Angioedema urticaria [keywords]
- Effect of ivermectin on allergy-type manifestations in occult strongyloidiasis. [JOURNAL ARTICLE]
- Ann Allergy Asthma Immunol 2016 Aug 23.
The immunomodulatory effects of helminths have been well described. However, there is a relative lack of literature regarding the link between parasites and allergic diseases. A number of patients with allergic symptoms have positive serologic test results for Strongyloides stercoralis.To identify patients with allergy-type symptoms and coexisting Strongyloides infection and to analyze the effect of Strongyloides eradication therapy with ivermectin on these symptoms.The medical records of our allergy clinic sites were reviewed for Strongyloides test results between January 2011 and October 2014. Each allergy-type symptom was assessed separately with regard to improvement after ivermectin therapy.Among the 1,446 patients who had Strongyloides serologic tests ordered, 127 (8.8%) had positive test results. Eighty-four patients had follow-up data regarding allergy-type symptoms after ivermectin treatment. Among these, 52 patients (61.9%) reported skin-related problems (pruritus, urticaria, angioedema, and/or rash). Forty-nine patients (58.3%) had asthma, and 73.8% had allergic rhinoconjunctivitis. Although respiratory symptoms typically did not respond to ivermectin treatment, 24 of 48 patients (50%) with skin symptoms reported a significant subjective improvement of symptoms after ivermectin treatment. Peripheral eosinophil counts significantly decreased after ivermectin treatment from 450 to 200/μL (P < .001).Serologic testing for strongyloides may be indicated for patients with allergy-type symptoms and a suggestive exposure history. Patients with strongyloidiasis and primarily cutaneous symptoms experienced significant symptomatic improvement after ivermectin therapy.
- [Evaluation and characterization of 125 patients with a history of reaction to beta-lactams]. [English Abstract, Journal Article]
- Rev Alerg Mex 2016 Jul-Sep; 63(3):227-36.
Reactions to beta-lactams are frequent and it is difficult to establish the relationship between the drug and symptoms.To describe the clinical characteristics and explore the immunological mechanisms of patients with suspected adverse reaction to beta-lactams.Retrospective study of patients with a history of beta-lactam reaction and tests for reactions to drugs.Out of 125 patients, 71 were women (56.8%); 73 had a history of immediate reaction and 52 delayed reaction; 590 allergy tests were done: specific IgE measurement, skin prick, patch, and provocation tests. The drugs most often related were amoxycillin, in 62 patients (49.6%), crystalline penicillin in 17 (13.6%), benzathine penicillin in 15 (12%), and cefalexin in 13 (10.4%). The severity of the reaction was mild in the majority (82%). 7.7% had a history of anaphylaxis and 10.8% sought care for a positive penicillin skin test, without history of reaction. Only 6.7% resulted in a positive test. More than 62% began testing two years after the reaction for which they sought care.The clinical history is insufficient to determine allergy to beta-lactams. In our sample, few patients with a history of beta-lactam reaction had evidence of immune-mediated reactions.
- A Rare Case of Hydromorphone-Induced Angioedema Effectively Managed by a Difficult Airway Response Team. [JOURNAL ARTICLE]
- A A Case Rep 2016 Aug 22.
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room. After being treated with antihistamines and steroids for 24 hours, the airway edema had resolved, leading to a successful extubation.
- Bacteriuria increases the risk of edematous attacks in hereditary angioedema with C1-inhibitor deficiency. [JOURNAL ARTICLE]
- Allergy 2016 Aug 22.
Urinary tract infections are considered among the most common infectious disorders in humans. Various infections may have a role in inducing HAE attacks. Our study intended to evaluate bacteriuria in the urinalysis of C1-INH-HAE patients.Urine specimens contributed by 139 C1-INH-HAE patients at the annual control visits were studied retrospectively for microorganisms. We analyzed the presence of bacteriuria in relation to the clinical symptoms.Taking into account 3 randomly selected urine specimens, we found that the cumulative number of edematous attacks was higher in patients with than in those without bacteriuria (p=0.019, p=0.022, p=0.014). Considering the same patients, attack number was significantly higher (14.51 vs. 8.63) in patients with than in those without bacteriuria (p<0.0001).In patients with bacteriuria, we found a higher incidence of edema formation during the year before evaluation, which may suggest the triggering role of bacteriuria in the occurrence of edematous episodes. This article is protected by copyright. All rights reserved.
- Anaphylaxis. [Journal Article, Review]
- Prim Care 2016 Sep; 43(3):477-85.
Anaphylaxis is an acute, systemic reaction mediated by immunoglobulin E hypersensitivity. Release of bioactive factors causes vasodilation and bronchiole constriction that can lead to hypotensive shock and asphyxiation. Differential diagnosis includes acute asthma, localized angioedema, syncope, and anxiety/panic attacks. Diagnostic tests lack specificity. Clinical diagnosis is based on demonstration of specific airway or cardiovascular compromise within proximity of allergen exposure. Treatment includes epinephrine, antihistamines, fluid resuscitation, and airway management. Prevention focuses on awareness/avoidance of triggers, implementation of personalized action plans, as well as immune modulation by desensitization in a closely controlled setting where available.
- Allergic Dermatoses. [Journal Article, Review]
- Prim Care 2016 Sep; 43(3):433-49.
The purpose of this article is to review the current available material pertaining to atopic dermatitis, contact dermatitis, urticaria, and angioedema. This article focuses on each disease process's clinical presentation, diagnosis, and management. Although atopic dermatitis and contact dermatitis are similar, their development is different and can affect a patient's quality of life. Urticaria and angioedema are also similar, but the differentiation of the two processes is crucial in that they have significant morbidity and mortality, each with a different prognosis.
- A case of eperisone hydrochloride-induced anaphylaxis: A true type I reaction? [LETTER]
- Allergol Int 2016 Aug 17.
- A nationwide study of acquired C1-inhibitor deficiency in France: Characteristics and treatment responses in 92 patients. [Journal Article]
- Medicine (Baltimore) 2016 Aug; 95(33):e4363.
Acquired angioedema (AAE) due to C1-inhibitor (C1INH) deficiency is rare. Treatment options for acute attacks are variable and used off-label. Successful treatment of the associated lymphoma with rituximab seems to prevent acute attacks in subjects with AAE. The aim of this study was to describe AAE manifestations, its associated diseases, and patients' responses to treatments in a representative cohort.A retrospective nationwide study was conducted in France. The inclusion criteria were recurrent angioedema attacks and an acquired decrease in functional C1INH <50% of the reference value.A total of 92 cases were included, with a median age at onset of 62 years. Facial edema and abdominal pain were the most frequent symptoms. Fifteen patients were hospitalized in the intensive care unit because of laryngeal edema, and 1 patient died. Anti-C1INH antibodies were present in 43 patients. The associated diseases were primarily non-Hodgkin lymphoma (n = 44, with 24 splenic marginal zone lymphomas) and monoclonal gammopathy of undetermined significance (n = 24). Three patients had myeloma, 1 had amyloid light-chain (of immunoglobulin) (AL) amyloidosis, 1 patient had a bronchial adenocarcinoma, and 19 patients had no associated disease. Icatibant relieved the symptoms in all treated patients (n = 26), and plasma-derived C1INH concentrate in 19 of 21 treated patients. Six patients experienced thromboembolic events under tranexamic acid prophylaxis. Rituximab prevented angioedema in 27 of 34 patients as a monotherapy or in association with chemotherapy. Splenectomy controlled AAE in 7 patients treated for splenic marginal zone lymphoma. After a median follow-up of 4.2 years, angioedema was on remission in 52 patients.AAE cases are primarily associated with indolent lymphoma-especially splenic marginal zone lymphoma-and monoclonal gammopathy of undetermined significance but not with autoimmune diseases or other conditions. Icatibant and plasma-derived C1INH concentrate control attacks; splenectomy and immunochemotherapy prevent angioedema in lymphoma setting.
- Determinants of angiotensin converting enzyme-inhibitor (ACEI) intolerance and angioedema in the UK clinical practice research datalink. [JOURNAL ARTICLE]
- Br J Clin Pharmacol 2016 Aug 15.
In this study we aimed to describe the occurrence and determinants of ACE-inhibitor (ACEI) intolerance and angioedema (AE) among patients initiating ACEI therapy in a real-world primary care population.Two nested case-control studies were conducted in a cohort of 276,977 patients aged ≥ 45 years initiating ACEIs from 2007 to 2014 in the UK Clinical Practice Research Datalink (CPRD). Cases of AE occurring for the first time during ACEI therapy (n = 416) were matched with AE-free controls (n = 4,335) on the duration of ACEI treatment. Switching to ARBs in the prescription records was used to identify ACEI intolerance cases (n = 24,709) which were matched with continuous ACEI users (n = 84,238) on the duration of ACEI therapy. Conditional logistic regression was used to assess the associations of demographic factors, co-morbidities and co-medication with AE and ACEI intolerance.AE during ACEI therapy was associated with age over 65 years (OR 1.36, 95%CI: 1.07-1.73), history of allergy (OR 1.53, 95%CI: 1.19-1.96), use of calcium channel blockers (OR 1.57, 95% CI 1.23; 2.01), anti-histamines (OR 21.25, 95%CI 16.44; 27.46) and systemic corticosteroids (OR 4.52, 95% CI: 3.26, 6.27). ACEI intolerance was significantly associated with more co-morbidities and co-medication compared to AE, including allergy (OR 2.02, 95% CI 1.96; 2.09), use of anti-asthmatic drugs (OR 1.51, 95% CI 1.42; 1.61) and anti-histamines (OR 1.53, 95% CI 1.43; 1.63).Among ACEI users developing AE or ACEI intolerance several co-morbidities and co-medication classes were significantly more prevalent compared to ACEI users not developing these adverse reactions. This article is protected by copyright. All rights reserved.
- International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1-Inhibitor deficiency. [JOURNAL ARTICLE]
- Allergy 2016 Aug 9.
The consensus documents published to date on hereditary angioedema with C1-inhibitor deficiency (C1-INH-HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1-INH-HAE.During an expert panel meeting that took place during the 9th C1-Inhibitor Deficiency Workshop in Budapest, 2015 [w w w.haenet. hu], pediatric data were presented and discussed and a consensus developed by voting.The symptoms of C1-INH-HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1-INH-HAE but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before the age of 1 year, C1-INH levels may be lower than in adults; therefore, it is advisable to confirm the diagnosis after the age of one year. All neonates/infants with an affected C1-INH-HAE family member should be screened for C1-INH deficiency. Pediatric patients should always carry a C1-INH-HAE information card, and medicine for emergency use. The regulatory approval status of the drugs for prophylaxis and for acute treatment is different in each country. Plasma-derived C1-INH, recombinant C1-INH, and ecallantide are the only agents licensed for the acute treatment of pediatric patients. Clinical trials are underway with additional drugs. It is recommended to follow-up patients in an HAE comprehensive care centre.The Pediatric-focused International Consensus for the diagnosis and management of C1-INH-HAE patients was created. This article is protected by copyright. All rights reserved.