Age-related cardiovascular outcomes in older adults receiving epinephrine for anaphylaxis in the emergency department

O’Brien, Maureen E.; Koehl, Jennifer L.; Raja, Ali S.; Erickson, Timothy; Hayes, Bryan D.

doi:10.1016/j.jaip.2019.04.040

Cited by 14 publications

(7 citation statements)

References 7 publications

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“…There is often increased resistance in using adrenaline for the management in anaphylactic patients with underlying cardiovascular disease. In a retrospective study of 296 patients, patients aged 80–89 years old had greater odds of experiencing an adverse cardiac effect compared with those between 50 and 59 years old (OR 8.8; 95% CI, 1.2–67.1) [23]. A large European Anaphylaxis registry observed that among their 1123 elderly anaphylactics, they were less likely to present with skin symptoms ( P < 0.001) and more likely to present with loss of consciousness (33%, P < 0.001).…”

Section: Anaphylaxis In the Elderlymentioning

confidence: 99%

Drug allergy management in the elderly

Wong

Li²

2021

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewDrug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug allergy testing and considerations in the management. Especially in the era of COVID-19, the elderly population is a vulnerable cohort and reviewing the management during this unprecedented time is both timely and relevant. Recent findingsIn recent years, larger scale studies focusing on the epidemiology and prevalence trends of drug allergies among older adults has been summarized in this review. Emphasis on anaphylaxis in the older adults has been studied.

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Section: Anaphylaxis In the Elderlymentioning

confidence: 99%

Drug allergy management in the elderly

Wong

Li²

2021

Current Opinion in Allergy &Amp; Clinical Immunology

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Section: Tratamentounclassified

“…Não existe nenhuma contraindicação absoluta para administração de adrenalina perante uma anafilaxia, sendo uma intervenção indispensável; no entanto, existe o risco potencial de ocorrência de eventos adversos cardíacos com a sua administração, destacando -se a isquemia e as taquidisritmias (55) . Este risco poderá estar aumentado nos idosos, com estudos demonstrando maior risco a partir dos 50 anos de idade, recomendando -se que os doentes com mais de 80 anos sejam cuidadosamente monitorizados (55) . De realçar que a utilização da adrenalina não está contraindicada nos doentes com doença cardiovascular, sendo que a sua utilização poderá aumentar a contratilidade miocárdica, assim como a circulação coronária, o que poderá minorar as situações de síndrome coronária aguda (6,15) .…”

Section: Tratamentounclassified

Anafilaxia no idoso: Particularidades na abordagem diagnóstica e terapêutica

Brosseron¹,

Ferreira²

2022

rpia

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Com o aumento global da esperança média de vida e consequente prevalência crescente de patologias relacionadas com o envelhecimento, as doenças do foro alérgico não são exceção, sendo cada vez mais frequentes na prática clínica diária. A anafilaxia, enquanto reação de hipersensibilidade grave e potencialmente fatal, encontra -se associada a uma maior morbimortalidade nesta faixa etária, apresentando particularidades próprias que merecem ser destacadas, não só ao nível do diagnóstico, como do seu tratamento. A presença de múltiplas comorbilidades e consequente polimedicação, frequentemente com fármacos anti -hipertensores que podem não só condicionar reações anafiláticas, como também dificultar o tratamento destas, juntamente com o predomínio de sintomas cardiovasculares e outros fatores inerentes ao envelhecimento, conferem maior vulnerabilidade a esta população. Assim, torna -se pertinente identificar e sensibilizar os profissionais de saúde para a existência de características particulares da anafilaxia no idoso, de modo a permitir uma intervenção mais direcionada e uma melhoria no prognóstico destes doentes.

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“…47 However, older patients with anaphylaxis seem to be more likely to experience a cardiac adverse event after adrenaline injection, with those older than 80 years having the highest risk. 48…”

Section: Adrenaline In Older Peoplementioning

confidence: 99%

“…Serious adverse effects, such as ventricular arrhythmias, hypertension, or myocardial ischemia, have not been reported following the use of adrenaline auto‐injectors 47 . However, older patients with anaphylaxis seem to be more likely to experience a cardiac adverse event after adrenaline injection, with those older than 80 years having the highest risk 48 …”

Section: Management Of Anaphylaxis In Older Peoplementioning

confidence: 99%

Management of anaphylaxis due to COVID‐19 vaccines in the elderly

Bousquet

Agache

Blain

et al. 2021

Allergy

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Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

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Age-related cardiovascular outcomes in older adults receiving epinephrine for anaphylaxis in the emergency department

Cited by 14 publications

References 7 publications

Drug allergy management in the elderly

Drug allergy management in the elderly

Anafilaxia no idoso: Particularidades na abordagem diagnóstica e terapêutica

Management of anaphylaxis due to COVID‐19 vaccines in the elderly

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