Risk of systemic reactions in patients taking beta-blocker drugs receiving allergen immunotherapy injections

Hepner, M.J.; Ownby, Dennis R.; Anderson, John A.; Rowe, Michael; Sears-Ewald, D.; Brown, Edwin G.

doi:10.1016/s0091-6749(05)80105-8

Cited by 96 publications

(40 citation statements)

References 6 publications

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“…Fatal reactions have also been reported in patients who had previously undergone serious systemic reactions to immunotherapy, in patients in whom a new vial of allergen has been opened, and in patients receiving beta-blocking agents (Lockey et al 1987, Malling and Weeke 1993, Reid et al 1993, Bousquet et al 1998. We should note that recent studies suggest that beta-blockers, particularly the more selective agents, may not pose a significant risk (Hepner et al 1990). Fatal reactions also occur from treatment errors (Table II).…”

Section: Immunotherapymentioning

confidence: 95%

Why Do People Die of Anaphylaxis?—A Clinical Review

Kumar

Teuber

Gershwin

2005

Journal of Immunology Research

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Anaphylaxis is a source of anxiety for patients and healthcare providers. It is a medical emergency that presents with a broad array of symptoms and signs, many of which can be deceptively similar to other diseases such as myocardial infarction, asthma, or panic attacks. In addition to these diagnostic challenges, anaphylaxis presents management difficulties due to rapid onset and progression, lack of appropriate self-treatment education and implementation by patients, severity of the allergic response, exacerbating medications or concurrent disease, and unpredictability. The most common causes of anaphylaxis are food allergies, stinging insects and immunotherapy (allergy shots) but idiopathic anaphylaxis, latex allergy and drug hypersensitive all contribute to the epidemiology. Reactions to IVP and other dyes are coined anaphylactoid reactions but have identical pathophysiology and treatment, once the mast cell has been degranulated. As many antigens can be the trigger for fatal anaphylaxis, it is useful to examine the features of each etiology individually, highlighting factors common to all fatal anaphylaxis and some specific to certain etiologies. Generally what distinguishes a fatal from non fatal reaction is often just the rapidity to apply correct therapy. Prevention is clearly the key and should identify high-risk patients in an attempt to minimize the likely of a severe reaction. Although fatal anaphylaxis is rare, it is likely underreported.

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Section: Immunotherapymentioning

confidence: 95%

Why Do People Die of Anaphylaxis?—A Clinical Review

Kumar

Teuber

Gershwin

2005

Journal of Immunology Research

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“…Corticosteroids are not part of the acute treatment of EIA, but a brief course of systemic corticosteroids may be prudent in all cases, and should be strongly considered following a severe episode. The use of beta adrenergic blocking agents can adversely affect the course of anaphylaxis by inducing refractory symptoms despite the administration of epinephrine [29]. Patients on beta blockers who present with anaphylaxis that is unresponsive to standard therapy may benefit from administration of glucagon.…”

Section: Acutementioning

confidence: 99%

“…Anticholinergic, beta-adrenergic, and phosphodiesterase inhibitors have not been shown to provide prophylactic benefits. Oral or inhaled disodium cromoglycate, a mast-cell stabilizer, has partially blocked EIA [29]. In one patient, sodium bicarbonate was helpful at preventing wheat-induced FT-EIA.…”

Section: Prevention and Pregnancymentioning

confidence: 99%

Exercise-induced anaphylaxis

Castells

Horan

Sheffer

2003

Curr Allergy Asthma Rep

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Exercise-induced anaphylaxis has been recognized with increasing frequency since its original description in 1980. Recent studies suggest food-induced reactions may occur frequently in this syndrome, which is a mast cell-dependent phenomenon. In this article, the clinical manifestations of exercise-induced anaphylaxis are reviewed, and food-related factors contributing to the disorder are considered.

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“…Case series of fatal and non-fatal anaphylaxis have reported the use of â-blockers in several instances but the number of patients at risk is uncertain [11][12][13]. However, one prospective study of patients receiving immunotherapy showed no increase of incidence of adverse reactions among patients receiving β-blockers compared with those not receiving β-blockers [14,15].…”

Section: Discussionmentioning

confidence: 99%