RATIONALE: Beta blockers(BB) have been associated with increased risk for severe anaphylactoid reaction(AR) from contrast media(CM); however, this was shown with intravenous CM(Arch Intern Med 1993;153:2033), prior to widespread use of low osmolar contrast media(LOCM), ACE inhibitors(ACE-I) and cardioselective BB. We assessed risk for AR with cardiac catheterization(CC) associated with BB or ACE-I exposure. METHODS: Patients who experienced adverse reactions during CC from January 2004-December 2013 were identified; 1-2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BB, ACE-I, Angiotensin receptor blockers, aspirin) and co-morbidities: cardiovascular disorders(CVD), asthma, atopy. RESULTS: We analyzed 71,782 CCs. Of these, severe 70 reactors were identified-46 (0.06%) fulfilled AR criteria. There were 35 mild-moderate and 11 severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), gender (63% vs 64% male), CVD rate (78% vs 93%), exposure to BB (46% vs 51%, cardioselective: 81% vs 80%) and ACE-I (37.0% vs 37.2%) in cases vs. controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency(p50.35) or severity (p50.40). Neither cardioselective BBs (p5 0.2) nor noncardioselective BB (p50.5) influenced AR severity. ACE-I had no effect on AR frequency (p50.35) or severity (p50.14). Lower AR frequency was associated with CVD (p50.01). CONCLUSIONS: In this case control-study, severe AR were rarely observed. Exposure to BB or ACE-I did not significantly influence AR frequency or severity; however, most BB were cardioselective. Our findings imply cardioselective BB or ACE-I suspension is not warranted in association with CC.
RATIONALE: Antibody Fab fragments (Fabs) prepared by digestion with papain lack effector functions including mast cell degranulation due to the absence of the Fc portion. In the present study, we tested the hypothesis that the application of allergen-specific monoclonal antibody (mAb) IgG1 Fabs downregulated atopic dermatitis-like skin inflammation in mice. METHODS: Balb/c mice sensitized by intraperitoneal injections of antiovalbumin (OVA) IgE mAbs on days 0, 1, 2, 7, 8, and 9 were challenged with OVA by its application to the skin on days 1, 2, 3, 8, 9, and 10. Anti-OVA IgG1 mAb (O1-10) Fabs were applied to the skin 30 min before the fourth to sixth challenges followed by measurement of clinical symptoms including erythema/hemorrhage, edema, scarring/dryness, and excoriation/erosion of the skin. Histological changes in the skin were also investigated. RESULTS: Significantly increased clinical symptoms were observed during the third to sixth OVA challenges. The application of O1-10 Fabs to the skin resulted in marked suppression of all of the clinical symptoms. Intact O1-10 failed to affect the clinical symptoms. Histologically, epidermal thickness and neutrophil accumulation in the skin were decreased following the treatment with O1-10 Fabs. Furthermore, the suppression of the clinical symptoms by the O1-10 Fabs was associated with decreases in mast cells as well as IL-17A and IL-13 in the skin. CONCLUSIONS: The present study demonstrates for the first time that the application of pathogenic allergen-specific IgG1 mAb Fabs to the skin appears to be effective in downregulating IgE-mediated atopic dermatitislike skin inflammation.
RATIONALE: Systemic reactions from subcutaneous immunotherapy (SCIT) occur in 2-5/1000 injections. An anaphylaxis preparedness initiative was implemented at an institution with a main campus and 9 regional sites, with a volume of > 20,000 SCIT injections annually. An online module to train staff to recognize and manage anaphylaxis was developed as part of the initiative. METHODS: We assigned an online module for anaphylaxis preparedness to physicians and nurses involved with SCIT. We used chi-square tests to compare pre/post-knowledge-based test questions and voluntary survey answers. RESULTS: We assigned the module to 73 physicians and 56 nurses. 32 physicians and 53 nurses completed the module and pre/post-test questions; 21 physicians and 24 nurses completed the pre/post-surveys. Scores on test questions increased from 75.0% to 92.2% (p < 0.001) for physicians and 76.3% to 91.1% (p < 0.001) for nurses after completion. Physicians ''very comfortable'' treating anaphylaxis increased from 5/21 (23.8%) to 13/21 (61.9%) (p 5 0.013), using epinephrine from 9/21 (42.9%) to 16/21 (76.2%) (p 5 0.028), and recognizing anaphylaxis from 10/21 (47.6%) to 18/21 (85.7%) (p 5 0.009). We observed only slight increases in the proportion of nurses ''very comfortable'' treating anaphylaxis (8/24 (33.3%) to 13/24 (54.2%); p50.15), using epinephrine (12/24 (50.0%) to 14/24 (58.3%); p 5 0.56), and recognizing anaphylaxis (15/24 (62.5%) to 17/24 (70.8%); p 5 0.54); the majority reported high comfort levels. All participants found the module ''somewhat helpful'' or ''very helpful''. CONCLUSIONS: This study supports an online training module as an essential component of a multi-faceted anaphylaxis preparedness initiative.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.