Current opinion in allergy and clinical immunology
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Curr Opin Allergy Clin Immunol · Aug 2006
ReviewEmergency treatment and prevention of insect-sting anaphylaxis.
Hymenoptera stings are thought to cause systemic allergic reactions in 0.4-5% of individuals, and to account for 40-100 deaths annually in the USA. This review examines current research on insect-sting anaphylaxis in the emergency department (ED), and provides suggestions on how to improve ED treatment and prevention. ⋯ Concordance with national guidelines for the treatment of anaphylaxis remains poor among insect-sting allergy patients. The development of a simple, clinical definition of anaphylaxis is urgently needed to facilitate identification of cases. Such a definition would help tremendously with dissemination of emergency management guidelines and the creation of systems for their implementation. All of these steps are essential for the improved treatment and prevention of insect-sting anaphylaxis in the ED.
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Curr Opin Allergy Clin Immunol · Jun 2006
ReviewOutcome evaluation of early discharge after hospitalization for asthma.
This review is designed to assess the evidence around the criteria used to decide when it is appropriate for an individual with asthma to be discharged from hospital. ⋯ The available data for adults with acute asthma on the appropriate end points for discharge from hospital are inadequate to provide firm conclusions. Children with acute asthma should be considered ready for discharge when clinically stable on 3-hourly bronchodilator.
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Curr Opin Allergy Clin Immunol · Aug 2005
Review Comparative StudyCardiovascular aspects of anaphylaxis: implications for treatment and diagnosis.
Anaphylactic cardiovascular collapse can be resistant to treatment with epinephrine (adrenaline) and, in some cases, diagnostic uncertainty compromises follow-up care. The purpose of this review is to examine recent studies relevant to the management and diagnosis of this condition. ⋯ Current evidence supports use of the supine/Trendelenburg position, epinephrine by intravenous infusion and aggressive volume resuscitation. If these fail, atropine should be considered for severe bradycardia and potent vasoconstrictors may be useful. To confirm the diagnosis of anaphylaxis, serial measurements of mast cell tryptase may be preferable to a single measurement.
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Curr Opin Allergy Clin Immunol · Jun 2005
ReviewEmergency management of food allergy: systems perspective.
Food-related allergic reactions are the leading cause of anaphylactic reactions treated in the emergency department, accounting for approximately 30 000 emergency department visits each year, and 150-200 deaths. The purpose of this review is to examine current research on food-related allergic reactions in the emergency department, and to provide suggestions for how to improve emergency department management. ⋯ Concordance with suggested guidelines for the treatment of severe acute allergic reactions remains poor. Development of a simple, clinical definition of food-related anaphylaxis is needed to improve emergency management. Dissemination of guidelines for the emergency management of anaphylaxis, and creation of systems to implement these guidelines, are essential for the improved treatment of food-related allergic reaction and anaphylaxis in the emergency department.
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Curr Opin Allergy Clin Immunol · Jun 2005
ReviewTreatment of asthma during pregnancy and perinatal outcomes.
Asthma is the most common, potentially serious medical problem to complicate pregnancy. Women with asthma have been shown to be at increased risk of complications during pregnancy. Managing asthma during pregnancy is unique because the effect of both the illness and the treatment on the developing fetus as well as the patient must be considered. This review summarizes the recent studies addressing the effects of asthma or asthma medications on perinatal outcomes, including the 2004 Asthma and Pregnancy Working Group of the National Asthma Education and Prevention Program. ⋯ The prevalence of asthma in pregnant women appears to be increasing. Recent evidence supports that pregnant women with moderate to severe asthma may have an increased risk of adverse perinatal outcomes. The goal of asthma management during pregnancy is to optimize maternal and fetal health.