The journal of allergy and clinical immunology. In practice
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J Allergy Clin Immunol Pract · Sep 2017
Temporal Trends in Epinephrine Dispensing and Allergy/Immunology Follow-up Among Emergency Department Anaphylaxis Patients in the United States, 2005-2014.
Anaphylaxis is a potentially life-threatening allergic reaction; measures including prescription of an epinephrine autoinjector (EAI) and allergy/immunology (A/I) follow-up may prevent future morbidity. ⋯ Over the past decade, rates of EAI dispensing and A/I follow-up after an ED visit for anaphylaxis have remained low, suggesting that patients may not be prepared to manage future episodes.
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J Allergy Clin Immunol Pract · Sep 2017
Diagnostic Accuracy of Inflammatory Markers for Diagnosing Occupational Asthma.
The assessment of airway responsiveness and inflammation is key to the investigation of occupational asthma (OA). ⋯ Blood eosinophil counts do not appear to be an effective aid for diagnosing OA. The performance of both sputum cell count analysis and a methacholine challenge before and after exposure to the offending agent may represent an effective alternative in diagnosing OA when SICs are unavailable.
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J Allergy Clin Immunol Pract · Sep 2017
Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor-Induced Upper Airway Angioedema.
Upper airway angioedema is a rare, unpredictable, and at times life-threatening adverse effect of angiotensin-converting enzyme inhibitors (ACE-Is) with no existing effective pharmacologic treatment. Icatibant is a bradykinin B2 receptor antagonist that may be beneficial in patients with ACE-I-induced angioedema. ⋯ Icatibant was no more efficacious than placebo in at least moderately severe ACE-I-induced angioedema of the upper airway.
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Up to 5% of the US population has suffered anaphylaxis. Fatal outcome is rare, such that even for people with known venom or food allergy, fatal anaphylaxis constitutes less than 1% of total mortality risk. The incidence of fatal anaphylaxis has not increased in line with hospital admissions for anaphylaxis. ⋯ For fatal venom anaphylaxis, risk factors include middle age, male sex, white race, cardiovascular disease, and possibly mastocytosis; insect triggers vary by region. Upright posture is a feature of fatal anaphylaxis to both food and venom. The rarity of fatal anaphylaxis and the significant quality of life impact of allergic conditions suggest that quality of life impairment should be a key consideration when making treatment decisions in patients at risk for anaphylaxis.
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J Allergy Clin Immunol Pract · Sep 2017
Observational StudyAnaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup.
Data on the incidence and characteristics of pediatric anaphylaxis are scarce. Reported causes of anaphylaxis are mostly those suspected by the physician in the emergency department (ED), which may not coincide with the real triggers. ⋯ The incidence of anaphylaxis is higher in children than previously reported in adults from the same center, and food is the trigger in most cases. To prevent erroneous diagnoses, the etiology of anaphylaxis should be established after an appropriate workup.