Recognition, Treatment, and Prevention of Anaphylaxis

Moore, Lindsey E.; Kemp, Ann M.; Kemp, Stephen F.

doi:10.1016/j.iac.2015.01.006

Cited by 10 publications

(13 citation statements)

References 42 publications

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“…Los medicamentos, alimentos y las picaduras de insectos ocasionan la mayoría de los episodios, pero virtualmente cualquier sustancia capaz de inducir la degranulación sistémica de los mastocitos y basófilos puede producirla (27). Los factores desencadenantes varían con la edad: en niños, adolescentes y adultos jóvenes; la principal causa de anafilaxia son los alimentos, mientras que en pacientes de edad mediana y avanzada, las causas más comunes son los medicamentos y las picaduras de insectos (6,(27)(28)(29)(30).…”

Section: Epidemiologíaunclassified

“…El diagnóstico de esta entidad es fundamentalmente clínico (27,39). Las manifestaciones clínicas de la anafilaxia, varían ampliamente según los órganos implicados, estas pueden ocurrir hasta dos horas posteriores a la exposición al alérgeno detonante, pero por lo general, ocurre alrededor de 30 minutos después para la exposición por vía oral o incluso más temprano en el caso de aplicación parenteral de medicamentos o picadura por insectos (40).…”

Section: Características Clínicasunclassified

“…Las manifestaciones clínicas de la anafilaxia, varían ampliamente según los órganos implicados, estas pueden ocurrir hasta dos horas posteriores a la exposición al alérgeno detonante, pero por lo general, ocurre alrededor de 30 minutos después para la exposición por vía oral o incluso más temprano en el caso de aplicación parenteral de medicamentos o picadura por insectos (40). La urticaria, angioedema y el enrojecimiento de la piel, son las manifestaciones más comunes de la anafilaxia (12,41), estas pueden estar ausentes en una anafilaxia rápidamente progresiva o en el contexto perioperatorio (27). En un estudio reciente que describe una cohorte de 2012 pacientes pediátricos y adultos con anafilaxia, la piel es el órgano más frecuentemente comprometido (84 %), seguido de síntomas cardiovasculares (72 %) y síntomas respiratorios (68 %) (42,43).…”

Section: Características Clínicasunclassified

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Anafilaxia: estado del arte

Londoño

Raigosa

Vásquez

et al. 2018

iatreia

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La anafilaxia se define como una reacción de hipersensibilidad, sistémica, de instauración rápida y potencialmente fatal, con manifestaciones clínicas y severidad variable, que resulta de la liberación súbita de mediadores de mastocitos y basófilos. El diagnóstico de esta entidad es fundamentalmente clínico, basándose en los patrones de manifestación y la exposición a un posible detonante. Actualmente varios estudios indican deficiencias en la identificación y manejo de esta enfermedad, lo que genera un riesgo elevado de mortalidad. En esta revisión presentamos puntos prácticos del manejo e identificamos las principales consideraciones a tener en cuenta en el primer nivel de atención.

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Section: Epidemiologíaunclassified

Section: Características Clínicasunclassified

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Anafilaxia: estado del arte

Londoño

Raigosa

Vásquez

et al. 2018

iatreia

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“…Anaphylaxis is an acute, potentially life threatening, systemic hypersensitivity reaction that occurs when a patient is re-exposed to a previously sensitized antigen. [1,2] The most common causes of perioperative anaphylaxis are muscle relaxants and antibiotics. [3] Midazolam is known as a safe drug and is widely used as an anxiolytic, sedative, and adjuvant to general anesthetics in patients with drug allergy.…”

Section: Introductionmentioning

confidence: 99%

Midazolam anaphylaxis during general anesthesia

et al. 2019

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Rationale:Midazolam is known as a safe drug and is widely used as a sedative and an anesthetic adjuvant. Therefore, there is a lack of awareness that midazolam can cause anaphylaxis. Midazolam anaphylaxis is rare, and only a few cases have been reported, but such a risk is always present. In this study, we report a case of midazolam anaphylaxis by an intravenous injection, in the prone position, during general anesthesia.Patient concerns:A 62-year-old woman was intravenously administered 1 mg midazolam during general anesthesia, and sudden severe hypotension, bronchospasm, decreased oxygen saturation, erythema, and diarrhea occurred.Diagnosis:Midazolam anaphylaxis was presumptively diagnosed by clinical symptoms and was confirmed by an intradermal test after 9 weeks.Interventions:The patient was treated with 100% oxygen, large volume of fluid, epinephrine, phenylephrine, ephedrine, dexamethasone and prednisolone, ranitidine, and flumazenil.Outcomes:Severe hypotension and decreased oxygen saturation were resolved within 20 minutes of the onset of anaphylaxis, and the patient was discharged after 3 days without any sequelae.Lessons:Midazolam anaphylaxis is very rare, but it can happen always. Therefore, the possibility of anaphylaxis due to midazolam should be considered and always be prepared for treatment.

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“…Anaphylaxis is a serious, systemic hypersensitivity reaction, usually of rapid onset, that may result in mortality. 1 Although the incidence of anaphylaxis in adults during general anesthesia is estimated to be 1:10 000 to 1:20 000 cases, 2 the incidence of anaphylaxis or allergic reactions during PPS is unknown but is unlikely to be equivalent. We used data from the Pediatric Sedation Research Consortium (PSRC) to evaluate the nature and incidence of allergic and anaphylactic reactions during PPS, the mortality rate associated with allergic and anaphylactic reactions during PPS, and the relationship between the development of allergic and anaphylactic reactions and the use of sedatives, analgesics, local anesthetics, and radiographic contrast material.…”

mentioning

confidence: 99%

The Incidence and Nature of Allergic and Anaphylactic Reactions During Pediatric Procedural Sedation: A Report From the Pediatric Sedation Research Consortium

Hertzog

Preisberga

Penfil³

2019

Hospital Pediatrics

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A B S T R A C TBACKGROUND AND OBJECTIVES: Anaphylaxis is rare but life-threatening. Its incidence during pediatric procedural sedation outside of the operating room is unknown. We used data from the Pediatric Sedation Research Consortium (PSRC) to determine the incidence and nature of allergic and anaphylactic reactions in this practice. METHODS:A retrospective observational study of prospectively collected information in the PSRC's multicenter database was performed. Cases of allergic reaction were identified. Because anaphylaxis is not a listed complication in the PSRC database, all cases for which allergic reaction was noted were reviewed for the occurrence of other complications or interventions that would suggest at least 2 organ system derangements consistent with anaphylaxis as well as for practitioner commentary stating the occurrence of anaphylaxis. Descriptive analyses of demographic information and summary statistics were performed, and multiple logistic regression analysis was used to evaluate associations between the occurrence of allergic reactions and medications. RESULTS:During the study period, 227 833 cases were entered into the PSRC database. There were 54 cases of allergic reaction (incidence 1:4219); 6 were consistent with anaphylaxis (incidence 1:37 972). A significant association between the development of allergic reaction and 4 sedative and/or analgesic medications was noted: midazolam (odds ratio [OR] 2.2; confidence interval [CI] 1.2-3.9), ketamine (OR 3.8; CI 2.1-7.1), methohexital (OR 48.8;, and morphine (OR 4.4; CI 1.04-18.2). There were no mortalities.CONCLUSIONS: Allergic reactions and anaphylaxis during pediatric procedural sedation are rare. In this study, the development of allergic reactions was significantly associated with the use of midazolam, ketamine, methohexital, and morphine.

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Recognition, Treatment, and Prevention of Anaphylaxis

Cited by 10 publications

References 42 publications

Anafilaxia: estado del arte

Anafilaxia: estado del arte

Midazolam anaphylaxis during general anesthesia

The Incidence and Nature of Allergic and Anaphylactic Reactions During Pediatric Procedural Sedation: A Report From the Pediatric Sedation Research Consortium

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