Summary
Background
Anaphylaxis hospitalizations are increasing in many countries, in particular for medication and food triggers in young children. Food‐related anaphylaxis remains an uncommon cause ...of death, but a significant proportion of these are preventable.
Aim
To review published epidemiological data relating to food‐induced anaphylaxis and potential risk factors of fatal and/or near‐fatal anaphylaxis cases, in order to provide strategies to reduce the risk of severe adverse outcomes in food anaphylaxis.
Methods
We identified 32 published studies available in MEDLINE (1966‐2017), EMBASE (1980‐2017), CINAHL (1982‐2017), using known terms and synonyms suggested by librarians and allergy specialists.
Results
Young adults with a history of asthma, previously known food allergy particularly to peanut/tree nuts are at higher risk of fatal anaphylaxis reactions. In some countries, cow's milk and seafood/fish are also becoming common triggers of fatal reactions. Delayed adrenaline injection is associated with fatal outcomes, but timely adrenaline alone may be insufficient. There is still a lack of evidence regarding the real impact of these risk factors and co‐factors (medications and/or alcohol consumption, physical activities, and mast cell disorders).
Conclusions
General strategies should include optimization of the classification and coding for anaphylaxis (new ICD 11 anaphylaxis codes), dissemination of international recommendations on the treatment of anaphylaxis, improvement of the prevention in food and catering areas, and dissemination of specific policies for allergic children in schools. Implementation of these strategies will involve national and international support for ongoing local efforts in relationship with networks of centres of excellence to provide personalized management (which might include immunotherapy) for the most at‐risk patients.
Oral immunotherapy (OIT) is now recognized as an alternative active treatment to strict food avoidance in certain patients with IgE-mediated food allergy. Studies have confirmed the efficacy of OIT ...to desensitize children with allergy to cow's milk, eggs, and peanuts. The benefits, risks, and constraints of OIT are becoming increasingly well understood. However, there is no consensual criteria to select patients to whom OIT could be proposed, and many issues remain to address including the definitions of desensitization and long-term efficacy, the assessment of patient's experience in real life, the optimization of buildup and maintenance protocols, and the utility of multiple food OIT. The recent authorization by medical agency concerning the first medicine for peanut OIT is a step forward towards higher standardization in the practice of OIT. This article summarizes in comprehensive narrative format data on efficacy, tolerance, impact on quality of life and adverse effects of OIT and discuss elements to consider in clinical practice before starting OIT.
To the Editor: Anaphylaxis-related mortality (AMR) has been estimated at less than 1 per million population from the United States and the United Kingdom.1-3 In these countries, the AMR remained ...stable during the last decade.1-3 In contrast, the incidence of anaphylaxis fatalities increased in Australia from 1997 to 2013.4 The most common triggers of fatal anaphylaxis cases are drugs, insect venoms, and foods, with drugs accounting for most of the fatalities.1-4 In France, comprehensive data from anaphylaxis-related deaths are collected by the National Mortality Center. Advancing age is known to be another risk factor for fatal anaphylaxis.1-3 This is likely explained by underlying comorbidities, such as cardiovascular or cerebrovascular diseases, and also by an increased medication use.1 Fatal anaphylaxis is mostly due to medications, mainly antibiotics, as described in Australia and the United States.2-4 Our data showed a decrease in antibiotic-related fatal cases, especially during the last decade, in line with the decrease of 10.7% in antibiotic consumption reported in France (ANSM report 20136). ...our work is the longest time period study reporting AMR. Appendix Table E1Characteristics of anaphylaxis fatalities by specific cause Characteristic Anaphylaxis Iatrogenicn = 1011 (63%) Insect stingsn = 220 (13.7%) Foodn = 8 (0.5%) Unspecifiedn = 364 (22.7%) Alln = 1603 (100%) Sex, n (%) Men 439 (56.0) 159 (20.3) 6 (0.8) 180 (23.0) 784 (100) Women 572 (69.8) 61 (7.4) 2 (0.2) 184 (22.5) 819 (100) Population Adult 993 (63.5) 217 (13.9) 6 (0.4) 348 (22.3) 1564 (100) Pediatric 18 (46.2) 3 (7.8) 2 (5.1)...
Therapeutic approach of anaphylaxis Tanno, Luciana Kase; Alvarez-Perea, Alberto; Pouessel, Guillaume
Current opinion in allergy and clinical immunology,
2019-August, Letnik:
19, Številka:
4
Journal Article
PURPOSE OF REVIEWAnaphylaxis is a recognized cause of death in all ages, which requires prompt recognition and treatment. We here propose to review the current and new pharmacological treatment of ...anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals with new tools that can be used to treat symptoms and prevent anaphylaxis.
RECENT FINDINGSThe recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and application of precision medicine. Several biologic therapies and new devices are emerging as potential preventive treatment for anaphylaxis.
SUMMARYAdrenaline (epinephrine) is still the first-line treatment for any type of anaphylaxis and is recognized as the only medication documented to prevent hospitalizations, hypoxic sequelae and fatalities. β2-adrenergic agonists and glucagon remains as the second-line treatment of anaphylaxis, meanwhile glucocorticoids and antihistamines should be used only as third-line treatment. Their administration should never delay adrenaline injection in anaphylaxis. More intuitive adrenaline autoinjectors design and features are required as well as a worldwide availability of adrenaline autoinjectors. Biological drugs, such as omalizumab, have been used as therapeutic adjuvants as a preventive treatment of anaphylaxis, but cost-effectiveness should be considered individually. Understanding the specifications of underlying mechanisms can potentially support improvements in the patients’ allergological work-up and open the opportunity of developments of potential new drugs, such as biological agents. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among healthcare providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
Peanut allergy (PA) has increased in developed countries and can have a dramatic effect on quality of life but data surrounding this is limited in France. Allergy to Peanuts imPacting Emotions And ...Life study (APPEAL) investigated the experience and impact of living with PA in France.
Respondents affected by PA directly (children aged 8-12 years, teenagers aged 13-17 years, or adults aged ≥ 18 years) or indirectly (caregiver) completed either an online questionnaire (APPEAL-1, N = 198), or provided in-depth interviews (APPEAL-2, N = 32). Quantitative data was evaluated using descriptive statistics. Qualitative data was analysed thematically, using MAXQDA software.
Of 198 responders in APPEAL-1, 88% stated that PA affects their daily activities, and 74% felt isolated as a result of living with PA. Feelings of worry about exposure to peanuts on social occasions where food is involved was reported by 91%. A total of 44% reported some restrictions in their job options, 85% in socializing. Psychological impact of PA included responders feeling emotions of frustration (89%), uncertainty (87%), and stress (93%) and 93% reporting encountering instances of feeling different due to their PA. Main factors that drove PA impact included social activities and relationships; whereas main coping strategies to avoid peanuts included monitoring, communication and planning.
The analysis of French respondents from the APPEAL study demonstrates the impact and burden of PA on allergic children, teenagers, adults and their caregivers, and highlights the unmet need to be addressed.
Anaphylaxis is a recognized cause of death for all ages. A better understanding of mortality data could help identify patients at risk and implement prevention measures. However, accurate ...epidemiological mortality data can differ widely due to a number of variables. Currently, the anaphylaxis-related mortality rate (AMR) is less than 1 per million population per year in most countries.1-6 In France, it was 0.83 per million population per year (95% CI, 0.80-0.88) for the period 1979-2011..6 However, data regarding anaphylaxis fatalities in children are scarce and vary from country to country. For example, the most common triggers of pediatric anaphylaxis fatalities the United Kingdom and Australia are food allergens, whereas drugs account for most of the pediatric anaphylaxis fatalities in the United States.
Article Note: See Pediatric Emergency Medicine Group in Acknowledgments CAPTION(S): Appendix S1-S2 Byline: Guillaume Pouessel, Marie Balerdi, Stephanie Lejeune, Valerie Deken, Francois Dubos, ...Matthieu Antoine, Antoine Deschildre,, S Akitani, M Amani, H Audry-Degardin, C Bonnel, M Boulyana, M Chenaud, E Cixous, F Chagnon, S Combes, F Delepoule, C Delvart, T Dhaoui, M Glowacki, M Gnansounou, O Guilluy, T Heuclin, N Kalach, A Le Mee, S Louf, A Martinot, A Martinet, S Mitha, D Penel, M Scalbert, C Thumerelle, C Trochu, Motohiro Ebisawa
Background
Anaphylaxis is a sudden multisystem allergic reaction which may result in a fatal outcome if not treated promptly. Guidelines worldwide suggest intramuscular adrenaline as the first‐line ...treatment for anaphylaxis outside a perioperative reaction. Adrenaline autoinjectors (AAIs) are widely used self‐administrable devices, especially in community settings. Different commercial AAIs have been authorized to be marketed in Europe. For an AAI to be efficacious, a rapid adrenaline delivery in patients, including those who are overweight or obese, resulting in an optimal cardiovascular (CV) response, is a key feature. AAIs are designed to achieve this requirement, which is reflected in their differing functional properties such as primary container selection, drug delivery mechanism (cartridge‐or syringe‐based), needle length, needle gauge, and adrenaline dose (150 μg, 300 μg, or 500 μg). However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices.
The purpose of this review
Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin‐to‐muscle distances of the participants.
Viruses are important triggers of asthma exacerbations. They are also detected outside of exacerbation. Alteration of anti-viral response in asthmatic patients has been shown although the mechanisms ...responsible for this defect remain unclear. The objective of this study was to compare in virus-infected and not-infected allergic asthmatic children, aged 6 to 16 years, admitted to hospital for a severe exacerbation, the innate immune response and especially the expression of pattern recognition receptor (PRR) and their function.
Virus identification was performed both during the exacerbation and at steady state (eight weeks later). Data assessed at both periods included clinical features, anti-viral response and inflammation (in sputum and plasma), and PRR expression/function in blood mononuclear cells.
Viruses were identified in 46 out of 72 children (median age 8.9 years) during exacerbation, and among them, in 17 at steady state. IFN-β, IFN-γ and IL-29 levels in sputum and plasma were similar between infected and not infected patients at both times, as well as the expression of TLR3, RIG-I and MDA5 in blood monocytes and dendritic cells. Airway inflammation in infected patients was characterized by significantly higher IL-5 concentration and eosinophil count. Compared to patients only infected at exacerbation, the re-infected children significantly exhibited lower levels of IFN-γ in plasma and sputum at exacerbation associated with modifications in PRR expression and function in blood mononuclear cells. These re-infected patients also presented an airway neutrophilic inflammation at steady state.
Our results reports in asthmatic children that impaired anti-viral response during virus-induced exacerbation is more pronounced in a subgroup of patients prone to re-infection by virus. This subgroup is characterized by altered PRR function and a different pattern of airway inflammation.
This multicenter prospective study was approved by the regional investigational review board (ref: 08/07).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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