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Medline ® Abstracts for References 47-53

of 'Anaphylaxis: Emergency treatment'

47
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Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and management.
AU
Ben-Shoshan M, La Vieille S, Eisman H, Alizadehfar R, Mill C, Perkins E, Joseph L, Morris J, Clarke A
SO
J Allergy Clin Immunol. 2013 Sep;132(3):739-741.e3. Epub 2013 Jul 27.
 
AD
PMID
48
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A retrospective study of epinephrine administration for anaphylaxis: how many doses are needed?
AU
Korenblat P, Lundie MJ, Dankner RE, Day JH
SO
Allergy Asthma Proc. 1999;20(6):383.
 
The precise amount of epinephrine needed to reverse severe symptomatology due to an anaphylactic reaction is unknown. We tried to determine how frequently more than one injection of epinephrine is required to treat an anaphylactic reaction. A retrospective review of patient charts with anaphylactic reactions requiring epinephrine, in response to inhalant allergen and hymenoptera venom immunotherapy as well as live hymenoptera stings, examined type of reaction; number, doses, and timing of epinephrine administered; and ancillary treatment. A total of 105 anaphylactic reaction events of varying severity (Ring's classification) were recorded (54--Grade I, 29--Grade II, 18--Grade III, 0--Grade IV, 4--unknown). The median epinephrine dose administered was 0.3 cc (range 0.1 to 0.8 cc, 1:1000). The timing of the first epinephrine injection was<or = 5 minutes in 27, 6-10 minutes in 13, 11-30 minutes in 16,<or = 30 minutes in 32, 31-60 minutes in 12, and>60 minutes in five epinephrine treated patients. Overall, 38 patients (35.5%; CI95, 26.4-44.6%) required>1 epinephrine injection. Of these, 11 experienced Grade I (11/54-20.3%; CI95, 9.6-31.0%), 12--Grade II (12/29-41.5%, CI95, 23.5-59.3%), and 13--Grade III (13/18-72.2%, CI95, 51.5-92.9%); reactivity was unknown in 2 patients. Forty-four patients also received an antihistamine, 10 received corticosteroids, and 30 received both medications and/or other ancillary therapy. A significant number of patients (>35%) with anaphylactic reactions received greater than one epinephrine dose to manage events for the three classes of severity. Patients at risk for anaphylaxis and their caregivers need to recognize that more than one dose of epinephrine may be required for treatment of anaphylaxis.
AD
Washington University School of Medicine, St. Louis, Missouri, USA.
PMID
49
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Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaign.
AU
Uguz A, Lack G, Pumphrey R, Ewan P, Warner J, Dick J, Briggs D, Clarke S, Reading D, Hourihane J
SO
Clin Exp Allergy. 2005;35(6):746.
 
BACKGROUND: Allergic reactions to food are well recognized in both children and adults, but because of their relative infrequency their typical features may not be readily recognized by patients and their medical care givers who are not allergists.
OBJECTIVE: We sought to investigate the circumstances and clinical characteristics of food allergies in adults and children in the community.
METHODS: Self-completed questionnaire responses over a 6-month period from 109 members of the Anaphylaxis Campaign, the major British patient resource group for people who have suffered severe allergic reactions.
RESULTS: One hundred and nine respondents reported 126 reactions during the study period. Seventy-five were children (under 16 years, median age 6 years at the time of reaction). Predictably more boys than girls were reported to have had reactions but more women reported reactions than men (P<0.05). Although the groups were equally aware of their food allergies the children had undergone diagnostic testsmore often (P<0.001). Foods were implicated in 112 (89%) of reports. Restaurants were implicated less often (14%) than in other series, probably reflecting British eating habits. Children with asthma reported more severe reactions than those without asthma (P=0.008), although frequency or severity of recent asthma symptoms was not associated with severity of allergic reaction reported. When available, self-injectable adrenaline was used in 35% of severe reactions and 13% of non-severe reactions (P=0.01). A quarter of adults who received one dose of adrenaline also received a second dose.
CONCLUSION: The allergens implicated in this report reflect previous data from similar patient groups in North America. Asthmatic children suffer more severe reactions than non-asthmatic children. It appears that British adults need better access to expert care of their allergies. Even when it is prescribed and available self-injectable adrenaline appears under-used in severe reactions. The incidence of severe but non-fatal allergic reactions in the UK may have been underestimated in the past.
AD
University of Southampton, UK.
PMID
50
TI
Use of multiple doses of epinephrine in food-induced anaphylaxis in children.
AU
Järvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A
SO
J Allergy Clin Immunol. 2008;122(1):133. Epub 2008 Jun 10.
 
BACKGROUND: Food allergy is the most common cause of anaphylaxis outside the hospital setting.
OBJECTIVE: We sought to determine the rate, circumstances, and risk factors for repeated doses of epinephrine in the treatment of food-induced anaphylaxis in children.
METHODS: Anonymous questionnaires were distributed to families of children with food allergies during allergy outpatient visits to a food allergy referral center. Demographic information, allergy and reaction history, and details regarding the last 2 anaphylactic reactions requiring epinephrine were collected.
RESULTS: A total of 413 questionnaires were analyzed. Seventy-eight children (median, 4.5 years of age; range, 0.5-17.5 years) reported 95 reactions for which epinephrine was administered. Two doses were administered in 12 (13%) and 3 doses in an additional 6 (6%) reactions treated with epinephrine. Peanut, tree nuts, and cow's milk were responsible for>75% of reactions requiring epinephrine. Patients receiving multiple doses of epinephrine more often had asthma (P = .027) than children receiving a single dose. The amount of food ingested or a delay in the initial administration of epinephrine were not risk factors for receiving multiple doses. The second dose of epinephrine was administered by a health care professional in 94% of reactions.
CONCLUSION: In this referral population of children and adolescents with multiple food allergies, 19% of food-induced anaphylactic reactions were treated with more than 1 dose of epinephrine. Prospective studies are necessary to identify risk factors for severe anaphylaxis and to establish rational guidelines for prescribing multiple epinephrine autoinjectors for children with food allergy.
AD
Division of Pediatric Allergy and Immunology and Jaffe Institute for Food Allergy, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. kirsi.jarvinen@mssm.edu
PMID
51
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Food-induced anaphylaxis and repeated epinephrine treatments.
AU
Oren E, Banerji A, Clark S, Camargo CA Jr
SO
Ann Allergy Asthma Immunol. 2007;99(5):429.
 
BACKGROUND: Research on the use of more than 1 dose of epinephrine in the treatment of food-induced anaphylaxis is limited.
OBJECTIVE: To perform a medical record review to examine the frequency of repeated epinephrine treatments in patients presenting with food-induced anaphylaxis to the emergency department (ED).
METHODS: We reviewed 39 medical records of patients who presented with food-induced allergic reactions to the Massachusetts General Hospital ED during a 1-year period. The analysis focused on the timing of the onset of symptoms and on the number of epinephrine treatments given before and during the ED visit.
RESULTS: Of the 39 patients, 34 had an acute food-induced allergic reaction. Nineteen had anaphylaxis. Twelve patients with anaphylaxis (63%; 95% confidence interval, 38%-84%) received at least 1 dose of epinephrine, and 3 (16%; 95% confidence interval, 3%-40%) were given 2 doses. Although statistical analysis was not possible, repeated epinephrine treatment occurred in patients with anaphylaxis to peanut or tree nut and hypotension. There was no apparent association between time from ingestion of the causative agent to epinephrine treatment(s).
CONCLUSIONS: Of patients presenting to the ED with food-induced anaphylaxis, approximately 16% were treated with 2 doses of epinephrine. This study supports the recommendation that patients at risk for food-induced anaphylaxis carry 2 doses of epinephrine. Further study is needed to confirm these results and to expand them to patients who do not present to the ED because that group may have a lower frequency of epinephrine use.
AD
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. eoren1@yahoo.com
PMID
52
TI
A second dose of epinephrine for anaphylaxis: how often needed and how to carry.
AU
Kelso JM
SO
J Allergy Clin Immunol. 2006;117(2):464.
 
AD
PMID
53
TI
Factors associated with repeated use of epinephrine for the treatment of anaphylaxis.
AU
Manivannan V, Campbell RL, Bellolio MF, Stead LG, Li JT, Decker WW
SO
Ann Allergy Asthma Immunol. 2009;103(5):395.
 
BACKGROUND: Studies looking at the use of repeated doses of epinephrine in patients experiencing anaphylaxis are limited.
OBJECTIVE: To determine which patients are most likely to receive repeated doses of epinephrine during anaphylaxis management.
METHODS: A population-based study with medical record review was conducted. All patients seen during the study period who met the criteria for the diagnosis of anaphylaxis were included.
RESULTS: The cohort included 208 patients (55.8% female). Anaphylaxis treatment included epinephrine in 104 patients (50.0%). Repeated doses were used in 27 patients (13.0%), 13 (48.1%) of them female. The median age of those who received repeated doses was 18.9 (interquartile range, 10-34) years vs 31.1 (interquartile range, 15-41) years for those who did not receive repeated doses (P = .06). The inciting agents were food (29.6%), insects (11.1%), medications (22.2%), others (7.4%), and unknown (29.6%). Patients who received repeated doses were more likelyto have wheezing (P = .03), cyanosis (P = .001), hypotension and shock (P = .03), stridor and laryngeal edema (P = .007), nausea and emesis (P = .04), arrhythmias (P<.01), and cough (P = .04) and less likely to have urticaria (P = .049). They were more likely to be admitted to the hospital than patients who did not receive repeated doses (48.2% vs 15.6%; P<.001). There was no significant difference in the history of asthma between patients who received repeated doses and those who did not (P = .17).
CONCLUSIONS: Of the patients, 13.0% received repeated epinephrine doses. Patients were younger and were likely to present with wheezing, cyanosis, arrhythmias, hypotension and shock, stridor, laryngeal edema, cough, nausea, and emesis and less likely to have urticaria. A history of asthma did not predict use of repeated doses of epinephrine. Our results help identify high-risk patients who may benefit from carrying more than 1 dose of epinephrine.
AD
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
PMID