Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis

Muñoz-Cano, Rosa; Pascal, Mariona; Araujo, Giovanna; Goikoetxea, M. J.; Valero, Antonio; Picado, César; Bartra, Joan

doi:10.3389/fimmu.2017.01193

Cited by 81 publications

(69 citation statements)

References 94 publications

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“…There may be temporal differences in severity from one allergen exposure event to another, possibly due to many factors (patient's clinical status, dose or type of allergen, cofactors, etc). In our study, around a quarter of anaphylaxis reactions had a cofactor which is quite similar to that previously reported …”

Section: Time Course Of Clinical Anaphylaxis Manifestations and Astiesupporting

confidence: 92%

The time course of anaphylaxis manifestations in children is diverse and unpredictable

Pouessel

Antoine

Lejeune

et al. 2019

Clin Experimental Allergy

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The most current clinical definition of anaphylaxis is that proposed by Sampson et al, and different scoring systems have been proposed to assess its severity. 1,2 Anaphylaxis symptoms range from mild, self-limiting local reactions to life-threatening anaphylaxis.All anaphylaxis guidelines emphasize early recognition and the need for prompt intramuscular adrenaline injection as the first-line treatment. 3 However, adrenaline for anaphylaxis is underused by patients, families and even by health professionals. In the European anaphylaxis registry, 27% of patients treated by a health professional received adrenaline. 4 Given this low rate, spontaneous resolution of anaphylaxis symptoms may occur without adrenaline injection. There are few data on the course of anaphylaxis manifestations in children treated with adrenaline or not. This study aimed to describe the time course of clinical manifestations in children experiencing anaphylaxis. All children (≤15 years) admitted for anaphylaxis to one of 18 paediatric emergency care units in the Nord-Pas-de-Calais region of France were prospectively included (2015-2017). A standardized questionnaire was filled out using data collected from the family and the medical records. Patients were diagnosed with anaphylaxis if they fulfilled the criteria reported by Sampson et al. 1 All medical records were analysed and reviewed by three independent physicians including one anaphylaxis expert to confirm the diagnosis. The 5-grade Astier score was used to analyse anaphylaxis severity. 2,5 (Figure S1). We assessed the effect of baseline characteristics on the risk of progression (improvement vs worsening) of anaphylaxis severity by using Chi-square and Student's t tests. Association of Astier score with adrenaline use was investigated by Mann-Whitney U test. Statistical testing was conducted at the two-tailed α-level of 0.05. This study was approved by the French Data Protection Authority and the Advisory Committee for Information Processing in Health Research.A total of 152 cases of anaphylaxis were identified, but three families refused the inclusion. The final sample consisted of 149 cases; each child had been admitted only once. Mean age at inclusion was 7.4 (4.7) years, and 87 (58%) were boys. Thirty-five (23%) children had a known food allergy to the trigger involved in the study case, and 17 (20%) a history of past anaphylaxis. An emergency kit had been prescribed for 35 children, including an adrenaline autoinjector (AAI) in 31.The main anaphylaxis triggers were foods (n = 110; 74%, including peanut, n = 32; 21%). The other triggers were medication (n = 13; 9%) and hymenoptera venom (n = 1). Twenty-five (17%) reactions were considered as idiopathic. Cofactors were involved in 35 (23%) cases including viral infection (n = 23; 15%) and physical exercise (n = 11; 7%).The emergency medical services (EMS) were called by the family in 63 (43%) cases, and 95 (63%) patients went directly to the emergency care unit. In all, 55 (37%) children received prehospital care by Guillaume Poues...

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Section: Time Course Of Clinical Anaphylaxis Manifestations and Astiesupporting

confidence: 92%

The time course of anaphylaxis manifestations in children is diverse and unpredictable

Pouessel

Antoine

Lejeune

et al. 2019

Clin Experimental Allergy

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“…These latter symptoms may be treated with acetaminophen and monitored. Non‐steroidal anti‐inflammatory drugs should be avoided as they may serve as augmenting factors and worsen the reaction .…”

Section: Discussionmentioning

confidence: 99%

Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults

et al. 2019

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Background and ObjectivesRare but potentially life‐threatening hypersensitivity reactions can occur during the administration of intravenous iron. To provide guidance to healthcare professionals caring for adults receiving intravenous iron, a panel of 10 Canadian clinical experts developed a practical algorithm for the identification and management of hypersensitivity reactions to intravenous iron.Materials and methodsA systematic search of PubMed to February 2018 was performed. Articles related to hypersensitivity reactions were selected for review. The algorithm was developed during a 1‐day live meeting based on the literature review and clinical expertise where evidence was lacking. The algorithm was then refined through an iterative process involving a web‐based platform and virtual meetings.ResultsThe algorithm provides guidance to healthcare professionals in preparing for and administering IV iron, as well as recognizing and managing hypersensitivity reactions to intravenous iron. Considerations for re‐challenging patients who have experienced prior reactions are provided.ConclusionHealthcare professionals who are involved in the care of patients receiving intravenous iron should be trained to anticipate, recognize and manage hypersensitivity reactions to intravenous iron to optimize patient care.

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“…It has been suggested that physical exercise, as well as the other facilitating factors, both increases the gastrointestinal absorption of food allergens and lowers the threshold for mastcell and basophil degranulation in sensitized individuals [48,49]. The great majority of patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) have serum IgE specific for omega-5 gliadin and only in a minority of cases for high molecular weight glutenin (HMW-glutenin) [50].…”

Section: Clinical Presentation and Natural Historymentioning

confidence: 99%

New Perspectives in Food Allergy

Martinis

Sirufo

Suppa

et al. 2020

IJMS

163

130

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The improvement of the knowledge of the pathophysiological mechanisms underlying the tolerance and sensitization to food antigens has recently led to a radical change in the clinical approach to food allergies. Epidemiological studies show a global increase in the prevalence of food allergy all over the world and manifestations of food allergy appear increasingly frequent also in elderly subjects. Environmental and nutritional changes have partly changed the epidemiology of allergic reactions to foods and new food allergic syndromes have emerged in recent years. The deepening of the study of the intestinal microbiota has highlighted important mechanisms of immunological adaptation of the mucosal immune system to food antigens, leading to a revolution in the concept of immunological tolerance. As a consequence, new prevention models and innovative therapeutic strategies aimed at a personalized approach to the patient affected by food allergy are emerging. This review focuses on these new perspectives and their practical implications in the management of food allergy, providing an updated view of this complex pathology.

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Mechanisms, Cofactors, and Augmenting Factors Involved in Anaphylaxis

Cited by 81 publications

References 94 publications

The time course of anaphylaxis manifestations in children is diverse and unpredictable

The time course of anaphylaxis manifestations in children is diverse and unpredictable

Canadian expert consensus: management of hypersensitivity reactions to intravenous iron in adults

New Perspectives in Food Allergy

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