Perioperative Anaphylaxis Gonzalez-Diaz, Sandra Nora; de Lira-Quezada, Cindy Elizabeth; Villarreal-Gonzalez, Rosalaura Virginia ...
Current treatment options in allergy,
06/2020, Letnik:
7, Številka:
2
Journal Article
Recenzirano
Purpose of the review
Perioperative anaphylaxis is a severe, systemic hypersensitivity reaction of rapid onset, that is generally unpredictable, may be life-threatening, and occurs after the use of ...different drugs, substances, or stimuli during an anesthetic or surgical procedure.
Recent findings
The potential causes of reactions during procedures depend on the moment it occurs. In the induction phase, neuromuscular blockers, intravenous antibiotics, and opioids should be considered. During the procedure, along with antibiotics and opioids, other causes include local anesthetics, nonsteroidal anti-inflammatory agents (NSAIDs), contrast media, clorhexidin, and latex. In the recovery phase, the most common agents are latex and medications which reverse anesthesia effects. Recently, sugammadex has been discovered to be an important causal agent.
Summary
Early onset of treatment is essential in anaphylaxis and could prevent complications or death. The management is the same in all ages following the accepted protocols for the management of anaphylaxis. Adrenaline is the treatment of choice. A complete review of the clinical and perioperative history is essential before any procedure in patients with prior anaphylaxis. It is recommended that surgeons and anesthesiologists communicate each other their concerns and ask the allergist if there is a doubt about an allergic reaction.
Asthma and allergic diseases have increased in recent decades and are more common in industrialized countries. Industrial areas with a considerably high number of inhabitants and vehicles can favor ...the presence of serious air pollution and therefore the appearance and exacerbation of respiratory allergy symptoms. The objective of this study was to determine the relationship between exposure to environmental pollutants with exacerbation of respiratory allergy.
A total of 240 subjects above 6 years old who lived in the metropolitan area of Monterrey, Nuevo León, Mexico, with diagnosis of allergic rhinitis and/or asthma, were included. The subject's address was registered in the database and the rhinitis control assessment test (RCAT) and the asthma control test (ACT) were applied. Environmental data were obtained from the Environmental Monitoring System (SIMA) of Nuevo León. Geolocation of industries and avenues in proximity of subject's addresses and SIMA stations were obtained through geographic information systems using ArcGis software.
The relation between pollutants and subjects’ RCAT, ACT, and spirometry results in the 14 stations was established. PM10 and forced vital capacity (FVC) had an r = 0.074 with p = 0.005, PM10 and absolute FEV1/FVC ratio presented an r = −0.102 with a p = 0.000; The distance found to be associated with a worsening of respiratory symptoms was living 165 m from a main road or 241 m from an industrial establishment.
Exposure to pollutants present in the environment are factors associated with increased symptoms in subjects with respiratory allergies.
Randomized Clinical Trials (RCTs) are important tools to establish the effects of a given intervention. Investigators should focus on outcomes that patients perceive: patient-important outcomes ...(PIOs), clinical endpoints that patients value directly and reflect how they feel, function, or survive. However, it is easier to consider surrogated outcomes to reduce costs and achieve better-looking results. The problem with these outcomes is that they indirectly measure PIOs, which might not correlate linearly or translate reliably into a positive PIO.
We systematically searched MEDLINE for atopic disease RCTs rated among the top 10 allergic diseases and general internal medicine journals from the last 10 years. Two independent reviewers worked in duplicate and independently to collect data from all eligible articles. We gathered information regarding the type of study, title, author information, journal, intervention type, atopic disease, and primary and secondary outcomes. We assessed the outcomes investigators used in RCTs of atopic diseases and asthma.
This quantitative analysis included n = 135 randomized clinical trials. The most studied atopic disease during the period selected was asthma (n = 69), followed by allergic rhinitis (n = 51). When divided by atopic disease, primary outcomes in RCTs valuing allergic rhinitis had the most significant proportion of PIOs (76.7), asthma surrogated outcomes (38), and asthma/allergic rhinitis laboratory outcomes (42.9). PIOs in allergic rhinitis trials had the most significant proportion of PIOs favoring the intervention (81.4), asthma had the greatest proportion of surrogated outcomes (33.3), and asthma/allergic rhinitis laboratory outcomes (40). When divided by atopic disease, trials studying atopic dermatitis and urticaria had the same proportion of PIOs (64.7) as their secondary outcomes. Asthma had the highest (37.5) surrogate outcomes. Journals of general/internal medicine had a greater proportion of PIOs, and a post hoc analysis showed a significant difference in the proportion and secondary outcomes that favored the intervention between PIOs and laboratory outcomes.
Approximately 7.5 out of 10 primary outcomes in RCTs published in general/internal medicine are PIOs compared to 5 out of 10 primary outcomes in atopic disease journals. Investigators should focus on selecting patient-important outcomes in their clinical trials to establish clinical guidelines with better-quality recommendations that impact patients’ life and values.
International Prospective Register of Systematic Reviews (PROSPERO, NIHR) ID: CRD42021259256.
Allergic diseases are one of the most frequent chronic diseases in the world. It has been established that there is a worldwide epidemic of allergic diseases; therefore, the treatment of allergies ...should be acknowledged as a worldwide priority and the specialty of allergy should be considered an important field in medicine. Due to the fact that allergic diseases involve many organs, and Allergy and Clinical Immunology is one of the specialties in which physicians may be trained to treat patients of all ages, the subject in medical schools is not always taught as an individual specialty but often as part of another subject such as internal medicine or pediatrics.
Certified allergists are an important contribution to health systems, providing the necessary care for patients who have allergic diseases. Undergraduate programs in many universities do not include allergy as a subject, contributing to a lack of knowledge regarding the correct management of allergic diseases. World Health Organization (WHO) recommends 1 allergist per 50,000 people; however, there is an uneven distribution of allergy and clinical immunology specialists. Most practitioners are localized mainly in larger cities and state capitals, while in other regions, specialists are still greatly needed. Support and training systems are required for allergy and clinical immunology specialists to promote continuing education and keep their clinical competence up to date, which will lead to better care for their patients. Increased exposure to the concepts of allergy and clinical immunology diagnosis and treatment in undergraduate education may also potentially lead to an increase in interest in the field of allergy and clinical immunology among physicians in training. This review will approach allergy education in Mexico and other parts of Latin America.
Introduction Sick building syndrome (SBS) refers to non-specific complaints, including upper-respiratory irritative symptoms, headaches, fatigue, and rash, which are usually associated with a ...particular building by their temporal pattern of occurrence and clustering among inhabitants or colleagues. The aim of the study was to determine the association between the clinical manifestations of sick building syndrome with outdoor pollutants and airborne pollen. Methods It was a descriptive and prospective observational study conducted from November 2021 to April 2022. It included subjects over 18 years old who completed an online survey on sick building syndrome (general symptoms, nasal, ocular, oropharyngeal, and skin symptoms) presented at home, housing information and personal history. The APS-330 from Pollen Sense ® was used to obtain data on pollen in the air and the local pollution monitoring system (SIMA) to obtain information regarding pollutants. For statistical analysis, SPSS version 16 was used. Results A total of 402 surveys were included; 91% of the subjects reported having at least 1 symptom. Females presented more general symptoms (fatigue and headache) than males. Subjects with a personal history of atopy showed a higher prevalence of practically all symptoms. Airborne pollen exposure was positively associated with mucosal symptoms in eyes and nose. Outdoor fungi spore exposure was positively associated with oculo-nasal and cutaneous symptoms in the scalp. Conclusion This study found significant associations with female gender and a history of atopy, which suggests a higher risk for these subjects. Despite the limitations of the study, we can conclude that there is an association between the clinical manifestations of sick building syndrome with indoor and outdoor pollution.
The most implicated microorganism in allergic rhinitis (AR) is Staphylococcus aureus (S. aureus), which sets super-antigens free that activate T cells, causing higher inflammatory response, that can ...lose control and may not respond to treatment. Conclusions Our data suggest that AR patients have higher levels of specific IgE for S. aureus. ...it is necessary to identify in patients who present with frequent exacerbations
Methods We reviewed a total of 40 records of adult asthmatic patients that were consulted at the Regional Center of Allergy and Clinical Immunology at the University Hospital in Monterrey, Mexico and ...to whom the EBT was measured. Conclusions Patients with uncontrolled asthma and higher doses of inhaled corticosteroids showed significant difference in EBT measurements compared to controlled asthma, establishing the EBT as a useful biomarker.
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