The journal of allergy and clinical immunology. In practice
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J Allergy Clin Immunol Pract · May 2014
Disparity in the availability of injectable epinephrine in a large, diverse US school district.
Food allergies affect 2.5% of the US population. Results of studies show that minorities have the highest prevalence of food allergies. The Houston Independent School District (HISD) has an urban, socioeconomically diverse population and the role of ethnicity and socioeconomic status (SES) with availability of epinephrine has not been explored in this population. ⋯ In the HISD, epinephrine injectors were more likely to be found in non-low SES schools versus low SES schools. Because minority students are disproportionately highly represented in low SES schools, there appears to be a disparity in the availability of injectable epinephrine for minority students in HISD schools.
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J Allergy Clin Immunol Pract · May 2014
Observational StudyPredictors of biphasic reactions in the emergency department for patients with anaphylaxis.
A biphasic reaction is the recurrence of anaphylaxis symptoms within 72 hours of the initial anaphylactic event, without re-exposure to the trigger. Biphasic reactions are uncommon and unpredictable, and risk factors for biphasic reactions are poorly understood. ⋯ Patients with a history of prior anaphylaxis, an unknown precipitant, or who present with symptoms of diarrhea or wheezing may be at increased risk for a biphasic reaction.
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J Allergy Clin Immunol Pract · May 2014
Review Case ReportsDelayed anaphylaxis to red meat masquerading as idiopathic anaphylaxis.
Anaphylaxis is traditionally recognized as a rapidly developing combination of symptoms that often includes hives and hypotension or respiratory symptoms. Furthermore, when a specific cause is identified, exposure to this cause is usually noted to have occurred within minutes to 2 hours before the onset of symptoms. This case is of a 79-year-old woman who developed a severe episode of anaphylaxis 3 hours after eating pork. ⋯ Diagnosis can be made by the presence of specific IgE to beef, pork, lamb, and milk, and the lack of IgE to chicken, turkey, and fish. Skin prick tests (but not intradermal tests) generally are negative. Management of these cases, now common across the southeastern United States, consists of education combined with avoidance of both ingestion of red meat and further tick bites.
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Disorders associated with mast cell activation range from relatively common IgE-mediated disease and chronic urticaria to rarer conditions such as mastocytosis or monoclonal mast cell activation disorder. Mast cell activation disorders can be mechanistically classified into primary (associated with abnormal production of mast cells that carry pathologic markers of clonality), secondary (normal mast cells activated in reaction to a microenvironmental trigger), and idiopathic (no etiology is found). Clinical presentations, diagnostic criteria as well as general principles of a stepwise therapy approach are discussed.
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J Allergy Clin Immunol Pract · May 2014
A multifaceted intervention for patients with anaphylaxis increases epinephrine use in adult emergency department.
Studies have documented inconsistent emergency anaphylaxis care and low compliance with published guidelines. ⋯ Significantly higher proportions of patients with anaphylaxis received epinephrine and were admitted to the ED observation unit after introduction of epinephrine autoinjectors and order set implementation. Slightly more than half of the biphasic reactions occurred within the recommended observation time of 4 to 6 hours. Analysis of these data suggests that the multifaceted approach to changing anaphylaxis management described here improved guideline adherence.