1/167. 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 = 1keywords = shock (Clic here for more details about this article) |
2/167. serum tryptase: an indicator of anaphylaxis following fluorescein angiography.BACKGROUND: anaphylaxis is a potentially fatal complication of fluorescein angiography. It is diagnosed by clinical signs. serum beta-tryptase serves as a specific indicator of mast cell activation and of anaphylactic shock that can be detected by radioimmunoassay. METHOD: This is a report on a 48-year-old woman who developed anaphylaxis during fluorescein angiography. This study investigates the role of beta-tryptase in anaphylactic shock resulting from intravenous fluorescein angiogram. RESULTS: A serum sample of beta-tryptase collected at the time of an adverse reaction to fluorescein angiography was determined by radioimmunassay to be elevated above 20 ng/ml (normal level <1 ng/ml). This indicates massive mast cell activation and anaphylactic shock. CONCLUSION: This case is the first in which elevated levels of beta-tryptase in serum indicated that the systemic adverse reaction to fluorescein was mast cell dependent. Additionally, beta-tryptase levels can be assayed to detect anaphylactic reactions several hours after a precipitating event.- - - - - - - - - - ranking = 3keywords = shock (Clic here for more details about this article) |
3/167. 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 = 6keywords = shock (Clic here for more details about this article) |
4/167. Acute liver injury that followed food-dependent exercise-induced anaphylaxis.We describe an unusual case of acute liver injury that followed food-dependent exercise-induced anaphylaxis (FDEIAn). A 45-year-old man who experienced anaphylactic shock induced by postprandial exercise and took alcohol that night was admitted the following day to our hospital because of general fatigue. Laboratory examinations revealed elevated hepatic enzymes (aspartate aminotransferase (AST) 6,110 IU, alanine aminotransferase (ALT) 4,178 IU). He had two similar episodes in the past. We speculated that acute liver injury in this case might be induced by interaction of anaphylactic shock and alcohol.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
5/167. in vitro released interferon-gamma in the diagnosis of drug-induced anaphylaxis.A 17-year-old Japanese male was referred with acute urticaria and anaphylaxis after the administration of PL (salicylamide, acetaminophen, anhydrous caffeine and promethazine methylene disalicylate) and Bufferin (aspirin and dialminate) for headache and a high grade fever. The results of prick test, patch test and drug-induced lymphocyte stimulation test with PL and Bufferin were all negative. The patient's peripheral blood mononuclear cells (PBMC) were cultured with or without PL for 72 hours, and the activity of interferon-gamma (IFN-gamma) in the culture supernatant was measured with EIA. A significantly high level of IFN-gamma was detected in PBMC from the patient, but very little in those from healthy control subjects with a history of exposure to PL. This finding may indicate the presence of drug-specific IFN-gamma producing T cells in patients with an anaphylactic shock reaction to medication. Assays that measure the drug-induced IFN-gamma production may thus be a useful diagnostic tool not only for identifying delayed-type hypersensitivity (DTH) to drugs, but also for predicting anaphylactic shock reaction to drugs.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
6/167. Occurrence of multiphasic anaphylaxis during a transcontinental air flight.anaphylaxis, a multisystem allergic reaction, represents a true medical emergency. anaphylaxis is characterized by a combination of the following: urticaria, angioedema, distributive shock, and respiratory failure. Most often, the patient is rapidly treated with prompt resolution of the anaphylaxis in either the out-of-hospital or emergency department (ED) setting. Infrequently, recurrent, or multiphasic, anaphylaxis is encountered, involving a reappearance of allergic phenomena after complete resolution of the original reaction. recurrence may involve nuisance-level issues such as urticaria; alternatively, multiphasic reactions may be characterized by cardiovascular collapse and/or respiratory compromise. Initially aggressive pharmacological therapy followed by prolonged observation in either the ED or the in-hospital setting is strongly recommended to monitor for potential recurrence.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
7/167. Anaphylactic shock following peritumoral injection of patent blue in sentinel lymph node biopsy procedure.Recently, sentinel lymph node dissection has been established for early staging of malignant melanoma. We describe an anaphylactic reaction due to patent blue injection in sentinel lymph node procedure, which was proven by positive results in intradermal testing with patent blue 1:100.- - - - - - - - - - ranking = 4keywords = shock (Clic here for more details about this article) |
8/167. Anaphylactic reactions to proton-pump inhibitors.OBJECTIVE: To report two cases of anaphylactic reactions to proton-pump inhibitors (PPIs). CASE SUMMARIES: A 54-year-old woman who had taken omeprazole in the past was treated with omeprazole 40 mg and developed periorbital edema, edema of the skin, pruritus, nausea, and vomiting about 45 minutes after taking one capsule. Five months later, she was treated with lansoprazole 30-mg capsules. Again, within 45 minutes she developed an even more serious reaction, with pruritus and urticaria on her whole body, increased sweating, facial edema, and loss of consciousness. A 61 -year-old man took one tablet of pantoprazole 40 mg one year after first being treated with the drug. Within hours after ingestion, he developed malaise, generalized pruritus and urticaria, a swollen tongue and eyes, and diffuse sweating; his blood pressure decreased to 75/50 mm Hg. DISCUSSION: Because of the acute onset of symptoms and close temporal association with exposure to the drug, as well as previous exposure to it, the reactions can be classified as anaphylactic shock to PPIs. These benzimidazole derivatives are chemically related; observations in a few patients, such as the first case above, suggest that cross-sensitivity may occur. The Uppsala Monitoring Centre (UMC) has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with PPIs. These reports account for 0.2% of the total of reported suspected adverse drug reactions to PPIs, compared with 0.8% anaphylactic reactions in the UMC database as a whole. CONCLUSIONS: These findings suggest that the chemically related PPIs can, as a group, cause anaphylactic reactions; however, the rate is comparatively low. Since anaphylaxis is a potentially serious reaction, more precise information is needed regarding its frequency, and healthcare professionals need to be aware of this possibility when prescribing these agents.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
9/167. Postmortem findings after fatal anaphylactic reactions.AIMS: To determine the frequency at which classic manifestations of anaphylaxis are present at necropsy after fatal anaphylactic reactions. methods: A register has been established of fatal anaphylactic reactions in the UK since 1992, traced from the certified cause of death and other sources. Details of the previous medical history and the reaction suggest anaphylaxis as the cause of death for 130 cases; a postmortem report was available for 56. RESULTS: The 56 deaths studied included 19 reactions to bee or wasp venom, 16 to foods, and 21 to drugs or contrast media. Death occurred within one hour of anaphylaxis in 39 cases. Macroscopic findings included signs of asthma (mucous plugging and/or hyper-inflated lungs) (15 of 56), petechial haemorrhages (10 of 56), pharyngeal/laryngeal oedema (23 of 56), but for 23 of 56 there was nothing indicative of an allergic death. Mast cell tryptase was raised in 14 of 16 cases tested; three of three tested had detectable IgE specific for the suspected allergen. CONCLUSIONS: In many cases of fatal anaphylaxis no specific macroscopic findings are present at postmortem examination. This reflects the rapidity and mode of death, which is often the result of shock rather than asphyxia. Investigations that might help determine whether anaphylaxis was the cause of death had rarely been performed. In the presence of a typical clinical history, absence of postmortem findings does not exclude the diagnosis of anaphylaxis.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
10/167. cyclosporine-induced anaphylaxis.OBJECTIVE: To describe a case of an anaphylactic reaction after first ingestion of oral cyclosporine capsules (Neoral). CASE SUMMARY: A 73-year-old white woman was admitted for the treatment of metastatic breast carcinoma with an experimental oral paclitaxel solution in combination with cyclosporine capsules. After ingestion of the cyclosporine capsules, the patient collapsed within one hour. She initially experienced severe hypotension and bradycardia. After a few minutes, she developed severe tachycardia, dyspnea, and decreased consciousness. Administration of epinephrine, dexamethasone, clemastine, oxygen, and gelofusine (succinylated gelatin 4% in NaCl 0.9%) infusion resulted in complete recovery after several hours. The planned oral paclitaxel administration was canceled. Intravenous paclitaxel was given the next day, preceded by standard premedication with dexamethasone, clemastine, and cimetidine, without complications. DISCUSSION: To our knowledge, this is the first report in the literature of an anaphylactic reaction after oral ingestion of cyclosporine capsules. Earlier reports of anaphylaxis concerned intravenous cyclosporine or oral solutions of cyclosporine (both Sandimmune). These anaphylactic reactions were considered to be due to the pharmaceutical vehicle Cremophor EL or related substances, which are well-known causes of anaphylaxis. The capsules used in this case contain the Cremophor EL-related polyoxyl 40 hydrogenated castor oil as a base; our patient's anaphylactic shock may have been due to this substance. CONCLUSIONS: In addition to earlier reports about anaphylactic reactions after administration of an intravenous or oral solution of cyclosporine, this case shows that anaphylactic shock can occur after ingestion of cyclosporine capsules.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
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