Anaphylactic Deaths: A Clinicopathologic Study of 43 Cases

Delage, Calude; Irey, Nelson S.

doi:10.1520/jfs10141j

Cited by 151 publications

(81 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Death occurred within 15 min [41]. Up to 20% of drug-related anaphylaxis deaths in Europe and up to 75% of deaths for all drugrelated anaphylaxis in the USA are caused by penicillin [40,46,47]. In the US, this corresponds to 500-1000 deaths/year [40].…”

Section: Death From Penicillin Anaphylaxismentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

View full text Add to dashboard Cite

SummaryThe Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.Keywords allergy, anaphylaxis, beta-lactam, BSACI, carbapenem, cephalosporin, children, cross-reactivity, desensitization, drug provocation test, epidemiology, hypersensitivity, monobactam, oral challenges, paediatrics, penicillin, serum-specific IgE, skin tests, Standards of Care Committee • This guideline addresses immediate and non-immediate allergic reactions to beta-lactams.• Up to 20% of drug-related anaphylaxis deaths in • Individuals with a positive skin test to an aminopenicillin but negative skin tests to penicillin determinants are likely to be sensitized to the aminopenicillin side chain. (B) In this situation, a cautious challenge to benzyl or phenoxymethyl penicillin can be considered to ascertain whether the patient has a selective penicillin allergy. (D) • If a cephalosporin is required in a patient with a clinical history of penicillin allergy and positive skin tests -the patient should undergo skin testing using a cephalosporin with a different side chain and, if negative, provocation testing should be undertaken to exclude allergy to the specific cephalosporin. (D)• If penicillin is required in a patient with a clinical history of cephalosporin allergy, skin testing should be undertaken with penicillins and, if negative, provocation testing to exclude allergy to penicillin. (B) If skin tests are positive, then penicillin avoidance or desensitization can be considered. (B)• If a cephalosporin is required by a patient with a previous reaction, skin testing to penicillins and the required cephalosporin should be carried out to establish whether sensitization is to the beta-lactam core or side chain. (B) This should be followed by either provo...

show abstract

Section: Death From Penicillin Anaphylaxismentioning

confidence: 99%

Management of allergy to penicillins and other beta‐lactams

Mirakian

Leech

Krishna

et al. 2015

Clin Experimental Allergy

225

229

View full text Add to dashboard Cite

show abstract

“…Whenever the hypoperfusion is complicated by increased capillary permeability, a rapidly irreversible circulatory fatal damage occurs (anaphylactic death). Delage and Irey (Delage & Irey, 1972), in their clinico-pathological study of 43 validated cases of drug-induced fatal anaphylactic shock, the predominant role of penicillin, subsequently confirmed (Di Maio & Di Maio 2001;Menchel et al, 1987;Weeden, 1988), is reported. In these as well as in other cases immunoglobulin E (IgE) antibodies have been tested to various allergens, present in contrast media (Di Maio & Di Maio 2001;Lang et al, 1995;Pumphrey & Roberts, 2000;Risgaard et al, 2008), sera (Vance & Strassmann, 1942;Johann-Liang et.…”

Section: Pathogenesismentioning

confidence: 84%

“…It is well known that the anaphylactic shock is an example of the immediate type of hypersensitivity reaction inducing a diffuse organ hypoperfusion. It has been defined (Delage & Irey, 1972) as the failure of the peripheral circulation induced by an antigen (allergen)-antibody reaction in already sensitized subjects for a foreign substance. Whenever the hypoperfusion is complicated by increased capillary permeability, a rapidly irreversible circulatory fatal damage occurs (anaphylactic death).…”

Section: Pathogenesismentioning

confidence: 99%

“…(Barnard, 1967;Da Broi & Moreschi, 2011;Delage & Irey, 1972;Di Maio & Di Maio, 2001;Edston & van Hage-Hamsten, 2005;James & Austen, 1964;Low & Stables, 2006;Lu et al, 2006;Menchel et al, 1987;Pumphrey & Roberts, 2000;Shen et al,2009;Yilmaz et al, 2009). You can find:  glottis edema and/or of the pharyngo-laryngeal districts;  congestion and/or pulmonary edema;  hyperinflation of the alveoli with acute emphysema;  endo-luminal bronchial secretions-this finding is more frequent if there's an asthmatic factor and it's usually related to a almost immediate death;  hemorrhagic petechiae: it's suggestive of an asphyxial component of the death and it's usually associated with an almost immediate death.…”

Section: Complete Necroscopic Exammentioning

confidence: 99%

See 1 more Smart Citation

Forensic Investigation in Anaphylactic Deaths

Trani¹,

Bonetti²,

Gualandri³

et al. 2011

Forensic Medicine - From Old Problems to New Challenges

View full text Add to dashboard Cite

“…Cardiac anaphylaxis in humans is characterized by coronary spasm, decreased le ventricular contractility, and/or arrhythmias [10,11,12,13]. Myocardial lesions might be the anatomical basis for the irreversible cardiac failure occasionally associated with systemic anaphylaxis [14].…”

Section: Introductionmentioning

confidence: 99%