Risk assessment in anaphylaxis: Current and future approaches

Simons, F. Estelle R.; Frew, Anthony J.; Ansotegui, Ignacio J.; Bochner, Bruce S.; Golden, David B.K.; Finkelman, Fred D.; Leung, Donald Y.M.; Lötvall, Jan; Marone, Gianni; Metcalfe, Dean D.; Müller, Ulrich; Rosenwasser, Lanny J.; Sampson, Hugh A.; Schwartz, Lawrence B.; Hage, Marianne van; Walls, Andrew F.

doi:10.1016/j.jaci.2007.05.001

Cited by 262 publications

(320 citation statements)

References 153 publications

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“…Currently, increases in serum tryptase levels are the preferred assay for detection of mast cell-mediated anaphylaxis in humans (1,10). To determine whether a similar increase in a mast cell-specific protease could differentiate IgE-from IgG-mediated anaphylaxis in mice, we determined serum MMCP1 levels before and after IgE-and IgGmediated anaphylaxis in this species.…”

Section: Resultsmentioning

confidence: 99%

“…Although increased serum levels of tryptase, which is released by degranulating mast cells, suggests IgE-mediated anaphylaxis (10)(11)(12), many cases of human anaphylaxis are not accompanied by elevated serum tryptase or detectable antigen-specific IgE (2, 7). Such cases could reflect an IgG-dependent (or IgM-or complement-dependent) anaphylaxis mechanism but might also be explained by the short half-life of tryptase in blood, the secretion of relatively small amounts of tryptase in mild anaphylaxis, and the association of antigen-specific IgE with high-affinity mast cell and basophil receptors (Rs) in the absence of detectable levels in blood (13,14).…”

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confidence: 99%

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Identification of markers that distinguish IgE- from IgG-mediated anaphylaxis

Khodoun

Strait

Armstrong

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

123

107

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IgG-mediated anaphylaxis occurs in mice and may contribute to human reactions to infused drugs. To distinguish IgE- from putative IgG-mediated human anaphylaxis, we developed blood markers for murine anaphylaxis and evaluated their human relevance. Both IgG- and IgE-mediated anaphylaxis were characterized by decreased basophil and monocyte percentages and an increased neutrophil percentage in mouse blood. IgE- but not IgG-mediated murine anaphylaxis was accompanied by large increases in IL-4 secretion, plasma soluble IL-4 receptor-α (IL-4Rα) concentration, and T-cell membrane IL-4Rα expression. T-cell IL-4Rα expression also increased when mice that express human Fcε receptor Iα were sensitized with IgG-depleted serum from a peanut-allergic individual and challenged with peanut extract. Increased T-cell IL-4Rα expression is likely to also be a marker for human IgE-mediated anaphylaxis, because IgE-activated human basophils secrete IL-4, and IL-4 increases human T-cell IL-4Rα expression in vitro. Murine IgG- but not IgE-mediated anaphylaxis was characterized by decreased neutrophil Fcγ receptor III (FcγRIII) expression that was observed even when the antigen dose was insufficient to induce shock. Human neutrophils cultured with IgG immune complexes also lost FcγRIII. These observations suggest that decreased blood neutrophil FcγRIII expression without increased IL-4Rα expression can be used to determine whether and when IgG-mediated anaphylaxis occurs in man.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Identification of markers that distinguish IgE- from IgG-mediated anaphylaxis

Khodoun

Strait

Armstrong

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

123

107

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“…While it was believed generally that coronary arteries were not involved primarily in the haemodynamic derangement associated with anaphylaxis, recent observations indicate that coronary blood flow can be impaired during anaphylaxis and this may contribute significantly to an unfavourable outcome [8,9]. A pre-existing coronary artery disease is now considered to be a negative prognostic factor of anaphylaxis [10]. In addition, acute ischaemic events, including angina and myocardial infarction, are considered currently as part of the clinical picture of anaphylaxis [11].…”

Section: Introductionmentioning

confidence: 99%

Allergy and the cardiovascular system

Triggiani

Patella²,

Staiano

et al. 2008

Clinical and Experimental Immunology

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154

147

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SummaryThe most dangerous and life-threatening manifestation of allergic diseases is anaphylaxis, a condition in which the cardiovascular system is responsible for the majority of clinical symptoms and for potentially fatal outcome. The heart is both a source and a target of chemical mediators released during allergic reactions. Mast cells are abundant in the human heart, where they are located predominantly around the adventitia of large coronary arteries and in close contact with the small intramural vessels. Cardiac mast cells can be activated by a variety of stimuli including allergens, complement factors, general anesthetics and muscle relaxants. Mediators released from immunologically activated human heart mast cells strongly influence ventricular function, cardiac rhythm and coronary artery tone. Histamine, cysteinyl leukotrienes and platelet-activating factor (PAF) exert negative inotropic effects and induce myocardial depression that contribute significantly to the pathogenesis of anaphylactic shock. Moreover, cardiac mast cells release chymase and renin that activates the angiotensin system locally, which further induces arteriolar vasoconstriction. The number and density of cardiac mast cells is increased in patients with ischaemic heart disease and dilated cardiomyopathies. This observation may help explain why these conditions are major risk factors for fatal anaphylaxis. A better understanding of the mechanisms involved in cardiac mast cell activation may lead to an improvement in prevention and treatment of systemic anaphylaxis.

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“…17,18 The diagnosis of anaphylaxis depends primarily on the history of exposure to a potential triggering agent or event, the brief time elapsed (minutes to several hours) between exposure and symptom onset, 3 the rapid evolution of symptoms and signs, and recognition of the pattern of target organ involvement with approximately 40 different cutaneous, respiratory, gastrointestinal, cardiovascular, and/or central nervous system symptoms. 3,17,18 Even in countries where measurements of tryptase levels or histamine levels are readily available in clinical laboratories, these assays take several hours to perform, and results are seldom, if ever, available on an emergency basis. In addition, even when tryptase or histamine levels are measured in a timely manner under optimal conditions, the levels are not necessarily elevated in all patients with a clinical diagnosis of anaphylaxis; for example, tryptase levels are seldom elevated in normotensive patients or anaphylaxis triggered by food.…”

Section: Diagnosis Of An Acute Anaphylaxis Episodementioning

confidence: 99%

“…Moreover, tryptase and histamine levels that are within normal limits cannot be used to refute the diagnosis of anaphylaxis. 3,17,18 Treating and Monitoring an Acute Anaphylaxis Episode Epinephrine (adrenaline) in ampules for injection by any route was the only medication that was universally available for anaphylaxis treatment. This reflects the World Health Organization position that epinephrine is an essential medication for anaphylaxis treatment (www.who.int) and also reflects the recommendations in anaphylaxis guidelines [5][6][7][8][9][10][11][12][13][14][15][16] and previous WAO anaphylaxis publications 19 -21 that prompt injection of epinephrine (adrenaline) is the initial medication of choice in anaphylaxis.…”

Section: Diagnosis Of An Acute Anaphylaxis Episodementioning

confidence: 99%

World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings

Simons

2010

Annals of Allergy, Asthma & Immunology

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BACKGROUND: The availability of anaphylaxis guidelines and of medications, supplies, and equipment for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings worldwide is unknown. OBJECTIVE: To ascertain the global availability of these essentials. METHODS: A survey instrument was developed and sent by e-mail in 2008 to a nonrandomized convenience sample of representative leading allergy-immunology specialists in 52 countries identified through the World Allergy Organization. Responses were analyzed by country. RESULTS: Surveys were returned from 44 of 52 countries on 6 continents, for an 85% response rate. Anaphylaxis guidelines were reported to be in use in 70% of the 44 responding countries. The diagnosis of acute anaphylaxis was reported to be based on clinical history and physical examination alone in 63% of responding countries. Medications for anaphylaxis treatment were reported to be available in the 44 responding countries as follows: epinephrine (adrenaline) for injection, 100%; any intravenous glucocorticoid, 89%; any intravenous H1-antihistamine, 77%; any intravenous H2-antihistamine, 70%; glucagon, 73%; atropine, 73%; dopamine, 86%; noradrenaline, 70%; vasopressin, 64%; and a beta 2-agonist for nebulization, 86%. Supplies and equipment for anaphylaxis treatment were reported to be available in responding countries as follows: for giving supplemental oxygen, 95%; for intubation, 89%; for giving intravenous fluid resuscitation, 91%; for monitoring oxygenation using pulse oximetry, 91%; and for continuous noninvasive blood pressure and cardiac monitoring, 81%. CONCLUSIONS: Allergy-immunology specialists reported that except for epinephrine ampules life-saving essentials for the assessment and management of anaphylaxis in health care settings were not universally available worldwide in 2008. Background: The availability of anaphylaxis guidelines and of medications, supplies, and equipment for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings worldwide is unknown.Objective: To ascertain the global availability of these essentials. Methods: A survey instrument was developed and sent by e-mail in 2008 to a nonrandomized convenience sample of representative leading allergy-immunology specialists in 52 countries identified through the World Allergy Organization. Responses were analyzed by country.Results: Surveys were returned from 44 of 52 countries on 6 continents, for an 85% response rate. Anaphylaxis guidelines were reported to be in use in 70% of the 44 responding countries. The diagnosis of acute anaphylaxis was reported to be based on clinical history and physical examination alone in 63% of responding countries. Medications for anaphylaxis treatment were reported to be available in the 44 responding countries as follows: epinephrine (adrenaline) for injection, 100%; any intravenous glucocorticoid, 89%; any intravenous H 1 -antihistamine, 77%; any intravenous H 2 -antihistamine, 70%; glucagon...

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Risk assessment in anaphylaxis: Current and future approaches

Cited by 262 publications

References 153 publications

Identification of markers that distinguish IgE- from IgG-mediated anaphylaxis

Identification of markers that distinguish IgE- from IgG-mediated anaphylaxis

Allergy and the cardiovascular system

World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings

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