1/43. 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 = 1keywords = physician (Clic here for more details about this article) |
2/43. methylprednisolone anaphylaxis.The exacerbation of asthma is a problem frequently encountered by emergency physicians. In addition to oxygen and beta adrenergic agonists, oral and intravenous corticosteroids are increasingly being used to alleviate bronchospasm and to prevent recurrence of dyspnea. methylprednisolone sodium succinate has been advocated as an intravenous adjunct in the treatment of asthma. We present the case of a steroid-dependent, 17-year-old male asthmatic, who experienced anaphylaxis, with respiratory arrest, within minutes of receiving intravenous methylprednisolone. Our patient rapidly responded to respiratory support and epinephrine. methylprednisolone-induced anaphylaxis is reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/43. anaphylaxis to dill.BACKGROUND: Allergic symptoms caused by spices and herbs are infrequent and usually mild, although occasionally, severe allergic reactions do occur. Symptoms of pruritus, rhinitis, cough, and edema have been reported to spices including curry, paprika, pepper, and mustard. To our knowledge, this is the first case of confirmed dill allergy, and the patient had severe allergic symptoms. OBJECTIVE: It is important to alert physicians to the possibility of allergic reactions caused by dill. methods AND RESULTS: The patient, who has a history of allergic rhinitis, developed symptoms of oral pruritus, tongue and throat swelling, urticaria, and immediate vomiting and diarrhea following ingestion of foods cooked with dill and subsequently with inhalation of foods prepared with dill. skin testing with fresh dill preparation was positive. CONCLUSION: These findings confirm that dill can cause IgE-mediated reactions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/43. The "Peter Pan" syndrome and allergy practice: facilitating adherence through the use of social support.The complexity of care of some patients in an allergy-immunology practice may be increased by behavioral abnormalities of the patients. Facilitating adherence through the use of social support may be the most effective treatment strategy for some of the most difficult of these patients. We report three patients whose medical management problems were alleviated largely because of the participation of their support system. All three patients were stabilized because of the acceptance of responsibility and support of the physician by the designated member of the patient's support system. The range of social support used to manage nonadherent patients ranged from directly providing instructions to a family member to the consistent presence of a spouse or companion at multiple clinical visits. In all cases, the success in management was attributed largely to the presence of a support system.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/43. Suspected insulin anaphylaxis and literature review.insulin allergy is a well-documented complication of insulin therapy. A 67-year-old man presented with symptoms suggestive of insulin anaphylaxis. In an attempt to allow him to continue insulin therapy, he underwent a desensitization protocol. During the protocol, he again experienced symptoms suggestive of anaphylaxis. An analysis of his case is presented in the context of current literature. All physicians treating patients with insulin should be aware of this serious complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/43. Anaphylactic shock from a latex allergy in a patient with spinal trauma.Allergy to latex is a condition that affects patients as well as health care workers. It is a spectrum of immunologic disorders that ranges from mild hypersensitivity to life-threatening anaphylaxis. Beginning in the early 1970s, the health care community has become more aware of this entity, leading to many improvements in the understanding, diagnosis and treatment of patients with latex allergy. Many hospitals have developed protocols and procedures for patients with latex sensitivity. However, some physicians remain unaware of the logistics of taking care of patients with this disorder. We present a case of a severe anaphylactic reaction to latex in a trauma patient with a spinal cord injury. The difficulty of treating the acutely injured patient with this disorder is illustrated. A list of equipment that may be included in a latex-free emergency kit is provided.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/43. anaphylaxis to celecoxib.BACKGROUND: Adverse reactions such as urticaria, angioedema, asthma, and anaphylaxis are known to be associated with nonsteroidal anti-inflammatory agents (NSAIDs). Celecoxib (Pfizer/Searle, Caguas, PR) is a new NSAID that differs in structure and mechanism of action of other similar drugs of this class. OBJECTIVE: Evaluation of a case of anaphylaxis to celecoxib (Celebrex). methods AND RESULTS: This report describes a 55-year-old woman who experienced the acute onset of pruritus, urticaria, respiratory distress, and hypotension minutes after ingesting a celecoxib capsule. She had taken the drug a previous time for tendonitis without difficulty. Treatment with epinephrine, corticosteroids, and intravenous fluids was successful. An IgE mechanism could not be detected. She has avoided the drug and has had no further problems. CONCLUSIONS: This is the first patient report of anaphylaxis attributable to celecoxib, a new NSAID. This suggests that physicians and other health care professionals should be aware of the potential serious side effects of this drug.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/43. Allergic reactions to isosulfan blue during sentinel node biopsy--a common event.BACKGROUND: Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy. methods: At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed. RESULTS: We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures. CONCLUSIONS: The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/43. Using test dose challenges to restore essential therapy in patients with idiopathic anaphylaxis and pharmacophobia: report of a patient with idiopathic anaphylaxis and statin phobia.Idiopathic anaphylaxis (IA) is a well-documented condition in which anaphylaxis occurs in the absence of an identifiable precipitant. However, many patients with IA find it difficult to accept this diagnosis and continue to search for an external cause. It is not uncommon for these highly anxious patients to discontinue essential medications that they feel are responsible for the reaction despite reassurance from their physicians to the contrary. In extreme cases, these patients may develop an actual phobia to preexisting medications and avoid them despite adverse consequences to their health. To illustrate this concept, we report a case involving a female patient with familial hypercholesterolemia who experienced a single episode of IA and developed a "statin phobia," falsely implicating her medication (lovastatin) for the reaction. After 5 years of failed therapy with other antihyperlipidemic agents, the patient finally agreed to undergo test dosing to a similar statin agent atorvastatin. On successful completion of the test, she resumed therapy with atorvastatin and her low-density lipoprotein (LDL) levels were reduced by 50% over 5 months. We conclude that patients with a confirmed diagnosis of IA who manifest phobic responses to beneficial medications should be reassured of the diagnosis promptly by their physician. When reassurance fails and the medication is essential to the patient's health, test dose challenges may be conducted to reintroduce the drug to the patient's regimen.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/43. Cardiopulmonary arrest induced by anaphylactoid reaction with contrast media.Anaphylactoid reactions to iodinated contrast media can cause life-threatening events and even death. A 44-year-old woman presented with cardiopulmonary arrest (CPA) immediately following the administration of nonionic iodinated contrast media for an intravenous pyelography. Her cardiac rhythm during CPA was asystole. She was successfully resuscitated by the radiologists supported by paged emergency physicians using the prompt intravenous administration of 1 mg of epinephrine. Neither laryngeal edema nor bronchial spasm was observed during the course of treatment, and she was discharged on the 4th day without any complications. The patient did not have a history of allergy, but had experienced a myocardial infarction and aortitis. She had undergone 11 angiographies and had been taking a beta-adrenergic receptor antagonist. Planned emergency medical backup is advisable to ensure resuscitation in the event of an anaphylactoid reaction to the use of contrast media in-hospital settings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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