1/15. Evidence of anaphylaxy after alteplase infusion.BACKGROUND AND PURPOSE: Although alteplase, a recombinant tissue plasminogen activator (tPA), is structurally identical to endogenous tPA and therefore should not induce allergy, single cases of acute hypersensitivity reactions have been reported. Until now, specific antibodies against alteplase were not detected in blood samples obtained in these patients. CASE DESCRIPTION: We report an anaphylactic reaction in a 70-year-old white female who was treated with intravenous alteplase for thrombolysis of acute ischemic stroke 160 minutes after onset of a right-sided hemiparesis. Thirty minutes after infusion of alteplase had been started, the patient suffered acute severe sinus tachycardia and hypotension, followed by cyanosis and loss of consciousness. The alteplase infusion was stopped, and following antiallergic therapy, tachycardia and hypotension resolved within 1 hour. The hemiparesis remained unaltered, but additional harm resulting from the hemodynamic complication was not observed. serum samples analyzed with a radioimmunoprecipitation assay were negative for total antibodies to alteplase, but in a subsequent ELISA, both samples were positive for IgE antibodies to alteplase. CONCLUSIONS: The detection of specific IgE antibodies reactive with alteplase in this patient could provide the first evidence of an anaphylactic-type reaction to alteplase in man. Because previous exposure to alteplase can be excluded, the results suggest that this patient had preexisting antibodies that were cross-reactive with one or more epitopes of alteplase and therefore precipitated the anaphylactic-type reaction.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/15. anaphylaxis should be considered to be a potential cause of stuporous state.anaphylaxis is not considered to cause stupor. We studied the case of a 69-year-old woman who lost consciousness after eating seafood. On her admittance to hospital she was in a state of stupor and elevated serum tryptase levels led us to the diagnosis of anaphylaxis.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
3/15. 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 = 1keywords = consciousness (Clic here for more details about this article) |
4/15. 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 = 1keywords = consciousness (Clic here for more details about this article) |
5/15. Anaphylactic reaction to the ingestion of raw onion. A case report.A case of severe systemic reactions (intense itching, urticaria, confusion, blurred vision, transient loss of consciousness, sweating, tachycardia) after ingestion of raw or lightly-cooked onion is described. The patient, a 44-year-old woman, had no troubles with well-cooked onions. Differently from the cases of sensitivity to onion described in literature, this patient was monosensitized, being skin tests negative to pollens, inhalants and other foods. The patient had 3.7 kU/L of onion-specific segum IgE, as determined by REAST. The density of onion-specific IgE (calculated as percent ratio to total IgE) was 30.8%. The reactivity of patient's serum IgE towards thermolabile and thermostable components has been tested with unheated and heated (30' at 100 degrees C) onion extracts bound to polystyrene beads and tested in the RAST system. Unheated extract resulted positive in class 2, heated extract negative, demonstrating that this patients, differently from similar clinical cases described in literature, had IgE antibodies recognizing just thermolabile onion fraction. This is the first case described in literature of a monosensitization to the thermolabile component of onion, negative also to related foods (Liliacee) and characterized by severe systemic reactions. The importance of specific-IgE density (%) rather their absolute amount (kU/L) as parameter predictive for the clinical severity of allergic reactions is discussed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
6/15. bezafibrate-induced anaphylactic shock: unusual clinical presentation.We report a case of a patient who suffered generalized urticaria, chest tightness, wheezing, nausea, vomiting, hypotension, and loss of consciousness. Two hours earlier she had taken Eulitop Retard following lunch. She had tolerated all the implicated food after the reaction. Allergy evaluation revealed intense positive responses to intradermal tests with bezafibrate active component and Eulitop Retard (skin tests in control subjects were negative). Specific IgE tests (RAST) to Eulitop Retard were negative. An IgE mechanism is suggested to be responsible for this adverse reaction on the basis of the positive skin tets. The delayed onset (two hours) of this anaphylactic shock is unusual. Although infrequent, it may be caused by the specific pharmacokinetic characteristics of this drug, which is a slow releasing agent, mainly absorbed in the gut. The drug was taken just after lunch, and this concomitant food ingestion could also have produced a delay in gastric drainage and a retarded drug absorption. An IgE-mediated accelerated type reaction could also explain this delay. Apparently the patient reacted after the first contact to the drug, and the absence of a sensitization period is not usual in this type of immune reponse. Finally, we recommend the performance of prick and intradermal skin tests prior to any systemic challenge when allergic reactions to fibric acid derivatives are suspected.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
7/15. Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits.BACKGROUND: latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. OBJECTIVE: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. methods: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. RESULTS: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific hevea species allergen similar to that of the foam layer sample. CONCLUSION: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
8/15. The bispectral index during an anaphylactic circulatory arrest.A 47-year-old woman with Cushing's syndrome suffered a severe anaphylactic reaction on induction of anaesthesia, resulting in circulatory arrest. A spontaneous cardiac output appeared after 25 minutes of chest compression and she regained consciousness three hours later, with no neurological deficit. A Bispectral Index monitor demonstrated values greater than 40 throughout the whole period of resuscitation. Possible implications for this observation are discussed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
9/15. Fatal buckwheat dependent exercised-induced anaphylaxis.Cases of food-dependent exercise-induced anaphylaxis (FEA) caused by buckwheat have been rare. Clinical, laboratory, and autopsy findings are present on an 8-year old girl with FEA caused by Japanese buckwheat. The patient consumed buckwheat noodles called "zaru soba" and immediately thereafter swam vigorously. Approximately 30 minutes later, she complained of abdominal pain, vomiting, coughing, and chest discomfort. Another ten minutes later her consciousness level deteriorated and she experienced cardiorespiratory arrest. The heart beat was restored and she was admitted to the hospital. She never regained consciousness and expired after another arrest 13 days later. Her IgE level was high (2,840 IU/ml) and the IgE-radioallergosorbent test (RAST) score was 2 for soybeans, 3 for buckwheat, 2 for rice, and 3 for wheat. An exaggerated hematemesis that occurred immediately after hospital admission indicated an inflammatory condition of the digestive tract that was caused by buckwheat. Marked ulceration accompanied with hemorrhage and necrosis was noted at the ileum. Extensive hemorrhage involving the endotracheal pulmonary field and lymphocyte infiltration of the alveolar space likely appeared after the inflammation. The analysis of buckwheat-specific IgE antibody by immunoblotting showed 7 bands that reacted with the IgE of the patient's serum, 4 bands: 16, 20, 24, and 58 kDa, were specific to the patient as compared to subjects not allergic to buckwheat. A first case of fatal FEA by buckwheat is reported with reference to specific IgE.- - - - - - - - - - ranking = 2keywords = consciousness (Clic here for more details about this article) |
10/15. Anaphylactic shock induced by gadoterate meglumine (DOTAREM).The use of contrast agent for magnetic resonance imaging improves the effectiveness of this diagnostic examination. Complexes of godolinium, which appear to be well tolerated, are used for this purpose. A few cases of anaphylactic shock have been attributed to these agents. We report a case of anaphylactic shock due to gadoterate meglumine (DOTAREM). While undergoing a magnetic resonance imaging examination, a 33-year-old nonatopic female patient became severely hypotensive, lost consciousness, and had generalized erythema immediately after the intravenous injection of this product. She recovered rapidly after she was given injection of epinephrine and her blood volume was restored with intravenous fluids. That DOTAREM had caused this immediate hypersensitivity reaction was proven by the positivity of prick-test and intradermal test at 10-3 (0.37 mg/ml) and in vitro leukocyte histamine release test. The results of these tests indicated that it was the gadoteric acid rather than the meglumine component of DOTAREM that was responsible: positivity of IDR at 10 mg/ml. skin tests and leukocyte histamine release test to gadopentetate dimeglumine (MAGNEVIST) were negative. In addition of the exceptional character, this observation provides evidence for an immediate hypersensitivity without cross reactivity with gadopentetate dimeglumine.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
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