Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected

Liccardi, Gennaro; Milanese, Manlio; Bilò, Maria Beatrice; Martini, M; Liccardi, M V; Gargano, Domenico; Giordano, A; Habetswallner, Francesco; Schiavo, M Lo; Madonna, F; Montera, M C; Pane, G; Papa, Alfonso; Pedicini, Antonio; Rogliani, Paola

doi:10.23822/eurannaci.1764-1489.198

Cited by 3 publications

(2 citation statements)

References 54 publications

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“…However, there is an increasing number of publications supporting the direct stimulation of mast cell degranulation, including activation of the Mas-related G protein-coupled receptor MRGPRX2, IgG and complement involvement and other non-IgE-mediated mechanisms of anaphylaxis for certain triggers [2,17,[36][37][38][39][40]. In the Table 2 are presented the most important anaphylaxis triggers reported in pregnancy, with selected references regarding the listed ones, together with classical immunologic or nonimmunologic mechanisms involved, associated effector cells and important mediators, as described mainly in non-obstetrical patients [1,2,17,19,20]. Anaphylaxis after intravenous iron administration in pregnant women, even fatal, was reported.…”

Section: The Immunology Of Anaphylaxis and Pregnancy-brief Overviewmentioning

confidence: 99%

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State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Simionescu

Stănescu

Popescu

2021

Life

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Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.

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Section: The Immunology Of Anaphylaxis and Pregnancy-brief Overviewmentioning

confidence: 99%

“…Anaphylaxis is an unpredictable, severe and potentially life-threatening hypersensitivity reaction [1,2]. Drug and food-related anaphylaxis has increased over time in parallel with an increased incidence of overall anaphylaxis from the last decade, according to data from Western countries [3,4].…”

Section: Introductionmentioning

confidence: 99%

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Simionescu

Stănescu

Popescu

2021

Life

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Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An Allergist-cardiologist Interdisciplinary Point of View

Calogiuri,

Savage,

Congedo

et al. 2023

CPD

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Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis; for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic complications of epinephrine administration. Numerous case reports and studies describe the unexpected onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.

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Anaphylaxis in Risky Populations

Beyaz

Gelincik

2023

CPD

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Anaphylaxis should be clinically diagnosed with immediate recognition, whereas, despite advances in the field of allergy, the symptoms of anaphylaxis remain to be under-recognized, diagnosis is often missed, and treatment is often delayed. Anaphylaxis presents with symptoms in a spectrum of severity, ranging from mild objective breathing problems to circulatory shock and/or collapse. Indeed, anaphylaxis management frequently relies on a ‘one-size-fits-all approach rather than a precision medicine care model, despite the evidence that anaphylaxis is a heterogeneous condition with differences in causative agents, clinical presentation, and host susceptibility. The key important risk factors for severe anaphylaxis and mortality are certain age groups or certain stages of life (infants, elderly and pregnant women), augmenting factors (physical exercise, alcohol consumption, menstruation, acute infections), concurrent use of some medications (beta-adrenergic blockers [β-blockers] and angiotensin-converting enzyme [ACE] inhibitors, non-steroidal anti-inflammatory drugs [NSAIDs], and proton pump inhibitors [PPIs]), and concomitant diseases (i.e. asthma, cardiovascular disease, mastocytosis). The present review aims to collectively address the patient groups who are at high risk of having anaphylaxis, those who have a more severe course, those that are difficult to diagnose, and require a special approach in treatment. Therefore, the risky populations like the elderly, pregnant women, patients receiving β-blockers or ACE inhibitors, those with concomitant cardiovascular diseases, asthma, and mastocytosis, or those having higher baseline serum tryptase levels are discussed, including their clinical presentations and treatment strategies. Additionally, anaphylaxis during the perioperative period is addressed.

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Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected

Cited by 3 publications

References 54 publications

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics

Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An Allergist-cardiologist Interdisciplinary Point of View

Anaphylaxis in Risky Populations

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