Anaphylaxis avoidance and management: educating patients and their caregivers

Addressing knowledge gaps in allergies among Syrian hospital patients: a cross-sectional study

Allergies have a significant impact on health and quality of life worldwide, yet there is limited research on the awareness and knowledge of allergies. This study aimed to explore the level of awareness and knowledge of allergies among visitors in Syrian hospitals. A cross-sectional study was conducted between May and September 2022, and a standardized international questionnaire was administered to 504 visitors in three hospitals in Syria. Data analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 23. The final sample comprised 504 questionnaires with 61.7% of participants achieving an average score. Statistical analysis revealed a significant difference in knowledge of allergy scores between the group with only elementary education (M = 3.76, SD = 1.67, p = 0.011), the group with no education (M = 3.65, SD = 1.65, p = 0.006), and the group with a university education (M = 4.44, SD = 1.25). Notably, no significant differences were found between the other educational groups. A one-way ANOVA was employed to assess the effect of place of living on knowledge of allergy, but no significant differences were observed between the groups (p = 0.462). Lastly, a significant negative correlation was detected between participant age and knowledge of allergy scores (r(502) = - 0.102, p = 0.022). Allergies represent a substantial global health concern that demands attention from healthcare providers, policymakers, and the public. This study emphasizes the importance of investing in health education and awareness campaigns to enhance knowledge and comprehension of allergies, particularly individuals with lower levels of education levels. By equipping individuals with the requisite information to effectively manage their allergies, their overall health and wellbeing can be improved.

Hypertensive Anaphylaxis After Moderna COVID-19 Vaccination: A Case Report

Hypotension after exposure to an allergen is a well-known indicator of an anaphylactic reaction. However, hypertensive anaphylaxis often goes unrecognized. Increased blood pressure can present as an anaphylactic reaction, which is called hypertensive anaphylaxis. A 48-year-old woman complained of a tickle sensation in the throat and dyspnea 30 minutes after being administered the first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. The patient had no history of hypertension, anxiety, or panic disorder. Forty-five minutes after the vaccination, stridor was noted, and the patient developed severe hypertension with a blood pressure of 197/153 mmHg. The patient also had tachycardia, cervical angioedema, and nausea, which occurred in a short period of time, indicating type I hypersensitivity reaction, that is, an anaphylactic reaction. The patient was diagnosed with Brighton classification Level 1 anaphylaxis caused by COVID-19 vaccination. For managing the patient, two intramuscular adrenaline injections, famotidine, chlorpheniramine, metoclopramide, and methylprednisolone were administered via intravenous infusion. After the administration of medications, all symptoms resolved, and the blood pressure was reduced. Other differential diagnoses for increased blood pressure after vaccination were excluded; therefore, we concluded that this phenomenon of increased blood pressure was hypertensive anaphylaxis. Not only hypotension but also the acute onset of increased blood pressure after vaccination may occur as a premonitory symptom of anaphylaxis. In hypertensive anaphylaxis, both anaphylaxis and increased blood pressure can be treated with intramuscular adrenaline injection. Clinicians should be aware of the occurrence of hypertensive anaphylaxis.

Pediatric Allergy: An Overview

Allergy is a broad topic encompassing common clinical allergic diseases, asthma, and complex immunodeficiencies. In this article, the authors discuss the most common allergic diseases and anaphylaxis and briefly review the current knowledge and management of food allergies, allergic rhinitis, otitis media, sinusitis, chronic cough, atopic dermatitis, urticarial and angioedema, contact dermatitis, allergic ophthalmopathy, drug allergy, latex allergy, and insect sting. Because the prevalence of allergic disorders continues to increase, it is increasingly important for physicians to stay up to date on most recent evidence-based diagnosis and management of allergic disorders.

Idiopathic anaphylaxis: What you do not know may hurt you

Idiopathic anaphylaxis (IA), like immunologic and nonimmunologic anaphylaxis, is a life-threatening, sometimes fatal allergic disease. Although the priority is immediate recognition and initiation of treatment, long-term care planning is important to help reduce anxiety and promote healthy growth and development. Learning to recognize, manage, and stabilize the child is an essential part of improving the family dynamics. Despite advancements in the management of anaphylaxis, research has shown a need for continued patient education and training to improve timely recognition and treatment. This article focuses on elucidating the clinical presentation, theories of pathogenesis, and diagnosis, treatment, and management of IA.

Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

Background

The aetiology of anaphylaxis differs according to types of foods consumed, fauna and foliage and cultural practices. Although the aetiology of anaphylaxis in Western countries are well known, the causes in South Asian countries have not been reported. We sought to determine the causes of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka.

Methods

238 episodes of anaphylaxis were reviewed in 188 patients who were referred and skin prick tests and in vitro tests (ImmunoCap) were carried out to assess the presence of allergen specific IgE. Clinical features and severity of anaphylaxis was also recorded along with treatment received.

Results

Anaphylaxis to food either following direct exposure 90/238 (37.5%) or after exercise in the form of food dependent exercise induced anaphylaxis 29/238 (12.2%) was the predominant cause of anaphylaxis. Allergy to cow's milk and red meat, after immediate exposure, accounted for 66/238 (27.7%) of instances of all episodes of anaphylaxis and 66/90 (73.33%) of anaphylaxis due to food. Vaccines accounted for 28/238 (11.8%) of instances of anaphylaxis, especially among children. Of those who developed anaphylaxis to the MMR (n = 14), 71.4% of them had specific IgE to cow's milk and 35.7% of them had specific IgE to beef. Of those who developed anaphylaxis to insect stings, 27/42 of these episodes occurred following stings of ants (family Formicidae). The predominant cause of anaphylaxis changed with the age, with food allergy being the most frequent trigger of anaphylaxis in childhood, while drug allergy and idiopathic anaphylaxis being more frequent after 30 years of age.

Conclusions

In this cohort, anaphylaxis to red meat appears to be the predominant cause of food induced anaphylaxis and presence of beef specific IgE and cow's milk, appears to be a predisposing factor for vaccine induced anaphylaxis.

Anaphylactic reactions presenting with hypertension

Background

Although a few case reports about hypertensive anaphylaxis (HA) are available in the present literature, there is no study about the prevalence of HA. In this study, we review our cases with anaphylaxis presenting with hypertension and ascertain its prevalence. The documents of the patients who had anaphylactic reactions after the procedures performed for the diagnosis and treatment of allergic diseases in GATA Haydarpasa Clinic of Allergy and Immunology between January 2010 and December 2014 were retrospectively reviewed. Within the study period, 324 patients had undergone 4332 procedures in which 62 of them had developed anaphylaxis.

Results

During the procedures, the rate of anaphylaxis was found to be 1.43 %. The rate of HA among the anaphylaxis patients was 12.9 % (8 of 62 patients). During treatments, 2 patients received adrenaline injections without any adverse reaction.

Conclusions

HA may be seen at a considerable rate during an anaphylactic reaction. Anaphylaxis and hypertension can be recovered by adrenaline injection when required. According to the best of our knowledge, this study is the first original study about the prevalence of HA in English-language medical literature.

Platelet activating factor in allergies

The platelet-activating factor (PAF) produced and released by mast cells, basophils, neutrophils, eosinophils, fibroblasts, platelets, endothelial cells, and even cardiac muscle cells plays an important role in inflammatory and thrombotic diseases. PAF has been shown to be an important mediator in anaphylaxis. Serum level of the factor correlates with the severity of systemic reactions. PAF is also involved in asthamatic patients' bronchoconstriction, mucus hypersecretion, and inflammation of bronchi. Furthermore, increased plasma levels of PAF have been reported in patients with urticarial. Studies have shown that PAF increases the permeability of skin's capillaries and indices the development of wheals, flare, and inflammatory reactions in the skin.This review focuses on the actions of the PAF on the eosinophiles and mast cells. Following that pathophysiological mechanism of the PAF in anaphylaxis bronchial asthma and urticaria was discussed.