The journal of allergy and clinical immunology. In practice
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J Allergy Clin Immunol Pract · Jan 2014
Retrospective study of drug-induced anaphylaxis treated in the emergency department or hospital: patient characteristics, management, and 1-year follow-up.
Drugs are a common cause of anaphylaxis, which is potentially life threatening. ⋯ Drugs are a common, yet under-recognized, cause of anaphylaxis. Only a small number of patients with DIA received epinephrine in the ED or had subsequent care with an allergist/immunologist. These findings are novel and identify areas for improvement in the care of individuals with DIA.
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J Allergy Clin Immunol Pract · Jan 2014
ReviewAntibiotic allergies in children and adults: from clinical symptoms to skin testing diagnosis.
Hypersensitivity reactions to β-lactam and non-β-lactam antibiotics are commonly reported. They can be classified as immediate or nonimmediate according to the time interval between the last drug administration and their onset. Immediate reactions occur within 1 hour after the last drug administration and are manifested clinically by urticaria and/or angioedema, rhinitis, bronchospasm, and anaphylactic shock; they may be mediated by specific IgE-antibodies. ⋯ Immediate reactions can be assessed by immediate-reading skin tests and, in selected cases, drug provocation tests. Nonimmediate reactions can be assessed by delayed-reading skin tests, patch tests, and drug provocation tests. However, skin tests have been well validated mainly for β-lactams but less for other classes of antibiotics.
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J Allergy Clin Immunol Pract · Jan 2014
Accountable care organizations and the allergist: challenges and opportunities.
For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). ⋯ Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals.
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J Allergy Clin Immunol Pract · Jan 2014
Multicenter StudyOral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions.
Peanut allergy creates the risk of life-threatening anaphylaxis that can disrupt psychosocial development and family life. The avoidance management strategy often fails to prevent anaphylaxis and may contribute to social dysfunction. Peanut oral immunotherapy may address these problems, but there are safety concerns regarding implementation in clinical practice. ⋯ Peanut oral immunotherapy carries a risk of systemic reactions. In the context of oral immunotherapy, those reactions were recognized and treated promptly. Peanut oral immunotherapy may be a suitable therapy for patients managed by qualified allergists/immunologists.
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J Allergy Clin Immunol Pract · Jan 2014
Comparative StudyA novel scoring system to distinguish vocal cord dysfunction from asthma.
Vocal cord dysfunction is often misdiagnosed and mistreated as asthma, which can lead to increased and unnecessary medication use and increased health care utilization. ⋯ The Pittsburgh Vocal Cord Dysfunction Index is proposed as a simple, valid, and easy-to-use tool for diagnosing vocal cord dysfunction. If confirmed by a prospective evaluation in broader use, it may have significant clinical utility by facilitating a timely and accurate diagnosis of vocal cord dysfunction, thereby preventing misdiagnosis and mistreatment as asthma. Future prospective validation studies will need to be performed.