Thromboembolic stroke: a sequela of Hymenoptera venom–induced anaphylaxis

Johnson, John A.; Frith, John A.; Casselman, Jason; Saad, Ali G.; Tcheurekdjian, Haig; Hostoffer, Robert

doi:10.1016/j.anai.2016.01.007

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Several trials have shown that patients with prior anaphylaxis to paclitaxel suspended in Cremophor are able to tolerate Abraxane. 10 According to our research, only three previously reported cases 1,11 have described the association between anaphylaxis, thrombocytopenia, and thrombus formation. All three cases described a significant decrease in platelets (8%-49%, P < 0.0001) and thrombus formation in patients with anaphylaxis, without shock.…”

Section: Discussionmentioning

confidence: 68%

Association of acute thrombocytopenia with anaphylaxis

Thota

Konduru

Mulla

et al. 2021

Baylor University Medical Center Proceedings

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A commonly seen phenomenon in the hospital and critical care setting is anaphylaxis. This acute systemic inflammatory reaction can lead to anaphylactic shock in severe cases and potentially be fatal. The role of platelets in anaphylactic reactions is not well established; however, platelets, among other mediators such as platelet-activating factor, have been shown to promote a prothrombotic state shortly after an acute hypersensitivity reaction. In addition, the aggregation of platelets promoted by platelet-activating factor and other mediators can also lead to thrombocytopenia. We present a case of a 57-year-old woman who developed severe anaphylaxis while receiving chemotherapy with paclitaxel suspended in Cremophor, a well-known allergen. She was profoundly thrombocytopenic following the reaction and was treated with therapeutic anticoagulation, with no thrombus formation.

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Section: Discussionmentioning

confidence: 68%

Association of acute thrombocytopenia with anaphylaxis

Thota

Konduru

Mulla

et al. 2021

Baylor University Medical Center Proceedings

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“…This case was previously published and will only be reviewed briefly here [4]. A 44 year old man was stung in his right knee by a flying insect.…”

Section: Casementioning

confidence: 99%

A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis

Peppers

Vatsayan

Dalal

et al. 2018

Immunity Inflam & Disease

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IntroductionAnaphylaxis is a life threatening systemic inflammatory process that share mediators involved in the coagulation cascade. Platelet activating factor, known to increase platelet aggregation, has also been implicated as an important mediator of anaphylaxis. Although other inflammatory reactions are associated with an increased risk of thrombosis, anaphylaxis is currently not reported as one of them. Furthermore the role platelets may have in the perianaphylaxis period is not well understood. We here in present a retrospective case series of three patients that had platelet aberrations suggestive of PAF involvement and clinically significant thrombosis in close relationship with anaphylaxis.ObjectiveTo investigate platelet response before and after anaphylaxis and indirect observation evidence of platelet activating factors involvement with possible increased risk of thrombosis.MethodsA retrospective investigation into medical records including medication administrations times, laboratory, and radiology results. Platelet levels pre‐ and post‐ anaphylaxis were statistically analyzed.ResultsCase 1, a 44 year old man had an anaphylactic reaction shortly after envenomation and subsequently suffered an acute infarction with thrombus in a cerebral artery. Case 2 is a 49 year old man with idiopathic anaphylaxis who developed a deep vein thrombosis after a protracted anaphylaxis event. Case 3 involved an 18 year old female with acute myeloid leukemia was found to have a thrombus in the celiac trunk following anaphylaxis. A paired two‐tailed Wilcoxon test on the subjects pre and post anaphylactic platelet levels resulted in a overall P < 0.0001.Conclusions and Clinical RelevanceThese three cases illustrate the potential role platelets may have in anaphylaxis and possible increased secondary risk for the development of thrombosis. Larger studies are required to determine incidence and risk factors for blood clots following anaphylaxis in order to provide management or screening recommendations.

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“…Previously, a case was reported in which a 30-year-old patient developed quadrantanopia and a left occipital lobe infarction on computed tomogra-phy thirty-eight hours after admission for an anaphylactic response to a wasp sting [4]. Another case was reported in which a 44-year-old patient presented with dysarthria, hemiplegia, and facial droop due to a thromboembolic stroke one hour after experiencing an anaphylactic response to a Hymenoptera sting [5]. A possible explanation is that physiological changes during anaphylactic shock, including an abrupt drop in blood pressure due to a decrease in venous tone and extravasation of intravascular fluids, may disrupt cerebral perfusion, leading to ischemic injury [6].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Secondary to Bleach Anaphylaxis

Rehman¹,

Osto²,

Ali

et al. 2022

crcp

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Anaphylaxis is a severe allergic reaction characterized by life-threatening airway, breathing, and hemostatic problems. There has been an established association between cerebral infarction following wasp or bee sting in the literature. A 54-year-old female was admitted to the hospital for acute anaphylaxis due to bleach exposure and developed a new-onset left-sided weakness. Head computed tomography demonstrated midline frontal calcifications but was negative for acute ischemia or hemorrhage. Magnetic resonance imaging multifocal infarcts of the internal capsule’s right temporal and posterior limb. The patient was started on aspirin 81 mg, atorvastatin 40 mg daily for secondary prevention of stroke, and physical, occupational, and speech therapies. Although exceedingly rare, decreased cerebral blood flow may occur secondary to anaphylaxis due to an abrupt drop in blood pressure leading to ischemic injury. The case characterizes a unique association between bleach anaphylaxis and ischemic stroke, which has not been previously reported.

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Thromboembolic stroke: a sequela of Hymenoptera venom–induced anaphylaxis

Cited by 5 publications

References 5 publications

Association of acute thrombocytopenia with anaphylaxis

Association of acute thrombocytopenia with anaphylaxis

A case series: Association of anaphylaxis with a significant decrease in platelet levels and possible secondary risk of thrombosis

Ischemic Stroke Secondary to Bleach Anaphylaxis

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