Rocuronium allergy. David Spoerl HUG (University Hospital Geneva)
|
|
- Henry Harvey
- 5 years ago
- Views:
Transcription
1 Rocuronium allergy David Spoerl HUG (University Hospital Geneva)
2 Rocuronium use
3 Sugammadex (Bridion ) Modified γ-cyclodextrin with 8 sugar molecules Designed to encapsulate rocuronium and antagonize its pharmaceutical effects Several case reports describing reversal of rocuronium-induced anaphylaxis Whether sugammadex is useful for antagonizing IgE-mediated or pseudoallergic reactions due to rocuronium remains a matter of debate
4 NMBA anaphylaxis (Quizz) Up to 75 % of reactions have been reported upon first known contact with the NMBA Quaternary and tertiary ammonium (QA) ions are thought to be the main allergenic epitopes in NMBAs. The estimated prevalence of cross-reactivity between NMBA is about 65% by skin tests and 80% by radioimmuno assay (RIA) inhibition tests Epitopes other than ammonium have been implicated in IgEmediated anaphylaxis to general anesthetics. Allergic reactions to NMBAs are almost exclusively IgE-mediated
5 Allergy Clin Immunol. 2011;128:366-73
6
7 Acta Anaesthesiol Scand. 2003;47: Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique. Berg CM, Heier T, Wilhelmsen V, Florvaag E. CONCLUSION: Nonmast-cell-mediated positive intradermal skin reactions are frequently occurring with rocuronium, even at vial dilution 1 : 1000.
8
9 NMBA anaphylaxis Allergic reactions to NMBAs are almost exclusively IgE-mediated?
10 Case 1 A 36 year old atopic female Fentanyl, lidocaine, propofol, suxamethonium and ceftriaxone, followed by repeated injections of rocuronium for abdominal surgery At the end of the procedure: generalized urticarial rash associated with bronchoconstriction and hypoxemia. She was treated with anti-histaminics, methylprednisolone and nebulized adrenaline, but only after treatment with 400 mg i.v. sugammadex her condition improved rapidly. Tryptase was not measured during the reaction.
11 Case 1-work up Skin tests for PPL, MD, amoxicillin, ceftriaxone, lidocaine, procaine, fentanyl, suxamethonium, propofol, latex and chlorhexidine: negative. Specific IgE for penicillin G and V, ampicillin, amoxicillin, chlorhexidine, QA, rocuronium, suxamethonium, ethylene oxide and latex were negative. BAT was negative for atracurium, chlorhexidine, rocuronium (concentration 1000, 100 and 10 ng/ml; highest stimulation index 1.5) and the mixture of rocuronium and sugammadex (concentration 1000, 100 and 10 ng/ml; highest stimulation index 0.9). The basal tryptase was within the normal range 6 months later. IDT for rocuronium at a concentration of 10 mg/ml: erythema without papule formation at the 10-3 and 10-2 dilution, clearly positive at 10-1 dilution, which is known to be irritative. The mixture of sugammadex and rocuronium (1:1 molecular) was negative in all tested dilutions (mild erythema at the 10-1 dilution).
12 Case 2 A 48 year old female scheduled for surgical resection of an unexplained left parietal cerebral mass. Induction with propofol and fentanyl, and 40 mg rocuronium: tachycardia, generalized urticarial rash, profound hypotension (mean arterial pressure between 40 and 50 mmhg). Hydrocortisone and clemastine were administered once. Despite repeated epinephrine injections and intravenous fluids the patient remained hypotensive. 53 minutes after the induction, 200 mg of sugammadex were injected, resulting in rapid hemodynamic normalization, disappearance of the urticarial rash and extubation 15 minutes later. Tryptase level of 36 mg/l (normal value <11.1 mg/l).
13 Case 2-work up Prick tests and IDT were negative to all substances used during the procedure as well as to latex, and chlorhexidine. Specific IgE were negative for rocuronium, chlorhexidine, suxamethonium, QA, ethylene oxide, and latex. BAT was negative for rocuronium, rocuronium and sugammadex mixture, and atracurium (same concentrations as in case 1, highest stimulation index for rocuronium 1.9, for rocuronium and sugammadex mixture 0.9). Basal tryptase was within normal range. Prick tests were positive to pure rocuronium 10 mg/ml, and negative for the 1:1 mixture of rocuronium and sugammadex. IDT to rocuronium was positive at 10-2 and 10-1 dilution, which is a presumably irritative dose. IDT using the 1:1 mixture of rocuronium and sugammadex was negative at 10-2 and 10-1 dilution
14 Case 3 A 69 year old male scheduled for craniotomy for suspected glioblastoma multiforme. Induction with propofol, sufentanyl and injection of 50 mg rocuronium: severe hypotension (mean arterial pressure between 40 and 50 mmhg), requiring intravenous fluids and epinephrine (total dose of 1.5 mg). 60 minutes after the first dose of rocuronium, a second dose of 20 mg was injected to facilitate transoesophageal echocardiography, that did not show signs of cardiogenic shock. 40 minutes after the second dose of rocuronium, 400 mg of sugammadex were injected. The blood pressure stabilized rapidly and the patient was extubated after a second dose of 200 mg of sugammadex, injected 20 minutes later. The patient did not receive corticosteroids or anti-histaminic drugs before extubation. Tryptase was within normal range during the reaction and two hours later
15 Case 3-work up Because of the necessity to rapidly perform the surgical procedure, skin tests were performed only three days after the reaction and still under corticosteroid treatment, possibly compromising their validity. Skin tests for all substances used during the procedure were negative. No specific IgE were found against rocuronium, chlorhexidine, suxamethonium, QA, and latex. Due to low basophil count (<0.01% of leucocytes), BAT was inconclusive. IDT for rocuronium was weakly positive at a 10-1 dilution, and negative for the 1:1 rocuronium and sugammadex mixture at the same dilution
16 Summary Two patients received standard treatment for anaphylaxis, including corticosteroids, anti-histaminic drugs and adrenaline, without sufficient apparent response. One patient received only epinephrine. The rapid clinical improvement within minutes after sugammadex in the three patients can thus not be explained by the standard treatment for anaphylaxis. Hypersensitivity to other drugs used during surgery in all three patients could not be identified by skin and specific ige-testing as well as BAT. Rocuronium hypersensitivity could not be demonstrated in the three patients, neither in vivo by skin tests nor in vitro by IgE to QA, IgE to rocuronium or BAT. Sugammadex mixed in a 1:1 ratio with rocuronium was able to neutralize the irritative effect of rocuronium in all performed skin tests.
17 Your evaluation?
18 Non-IgE mediated activation: hmrgprx2 Nature. 2015; 519:
19 Your evaluation? Our hypothesis is that rocuronium induced a non-ige (anaphylactoid/ pseudoallergic) reaction in our patients and that sugammadex was able to reverse this reaction
20 Investigations-HUG
21 Investigations-HUG
22 Conclusions We report three cases of probable non-ige mediated (pseudo-allergic, anaphylactoid) reactions to rocuronium, which rapidly resolved after administration of sugammadex. Our study confirmed the specificity of sugammadex for inhibiting rocuronium induced pseudo-allergic reaction, and not other NMBA induced non-ige mediated reactions. Our study speak against an unspecific stabilizing effect of sugammadex on mast cells and support our hypothesis that sugammadex suppresses rocuronium specific, non-ige mediated mast cell activation.
23 Future perspectives It is possible that the high rate of anaphylactic reactions reported in NMBA naïve patients, as well as the high percentage of cross-reactivity reported in NMBA allergic patients (mostly based on skin test results), might in fact be due to the effects of NMBA on the hmrgprx2 receptor and therefore be pseudo-allergic (anaphylactoid) and not allergic. This mechanism may also explain the irritative reaction in skin tests with NMBAs. Further studies in larger cohorts are needed to clarify the role hmrgprx2 receptor in immediate type reactions to drugs. In the meanwhile, neither the presence of IgE in the serum nor positive skin tests per se allows to affirm that a given anaphylactic reaction is IgE mediated.
24 Thank you
25 Investigations-literature Sugammadex is able to prevent basophil activation by rocuronium, provided that sugammadex and rocuronium were pre-incubated prior to basophil stimulation (Anaesthesia 2011;66: ) These in vitro experiments were consistent with data from skin tests in rocuronium sensitized patients: Clarke et al. showed that these patients were anergic to sugammadex-bound rocuronium and concluded that sugammadex was able to prevent rocuronium from interacting with the immune system, presuming an underlying IgE mediated mechanism. (Anaesthesia 2012;67: ).
26 Mast cell activation Nat Rev Immunol. 2004;4:
27 In vitro tests: sige IgE to suxamethonium has repeatedly been reported to be too insensitive to diagnose allergy from NMBAs in general (sensitivity varying between 30 and 60%) IgE QA: Sensitivity 88-97%, specificity % (Anesthesiology. 2003;99:536-45) IgE Rocuronium: sensitivity 68%, specificity 93% with 0.35kUa/l. Morphine: Sensitivity of 88% and specificity of 100 % 5% of the sera of blood donors and 10% of the sera routinely analysed in two allergy laboratories demonstrated IgE reactivity for morphine (Acta Anaesthesiol Scand 2005;49: ). Anesthesiology 2007; 107:253 9
28 In vitro tests: sige Anesthesiology 2007; 107:253 9
29 Spec=18/(18+13)=58 Allergy 2011; 66:
30
31 RE-exposure
32 RE-exposure
33 NMBA anaphylaxis Allergic reactions to NMBAs are almost exclusively IgE-mediated?
Sign up to receive ATOTW weekly -
ANAPHYLAXIS ANAESTHESIA TUTORIAL OF THE WEEK 38 1 th DECEMBER 2006 Dr. Sara Rees Cardiff, UK Case History You are anaesthetising a fit and well 40 year old woman for total abdominal hysterectomy for menorrhagia.
More informationPerioperative Anaphylaxis. Aleena Banerji, MD AAAAI 2014 San Diego, California
Perioperative Anaphylaxis Aleena Banerji, MD AAAAI 2014 San Diego, California Objectives Better understand the differential diagnosis of perioperative anaphylaxis Evaluate and manage patients with a history
More informationANAPHYLAXIS IN ANESTHESIA
ANAPHYLAXIS IN ANESTHESIA Content I. Definition II. Epidemiology III. Etiology IV. Recognition V. Diagnosis VI. Observation and follow up VII.Drugs Definition Prophylaxis : protection Anaphylaxis : against
More information!Intra-Operative Reactions!
XXII World Allergy Congress Drug Allergy: Management of Drug Hypersensitivity!!Intra-Operative Reactions! Prof Pascal DEMOLY! Division of Allergy! University Hospital of Montpellier! INSERM U657! France!
More informationUtility of basophil activation testing to assess perioperative anaphylactic reactions in real-world practice
ORIGINAL RESEARCH Utility of basophil activation testing to assess perioperative anaphylactic reactions in real-world practice Bernadette Eberlein 1, Sibylle Wigand 1, Heidrun Lewald 2, Eberhard Kochs
More informationPERIOPERATIVE ANAPHYLAXIS: A BRIEF REVIEW
PERIOPERATIVE ANAPHYLAXIS: A BRIEF REVIEW DEC 2011 ANDREW TRIEBWASSER DEPARTMENT OF ANESTHESIA HASBRO CHILDREN S HOSPITAL ADVERSE DRUG REACTIONS (ADR) IN THE PERIOPERATIVE ENVIRONMENT: OVERVIEW most perioperative
More informationClinical & Experimental Allergy
doi: 10.1111/j.1365-2222.2009.03404.x Clinical & Experimental Allergy, 40, 15 31 BSACI GUIDELINES BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia P. W. Ewan 1,
More informationThis item is the archived peer-reviewed author-version of:
This item is the archived peer-reviewed author-version of: Reply Reference: Van Gasse Athina L., Hagendorens Margo, Sabato Vito, Bridts Christiaan, de Clerck Luc S., Ebo Didier.- Reply The journal of allergy
More informationAnaphylaxis during Anesthesia in Norway
Anesthesiology 2005; 102:897 903 Anaphylaxis during Anesthesia in Norway A 6-Year Single-center Follow-up Study 2005 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Torkel
More informationAnaphylaxis during general anaesthesia: one-year survey from a British allergy clinic
483 Original Article Anaphylaxis during general anaesthesia: one-year survey from a British allergy clinic Chong Y Y, Caballero M R, Lukawska J, Dugué P Department of Rheumatology and Immunology, Singapore
More informationTeicoplanin allergy an emerging problem in the anaesthetic allergy clinic
British Journal of Anaesthesia, 115 (4): 595 600 (2015) doi: 10.1093/bja/aev307 Clinical Practice Teicoplanin allergy an emerging problem in the anaesthetic allergy clinic L. C. Savic 1, T. Garcez 3, P.
More informationThis is a repository copy of Teicoplanin allergy - an emerging problem in the anaesthetic allergy clinic.
This is a repository copy of Teicoplanin allergy - an emerging problem in the anaesthetic allergy clinic. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/92200/ Version: Accepted
More informationPerioperative Anaphylaxis
Perioperative Anaphylaxis P.M. Mertes, MD, PhD a,b, *, K. Tajima, MD a,b, M.A. Regnier-Kimmoun, MD a,b, M. Lambert, MD a,c, G. Iohom, MD, PhD d, R.M. Gueant-Rodriguez, MD, PhD e,f, J.M. Malinovsky, MD,
More informationThis is a repository copy of Chlorhexidine Allergy in 4 Specialist Allergy Centres in the UK, : Clinical Features and Diagnostic Tests..
This is a repository copy of Chlorhexidine Allergy in Specialist Allergy Centres in the UK, 00-0: Clinical Features and Diagnostic Tests.. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk//
More informationDrug Allergy HSJ 19/09/2011
Drug Allergy HSJ 19/09/2011 BSACI Guidelines Definitions Mechanisms Clinical Features Risk factors Diagnosis Investigations Criteria for referral/investigation Mirakian et al. Clin Exp All 2008 ; 39: 43-61
More informationImmediate Allergic Hypersensitivity to Quinolones Associates with Neuromuscular Blocking Agent Sensitization
Original Article Immediate Allergic Hypersensitivity to Quinolones Associates with Neuromuscular Blocking Agent Sensitization Paul Rouzaire, PharmD, PhD a,b,c, *, z, Audrey Nosbaum, MD b,c,d, *, Christine
More informationAnaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus A case report
Anesth Pain Med 2015; 10: 187-191 http://dx.doi.org/10.17085/apm.2015.10.3.187 Case Report Anaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus A case
More informationImmunoglobulin E Antibodies to Rocuronium
Anesthesiology 2007; 107:253 9 Copyright 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Immunoglobulin E Antibodies to Rocuronium A New Diagnostic Tool Didier
More informationCore Safety Profile. Pharmaceutical form(s)/strength: Solution for Injection CZ/H/PSUR/0005/002 Date of FAR:
Core Safety Profile Active substance: Rocuronium bromide Pharmaceutical form(s)/strength: Solution for Injection P-RMS: CZ/H/PSUR/0005/002 Date of FAR: 31.05.2012 4.3 Contraindications Hypersensitivity
More informationRocuronium: high risk for anaphylaxis?
British Journal of Anaesthesia 86 (5): 678±82 (2001) Rocuronium: high risk for anaphylaxis? M. Rose 1 and M. Fisher 12 * 1 Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia. 2 Department
More informationperioperativecpd.com continuing professional development Perioperative anaphylaxis
perioperativecpd.com continuing professional development Perioperative anaphylaxis Original article by: Dr. Rebecca Yim Resident Anaesthesiologist, Queen Mary Hospital, Hong Kong Key Points Early recognition
More informationAllergy The diagnostic process Main examinations and interpretation
Brochure for healthcare professionals Allergy The diagnostic process Main examinations and interpretation Physical examination and medical interview As symptoms are not always typical and specific to allergic
More informationDubai Anaesthesia -2015
Dubai Anaesthesia -2015 5-7 March 2015 Anaphylactic and Anaphylactoid Reactions during Anaesthesia Dr P F Kotur Vice Chancellor & Sr. Prof. of Anaesth, Sri Devaraj Medical University Kolar, Karnataka,
More informationPerioperative allergy and anaphylaxis in children : a review
(Acta Anaesth. Belg., 2018, 69, 13-24) Perioperative allergy and anaphylaxis in children : a review S. Provinciael (*), V. Saldien (*), G. Hans (*) and M. Vercauteren (**) Abstract. Objective: Perioperative
More informationKeywords anesthesia, drug hypersensitivity, food hypersensitivity
Anesthesia in the patient with multiple drug allergies: are all allergies the same? Pascale Dewachter a, Claudie Mouton-Faivre b, Mariana C. Castells c and David L. Hepner d a Pôle d Anesthésie-Réanimation,
More informationA retrospective study of suspected anaphylactic reactions during anesthesia in Belgium
(Acta Anaesth. Belg., 2018, 69, 39-43) A retrospective study of suspected anaphylactic reactions during anesthesia in Belgium R. Van den Eynde (*), F. Soetens (**), I. Leunen (**), L. Al Tmimi (*), M.
More informationScope of Practice Allergy Skin Testing in Australia In relation to revised Medicare Benefits Schedule item numbers effective 1 November 2018
Scope of Practice Allergy Skin Testing in Australia In relation to revised Medicare Benefits Schedule item numbers effective 1 November 2018 A. Introduction The Australasian Society of Clinical Immunology
More informationSupplementary Online Content
Supplementary Online Content Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA. doi:10.1001/jama.2018.19283 Table 1. Hypersensitivity reaction types Table
More informationThe term anaphylaxis was coined by Nobel
REVIEW ARTICLE Anaphylaxis During the Perioperative Period David L. Hepner, MD*, and Mariana C. Castells, MD, PhD *Department of Anesthesiology, Perioperative and Pain Medicine, and Allergy and Clinical
More informationAllergy & Anaphylaxis
Allergy & Anaphylaxis (why, where, and what to do) Robert H. Brown, M.D., M.P.H. Professor Departments of Anesthesiology, Environmental Health Sciences, Medicine, and Radiology The Johns Hopkins Medical
More informationRocuronium bromide induced anaphylaxis in a child -A case report-
Case Report Korean J Anesthesiol 2010 December 59(6): 411-415 DOI: 10.4097/kjae.2010.59.6.411 Rocuronium bromide induced anaphylaxis in a child -A case report- Young Ho Jang 1, Sang Gyu Kim 2, Yong Hoon
More informationPerioperative Anaphylaxis
Perioperative Anaphylaxis P.M. Mertes, MD, PhD a,b, *,M.Lambert,MD a,b, R.M. Gueant-Rodriguez, MD, PhD c,d,i.aimone-gastin,md, PhD c,d, C. Mouton-Faivre, MD a, D.A. Moneret-Vautrin, MD, PhD e, J.L. Gueant,
More informationAnaphylaxis Angioedema Transplantation & graft rejection
Anaphylaxis Angioedema Transplantation & graft rejection 1 Learning objectives 1.Anaphylaxis: definition, causes, C/P, Ix, Rx 2.Angioedema: definition, causes, C/P, IX,RX 3.Transplantation & graft rejection:
More informationWho Should Be Premediciated for Contrast-Enhanced Exams?
Who Should Be Premediciated for Contrast-Enhanced Exams? Jeffrey C. Weinreb, MD,FACR Yale University School of Medicine jeffrey.weinreb@yale.edu Types of Intravenous Contrast Media Iodinated Contrast Agents
More informationAnnex II. Scientific conclusions and grounds for the maintenance of the marketing authorisations presented by the EMA
Annex II Scientific conclusions and grounds for the maintenance of the marketing authorisations presented by the EMA 22 Scientific conclusions Overall summary of the scientific evaluation of pholcodine-containing
More informationThe Quest for Clinical Relevance
Allergy Testing in Laboratory The Quest for Clinical Relevance 1989 20130 3 1989 A Good Year Current Concepts Lecture Allergy 1989 a good year WHY ME? Current Concepts Lecturers 1989 Andrew Wootton David
More informationOverview Of Allergy Testing Methods
Overview Of Allergy Testing Methods Hector P. Rodriguez MD Columbia Presbyterian Medical Center Inhalant Allergy Mechanism Antibody (Ab( Ab): allergen-specific IgE Binds to specific receptors on mast cells
More informationPractical Guidelines for Perioperative Hypersensitivity Reactions
REVIEWS Practical Guidelines for Perioperative Hypersensitivity Reactions Laguna JJ 1#, Archilla J 2, Doña I 3#, Corominas M 4, Gastaminza G 5#, Mayorga C 3#, Berjes-Gimeno P 6, Tornero P 7, Martin S 2,
More informationSkin Reactions to Intradermal Neuromuscular Blocking Agent Injections
Anesthesiology 2007; 107:245 52 Copyright 2007, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Skin Reactions to Intradermal Neuromuscular Blocking Agent Injections
More informationAnaphylaxis: Treatment in the Community
: Treatment in the Community is likely if a patient who, within minutes of exposure to a trigger (allergen), develops a sudden illness with rapidly progressing skin changes and life-threatening airway
More informationSyddansk Universitet. Published in: Clinical and Translational Allergy. DOI: /s Publication date: 2017
Syddansk Universitet Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid Brandt, Nicolaj; Garvey, Lene
More informationMichaela Lucas. Clinical Immunologist/Immunopathologist. Pathwest, QE2 Medical Centre, Princess Margaret Hospital
Michaela Lucas Clinical Immunologist/Immunopathologist Pathwest, QE2 Medical Centre, Princess Margaret Hospital School of Medicine and Pharmacology, School of Pathology and Laboratory Medicine University
More informationAllergic Emergencies and Anaphylaxis. George Porfiris MD, CCFP(EM),FCFP TEGH
Allergic Emergencies and Anaphylaxis George Porfiris MD, CCFP(EM),FCFP TEGH Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationAllergy Status Identification And Documentation
Allergy Status Identification And Documentation Basic Medication Safety (BMS) Certification Course King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs Learning
More informationAllergic reactions anaphylaxis *** CME Version *** Aaron J. Katz, AEMT-P, CIC
Allergic reactions anaphylaxis *** CME Version *** Aaron J. Katz, AEMT-P, CIC www.es26medic.net Some terms Allergic reaction Exaggerated immune system response to an allergen Allergen The thing that causes
More informationAnaphylaxis: clinical features, management and avoidance
Anaphylaxis: clinical features, management and avoidance James Bateman MRCP and Robin Ferner MSc, MD, FRCP VM Our series on serious ADRs focusses on rare but potentially fatal drug reactions and how to
More informationImmunoCAP Tryptase Product information
ImmunoCAP Tryptase Product information 1 Clinical utility of ImmunoCAP Tryptase Risk marker for severe reactions elevated baseline levels indicate increased risk for severe reactions (1-3) in insect and
More informationAdverse drug reactions. Dr. Mark Haworth MBChB DA MRCA
Adverse drug reactions Dr. Mark Haworth MBChB DA MRCA Types of drug reaction The appearance of known side effects to a drug e.g. respiratory depression following the administration of opioid analgesics
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis IERHA Immunization Program September 2016 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever, lymphadenopathy
More informationAnaphylaxis and Anesthesia
CLINICAL CONCEPTS AND COMMENTARY Bruno Riou, M.D., Editor Anesthesiology 2009; 111:1141 50 Copyright 2009, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Anaphylaxis
More informationAnaphylaxis. Emergencies for the general physician. Shuaib Nasser Consultant in Allergy and Asthma Cambridge University Hospitals NHS Foundation Trust
Anaphylaxis Emergencies for the general physician Shuaib Nasser Consultant in Allergy and Asthma Cambridge University Hospitals NHS Foundation Trust Definition- Anaphylaxis A potentially life-threatening
More informationSuspected Anaphylactic Reactions Associated with Anaesthesia. Revised Edition 1995
Suspected Anaphylactic Reactions Associated with Anaesthesia Revised Edition 1995 2 Published by The Association of Anaesthetists of Great Britain and Ireland and The British Society of Allergy and Clinical
More information8/8/2016. Overview. Back to Basics: Immunology. Adverse Reactions to Drugs: Dispelling Myths
Adverse Reactions to Drugs: Dispelling Myths Allison Ramsey, MD NPA Annual Conference September 30, 2016 Overview Review of types of hypersensitivity reactions Penicillin allergy IV contrast allergy Local
More information7/25/2016. Use of Epinephrine in the Community. Knowledge Amongst Paramedics. Knowledge Amongst Paramedics survey of 3479 paramedics
Recognition & Management of Anaphylaxis in the Community S. Shahzad Mustafa, MD, FAAAAI Disclosures Speaker s bureau Genentech, Teva Consultant Genentech, Teva Outline Knowledge gap Definition Pathophysiology
More informationMultiple Drug Allergies
Management of Patients with Multiple Drug Allergies Roland Solensky, MD, FAAAAI The Corvallis Clinic Corvallis, OR roland.solensky@corvallisclinic.com Conflict of Interest Financial: None Research: Merck,
More informationMastocytosis and Anaesthesia Advice for patients
What is mastocytosis? Mastocytosis is a very rare disorder affecting mast cells. In people who do not have mastocytosis, mast cells are triggered during allergy attacks. They release substances that cause
More information4/15/2018. Abnormal or hypersensitive reactions of the immune system to an allergen or antigen
Edward C. Adlesic, DMD Assistant Professor Oral and Maxillofacial Surgery Assistant Professor Dental Anesthesiology University of Pittsburgh School of Dental Medicine Abnormal or hypersensitive reactions
More informationDiagnosis and management of suspected drug allergies
Diagnosis and management of suspected drug allergies SPL Sophie Farooque MRCP Allergic reactions can be caused by commonly prescribed drugs and can lead to fatal anaphylaxis. Here, the author describes
More informationANAPHYLAXIS EMET 2015
ANAPHYLAXIS EMET 2015 ANA = AGAINST PHYLAX = PROTECTION No standardised definition (they re working on it) All include the similar concept of: A serious, generalised or systemic, allergic or hypersensitivity
More informationAntiallergics and drugs used in anaphylaxis
Antiallergics and drugs used in anaphylaxis Antiallergics and drugs used in anaphylaxis The H 1 -receptor antagonists are generally referred to as antihistamines. They inhibit the wheal, pruritus, sneezing
More informationTransfusion and Allergy: What is it, and what is it not? Prof. Olivier GARRAUD INTS, Paris Université de Lyon/Saint-Etienne France
Transfusion and Allergy: What is it, and what is it not? Prof. Olivier GARRAUD INTS, Paris Université de Lyon/Saint-Etienne France The commonest picture of Allergy Allergy is commonly sensed as an Antibody
More informationAntibiotic allergy in the Intensive Care. Sanjay Swaminathan Clinical Immunologist, Westmead and Blacktown Hospitals September 28, 2017
Antibiotic allergy in the Intensive Care Sanjay Swaminathan Clinical Immunologist, Westmead and Blacktown Hospitals September 28, 2017 Outline of talk True or false? Case example Types of drug allergy
More informationImmunological transfusion reactions
Immunological transfusion reactions Immunological transfusion reactions can be hemolytic or non-hemolytic in nature. Both types can be separated into acute (those occurring immediately after transfusion)
More informationEmergency Treatment of Anaphylaxis Policy and Guidelines
Emergency Treatment of Anaphylaxis Policy and Guidelines This procedural document supersedes: PAT/EC 3 v.6 Emergency Treatment of Anaphylaxis Policy and Guidelines This procedural document should be used
More informationAnaphylaxis and anaesthesia
Veterinary Anaesthesia and Analgesia, 2010, 37, 306 310 doi:10.1111/j.1467-2995.2010.00551.x EDITORIAL Anaphylaxis and anaesthesia Elizabeth Armitage-Chan Davies Veterinary Specialists, Higham Gobion,
More informationImmunologic Mechanisms of Tissue Damage. (Immuopathology)
Immunologic Mechanisms of Tissue Damage (Immuopathology) Immunopathology Exaggerated immune response may lead to different forms of tissue damage 1) An overactive immune response: produce more damage than
More information= CHEMOTHERAPY REACTIONS = Joana Caiado MAIN TOPICS DIAGNOSIS. Clinical evaluation. In vivo evaluation. In vitro evaluation
1203 Course: Drug Hypersensitivity and Allergy: From Diagnosis To Treatment = CHEMOTHERAPY REACTIONS = Joana Caiado Immunoallergology Department Hospital Santa Maria Lisbon Portugal February 22 nd MAIN
More informationSkin testing with β-lactam antibiotics for diagnosis of β-lactam hypersensitivity in children
Asian Pacific Journal of Allergy and Immunology ORIGINAL ARTICLE Skin testing with β-lactam antibiotics for diagnosis of β-lactam hypersensitivity in children Wiparat Manuyakorn, 1 Prapasiri Singvijarn,
More informationcontact activation in formation diseases 67 endothelial cells and kinin formation 73 processing and degradation 68 70
Subject Index Adenosine, mast cell activation modulation 60 Age, risk factor 17, 18 Allergen elicitors 9, 10 insects, see Insect venom-induced microarrays for 136 overview of characteristics 23 recognition
More informationFood Allergy Testing and Guidelines
Food Allergy Testing and Guidelines Dr Gosia Skibinska Primary Care Allergy Training Day, 15 th October 2011 Food Allergy Testing and Guidelines Food allergy Testing Guidelines Cases Food Allergy NICE
More informationAnaphylaxis: Recent Updates in Diagnosis
Anaphylaxis: Recent Updates in Diagnosis Gaurav Singh Tomar Department of Neuroanesthesiology & Critical care All India Institute of Medical Sciences, New Delhi, India 1 Introduction Allergy is a disease
More informationEPIPEN INSERVICE Emergency Administration of Epinephrine for the Basic EMT. Michael J. Calice MD, FACEP St. Mary Mercy Hospital
EPIPEN INSERVICE Emergency Administration of Epinephrine for the Basic EMT Michael J. Calice MD, FACEP St. Mary Mercy Hospital Case #1 NR is an 8 yo male c/o hot mouth and stomach ache after eating jelly
More informationIdiopathic Anaphylaxis. Paul A. Greenberger, MD, FAAAAI 2/28/2014 Course # 1605
Idiopathic Anaphylaxis Paul A. Greenberger, MD, FAAAAI 2/28/2014 Course # 1605 Objectives Review definition and classification of idiopathic anaphylaxis Consider the differential diagnosis Critique lab
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis Public Health Immunization Program June 2018 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever,
More informationAllergy and Immunology Review Corner: Chapter 71 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al.
Allergy and Immunology Review Corner: Chapter 71 of Middleton s Allergy Principles and Practice, 7 th Edition, edited by N. Franklin Adkinson, et al. Chapter 71: In Vivo Study of Allergy Prepared by Jacob
More informationAnaphylaxis/Latex Allergy
Children s Acute Transport Service CATS Clinical Guideline Anaphylaxis/Latex Allergy Document Control Information Author D Lutman Author Position Consultant Document Owner E Polke Document Owner Position
More informationDrug allergy and Skin Disorders. Timothy Craig, DO, FACOI Professor of Medicine and Pediatrics Distinguished Educator Penn State University, Hershey
Drug allergy and Skin Disorders Timothy Craig, DO, FACOI Professor of Medicine and Pediatrics Distinguished Educator Penn State University, Hershey The best screening test for anaphylaxis is? A. histamine
More informationMyBioSource.com. Instructions for use. Histamine Release
Instructions for use Histamine Release Supplementary kit for the determination of the release of histamine from heparinized whole blood (this kit has to be used in combination with the Histamine ELISA,
More informationPolicy for the Treatment of Anaphylaxis in Adults and Children
Policy for the Treatment of Anaphylaxis in Adults and Children June 2008 Policy Title: Policy for the Treatment of Anaphylaxis in Adults or Children Policy Reference Number: PrimCare08/17 Implementation
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Drug Allergy. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio
More informationSuccinycholine: Succinylcholine has no place in pediatric anesthesia. Wads Ames MBBS FRCA
Succinycholine: Succinylcholine has no place in pediatric anesthesia Wads Ames MBBS FRCA Food And Drug Administration Created in 1906 Responsible for protecting and promoting public health through the
More informationProduct Information BROWN SNAKE ANTIVENOM AUST R 74897
Product Information APPROVED NAME BROWN SNAKE ANTIVENOM AUST R 74897 DESCRIPTION BROWN SNAKE ANTIVENOM is prepared from the plasma of horses immunised with the venom of the brown snake (Pseudonaja textilis).
More informationKDIGO Conference San Francisco March KDIGO. Mechanisms of drug hypersensitivity. A. J. Bircher Dermatology/Allergology
Conference San Francisco March 27 30 2014 Mechanisms of drug hypersensitivity A. J. Bircher Dermatology/Allergology University Hospital Basel Switzerland andreas.bircher@unibas.ch Disclosure of Interests
More informationCONCLUSIONS: For the primary end point in the total population, there were no significant differences between treatments. There were small, but statis
V. Clinical Sciences A. Allergic Diseases and Related Disorders 1. Upper airway disease a. Clinical skills and interpretive strategies for diagnosis of upper airway diseases: skin testing (epicutaneous
More informationAnesthesia related hypersensitivity. Anesthesie gerelateerde overgevoeligheid
Faculteit Geneeskunde & Gezondheidswetenschappen Anesthesia related hypersensitivity New diagnostics and novel epidemiological data Anesthesie gerelateerde overgevoeligheid Nieuwe diagnostiek en epidemiologische
More informationHypersensitivity is the term used when an immune response results in exaggerated or inappropriate reactions harmful to the host.
Hypersensitivity is the term used when an immune response results in exaggerated or inappropriate reactions harmful to the host. Hypersensitivity vs. allergy Hypersensitivity reactions require a pre-sensitized
More informationThe Latest Approaches to Reversal of Neuromuscular Blocking Agents
The Latest Approaches to Reversal of Neuromuscular Blocking Agents Janay Bailey, Pharm.D. Anesthesiology 2017; 126:173-90 Objectives Pharmacists Determine optimal paralytic choices in knowing if reversal
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationReducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice
Original Article Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice P.M. Mertes 1, M.C. Laxenaire 1, A. Lienhart 2, and the working group for the SFAR* and W. Aberer
More informationEmergency Department Guideline. Anaphylaxis
Emergency Department Guideline Inclusion criteria: 1. Acute onset of an illness (minutes to hours) with a AND (b OR c): a. Skin and/or mucosa (pruritus, flushing, hives, angioedema) b. Respiratory compromise
More informationRash during Procedural Sedation for Trimalleolar Fracture
Rash during Procedural Sedation for Trimalleolar Fracture Saint John, Emergency Medicine Case Rounds 10 October, 2017 Dr. Jacqueline Hiob, BScPharm MD PGY1, FRCP Emergency Medicine Learning points for
More information2 QUALITATIVE AND QUANTITATIVE COMPOSITION
SUMMARY OF PRODUCT CHARACTERISTICS 1 NAME OF THE MEDICINAL PRODUCT Rocuronium bromide 10 mg/ml solution for injection/ infusion 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each ml of solution of Rocuronium
More information: ALLERGIC REACTION
6208.05: ALLERGIC REACTION INTRODUCTION Allergic (hypersensitivity) reactions are most often secondary to an exaggerated immune system response to a harmless foreign antigen (e.g. insect bite or sting,
More informationAllergic Reactions to Vaccines Seminar 1819 San Antonio February 22, 2013
Allergic Reactions to Vaccines Seminar 1819 San Antonio February 22, 2013 John M Kelso, MD Division of Allergy, Asthma and Immunology Scripps Clinic San Diego CA Clinical Professor of Pediatrics and Internal
More informationDrug allergy. Dean Tey. Monday 17 May Paediatric Allergist & Immunologist
Drug allergy Dean Tey Paediatric Allergist & Immunologist Monday 17 May 2010 Drug challenge Gold standard for determining if a patient is tolerant or allergic to a particular drug Patient is admitted to
More informationIgE-mediated allergy to chlorhexidine
IgE-mediated allergy to chlorhexidine Lene Heise Garvey, MD, a Mogens Krøigaard, MD, a Lars K. Poulsen, DMSc, b Per Stahl Skov, PhD, c Holger Mosbech, DMSc, a,b Lennart Venemalm, PhD, d Fredrik Degerbeck,
More informationCase Report. Mechanisms of Anaphylaxis. Case Report. Case Report 37 y/o WF Is this anaphylaxis? What would you do at this point?
Mechanisms of Anaphylaxis Richard F. Lockey, M.D. Division of Allergy and Immunology Department of Internal Medicine University of South Florida Morsani College of Medicine and James A. Haley Veterans
More informationPreliminary Communication Cichocka-Jarosz, Dorynska, Pietrzyk & Spiewak
For reprint orders, please contact: reprints@futuremedicine.com Laboratory markers of mast cell and basophil activation in monitoring rush immunotherapy in bee venom-allergic children Aim: To evaluate
More informationAnaphylaxis Independent Learning Package
Anaphylaxis Independent Learning Package What is Anaphyalxis? Anaphylaxis is a very severe allergic reaction, usually to a substance to which an individual has previously shown sensitivity. It is for this
More informationFollowing up patients after treatment for anaphylaxis
Following up patients after treatment for anaphylaxis Unsworth D J. Following up patients after treatment for anaphylaxis. Practitioner 2012;256 (1749):21-24 Dr David J Unsworth PhD FRCP FRCPath Consultant
More information