to chlorhexidine has been reported in the literature but life-threatening anaphylactic shock is rare. We present a case of severe anaphylactic shock due to chlorhexidine occurring during surgery. Literatures suggest that profound anaphylactic shock to chlorhexidine is commonly preceded by milder, non-specific reactions. These mild symptoms are often dismissed by both the patient and physicians alike. Direct questioning of these symptoms is necessary as a part of the pre-operative assessment and the patient should be referred for further immunology testing if indicated.

Matched MeSH terms: Anaphylaxis

Fulltext Anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) in rural Sarawak, Malaysian Borneo

Steve Utap M, Bin Mohd Jamal MS

Rural Remote Health, 2019 08;19(3):5163.

PMID: 31421666 DOI: 10.22605/RRH5163

Nycticebus spp, commonly known as the slow lorus, is a small nocturnal primate found mainly in Asia. The adult slow loris weighs between 265 g and 1150 g depending on the type of species. It has a characteristic round head with large, forward-facing eyes. Slow lorises are known for their poisonous bite and are the only venomous primates. To date, there have been two published cases of slow loris bite in humans. This case report illustrates a case of anaphylactic shock following a bite of a wild Kayan slow loris (Nycticebus kayan) to a young man at Mulu District, in a remote area of Sarawak, Malaysian Borneo. The patient developed dyspnoea, a feeling of suffocation, swollen lips and cramp-like sensations over both hands. He subsequently developed syncope and hypotension. The patient was clinically stable following intramuscular injection of adrenaline 0.5 mg stat dose.

Matched MeSH terms: Anaphylaxis/drug therapy*; Anaphylaxis/etiology*

Fulltext A fatal case of anaphylactic shock caused by the lesser banded hornet, Vespa affinis indosinensis in peninsular Malaysia

Lee HL, Krishnasamy M, Jeffery J

Trop Biomed, 2005 Jun;22(1):81-2.

PMID: 16880759 MyJurnal

The hornets are a group of venomous stinging insects that at times cause human death. A fatal case of a child stung by the lesser banded hornet Vespa affinis indosinesis is reported. Though often covered by the mass media, this constitutes the first scientifically reported case.

Matched MeSH terms: Anaphylaxis/diagnosis*; Anaphylaxis/pathology

Fulltext Identification of Soluble Mediators in IgG-Mediated Anaphylaxis via Fcγ Receptor: A Meta-Analysis

Kow ASF, Chik A, Soo KM, Khoo LW, Abas F, Tham CL

Front Immunol, 2019;10:190.

PMID: 30809224 DOI: 10.3389/fimmu.2019.00190

Background: Anaphylaxis is an acute and life-threatening allergic response. Classically and most commonly, it can be mediated by the crosslinking of allergens to immunoglobulin E (IgE)- high affinity IgE receptor (FcεRI) complex found mostly on mast cells. However, there is another pathway of anaphylaxis that is less well-studied. This pathway known as the alternative pathway is mediated by IgG and its Fc gamma receptor (Fcγ). Though it was not documented in human anaphylaxis, a few studies have found that IgG-mediated anaphylaxis can happen as demonstrated in rodent models of anaphylaxis. In these studies, a variety of soluble mediators were being evaluated and they differ from each study which causes confusion in the suitability, and reliability of choice of soluble mediators to be analyzed for diagnosis or therapeutic purposes. Hence, the objective of this meta-analysis is to identify the potential soluble mediators that are involved in an IgG-mediated anaphylaxis reaction. Methods: Studies related to IgG-mediated anaphylaxis were sourced from five search engines namely PubMed, Scopus, Ovid, Cochrane Library, and Center for Agricultural Bioscience International (CABI) regardless of publication year. Relevant studies were then reviewed based on specific inclusion factors. The means and standard deviations of each soluble mediator studied were then extracted using ImageJ or Get Data Graph Digitiser software and the data were subjected to meta-analysis. Results: From our findings, we found that histamine, serotonin, platelet activating factor (PAF), β-hexosaminidase, leukotriene C4 (LTC4), mucosal mast cell protease-1 (MMCP-1), interleukins (IL)-4,-6, and-13; tumor necrosis factor alpha (TNF-α), and macrophage inflammatory protein-1α (MIP-1α) were often being analyzed. Out of these soluble mediators, histamine, PAF, β-hexosaminidase, IL-6, and-13, MIP-1α and TNF-α were more significant with positive effect size and p < 0.001. As study effect was relatively small, we performed publication bias and found that there was publication bias and this could be due to the small sample size studied. Conclusion: As such, we proposed that through meta-analysis, the potential soluble mediators involved in rodent IgG-mediated anaphylaxis to be histamine, PAF, β-hexosaminidase, IL-6 and-13 and MIP-1α, and TNF-α but will require further studies with larger sample size.

Matched MeSH terms: Anaphylaxis/etiology*; Anaphylaxis/metabolism*

Effects of delay in infusion of N-acetylcysteine on appearance of adverse drug reactions after acetaminophen overdose: a retrospective study

Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW

Pharmacoepidemiol Drug Saf, 2010 Oct;19(10):1064-70.

PMID: 20712021 DOI: 10.1002/pds.1955

To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.

Matched MeSH terms: Anaphylaxis/chemically induced; Anaphylaxis/drug therapy

Fulltext A case report of an unusual complication from bee sting: acute brachial plexopathy

Kee HF, Hasan S, Wan Aliaa WS, Basri HB

Pak J Med Sci, 2014 Mar;30(2):455-6.

PMID: 24772163

Brachial plexopathy is usually related to trauma like direct injury to the nerve and stretching injuries. Neurological complications following bee sting are uncommon. Here, we describe a rare case of acute brachial plexopathy as a neurological complication following bee sting. A23-year-old maleinitially presented with angioedema and anaphylactic shock one hour after a bee stung at his neck. Twenty four hours after the incidence, he presented with sudden onset of left upper limb weakness. Nerve conduction study and electromyography had shown evidence of left brachial plexopathy.

Matched MeSH terms: Anaphylaxis

Fulltext "Two Stones on One Bird": A Case Report on Severe Biphasic Anaphylaxis Masquerading as Life-Threatening Acute Asthma

Payus AO, Ibrahim A, Mustafa N

Open Access Maced J Med Sci, 2018 Nov 25;6(11):2136-2138.

PMID: 30559876 DOI: 10.3889/oamjms.2018.317

BACKGROUND: Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode.

CASE REPORT: Here, we present a case of a young man who has childhood asthma with the last attack more than 10 years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation.

CONCLUSION: The objective of this case report is to emphasise the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it.

Matched MeSH terms: Anaphylaxis

Isolated hypotension after the induction of general anesthesia refractory to fluids and vasopressors: An indicator of anaphylaxis

Mok CS, Vanessa L

Med J Malaysia, 2021 03;76(2):267-269.

PMID: 33742644

Differentiating between anaphylaxis and hypotension during general anaesthesia is difficult, especially when patients present with only hypotension and without any of the other classical features of anaphylaxis. We report the successful management of an anaphylactic reaction to rocuronium that presented as isolated hypotension in a 45-year-old Indonesian man presented with lacerations on the scalp and right pinna caused by an assault to the head after the induction of general anaesthesia, refractory to fluids and high doses of vasopressors. This case highlights that a possible indicator of anaphylaxis can be the presence of isolated hypotension during.

Matched MeSH terms: Anaphylaxis

Fulltext Association of Immunoglobulin G abnormalities in diseases: a mini review

Foong, Audrey Kow Siew, Nuha Fahimah Binti Wan Zahidi, Chau, Ling Tham

Life Sciences, Medicine and Biomedicine, 2018;2(1):24-39.

MyJurnal

Immunoglobulins are antibodies that play important roles in preserving our immune system. They have the ability to initiate humoral responses and remove antigen from the body. Out of the five major isotypes of immunoglobulins, IgG are most abundantly found in human serum. Abnormalities – deficiency or elevation in the level of IgG are found to be associated to the occurrence of several autoimmune diseases. These may include rheumatoid arthritis, Crohn’s disease, Mikulicz’s disease, Kuttner’s tumour and Hashimoto’s thyroiditis. Apart from autoimmune diseases, IgG has been found to play a role in initiating anaphylaxis, a severe and life threatening form of allergy and lately it has been discovered in cases of dengue virus infection too. It is important to acknowledge the roles of IgG on diseases especially subclass IgG4 which the elevation has been tied to numerous diseases such as Kuttner’s tumour and Hashimoto’s thyroiditis hence termed IgG4-related diseases. In addition, the roles of IgG in anaphylaxis are of importance, too, as IgG has been used in allergy immunotherapy. Hence, this review is a mini compilation of effects of IgG abnormalities based on their subclasses. Hopefully it will provide insightful understanding on the development of diagnostic and therapeutic courses for the aforementioned IgG abnormalities in the future.

Matched MeSH terms: Anaphylaxis

Fulltext Successful Modified Desensitization Therapy with Analog Insulin in an Individual with Severe Allergy to Multiple Insulin Preparations: A Case Report

Seman WJW, Nasruddin AB, Noor NM

J ASEAN Fed Endocr Soc, 2018;33(1):53-56.

PMID: 33442111 DOI: 10.15605/jafes.033.01.09

We present a case of a 27-year-old female with T2 DM who developed allergic reactions after commencement of insulin therapy. Trial with different types of insulin resulted in a series of allergic reactions ranging from urticarial rash to development of angioedema, bronchospasm and anaphylactic shock. She was successfully treated with a modified insulin desensitization protocol using rapid-acting insulin.

Matched MeSH terms: Anaphylaxis

Fulltext Tako-Tsubo like syndrome triggered by meperidine

Sacco A, Morici N, Belli O, Bossi I, Mafrici A, Klugmann S

Med J Malaysia, 2011 Dec;66(5):520-1.

PMID: 22390119

We present a case of "inverted Tako-Tsubo" syndrome in a woman sedated with meperidine before undergoing a colonscopy. We discuss possible etiology of this ventricular dysfunction.

Matched MeSH terms: Anaphylaxis/chemically induced*

Immunoglobulin E reactivity to latex antigens in the sera of patients from Finland and the United States

Kurup VP, Kelly KJ, Turjanmaa K, Alenius H, Reunala T, Palosuo T, et al.

J Allergy Clin Immunol, 1993 Jun;91(6):1128-34.

PMID: 8509575

BACKGROUND: Patients with latex sensitivity and latex antigens from the United States and Finland, two countries where allergic reactions to latex have been widely reported, were evaluated to determine the spectrum of immune responses.

METHODS: Sera from 27 patients from Finland and 18 from the United States with latex allergy and control sera from nonsensitive individuals were studied for latex-specific IgE antibodies. Four antigen preparations were used: two extracted from gloves and one each extracted from rubber tree sap from Malaysia and India. All 45 patients had skin prick test results that were positive to latex antigens, and all sera were evaluated by enzyme-linked immunosorbent assay (ELISA) with the various antigens.

RESULTS: There were considerable differences in the reactivity of patient sera with the different antigens. Only 50% of the sera from patients with latex allergy from Finland demonstrated significant levels of IgE to latex as determined by enzyme-linked immunosorbent assay. These patients showed more reactivity with rubber tree sap antigens than with glove antigens. However, 72% of the patients from the United States demonstrated antibodies to latex, and no marked differences were noted between the antigen extracts.

CONCLUSIONS: The results indicate that reagents such as rubber tree sap, which contain multiple clinically significant antigenic components, should be included in evaluation of latex allergy and that differences in patient populations may result in serologic variances.

Matched MeSH terms: Anaphylaxis/immunology

Displaying publications 1 - 20 of 34 in total