Anaphylaxis: the acute episode and beyond

Simons, F. Estelle R.; Sheikh, Aziz

doi:10.1136/bmj.f602

Cited by 54 publications

(47 citation statements)

References 53 publications

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“…On initial exposure to an antigen in susceptible individuals, IgE is produced and binded to mast cells and basophils. On reexposure, the multimeric antigen cross-links the Fab portions of two surfacebound IgE molecules, inducing the increase of intracellular calcium and the sudden release of chemical mediators (histamine, tryptase, leucotrienes, prostaglandins, platelet activating factor and other infl ammatory mediators) into the systemic circulation from the mast cells [1,17,18]. An interesting fact is that some of www.hophonline.org the secondary mediators released, in particular by eosinophils, have the ability to inhibit anaphylaxis and thus the process may be selflimiting in less severe reactions.…”

Section: Mechanisms Sympthoms and Triggers For Anaphylaxismentioning

confidence: 99%

“…Th e most widely used defi nition of anaphylaxis is "a serious allergic reaction that is rapid in onset and may cause death", and occurs suddenly aft er contact with an allergy-causing substance [1,2,3,4]. Th is acute reaction is an alarming medical emergency as represents life-threatening systemic condition where multiple body organ systems are usually aff ected (cutaneous, gastrointestinal, respiratory, cardiovascular, or central nervous system) [1,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Th is acute reaction is an alarming medical emergency as represents life-threatening systemic condition where multiple body organ systems are usually aff ected (cutaneous, gastrointestinal, respiratory, cardiovascular, or central nervous system) [1,5,6]. Th e condition has been classifi ed on the basis of its severity (mild, moderate or severe anaphylaxis) [7].…”

Section: Introductionmentioning

confidence: 99%

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The modern aspects of anaphylaxis therapy

Puletić¹,

Milijašević

2016

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Anaphylactic reaction is a most serious allergy where the symptoms may occur shortly after contact with an allergen and can get worse quickly. Therefore, timely and appropriate treatment is of crucial importance. Methods: In this article, we draw on evidence from publications on the subject of anaphylaxis treatment that we got by searching Google Scholar and PubMed databases. Used articles included: systematic reviews, case reports and randomised controlled trials. We also used World Allergy Organization guidelines for the management and the assessment of anaphylaxis. A literature search with the keywords "anaphylaxis treatment", "anaphylactic shock", and "allergy" identifi ed a number of potentially eligible studies, of which 42 satisfi ed our eligibility criteria and were therefore included in this review. Topic: There was evidence regarding the optimum route, dose and site of adrenaline administration ,with the latest recommendations indicating the intramuscular route (i.m.) in the mid-outer thigh as the optimum treatment. We found studies suggesting the purpose of applying H1 and H2 antihistamines, systemic glucocorticosteroids, calcium and methylxantines to manage anaphylactic shock, recommended doses and mode of administration. With regard to treatment, we focused on acute rather than on long-term management. Further, we have taken into consideration the mechanisms, common triggers and clinical manifestations of anaphylaxis. Conclusion: Adrenaline represents the fi rst choice drug and it is necessary to be applied as soon as possible. However, there is a controversy regarding the application of the other specifi ed medications in this life-threatening condition.

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Section: Mechanisms Sympthoms and Triggers For Anaphylaxismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The modern aspects of anaphylaxis therapy

Puletić¹,

Milijašević

2016

Hosp Pharm Int Multi J

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“…For the emergency treatment of anaphylaxis, prompt intramuscular injection of epinephrine (Epi) in the thigh is the treatment of choice (1)(2)(3)(4). Epi auto-injectors such as EpiPen ® (Mylan Inc, Basking Ridge, NJ) and Auvi-Q™ (Sanofi-Aventis, Bridgewater, NJ) are widely recommended for the treatment of anaphylaxis in community settings; however, they are not necessarily carried or used by patients at risk for anaphylaxis in the community (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…Epi auto-injectors such as EpiPen ® (Mylan Inc, Basking Ridge, NJ) and Auvi-Q™ (Sanofi-Aventis, Bridgewater, NJ) are widely recommended for the treatment of anaphylaxis in community settings; however, they are not necessarily carried or used by patients at risk for anaphylaxis in the community (1)(2)(3)(4). An alternative Epi formulation, rapidly disintegrating sublingual tablets (RDSTs), is being developed for the potential use in community settings (5)(6)(7)(8) and might offer the advantages of a wider dose range of Epi beyond the 0.15-and the 0.3-mg fixed doses currently available in EpiPen ® and Auvi-Q™ auto-injectors, and enhanced stability of Epi in a solid dosage form that might reduce the need for annual replacement associated with the use of auto-injectors containing Epi in aqueous solution (9).…”

Section: Introductionmentioning

confidence: 99%

Sublingual Diffusion of Epinephrine Microcrystals from Rapidly Disintegrating Tablets for the Potential First-Aid Treatment of Anaphylaxis: In Vitro and Ex Vivo Study

et al. 2015

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Abstract. For the first-aid treatment of anaphylaxis, epinephrine (Epi) 0.3 mg intramuscular (IM) injection in the thigh is the drug of choice. Epi auto-injectors are widely recommended for anaphylaxis treatment in community settings but not necessarily carried or used as prescribed when anaphylaxis occurs. We therefore developed rapidly disintegrating sublingual tablets (RDSTs) as an alternative noninvasive dosage form. Our objective in this study was to evaluate the effect of reducing Epi particle size on its in vitro and ex vivo diffusion, with the goal of enhancing Epi sublingual absorption from Epi RDSTs. Epi particle size was reduced by top-bottom technique using a microfluidizer for one pass at 30,000 Psi. The micronized Epi crystals (Epi-MC) were characterized using Zetasizer, Fourier transform infrared (FT-IR), differential scanning calorimetry (DSC), and scanning electron microscopy (SEM). Epi RDSTs were formulated and manufactured using our previously developed method. In vitro and ex vivo diffusion of Epi 10, 20, and 40 mg RDSTs and Epi-MC 10 and 20 mg RDSTs (n=4) were evaluated using Franz cells. Epi 10 mg solution was used as a control. Mean (±standard deviation (SD)) Epi particle size was successfully reduced from 131.8±10.5 to 2.5±0.4 μm. Cumulative Epi diffused and influx from 40 mg Epi RDSTs and 20 mg Epi-MC RDSTs were not significantly different from each other in vitro and ex vivo (p>0.05). Also, Epi permeability from 20 mg Epi-MC RDSTs was significantly higher than from the rest (p<0.05). Epi-MC RDSTs improved Epi diffusion twofold and might have the potential to reduce the Epi dose needed in RDSTs by 50%.

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