First European data from the network of severe allergic reactions ( NORA )

Background: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Methods: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. Results: 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. Conclusion: This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified.

Section: Discussionmentioning

confidence: 81%

“…Despite these guidelines, the use of adrenaline is still suboptimal [4]. Different potential barriers to the use of adrenaline have been hypothesized and analyzed [5,6,7,8].…”

Section: Introductionmentioning

confidence: 99%

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

Cardona

Ferré-Ybarz²,

Guilarte³

et al. 2017

“…The remaining patients were tried to locate by consulting registration offices. A modified German anaphylaxis registry questionnaire [3] was sent to their current address as primary research tool, and patients were requested to complete the form. The questionnaire contained questions about re-stings since discontinuation of VIT, culprit insect, frequency, setting, and symptoms of re-stings.…”

Section: Methodsmentioning

confidence: 99%

“…In children, anaphylactic reactions to hymenoptera stings are estimated to occur in 0.4-0.8% [1,2]. Hymenoptera venom allergy accounts for 20.2% of anaphylactic reactions, which is the second leading cause of anaphylaxis in childhood and adolescence after food allergy [3,4]. Golden et al [2,5] showed that up to one third of children with at least moderate systemic reactions do not outgrow their hypersensitivity and require causal treatment.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines

Fiedler

Miehe

Treudler

et al. 2017

Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Results: Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Conclusions: Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial.

“…Food allergy, an IgE antibody-mediated and potentially life-threatening [1] chronic immunological disease, is a significant clinical problem in Europe and appears to have increased within the past years [2]. Based on clinical food challenge data, peanut and soybean are among the most prevalent elicitors of allergic reactions to foods in Europe [3].…”

Section: Introductionmentioning

confidence: 99%

A Novel Multipeptide Microarray for the Specific and Sensitive Mapping of Linear IgE-Binding Epitopes of Food Allergens

Kühne¹,

Reese²,

Ballmer‐Weber

et al. 2015

Background: The identification of B-cell epitopes of food allergens can possibly lead to novel diagnostic tools and therapeutic reagents for food allergy. We sought to develop a flexible, low-tech, cost-effective and reproducible multipeptide microarray for the research environment to enable large-scale screening of IgE epitopes of food allergens. Methods: Overlapping peptides (15-mer, 4 amino acid offset) covering the primary sequence of either peanut allergen Ara h 1 or all 3 subunits of the soybean allergen Gly m 5 were simultaneously synthesized in-house on a porous cellulose matrix. Identical peptide microarrays created with up to 384 duplicate peptide-cellulose microspots each were investigated for specificity and sensitivity in IgE immunodetection and in direct experimental comparison to the formerly established SPOT™ membrane technique. Results: The in-house microarray identified with 98% reproducibility the same IgE-binding peptides as the SPOT™ membrane technique. Additional IgE-binding peptides were identified using the microarray. While the sensitivity was increased between 2- and 20-fold, the amount of human serum required was reduced by at least two thirds over the SPOT™ membrane technique using the microarray. After subtraction of the potential background, we did not observe non-specific binding to the presented peptides on microarray. Conclusions: The novel peptide microarray allows simple and cost-effective screening for potential epitopes of large allergenic legume seed storage proteins, and it could be adapted for other food allergens as well, to study allergenic epitopes at the individual subject level in large paediatric and adult study groups of food allergic subjects.