The passage of Australia's Modern Slavery Act 2018 received bipartisan support and was heralded within both Houses of Parliament as a significant step towards addressing Australia's complicity in modern slavery. Political discourse surrounding the legislation, however, exhibits a profound and disconcerting dehistoricisation, emphasising particularities of global supply chains and contemporary transnational capitalism. Australia's own histories of slavery, slaverylike conditions and unfree labour are overwhelmingly absent from these narratives, which are framed instead by occasional references to the transatlantic slave trade. Attending particularly to histories of coerced Pacific labour within Australia, we analyse these absences as reflective of deeply rooted fissures of memory and power within Australia's national imaginaries, and of the exercise of colonial power both within the settler state and in its entanglements with the region. Through reference to two threads of Pacific labour history in Australia-the struggle for recognition of the 19th-century Pacific labour trade, and the labour patterns of 20th-century Papuan and New Guinean domestic workers-we argue for an alternate genealogy of modern slavery, one that re-centres attention to race and coloniality, and attends more fully to the presence of the past in the exploitations of the present.
Introduction: Patients who have an adverse drug reaction are frequently labelled drug allergic without undergoing proper evaluation and confirmatory testing. These drug allergy labels may be inaccurate, leading to unnecessary lifelong avoidance. The aim of this study was to review the patients that underwent drug provocation tests (DPTs) in our centre and examine the usefulness of DPTs in confirming or rejecting a diagnosis of drug hypersensitivity. Materials and Methods: The study design was a retrospective chart review of all adult patients who underwent drug provocation in the allergy unit at the National University Hospital, Singapore, for single or multiple suspected drug allergies from the period January 2009 to June 2011. Results: Eighty-seven patients underwent 123 DPTs (median age 41; interquartile range 28 to 50). Twenty-one patients underwent multiple DPTs. The most common culprit drugs reported were antibiotics (43.9%) of which beta-lactams were implicated in 75.9% of the cases. This was followed by non-steroidal anti-inflammatory drugs (NSAIDS) in 15.4%, paracetamol in 7.3% and both NSAIDs and paracetamol in 3.3%. Rash was the most commonly reported symptom (41.5%), followed by angioedema (32.5%), anaphylaxis (9.8%), and other symptoms including respiratory (2.4%), gastrointestinal (0.8%) and others (13.0%). The majority of DPTs were performed to antibiotics (43.9%), NSAIDs (19.5%) and paracetamol (6.5%). DPTs were negative in 93.5% of subjects and positive in 6.5%. Of the 8 positive DPTs, none had a serious reaction, with 5 patients requiring rescue therapy, which comprised solely of oral antihistamines. Conclusion: Suspected drug hypersensitivity is common but true drug allergy is rare. DPTs remain the gold standard and should be included as part of an investigative protocol. DPTs are a safe and valuable diagnostic tool in the hands of the experienced clinician.
Key words: Antibiotics, Drug allergy, Gold standard, NSAIDS
Hayley Pryse-Hawkins works as a heart failure sister at the Royal Brompton Hospital in London and is seconded part time to the British Heart Foundation. Lucy Davies talks to her about her role, its challenges and how she sees the future for patients with heart failure.
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