1/355. Anaphylactoid reactions and nephrotic syndrome--a considerable risk during factor ix treatment in patients with haemophilia B and inhibitors: a report on the outcome in two brothers.anaphylaxis/anaphylactoid reactions have recently been reported after few treatments with factor ix concentrates in patients with haemophilia B at the same time as inhibitors to factor ix were demonstrated. In some of these cases nephrotic syndrome has appeared during immune tolerance induction (ITI) with high doses of factor ix concentrates. Gene deletions seem to be associated with a high risk of developing antibodies to factor ix. This report presents two brothers with deletion of 1 bp in exon f of the factor ix gene. Both showed anaphylactoid reactions and they were desensitized using slow i.v. injections of factor ix. At the time of anaphylaxis, inhibitors of factor ix in a low titre could be demonstrated. The elder brother responded well after a short time on ITI and has no spontaneous bleedings on regular prophylaxis although in a somewhat higher dose than expected. On the other hand, in spite of comparable regimens, the younger brother has so far been resistant to ITI. Moreover, during treatment with extremely high doses of factor ix concentrate he developed nephrotic syndrome which only slowly subsided after treatment with corticosteroids and withdrawal of factor ix.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/355. diagnosis of phacoanaphylactic endophthalmitis by fine needle aspiration biopsy.diagnosis of phacoanaphylactic endophthalmitis (or lens induced uveitis), a rare autoimmune disease, is difficult due to variable clinical presentation. We sought to diagnose a case based on the cytopathology of the anterior chamber aspirate. This is a case report of spontaneous phacoanaphylactic endophthalmitis in a 79-year-old woman with no history of eye trauma or surgery. After clinical examination, diagnostic anterior chamber paracentesis was performed. Cytologic examination of the aspirate revealed polymorphonuclear leukocytes, histiocytes, and plasma cells surrounding amorphous lens material. A mature cataract was removed subsequently, and the eye has remained free of inflammation postoperatively. As the clinical diagnosis of phacoanaphylactic endophthalmitis is often difficult, cytopathology of an anterior chamber aspiration specimen may be useful in diagnosing this rare, treatable condition. As far as we know, this is the first case report of the diagnosis of phacoanaphylactic endophthalmitis solely by anterior chamber fine needle aspiration biopsy.- - - - - - - - - - ranking = 0.4keywords = rate (Clic here for more details about this article) |
3/355. Lymphocyte transformation test for the evaluation of adverse effects of antituberculous drugs.The usefulness of the lymphocyte transformation test (LTT) for the analysis of adverse reactions to antituberculous drugs was evaluated. - The LTT was performed with isoniazid and rifampicin in 15 tuberculosis and 2 MOTT (Mycobacteria other than tuberculosis)-infection patients who suffered drug reactions, in 23 patients without any adverse reactions, in 7 controls previously exposed to antituberculous drugs, and in 14 controls who had never been exposed. 4/15 of the hepatotoxic reactions only showed a positive LTT with rifampicin, 3/15 only with isoniazid, and in 8/15 the LTT was negative. In an anaphylactoid shock reaction the LTT was extremely exaggerated for both rifampicin and isoniazid. In patients without any side effects only one slightly increased LTT due to isoniazid was observed. Two healthy controls with previous contact to these drugs showed a positive LTT for isoniazid, one of those with both rifampicin and isoniazid. The LTT was negative in all control persons without any former contact to antituberculous medications. In most cases hepatotoxicity seems to be a pure toxic reaction without the participation of cellular immune mechanisms. LTT can be useful for identifying the drug responsible for immunological side effects.- - - - - - - - - - ranking = 0.2keywords = rate (Clic here for more details about this article) |
4/355. Moderately severe anaphylactoid reaction to pentastarch (200/0.5) in a patient with acute severe asthma.The use of synthetic colloids for resuscitation and volume replacement is common in the intensive care unit. Although adverse reactions have been reported to colloid solutions, the incidence of severe reactions to the starch derivatives is low. We report a case of an anaphylactoid reaction to pentastarch (200/0.5) in a young asthmatic who received it as a fluid challenge in the intensive care unit. The pathogenesis and implications of such a reaction in an asthmatic are discussed.- - - - - - - - - - ranking = 0.8keywords = rate (Clic here for more details about this article) |
5/355. Subsequent general anaesthesia in patients with a history of previous anaphylactoid/anaphylactic reaction to muscle relaxant.Of 151 patients with a possible anaphylactoid/anaphylactic reaction to a muscle relaxant investigated over a 20-year period, follow-up for any subsequent general anaesthesia was complete in 145 (96%). One hundred and twenty-two anaesthetics in 72 patients were documented. There were no anaesthetic-related deaths. No subsequent reactions were seen if muscle relaxants were not used in the subsequent anaesthetic, nor were they in patients with severe reactions if the original intradermal test had been equivocal or negative. In the patients with a severe reaction and a positive intradermal test to one or more muscle relaxants, six out of 40 later anaesthetics using muscle relaxants were associated with clinical problems, three being probable anaphylactic reactions, whilst three were minor. Intradermal testing should be performed prior to surgery in this group of patients for the muscle relaxant(s) planned, or an anaesthetic technique which avoids relaxants should be used. This review should encourage other centres to undertake similar follow-up.- - - - - - - - - - ranking = 0.78918136807024keywords = death (Clic here for more details about this article) |
6/355. Cryofiltration apheresis and plasma fractionation causing anaphylactoid reactions in patients receiving angiotensin converting enzyme inhibitors.Severe anaphylactoid reactions and even death have been reported in hemodialysis patients using certain membrane dialyzers while receiving angiotensin converting enzyme (ACE) inhibitors. We report mild to moderate anaphylactoid reactions in 4 patients receiving plasmapheresis with on-line membrane filters after being placed on ACE inhibitors. Of 21 patients receiving 497 plasma fractionation procedures, only the 2 patients who were receiving ACE inhibitors developed anaphylactoid reactions. Of 28 patients who had 680 cryofiltration procedures, only 2 of 5 patients who were taking ACE inhibitors developed anaphylactoid reactions. All patients developed facial flushing, increased warmth, bradycardia, and hypotension after approximately 1/2 to 1 L of plasma was processed during the procedures. Only a few procedures caused severe hypotension requiring discontinuation of the procedure. We quantified vasodilatory mediators in 1 patient, who developed pronounced symptoms. Results were obtained for 6-keto PGF1alpha, PGD-M, and methyl histamine in plasma. In addition, in the same patient, 2,3 dinor 6-keto PGF1alpha and methyl histamine were quantified in urine samples. Our results showed that plasma and urinary metabolites were not grossly elevated although they did increase slightly. Mild to moderate anaphylactoid reactions were observed in some patients on ACE inhibitors receiving plasma fractionation or cryofiltration apheresis. This was resolved by discontinuing either the ACE inhibitor, plasma fractionation, or cryofiltration apheresis.- - - - - - - - - - ranking = 1.1891813680702keywords = death, rate (Clic here for more details about this article) |
7/355. Anaphylactic reaction secondary to a medication administration error in a patient receiving intravenous antibiotics.The occurrence of either medication administration errors or adverse drug reactions (ADRs) in hospitalized patients are well documented events. The combination of the two sequelae to drug therapies can lead to potentially life threatening episodes. In the case reported here, a medication administration error led to an ADR which threatened the life of a 12-month-old boy. The patient was receiving doses of cefotaxime sodium and nafcillin sodium, and was inadvertently administered a dose of cefoxitin sodium through a nursing staff medication administration errors. The patient experienced marked flushing; pitting edema, tachycardia, and a rapid respiration rate. Wheezing was absent. The patient recovered spontaneously after discontinuance of the inappropriately administered cefoxitin sodium dose, and discontinuance of cefotaxime sodium as well. pharmacists must remain diligent in the review of the drug use process in institutions. Appropriate reconstitution, labeling, and dispensing of prescribed IV medications does not necessarily lead to appropriate administration of the drug. pharmacy staff reviewal of the medication administration process must be carried out in conjunction with the nursing staff to ensure appropriate drug use. Patient and professional alike will benefit from such actions.- - - - - - - - - - ranking = 0.2keywords = rate (Clic here for more details about this article) |
8/355. anaphylaxis in labor secondary to prophylaxis against group B streptococcus. A case report.BACKGROUND: Two strategies have been recommended by the Centers for disease Control and Prevention and approved by the American College of obstetrics and gynecology to help prevent group B streptococcal disease in the newborn. Both involve using penicillin in labor. However, the potential for allergic and even anaphylactic reactions to penicillin exists. CASE: A patient was treated for risk factors for group B streptococcus in labor and suffered a serious anaphylactic reaction to penicillin; it resulted in an emergency cesarean section. Although the patient and infant were eventually discharged, the patient developed disseminated intravascular coagulation and suffered acute tubular necrosis that required dialysis. CONCLUSION: Prophylaxis against group B streptococcal sepsis is of proven benefit, but the possible harm to the mother and fetus from treatment with penicillin must be recognized.- - - - - - - - - - ranking = 0.2keywords = rate (Clic here for more details about this article) |
9/355. A study on severe food reactions in sweden--is soy protein an underestimated cause of food anaphylaxis?BACKGROUND AND methods: Because of a fatal case of soy anaphylaxis occurring in sweden in 1992, a study was started the following year in which all physicians were asked to report fatal and life-threatening reactions caused by food. The results of the first 3 years of the study are reported here, including results from another ongoing study on deaths from asthma during the same period. RESULTS: In 1993-6, 61 cases of severe reactions to food were reported, five of them fatal. Peanut, soy, and tree nuts seemed to have caused 45 of the 61 reactions, and four of them were fatal. If two cases occurring less than a year before our study started are included, we are aware of two deaths caused by peanuts and four deaths caused by soy. All four youngsters who died from soy anaphylaxis with asthma were severely allergic to peanuts but had no previously known allergy to soy. In most cases, there was a rather symptom-free period for 30-90 min between early mild symptoms and severe and rapidly deteriorating asthma. CONCLUSIONS: Soy has probably been underestimated as a cause of food anaphylaxis. Those at risk seem to be young people with asthma and peanut allergy so severe that they notice symptoms after indirect contact.- - - - - - - - - - ranking = 2.3675441042107keywords = death (Clic here for more details about this article) |
10/355. Anaphylactic reactions to suxamethonium (succinylcholine).We present the case of a woman who had two severe anaphylactic episodes with hypotension and bradycardia in relation to the administration of general anesthesia. In the allergy evaluation, IgE antibodies to suxamethonium, a muscle relaxant which was used in both procedures, were detected by skin prick tests. No cross-reaction was found to other muscle relaxants derived from quaternary ammonium. The patient was able to be operated on, and did not present any adverse reactions to the use of local anesthesia or to general anesthesia using pancuronium as a muscle relaxant.- - - - - - - - - - ranking = 0.2keywords = rate (Clic here for more details about this article) |
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