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Prenzel F, Nissler K, Siekmeyer M, Vom Hove M, Schleicher G, Kiess W, Lipek T. Got a Pen for Allergen Immunotherapy? Lessons from Near-Fatal Anaphylaxis with Pulmonary Edema. J Asthma Allergy 2020; 13:753-756. [PMID: 33408488 PMCID: PMC7781355 DOI: 10.2147/jaa.s287315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022] Open
Abstract
On our pediatric intensive care unit, we successfully treated a 10-year-old boy with severe pulmonary edema due to anaphylaxis after his last injection of a 3-year course of allergen immunotherapy (AIT). In view of the severity of the adverse event, we initiated a case analysis with all involved medical professionals. The evaluation revealed delayed administration of epinephrine due to dosing uncertainty and underestimation of severity. Consequently, all involved institutions established epinephrine auto-injectors (EAIs) in their emergency equipment. We suggest providing EAIs in every practice conducting AIT, as well as in pediatric emergency rooms and ambulances. We would like to remind readers of the risk of anaphylaxis, even on the last day of AIT.
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Affiliation(s)
- Freerk Prenzel
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.,Leipzig Interdisciplinary Center for Allergy (LICA), Leipzig, Germany
| | - Karl Nissler
- Department of Pediatrics, Sana Hospitals Leipzig Region, Borna, Germany
| | - Manuela Siekmeyer
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany
| | - Maike Vom Hove
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.,Leipzig Interdisciplinary Center for Allergy (LICA), Leipzig, Germany
| | | | - Wieland Kiess
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany
| | - Tobias Lipek
- Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.,Leipzig Interdisciplinary Center for Allergy (LICA), Leipzig, Germany
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2
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Spindola MAC, Solé D, Aun MV, Azi LMTDA, Bernd LAG, Garcia DB, Capelo AV, Cumino DDO, Lacerda AE, Lima LC, Morato EF, Nunes RR, Rubini NDPM, da Silva J, Tardelli MÂ, Watanabe AS, Curi EF, Sano F. [Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:534-548. [PMID: 33077175 PMCID: PMC9373446 DOI: 10.1016/j.bjan.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/17/2020] [Accepted: 06/20/2020] [Indexed: 11/20/2022]
Abstract
Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
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Affiliation(s)
- Maria Anita Costa Spindola
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil; Sociedade Brasileira de Anestesiologia, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Associação Brasileira de Alergia e Imunologia, Brazil
| | - Marcelo Vivolo Aun
- Associação Brasileira de Alergia e Imunologia, Brazil; Faculdade Israelita de Ciências da Saúde Albert Eisntein, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital Universitário, São Paulo, SP, Brazil
| | - Liana Maria Tôrres de Araújo Azi
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
| | - Luiz Antonio Guerra Bernd
- Associação Brasileira de Alergia e Imunologia, Brazil; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Daniela Bianchi Garcia
- Sociedade Brasileira de Anestesiologia, Brazil; Hospital Infantil Pequeno Príncipe, Curitiba, PR, Brazil
| | - Albertina Varandas Capelo
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade Federal do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil
| | | | - Alex Eustáquio Lacerda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Associação Brasileira de Alergia e Imunologia, Brazil
| | - Luciana Cavalcanti Lima
- Associação Brasileira de Alergia e Imunologia, Brazil; Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Edelton Flávio Morato
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Rogean Rodrigues Nunes
- Sociedade Brasileira de Anestesiologia, Brazil; Hospital Geral de Fortaleza (HGF), Departamento de Anestesia, Fortaleza, CE, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jane da Silva
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil; Sociedade Brasileira de Anestesiologia, Brazil
| | - Maria Ângela Tardelli
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Alexandra Sayuri Watanabe
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Erick Freitas Curi
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Flávio Sano
- Associação Brasileira de Alergia e Imunologia, Brazil; Hospital Nipo Brasileiro, São Paulo, SP, Brazil
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Spindola MAC, Solé D, Aun MV, Azi LMTDA, Bernd LAG, Garcia DB, Capelo AV, Cumino DDO, Lacerda AE, Lima LC, Morato EF, Nunes RR, Rubini NDPM, da Silva J, Tardelli MÂ, Watanabe AS, Curi EF, Sano F. Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) – Part I: post-crisis guidelines and treatment. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 33077175 PMCID: PMC9373446 DOI: 10.1016/j.bjane.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Maria Anita Costa Spindola
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil; Sociedade Brasileira de Anestesiologia, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Associação Brasileira de Alergia e Imunologia, Brazil
| | - Marcelo Vivolo Aun
- Associação Brasileira de Alergia e Imunologia, Brazil; Faculdade Israelita de Ciências da Saúde Albert Eisntein, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital Universitário, São Paulo, SP, Brazil
| | - Liana Maria Tôrres de Araújo Azi
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
| | - Luiz Antonio Guerra Bernd
- Associação Brasileira de Alergia e Imunologia, Brazil; Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Daniela Bianchi Garcia
- Sociedade Brasileira de Anestesiologia, Brazil; Hospital Infantil Pequeno Príncipe, Curitiba, PR, Brazil
| | - Albertina Varandas Capelo
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade Federal do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil
| | | | - Alex Eustáquio Lacerda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Associação Brasileira de Alergia e Imunologia, Brazil
| | - Luciana Cavalcanti Lima
- Associação Brasileira de Alergia e Imunologia, Brazil; Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Edelton Flávio Morato
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil
| | - Rogean Rodrigues Nunes
- Sociedade Brasileira de Anestesiologia, Brazil; Hospital Geral de Fortaleza (HGF), Departamento de Anestesia, Fortaleza, CE, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jane da Silva
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil; Sociedade Brasileira de Anestesiologia, Brazil
| | - Maria Ângela Tardelli
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Alexandra Sayuri Watanabe
- Associação Brasileira de Alergia e Imunologia, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Erick Freitas Curi
- Sociedade Brasileira de Anestesiologia, Brazil; Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Flávio Sano
- Associação Brasileira de Alergia e Imunologia, Brazil; Hospital Nipo Brasileiro, São Paulo, SP, Brazil
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Macharadze T, Davies A, Fedor I. A Well-Trained Team During Anaphylactic Shock After Rocuronium in a Patient With Aortic Stenosis: A Case Report. Front Med (Lausanne) 2020; 6:305. [PMID: 31998727 PMCID: PMC6962115 DOI: 10.3389/fmed.2019.00305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
A 66-year-old patient with aortic stenosis was scheduled for an aortic valve replacement and coronary artery bypass surgery. Anesthesia was induced by intravenous injection of midazolam, fentanyl, and propofol. After administration of rocuronium, he developed anaphylactic shock, which was diagnosed by clinical signs, vital parameters, and unresponsiveness to the usual vasopressors. After 30 min of cardiopulmonary resuscitation, the patient survived without any neurological deficits. This case is a reminder that early recognition and treatment of intraoperative hypersensitivity reactions are imperative. Anesthetists should also receive simulation training to achieve an adequate experience in a safe environment. With a well-trained team, it is possible to save the life of patients with aortic stenosis.
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Affiliation(s)
- Tamar Macharadze
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital Manchester University, Manchester, United Kingdom.,Department of Molecular Biology, Davit Tvildiani Medical University, Tbilisi, Georgia
| | - Andrew Davies
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital Manchester University, Manchester, United Kingdom
| | - Igor Fedor
- Cardiothoracic Critical Care Unit, Wythenshawe Hospital Manchester University, Manchester, United Kingdom
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Perioperative anaphylaxis-management and outcomes in NAP6. Br J Anaesth 2018; 121:120-123. [PMID: 29935563 DOI: 10.1016/j.bja.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
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