Allergy and asthma proceedings :
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Allergy Asthma Proc · Jan 2019
Anaphylaxis risk factors for hospitalization and intensive care: A comparison between adults and children in an upstate New York emergency department.
Background: Anaphylaxis is an acute, systemic allergic reaction that can be life threatening, and with an increasing incidence and costs associated with hospitalization and intensive care. Objective: To assess the risk factors for hospitalization by comparing pediatric and adult patients. Methods: We performed a retrospective chart review for patients with anaphylactic reactions who presented to the Albany Medical Center emergency department between 2005 and 2012. ⋯ Conclusion: Anaphylaxis remains underrecognized and improperly treated in the emergency department. Severity of symptoms and receiving multiple doses of epinephrine were associated with hospitalization in both children and adults. Medicare and/or Medicaid insurance, and cardiovascular or cutaneous symptoms were characteristics associated with ICU admission in our cohort.
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Although allergists often evaluate rashes associated with allergic, IgE mediated etiologies, it is important to consider a wide range of differential diagnoses that includes inflammatory, infectious, and autoimmune etiologies. The case of a 58-year-old woman with a 1-year history of progressive pruritic rash that did not improve with topical creams and steroids is presented. ⋯ Even in the context of a medical history of atopy, one must consider nonallergic causes of rash, including abnormal presentations of systemic conditions. It is important to determine the specific etiology of the rash because this will dictate treatment and prognosis and/or complications of the disease associated with the skin manifestations.
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Allergy Asthma Proc · Sep 2018
Randomized Controlled Trial Multicenter StudySeasonal variability of exacerbations of severe, uncontrolled eosinophilic asthma and clinical benefits of benralizumab.
Benralizumab is a humanized, afucosylated, monoclonal antibody that targets interleukin-5 receptor alpha and induces direct, rapid, and nearly complete depletion of eosinophils via enhanced antibody-dependent cell-mediated cytotoxicity. In the United States, benralizumab is indicated for add-on maintenance treatment of patients ≥12 years old with severe asthma and an eosinophilic phenotype. ⋯ Benralizumab significantly and consistently reduced asthma exacerbations across all seasons versus placebo for patients with severe, uncontrolled eosinophilic asthma.
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Allergy Asthma Proc · Sep 2018
Improved diagnostic clarity in shrimp allergic non-dust-mite sensitized patients.
Allergen specific immunoglobulin E (sIgE) levels predictive of shrimp allergy have not been identified, but these may be helpful in identifying patients at risk for shrimp-induced allergic reactions. ⋯ HDM sensitization influences shrimp and HDM component sIgE levels and, consequently, their diagnostic accuracy in shrimp allergy. In our series, in the patients who were non-HDM sensitized, a shrimp sIgE level of >3.55 kUA/L showed 100% sensitivity and, Der p 10 sIgE of >3.98 kUA/L showed 100% specificity for the diagnosis of shrimp allergy. These levels may not be applicable to every patient and, therefore, may not obviate the need for OFC.
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Allergy Asthma Proc · Jul 2018
Pitfalls in anaphylaxis diagnosis and management at a university emergency department.
Some previous reports revealed suboptimal management of anaphylaxis (ANX) in the emergency department (ED). ⋯ The observed low rates of appropriate diagnostic coding of ANX, of epinephrine administration, epinephrine autoinjector prescribing at discharge, and referral for allergy evaluation call for more education on these issues. Some of these pitfalls can be partly attributed to the setting in a university ED where health providers are usually busy in rendering urgent care.