The Journal of allergy and clinical immunology
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J. Allergy Clin. Immunol. · Jun 2004
Incorrect allergy injections: allergists' experiences and recommendations for prevention.
There are several reports of fatalities caused by allergen immunotherapy and skin testing. Patients have been reported who have received incorrect allergy injections. These could put them at risk for anaphylactic reaction and a possible fatality. ⋯ Specific reasons given for the incorrect injections were patient name similar to that of another patient with incorrect name check and nurse error resulting in an incorrect dose. We conclude that allergy injections are a potential safety concern. There are a variety of prevention strategies that could be implemented to reduce or eliminate this risk, such as improved nurse training in the administration of allergy injections and compliance with the recommendations in the "Allergen Immunotherapy: A Practice Parameter" for use of patient-specific vials, standardized dosage sheets, and implementation of triple-checking of identity to make sure the correct patient is receiving the correct injection.
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J. Allergy Clin. Immunol. · May 2004
Randomized Controlled Trial Clinical TrialTreatment of asthma with nebulized lidocaine: a randomized, placebo-controlled study.
In 2 prior uncontrolled studies, nebulized lidocaine reduced oral glucocorticoid use in patients with severe glucocorticoid-dependent asthma. ⋯ Nebulized lidocaine provided effective and safe therapy in subjects with mild-to-moderate asthma.
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J. Allergy Clin. Immunol. · May 2004
ReviewFirst-aid treatment of anaphylaxis to food: focus on epinephrine.
Avoiding food triggers for anaphylactic reactions (severe acute systemic allergic reactions) is easier said than done. Most episodes of anaphylaxis to food occur unexpectedly in the community in the absence of a health care professional. All individuals at risk should therefore have an emergency action plan in place. ⋯ We examine a therapeutic dilemma: the issue of epinephrine dose selection in an individual for whom no optimal fixed-dose auto-injector formulation exists, and a therapeutic controversy: the issue of epinephrine injection versus an oral H1-antihistamine in anaphylaxis episodes that appear to be mild. The pharmaceutical industry could address the first of these issues by providing a wider range of epinephrine fixed doses in easy-to-use auto-injectors, or by providing adjustable epinephrine doses in auto-injectors. The second issue could be addressed in part by development of alternative routes of epinephrine administration for the first-aid, out-of-hospital treatment of anaphylaxis.
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J. Allergy Clin. Immunol. · May 2004
Should beta-blockers be given to patients with heart disease and peanut-induced anaphylaxis? A decision analysis.
Beta-blocker therapy postmyocardial infarction is generally recommended because it reduces mortality. However, beta-blockers may increase anaphylaxis mortality in the growing population of patients with peanut-induced anaphylaxis. ⋯ Our results suggest that for patients postmyocardial infarction or with congestive heart failure who are at risk for peanut-induced anaphylaxis, beta-blocker use should still improve survival. However, the epidemiology of anaphylaxis and effects of beta-blocker therapy on anaphylaxis incidence and mortality require further study.
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J. Allergy Clin. Immunol. · Mar 2004
Airway peptidoglycan and immunostimulatory DNA exposures have divergent effects on the development of airway allergen hypersensitivities.
Environmental exposures to toll-like receptor (TLR) ligands have been suggested to provide immunologic protection against allergic diseases. However, some TLRs use unique intracellular signaling pathways, suggesting that ambient TLR ligand exposures might induce a range of host responses. ⋯ Considered in a larger context, these results suggest that inspired air is likely to contain TLR ligands capable of both preventing and precipitating the asthmatic phenotype.