Anaphylactic reaction concentrate

Ludolph-Hauser D, Rueff F, Fries C, et al Con- 40 stitutively raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to Hyme-noptera stings. Lancet 2001 357 361-362. 

Histamine is a critical mediator in anaphylactic reactions. It is a diamine produced by decarboxylation of the amino acid histidine in the Golgi apparatus of mast cells and basophils. Once secreted, it is rapidly metabolized by histamine methyltransferase [2]. Plasma histamine levels are elevated in anaphylaxis, reaching a concentration peak at 5 min and declining to baseline by 30-60 min [3]. Therefore, histamine samples for assessing an anaphylactic reaction should be obtained within 15 min of the onset of the reaction. Urinary metabolites of histamine may be found for up to 24 h. 

Finally, other mediators such as leukotrienes and prostaglandins may also play a role. Denzlinger et al. [17] first reported an increase in urinary leukotriene E4 in anaphylactic reactions. This has been recently confirmed [18], along with an increase in 9a,l iP PGFj concentrations during anaphylaxis. 

Thiopentone administration is associated with a threefold increase in circulating histamine concentrations. Hypersensitivity reactions range from cutaneous rashes to severe or fatal anaphylactic reactions. The incidence of life-threatening reactions is 1 14000-1 20000. 

Acute anaphylaxis occurred in an 18-year-old man after the third course of intradermal injections of triamcinolone suspension ( Kenalog 10 mg per treatment) for alopecia areata (446). Subsequent rechallenge with intradermal triamcinolone 1 ml resulted in the same anaphylactic reaction as before and his serum IgE concentration was increased. 

Poloxamers are neutral block copolymers such as 12, consisting of two terminal hydrophilic polyoxyethylene blocks flanking a central hydrophobic polyoxypropylene block. Poloxamer 188 (e.g., Pluronic F-68) was used in the first generation PFC emulsions, but was far from adequate Its surface activity is relatively poor, translating into low emulsions stability the purity of the commercial products is usually rather low its cloud point ( 110-115°C) prevents sterilization at the standard temperature of 121°C its tendency to form gels limits the PFC concentration in the emulsions and, finally, Pluronic F-68 has been found to be responsible for the unpredictable transientcomplement activation-mediated anaphylactic reaction observed in some patients in response to the injection of Fluosol. ... 

Allergic and anaphylactic reactions due to factor IX inhibitor have been described (SEDA-21, 343) (6). Anaphylactic reactions occur particularly in patients with undetectable concentrations of factor IX, because of major disruptions in the factor IX gene (10). In patients with factor IX inhibitor, IgGl subclass antibodies have been found, which may activate complement, resulting in allergic reactions (SEDA-21, 343) (10). However, it has also been suggested that allergic reactions to factor IX products are IgE-mediated. 

Anaphylactic reactions have also been reported following the consumption of foods derived from, or containing, soy beans. Recently there has been concern at the concentration of phytoestrogens in some soy-derived products. Administration of soy protein to humans has resulted in significantly decreased serum lipid concentrations. " ... 

Nephrotoxicity may be prevented or diminished by prehydration with 21 of normal saline administered over a 6-8 h period, followed by continued hydration during and after the cisplatin infusion. Nausea and vomiting may be managed with antiemetics. Electrolyte concentration should be monitored and supplemented as needed. Treatment for an anaphylactic reaction would include antihistamines, administered with or without epinephrine. If accidental exposure to the eyes or skin occurs, the affected skin area should be washed thoroughly with soap and water, and eyes should be flushed with copious amounts of tepid water for at least 15 min. Seizures should be treated with diazepam, lorazepan, phenobarbital, or phenytoin. 

Reactions to intravenous iron include headache, malaise, fever, generalized lymphadenopathy arthralgias, urticaria, and in some patients with rheumatoid arthritis, exacerbation of the disease. Phlebitis may occur with prolonged infusions of a concentrated solution or when an intramuscular preparation containing 0.5% phenol is used in error. Of greatest concern is the rare anaphylactic reaction, which may be fatal despite treatment. 

Penicillins have a very low toxicity, but high concentrations (renal failure, intraihccal administration) may produce encephalopathy, which can be fatal. HyperseDsitivity is the most important side-effect of the penicillins, which may cause rashes and, rarely, anaphylactic reactions that are fatal in about 10% of cases. 

In their cured state UF resins are nontoxic. Urea itself is also harmless. However, free formaldehyde and formaldehyde generated by slow hydrolysis of the aminoplastic bond are highly reactive and combine easily with proteins in the human body. This may cause a painful inflammation of the mucous membranes of the eyes, nose, and mouth [25]. Even a low concentration of formaldehyde vapor in the air can cause disagreeable irritations of the nose and eyes. However, such irritations usually disappear in a short time without permanent damage. Occasionally, allergic or anaphylactic reactions develop and complete removal from exposure is necessary. 

Since elicitation of antibody-mediated hypersensitivity reactions requires as a rule at least divalent or trivalent antigens, and is usually best achieved with multivalent conjugates, the specific inhibition of such reactions by monovalent haptens seems theoretically possible and depends primarily on the concentrations of inhibiting and eliciting haptens and on antibody affinity and concentration. It has been shown that anaphylactic reactions in vivo assessed by the PCA technique, or by observation of systemic shock or urticarial skin reactions, can be completely in-... 

In view of the very high degrees of sensitivity of the subjects, the occasional reaction to high concentrations of the neutral compound cis-[Pt(OHC2H4NH2)Cl2] may be due to slight contamination and 0.001% [PtClJ " would suffice. Impurities of this order could explain the anaphylactic reactions to cw-[Pt(NH3)2Cl2] used for the treatment of certain cancers, reported by Khan et al. (1975). 

Cardiac arrest shortly after the induction for emergency thyroidectomy in a patient with decompensated thyrotoxicosis has been reported [5" ]. Raised plasma tryptase concentrations confirmed an anaphylactic reaction. The authors discussed the differential diagnosis of collapse, which includes thyroid storm. 

A 8-month-old boy with hemophilia B was given plasma-derived factor IX concentrate and after 1 month developed recurrent anaphylactic reactions following infusions of factor IX, with shortness of breath, wheeze, and widespread urticaria [70 ]. High-dose factor IX immune tolerance therapy was successful in eradicating the inhibitor for 40 months. Two more attempts to achieve immune tolerance with high-dose factor IX were complicated by recurrent anaphylactic reactions. 

Immunologic Allergic reactions, such as anaphylaxis and transfusion reactions, are potential adverse reactions to prothrombin complex concentrates [32 ]. Patients with IgA deficiency and anti-IgA antibodies can have anaphylactic reactions after exposure to IgA-containing blood products, including prothrombin complex concentrates [71 ]. 

Chowdary P, Nair D, Davies N, Malde R, Gatt A. Anaphylactic reaction with prothrombin complex concentrate in a patient with IgA deficiency and anti-IgA antibodies. Blood Coagul Fibrinolysis 2010 21(8) 764-5. 

The various chemicals to which HCWs can potentially be exposed and which have been reported to cause CU are listed in Table 5. Practitioners evaluating HCWs for CU should be cautious in testing these chemicals, since appropriate test concentrations have not been defined and anaphylactic reactions are a serious threat, even with prick testing. Furthermore, except for latex, serologic testing is not available. In the case of latex, a radioimmunoassay (RIA) can be... 

It is common practice not to add iron to TPN solutions because of the possibility of physical incompatibility and the risk of anaphylaxis when iron-dextran preparations are used. Fatal anaphylactic reaction secondary to intramuscular iron dextran injections (Becker et al, 1966), as well as other local and systemic reactions following intravenous administration, particularly using the bolus dosage method, have been described (Hamstra et al., 1980). Yet many recent reports attest to the low frequency of the above complications and the apparent safety of using lower doses in nutrient solutions for adults and children (Hamstra et al., 1980 Gilbert et al., 1979 Figueredo and Kaminski, 1979 Halpin et al., 1980 Peters et al, 1980 Reed et al, 1981). Similarly, physical incompatibility problems are less common with the lower doses and lower iron concentrations. As an alternative iron source, ferrous citrate may prove to be a more suitable intravenous iron supplement than dextran (Sayers et al, 1983). 

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