Management of allergy transfer upon solid organ transplantation

Allergy transfer upon solid organ transplantation has been reported in the literature, although only few data are available as to the frequency, significance, and management of these cases. Based on a review of 577 consecutive deceased donors from the Swisstransplant Donor-Registry, 3 cases (0.5%) of fatal anaphylaxis were identified, 2 because of peanut and 1 of wasp allergy. The sera of all 3 donors and their 10 paired recipients, prospectively collected before and after transplantation for the Swiss Transplant Cohort Study, were retrospectively processed using a commercial protein microarray fluorescent test. As early as 5 days posttransplantation, newly acquired peanut-specific IgE were transiently detected from 1 donor to 3 recipients, of whom 1 liver and lung recipients developed grade III anaphylaxis. Yet, to define how allergy testing should be performed in transplant recipients and to better understand the impact of immunosuppressive therapy on IgE sensitization, we prospectively studied 5 atopic living-donor kidney recipients. All pollen-specific IgE and >90% of skin prick tests remained positive 7 days and 3 months after transplantation, indicating that early diagnosis of donor-derived IgE sensitization is possible. Importantly, we propose recommendations with respect to safety for recipients undergoing solid-organ transplantation from donors with a history of fatal anaphylaxis.

Space requirements for pharmaceutical functions in selected nonuniversity hospitals

The size of the average pharmacy is normally developed by gathering information from a large number of hospital pharmacies. The services provided by these pharmacies vary significantly. This tabulation is from selected hospitals that provided comprehensive pharmacy services. Fifty-four responses were tabulated. The results presented in this article indicate that these pharmacies require additional staff members and greater space allocation than the average hospital pharmacy department reported in other studies. Hospitals between 100-199 beds averaged 9.8 sq ft per bed, 200-299 bed hospitals averaged 10.1, 300-399 bed hospitals averaged 9, 400-499 bed hospitals averaged 8, and those over 500 beds averaged 9.4 sq ft per bed.

Coumarin necrosis

Necrosis of the skin developed soon after the initiation of coumarin therapy in an elderly woman. Inadvertent rechallenge resulted in similar lesions. Coumarin necrosis is a poorly understood phenomenon unlikely to respond to therapy. Fortunately, its incidence is quite rare, considering the widespread use of this anticoagulant.