What is in an allergy steroid shot
Topical corticosteroids include medications that you rub on your skin and intranasal medications that you spray into your nostrils. Reactions to these drugs tend to be mild and are believed to happen in as numerous as 6% of cases.
If a topical steroid allergy is suspected, it is often hard to discern whether the rash is related to the drug or is simply a worsening of the underlying condition. Similarly, a reaction to an inhaled corticosteroid could as easily be blamed on the underlying allergy.
Oftentimes, a person will suspect a steroid allergy if a topical or inhaled agent causes a diverse type of reaction (such as the appearance of a rash following the use of a decongestant spray).
More often than not, an allergy will be suspected if the condition worsens or fails to improve with treatment.
Diagnosis would involve allergy patch testing. Commercially available assays, such as the TRUE test, can assess a person's sensitivity to a wide range of corticosteroid drugs.
Patch testing can be tricky, however, since the anti-inflammatory effects of the steroids can sometimes dampen the reaction and lead to a untrue negative result.
Systemic Steroid Allergy
Systemic corticosteroids include both oral and injected formulations.
They are considered systemic because they are distributed through the entire body as opposed to localized treatment.
While systemic reactions are rare, they can be life-threatening. Those that develop rapidly are considerably more dangerous. Systemic reactions can develop in one of two ways:
Immediate reactions most often happen within an hour of a drug being taken. Symptoms may include hives, facial swelling, respiratory distress, rapid heart rate, fever, confusion, and a blistering skin rash.
The diagnosis would involve the use of a skin test and/or radioallergosorbent (RAST) test. Since the tests are prone to untrue negatives, a negative result should be followed by a drug challenge (in which a person is given a low dose of the drug to see if he or she reacts).
Non-immediate reactions are generally mild and can happen up 48 hours following the use of an oral or injected drug. Symptoms may include hives or a disseminated (widespread) rash. While a skin or patch test may be used to diagnose the condition, the reading should be delayed for one to two days to compensate for the delayed nature of the reactions.
Since there may be significant cross-reactivity between corticosteroid drugs, any positive result should be followed by a battery of allergy tests to identify which, if any, formulations are safe to use.
A positive patch test for budesonide and tixocortol is generally a strong indication of a steroid allergy.
Thanks for your feedback!
Q-I`m considering putting my 1 1/2-year-old poodle on cortisone for an itching problem.
What side effects should I expect?
A-The side effects of cortisone can be divided into two categories: common
»nuisance» reactions and less common but more serious disease syndromes related to the size of the cortisone dosage and duration of use.
In the first category, mild side effects can include increased water consumption and, consequently, increased urination. This reaction can be so severe that the dog is unable to hold its urine for the night and may have
»accidents» in the home.
The drug can also stimulate a dog`s appetite. In addition, cortisone makes some dogs sluggish. These two reactions can combine to make a dog overweight, another potential problem.
In the second, more serious category of reactions, cortisone greatly reduces an animal`s resistance to infections of every types. Viral and bacterial infections, fungal and parasitic conditions are every far more likely to happen in a dog that is on cortisone.
To cite a common example, dogs that are on the drug for endless periods of time often develop urinary tract or bladder infections.
Various other infections may attack anywhere, including in the skin.
Dogs on cortisone may also develop negative changes in the liver: Fat replaces some of the athletic cells in the liver, and over a endless period of time, this can compromise the efficiency of the liver`s functioning.
Yet another syndrome, called Cushing`s disease, can also develop in dogs given cortisone for a endless period. This can cause numerous problems: weakness, hair loss, extremely fatty livers, a tendency toward thyroid problems and diabetes. Proceed cautiously. Sometimes cortisone is the best treatment for an itchy dog, especially if istered for only a limited period, such as to ease a seasonal allergy.
For example, if a dog itches every year when pollens are in full »bloom,» some form of cortisone, given for the four to eight weeks when the allergies are at their worst, will own extremely little, if any, long-term side effects.
If your poodle`s itching problem does not reply to short-term therapy, you may face putting the dog on cortisone for the relax of its life. Before opting for that, fully investigate the root causes of the itching.
Every year about this time I feel compelled to alert dog owners about protecting pets against heartworm. As the mosquito season approaches, so does the threat of heartworm, but taking a few simple precautions can save your dog`s life.
Each year perhaps as numerous as 35 percent of dog owners neglect to safeguard their pets against heartworm.
I wish I could attribute this to forgetfulness, but in most cases the problem stems from ignorance and indifference.
I only hope I can impress such owners with the fatal facts:
Heartworm can kill-Heartworms (Dirofilaria immitis) can be 14 inches long! If left untreated, they cause death in 50 percent of cases. Large accumulations of the worms bring on congestive heart failure and impair circulation, causing serious damage to the heart, lungs, liver and kidneys.
Mosquitos carry the disease-The mosquito transmits the illness when it bites a dog already carrying heartworm larvae, ingests the dog`s blood, then bites another uninfected dog. If your dog acts listless, coughs frequently, seems to exhibit poor endurance, has difficulty breathing and is losing weight, take it to a veterinarian immediately.
Even if the dog is infected, it can generally be saved, though at some risk and grand expense.
Prevention is the key-Heartworm is almost 100 percent preventable. The first step is to take your dog to a veterinarian at the onset of spring for a heartworm test. If results are negative, the vet will prescribe heartworm pills.
Previously, the pills had to be given daily throughout the mosquito season. Today there`s Heartgard-30, istered only once a month. If you discover that giving your dog a pill is hard, heartworm medication also comes in liquid and chewable tablets but must be given daily.
Infected dogs can be saved-If a dog tests positive for heartworm, this doesn`t automatically spell death. The disease can be cured, but treatment is lengthy, involving a endless stay in a veterinary hospital. And when a dog returns home, it remains feeble for fairly a while.
Never use ancient heartworm pills-Never be penny-wise and pill-foolish.
Though giving your dog heartworm pills left over from the year before would save the expense of visiting the vet, don`t do it. You may simply incur another expense: disposal of your pet`s body. If a dog has already contracted heartworm and is given the pill, it can prove fatal.
The threat of heartworm persists-Despite the advent of effective heartworm treatment, which should own made the disease as »outmoded» as smallpox, cases of heartworm are increasing.
So if you feel you can`t afford to give a dog proper medical attention, you should not own a dog. It`s as simple as that. —
Dr. Huntington welcomes questions from readers. Although she cannot reply to them individually, she will answer those of general interest in this column. Record to Dr. Huntington, c/o The Chicago Tribune, 435 N. Michigan Ave., Chicago, Ill. 60611. If your pet`s problem is urgent, consult your vet.
Immunotherapy should be istered in a setting that permits the immediate recognition and management of adverse reactions.
The preferred location for such istration is the prescribing physician’s office. However, patients can get immunotherapy injections at another health care facility if the physician and staff at that location are trained and equipped to recognize and manage immunotherapy reactions, particularly anaphylaxis.– Allergen Immunotherapy: A Practice Parameter 3rd update- Joint Task Force on Practice Parameters, AAAAI and ACAAI
Allergy shots are the most effective therapy for treating nasal allergies and their attendant complications.
My patients often call them life changing. Despite their effectiveness, numerous patients who would benefit from them select not to utilize this therapy. The most common reason they select not to do so is not money, since insurance coverage is generally extremely excellent, or fear of needles, since the injections are relatively painless. The biggest reason is time. Allergy shots must be istered in a medically supervised setting where the provider and staff are familiar with the shot process and own the means to diagnose and manage acute allergic reactions. This means coming to the doctor’s office to get injections.
Given the busy modern lifestyle, this can be a significant time commitment. So why does it own to be this way? The answer is safety.
Allergy shots are generally a safe procedure, but, love every medical procedures, there is risk involved. Overall, systemic allergic reactions happen in about 1 out of every 500 injections. From 1980-1990, about 5% of patients experienced a systemic reaction. From 1990-2000, this rate fell to about 1% of patients.
The tremendous drop in reaction rates is attributable in part to better standardization of allergen extracts and to the widespread implementation of computerized immunotherapy monitoring systems, which drastically reduced dosing errors. Indeed, the most recent data suggests that only 25% of systemic reactions are due to dosing errors, while almost half are due to receiving injections during a severe allergy flare. Fortunately, most reactions to allergy shots are mild to moderate, but severe reactions, even fatalities, do happen.
Fatality rates own remained fairly constant at 1:2.5 million injections, about the same risk as being in a commercial airline accident, 1:2.5 million flights.
Those numbers should be reassuring to patients but also might lead some to conclude that allergy shots are indeed safe enough for home istration. They’re not, and here’s why: Allergy shots are as safe as they are because the vast majority are given in a medically supervised setting. All of the above data looking at safety come from patients who received shots at the office of their allergist or another physician.
We don’t know what the reaction rates or safety outcomes would own been if the same patient population had been allowed to get injections at home, but I can’t imagine that they would be better.
Allergen immunotherapy is a complicated process that requires careful monitoring of doses, frequent dose adjustment, and clinical training to assess if patients are well enough to get their shots. Allergists own years of training and experience in this regard as well as in the diagnosis and management of acute allergic reactions. We own dedicated staff whose sole occupation is to ister injections and computer managed protocols designed to reduce error.
Every of this helps the allergist deliver the most effective therapies with the highest degree of safety. You should accept no less.
Categories: aaaai, acaai, allergic reactions, allergy shots, Anaphylaxis, at home shots, build immunity, Current Topics, immunotherapy | Tags: allergy shots, allergy shots at home, immunotherapy, risk of allergy shots at home, safety of allergy shots at home | Permalink
Topic of the Quarter
What are allergies?
Allergies are caused by an abnormal response of the immune system to triggers in the environment.
Symptoms can involve the nose and sinuses, the lungs, the skin, and the stomach and GI tract.
They can be caused by something you breathe (an inhalant) such as pet dander, pollen, or mold; by something you swallow such as food or medicine; something you touch such as poison ivy, cosmetics, or chemicals; or stinging insects.
How are allergies treated?
The first step is diagnosis. Allergy testing allows us to identify what your specific triggers are. Knowing your allergies helps us to make the appropriate treatment decisions, which may include avoidance, medications, or allergy shots.
What helpful of allergy tests do you do?
We act out three basic types of allergy tests: skin prick tests, blood tests, and skin patch tests.
We can use these to test you to inhalant, food, insect, and contact allergies. We also use spirometry (a lung function test) to assist us manage patients with asthma.
What is a skin prick test?
Skin prick testing can be used to diagnose inhalant and food allergies. For inhalant allergy testing, we use a standard panel of 34 extracts that contains the most common indoor and outdoor allergens, including: dust mite, dog, cat, mold, and grass, tree, and weed pollens.
We can also test to other inhalants such as horse or rabbit, and to multiple foods if needed.
The testing procedure may be performed in one or two steps. Step one is called a scratch test. We act out this on your back and may test 30 or more allergens. This does not cause bleeding and is typically not painful. The results are ready in 20 minutes. If step one is negative, we proceed to step two. This step is called an intradermal test. This also will take 20 minutes.
Insect testing is done by a special skin test protocol and may take up to 2 hours.
What is the difference between skin and blood testing?
Skin testing is preferred for two reasons. First, it is more precise than blood testing. Second, it also gives us the advantage of knowing the results the same day. We can discuss management of your allergies at the same office visit, instead of asking you to come back later when we own the results. Sometimes, if we can not act out skin tests for medical or practical reasons, we can then order blood tests as an alternative.
Why do I need to stop some of my medicines?
Skin prick tests may be affected by certain medications such as antihistamines, steroids, tricyclic antidepressants, and cough/cold medicines.
These should be stopped if possible. Medications such as inhalers, Singulair, blood pressure medicines, and nose sprays DO NOT need to be discontinued.
What is asthma?
Asthma is a chronic disease of the lungs that can cause periodic symptoms such as wheeze, shortness of breath, chest tightness, and cough. Some common triggers for asthma attacks are exercise, allergies, and respiratory infections love the common cold.
What is spirometry?
Spirometry is a test that measures how well your lungs are working.
It can assist to diagnose and manage asthma and other chronic lung diseases. It is a simple test that takes about 5 minutes. Typically, patients 7 years ancient and up can act out this test. You should be on every of your regular medications when you do this test.
What are allergy shots (immunotherapy)?
Allergy shots are a treatment for inhalant or insect allergies. Unlike medications, which only treat the symptoms, allergy shots treat the cause of the problem (your immune system).
How often do I own to get a shot?
The first 4-6 months you will come in 1-2 times a week. This is called the «build-up» phase.
During this time, your dose will be increased from an initial, extremely feeble dose to the maximum «maintenance» dose. We follow this schedule to reduce the risk of side effects. Once you are at maintenance, you will come every 3-4 weeks.
Immunotherapy for insect allergy follows a slightly diverse schedule.
How endless will the shots take to work?
Some patients may experience some symptom relief within the first 6 months. The majority of patients (80-90%) will notice a reduction in their symptoms 12-18 months after starting.
How endless do I own to take allergy shots?
Most patients are on shots for about 5 years.
This is because medical studies own shown that stopping shots too soon often leads to a recurrence of symptoms. Most patients who stay on shots at least 5 years will benefit for an extended period of time after stopping.
What helpful of side effects can allergy shots cause?
Allergy shots are generally well tolerated. The most common side effect is swelling, itching, and redness at the site of the injection. Symptoms at any site other than where the shot was given may be a sign of a serious reaction called anaphylaxis. This is a potentially life-threatening reaction and needs to be treated immediately.
We take every precaution to reduce the risk of anaphylaxis. Because of this, every time you come for a shot, you must stay for 30 minutes. There are no exceptions to this rule.
When can I get shots?
Please see Locations and Hours for allergy shot times.
Updated: April, 2019
Updated: September, 2012
Originally Posted: July 2004
Richard F. Lockey, MD
Professor of Medicine, Pediatrics and Public Health
Director of the Division of Allergy and Immunology
Joy McCann Culverhouse Chair of Allergy and Immunology
University of South Florida College of Medicine and the James A.
Haley Veterans' Hospital
Tampa, Florida, USA
This disease summary is provided for informational purposes for physicians only.
Symptoms and Signs of Anaphylaxis
The initial manifestation of anaphylaxis may be loss of consciousness. Patients often describe "a sense of doom." In this instance, the symptoms and signs of anaphylaxis are isolated to one organ system, but since anaphylaxis is a systemic event, in the vast majority of subjects two or more systems are involved.
Gastro-intestinal: Abdominal pain, hyperperistalsis with faecal urgency or incontinence, nausea, vomiting, diarrhea.
Oral: Pruritus of lips, tongue and palate, edema of lips and tongue.
Respiratory: Upper airway obstruction from angioedema of the tongue, oropharynx or larynx; bronchospasm, chest tightness, cough, wheezing; rhinitis, sneezing, congestion, rhinorrhea.
Cutaneous: Diffuse erythema, flushing, urticaria, pruritus, angioedema.
Cardiovascular: Faintness, hypotension, arrhythmias, hypovolemic shock, syncope, chest pain.
Ocular: Periorbital edema, erythema, conjunctival erythema, tearing.
Genito-urinary: Uterine cramps, urinary urgency or incontinence.
Severe initial symptoms develop rapidly, reaching peak severity within 3-30 minutes.
There may occasionally be a quiescent period of 1–8 hours before the development of a second reaction (a biphasic response). Protracted anaphylaxis may happen, with symptoms persisting for days. Death may happen within minutes but rarely has been reported to happen days to weeks after the initial anaphylactic event.
Emergency Treatment of Anaphylaxis
Anaphylaxis caused by radio-contrast media
Mild adverse reactions are experienced by approximately 5% of subjects receiving radio-contrast media.
U.S. figures propose that severe systemic reactions happen in 1:1000 exposures with death in 1:10,000-40,000 exposures.
Insect venom anaphylaxis
Studies from Australia, France, Switzerland and the USA propose incidences of systemic reactions to Hymenoptera stings ranging from 0.4% to 4% of the population. In the USA, at least 40 allergic deaths happen each year as a result of Hymenoptera stings.
The term anaphylaxis is often reserved to describe immunological, especially IgE-mediated reactions.
A second term, non-allergic anaphylaxis, describes clinically identical reactions that are not immunologically mediated.
The clinical diagnosis and management are, however, identical.
The differential diagnosis for anaphylaxis includes:
- carcinoid syndrome
- hereditary angioedema
- cholinergic urticaria
- myocardial infarction
- cold urticaria
- overdose of medication
- status asthmaticus
- foreign body aspiration
- respiratory difficulty or circulatory collapse, including vasovagal reactions
- pulmonary embolism
- globus hystericus
- sulfite or monosodium glutamate ingestion
Upper airway obstruction, bronchospasm, abdominal cramps, pruritus, urticaria and angioedema are absent in vasovagal reactions.
Pallor, syncope, diaphoresis and nausea generally indicate a vaso-vagal reaction but may happen in either condition.
If a reaction occurs during a medical procedure, it is significant to consider a possible reaction to latex or medication used for or during anesthesia.
Causes of Anaphylaxis
Cytoxic and Immune Complicated – Complement-Mediated Reactions
Narcotics are mast cell activators capable of causing elevated plasma histamine levels and non-allergic anaphylaxis.
They are most commonly observed by anesthesiologists.
Modulators of Arachidonic Acid Metabolism
Exercise alone can cause anaphylaxis as can food-induced anaphylaxis, Exercise-induced anaphylaxis can happen during the pollinating season of plants to which the individual is allergic.
Whole Blood, Serum, Plasma, Fractionated Serum Products, Immunoglobulins, Dextran
Anaphylactic responses own been observed after the istration of whole blood or its products, including serum, plasma, fractionated serum products and immunoglobulins.
One of the mechanisms responsible for these reactions is the formation of antigen-antibody reactions on the red blood cell surface or from immune complexes resulting in the activation of complement. The athletic by-products generated by complement activation (anaphylatoxins C3a, C4a and C5a) cause mast cell (and basophil) degranulation, mediator release and generation, and anaphylaxis. In addition, complement products may directly induce vascular permeability and contract smooth muscle.
Cytotoxic reactions can also cause anaphylaxis, via complement activation.
Antibodies (IgG and IgM) against red blood cells, as occurs in a mismatched blood transfusion reaction, activate complement. This reaction causes agglutination and lysis of red blood cells and perturbation of mast cells resulting in anaphylaxis.
Non-immunologic Mast Cell Activators
Catamenial anaphylaxis is a syndrome of hypersensitivity induced by endogenous progesterone secretion. Patients may exhibit a cyclic pattern of attacks during the premenstrual part of the cycle.
Hymenoptera venoms (bee, wasp, yellow-jacket, hornet, fire ant) contain enzymes such as phospholipases and hyaluronidases and other proteins which can elicit an IgE antibody response.
Examples of miscellaneous agents which cause anaphylaxis are insulin, seminal proteins, and horse-derived antitoxins, the latter of which are used to neutralize venom in snake bites.
Individuals who own IgA deficiency may become sensitized to the IgA provided in blood products. Those selective IgA deficient subjects (1:500 of the general population) can develop anaphylaxis when given blood products, because of their anti-IgA antibodies (probably IgE-anti-IgA).
C = Corticosteroids
Corticosteroids do not benefit acute anaphylaxis but may prevent relapse or protracted anaphylaxis. Hydrocortisone (100 to 200 mg) or its equivalent can be istered every 6 to 8 hours for the first 24 hours. Doses must be adjusted for children.
Prevention of Anaphylaxis
Agents causing anaphylaxis should be identified when possible and avoided.
Patients should be instructed how to minimize exposure.
Beta-adrenergic antagonists, including those used to treat glaucoma, may exacerbate anaphylaxis and should be avoided, where possible. Angiotensin-converting enzyme (ACE) inhibitors may also increase susceptibility to anaphylaxis, particularly with insect venom-induced anaphylaxis.
Epinephrine is the drug of choice to treat anaphylaxis. Individuals at high risk for anaphylaxis should be issued epinephrine syringes for self-istration and instructed in their use. Intramuscular injection into the anterolateral thigh is recommended since it results in immediate elevation of plasma concentrations and has immediate physiological effects.
Subcutaneous injection results in delayed epinephrine absorption. Patients must be alerted to the clinical signs of impending anaphylaxis and the need to carry epinephrine syringes at every times and to use it at the earliest onset of symptoms. Unused syringes should be replaced when they reach their use-by/expiration date, as epinephrine content and bioavailability of the drug decreases in proportion to the number of months past the expiration date.
Pre-treatment with glucocorticosteroids and H1 and H2 antihistamines is recommended to prevent or reduce the severity of a reaction where it is medically necessary to ister an agent known to cause anaphylaxis, for example, radio-contrast media.
Other significant patient instructions include:
a) Personalized written anaphylaxis emergency action plan
b) Medical Identification (e.g., bracelet, wallet card)
c) Medical record electronic flag or chart sticker, and emphasis on the importance of follow-up investigations by an allergy/immunology specialist
Food-associated, exercise-induced anaphylaxis
This is more common in females, and over 60% of cases happen in individuals less than 30 years of age.
Patients sometimes own a history of reacting to the food when younger and generally own positive skin tests to the food that provokes their anaphylaxis.
A = Airway
Ensure and establish a patent airway, if necessary, by repositioning the head and neck, endotracheal intubation or emergency cricothyroidotomy. Put the patient in a supine position and elevate the lower extremities. Patients in severe respiratory distress may be more comfortable in the sitting position.
Antibiotics and Other Drugs
PENICILLIN, CEPHALOSPORIN, AND SULPHONAMIDE ANTIBIOTICS
Penicillin is the most common cause of anaphylaxis, for whatever reason, not just drug-induced cases.
Penicillin and other antibiotics are haptens, molecules that are too little to elicit immune responses but which may bind to serum proteins and produce IgE antibodies. Serious reactions to penicillin happen about twice as frequently following intramuscular or intravenous istration versus oral istration, but oral penicillin istration may also induce anaphylaxis. Neither atopy, nor a genetic history of allergic rhinitis, asthma or eczema, is a risk factor for the development of penicillin allergy.
Muscle relaxants, for example, suxamethonium, alcuronium, vecuronium, pancuronium and atracurium, which are widely used in general anesthesia, account for 70-80% of every allergic reactions occurring during general anesthesia.
Reactions are caused by an immediate IgE-mediated hypersensitivity reaction.
Sodium and Potassium Sulfites, Bisulfites, Metabisulfites, and Gaseous Sulfur Dioxides
These preservatives are added to foods and drinks to prevent discoloration and are also used as preservatives in some medications. Sulfites are converted in the acid environment of the stomach to SO2 and H2SO3, which are then inhaled. They can produce asthma and non-allergic hypersensitivity reactions in susceptible individuals.
Aspirin, Ibuprofen, Indomethacin and other Non-steroidal Anti-inflammatory Agents (NSAIDs)
IgE antibodies against aspirin and other NSAIDs own not been identified.
Affected individuals tolerate choline or sodium salicylates, substances closely structurally related to aspirin but diverse in that they lack the acetyl group.
C = Circulation
Minimize or eliminate continued exposure to causative agent by discontinuing the infusion, as with radio-contrast media, or by placing a venous tourniquet proximal to the site of the injection or insect sting. Assess adequacy of perfusion by taking the pulse rate, blood pressure, mentation and capillary refill time.
Establish I.V. access with large bore (16- to 18-gauge) catheter and ister an isotonic solution such as normal saline. A second I.V. may be established as necessary. If a vasopressor, such as dopamine becomes necessary, the patient requires immediate transfer to an intensive care setting.
The same ABC mnemonic can be used for the pharmacologic management of anaphylaxis:
Elective Medical Procedures
B = Breathing
Assess adequacy of ventilation and provide the patient with sufficient oxygen to maintain adequate mentation and an oxygen saturation of at least 91% as sure by pulse oximetry.
Treat bronchospasm as necessary. Equipment for endotracheal intubation should be available for immediate use in event of respiratory failure and is indicated for poor mentation, respiratory failure, or stridor not responding immediately to supplemental oxygen and epinephrine.
In theory, any food glycoprotein is capable of causing an anaphylactic reaction. Foods most frequently implicated in anaphylaxis are:
- Shellfish (shrimp, crab, lobster, oyster, scallops)
- Milk (cow, goat)
- Seeds (cotton seed, sesame, mustard)
- Tree nuts (walnut, hazel nut/filbert, cashew, pistachio nut, Brazil nut, pine nut, almond)
- Chicken eggs
- Peanut (a legume)
- Fruits, vegetables
Food sensitivity can be so severe that a systemic allergic reaction can happen to particle inhalation, such as the odors of cooked fish or the opening of a package of peanuts.
A severe allergy to pollen, for example, ragweed, grass or tree pollen, can indicate that an individual may be susceptible to anaphylaxis or to the oral allergy syndrome (pollen/food syndrome) (manifested primarily by severe oropharyngeal itching, with or without facial angioedema) caused by eating certain plant-derived foods.
This is due to homologous allergens found between pollens and foods. The main allergen of every grasses is profilin, which is a pan-allergen, found in numerous plants, pollens and fruits, and grass-sensitive individuals can sometimes react to numerous plant-derived foods.
Typical aero-allergen food cross-reactivities are:
- Mugwort pollen: celery, apple, peanut and kiwifruit
- Birch pollen: apple, raw potato, carrot, celery and hazelnut
- Ragweed pollen: melons (watermelon, cantaloupe, honeydew) and banana
- Latex: banana, avocado, kiwifruit, chestnut and papaya
Food-associated, exercise-induced anaphylaxis may happen when individuals exercise within 2-4 hours after ingesting a specific food.
The individual is, however, capable to exercise without symptoms, as endless as the incriminated food is not consumed before exercise. The patient is likewise capable to ingest the incriminated food with impunity as endless as no exercise occurs for several hours after eating the food.
B = Benadryl (diphenhydramine)
Antihistamines are not useful for the initial management of anaphylaxis but may be helpful once the patient stabilizes. Diphenhydramine may be istered intravenously, intramuscularly or orally.
Cimetidine offers the theoretical benefit of reducing both histamine-induced cardiac arrhythmias, which are mediated via H2 receptors, and anaphylaxis-associated vasodilation, mediated by H1 and H2 receptors. Cimetidine, up to 300 mg every 6 to 8 hours, may be istered orally or slowly I.V. Doses must be adjusted for children.
Radiocontrast Media, Low-molecular Weight Chemicals
Mast cells may degranulate when exposed to low-molecular-weight chemicals. Hyperosmolar iodinated contrast media may cause mast cell degranulation by activation of the complement and coagulation systems.
These reactions can also happen, but much less commonly, with the newer contrast media agents.
The prevalence of food-induced anaphylaxis varies with the dietary habits of a region. A United States survey reported an annual occurrence of 10.8 cases per 100,000 person years. By extrapolating this data to the entire population of the USA, this suggests approximately 29,000 food-anaphylactic episodes each year, resulting in approximately 2,000 hospitalizations and 150 deaths.
Similar findings own been reported in the United Kingdom and France. Food allergy is reported to cause over one-half of every severe anaphylactic episodes in Italian children treated in emergency departments and for one-third to one-half of anaphylaxis cases treated in emergency departments in North America, Europe and Australia. It is thought to be less common in non-Westernized countries. A study in Denmark reported a prevalence of 3.2 cases of food anaphylaxis per 100,000 inhabitants per year with a fatality rate of approximately 5%.
Risk factors for food anaphylaxis include asthma and previous allergic reactions to the causative food.
One percent to 5% of courses of penicillin therapy are complicated by systemic hypersensitivity reactions.
Point two percent is associated with anaphylactic shock, and mortality occurs in 0.02% of the cases. If a patient has a strongly positive skin test or circulating IgE antibody to penicillin, there is a 50-60% risk of an anaphylactic reaction upon subsequent challenge. In patients with a case history suggestive of penicillin allergy and negative skin tests, the risk of anaphylaxis is extremely low. Atopy and mold sensitivity are not risk factors for the development of penicillin allergy.
A = Adrenalin = epinephrine
Epinephrine is the drug of choice for anaphylaxis.
It stimulates both the beta-and alpha-adrenergic receptors and inhibits further mediator release from mast cells and basophils. Animal and human data indicate that platelet activating factor (PAF) mediates life-threatening manifestations of anaphylaxis. The early use of epinephrine in vitro inhibits the release of PAF in a time-dependent manner, giving support to the use of this medication with the first signs and symptoms of anaphylaxis. The usual dosage of epinephrine for adults is 0.3-0.5 mg of a 1:1000 w/v solution given intramuscularly, preferably in the anterolateral thigh, every 10-20 minutes or as necessary.
The dose for children is 0.01 mg/kg to a maximum of 0.3 mg intramuscularly, preferably in the anterolateral thigh, every 5-30 minutes as necessary. Lower doses, e.g., 0.1 mg to 0.2 mg istered intramuscularly, preferably in the anterolateral thigh, as necessary, are generally adequate to treat mild anaphylaxis, often associated with skin testing or allergen immunotherapy. Epinephrine should be given early in the course of the reaction and the dose titrated to the clinical response.
For severe hypotension, 1 cc of a 1:10,000 w/v dilution of epinephrine given slowly intravenously is indicated. The patient's response determines the rate of infusion.
Anaphylaxis to muscle relaxants occurs in approximately 1 in 4,500 of general anesthesia, with fatalities occurring in 6% of these cases. Risk factors are female sex (80% of cases). Atopy is not a risk factor; previous drug allergy may be a risk factor.
In patients with a history of anaphylaxis, skin tests to diverse muscle relaxants may be helpful. If the test result is positive, the muscle relaxant should not be used. A negative result provides evidence that the muscle relaxant can probably be istered safely.
Latex is a milky sap produced by the rubber tree Hevea brasiliensis. Latex-related allergic reactions can complicate medical procedures, for example, internal examinations, surgery, and catheterization. Medical and dental staff may develop occupational allergy through use of latex gloves.
Flushing, tachycardia, angioedema, upper airway obstruction, urticaria and other signs and symptoms of anaphylaxis can happen without a recognizable cause.
Diagnosis is based primarily on the history and an exhaustive search for causative factors. Serum tryptase and urinary histamine levels may be useful, in specific, to law out mastocytosis.
Definition of Anaphylaxis
Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells. Anaphylaxis is defined by a number of signs and symptoms, alone or in combination, which happen within minutes, or up to a few hours, after exposure to a provoking agent.
It can be mild, moderate to severe, or severe. Most cases are mild but any anaphylaxis has the potential to become life-threatening.
Anaphylaxis develops rapidly, generally reaching peak severity within 5 to 30 minutes, and may, rarely, final for several days.
Allergy / immunology specialists frolic a uniquely significant role to confirm the etiology of anaphylaxis, prepare the patient for self istration of epinephrine, educate the patient and/or family about allergen avoidance, and law out any underlying condition, such as mastocytosis, which can predispose a patient to develop anaphylaxis. Referral to an allergist / immunologist is indicated for patients with this disease.