Pulmonary anaphylaxis

Prodromi of anaphylaxis comprise metallic fishy taste, anxiety, sweating, headache, disorientation. Autopsy cases have shown few specific findings sometimes there is inflation of the lung and pulmonary edema with peribronchial eosinophilic... 

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Hypersensitivity Anaphylaxis angioedema arthralgia chills drug fever eczematous, erythematous, or maculopapular eruptions lupus-like syndrome associated with pulmonary reactions myalgia pruritus urticaria. 

Adverse side effects include fever, pulmonary edema, vomiting, headache, and anaphylaxis. Neutralizing antibodies may develop over time and necessitate adjusting the dosage upward to compensate for the loss of therapeutic activity. 

Superinfection, hepatotoxicity, peripheral neuropathy (may be irreversible), Stevens-lohnson syndrome, permanent pulmonary function impairment, and anaphylaxis occur rarely... 

Serious, acute hypersensitivity reactions, such as urticaria, angioedema, broncho-constriction, and anaphylaxis, may occur. Other rare reactions include pancreatitis, colitis, endocrine disorders (e.g., diabetes mellitus), hyperthyroidism or hypothyroidism, ophthalmologic, neuropsychiatric, autoimmune, ischemic, infectious, and pulmonary disorders. 

Adverse effects include nausea, vomiting, diarrhoea, anaphylaxis, hepatic necrosis, fever, bone marrow depression, osteoporosis, menstrual dysfunction, cirrhosis, pulmonary infiltrates and fibrosis, renal toxicity and depigmentation. 

Adverse effects include nausea, vomiting, allergic reactions, fever, anaphylaxis, skin rash, Raynaud s phenomenon, stomatitis, pulmonary fibrosis, hyperpigmentation, renal and hepatic toxicity. 

When given rapidly, protamine causes hypotension due to a decrease in vascular resistance, possibly linked to the release of nitric oxide from endothelium. Flypotension can be minimised by slow administration over 10-15 minutes. Protamine does not affect myocardial contractility. In some patients, systemic hypotension occurs in conjunction with pulmonary hypertension and, in severe cases, right ventricular failure. The mechanism is activation of the complement pathways by the heparin-protamine complex leading to release of thromboxane A2, which mediates pulmonary vasoconstriction. Unlike in anaphylaxis, plasma histamine concentrations are not increased. When this syndrome develops protamine administration should be stopped, and some have recommended giving heparin in an attempt to reduce the size of the heparin-protamine complex. 

Royal jelly Tonic Bronchospasm, anaphylaxis Avoid in patients with chronic allergies or respiratory diseases asthma, chronic obstructive pulmonary disease, emphysema, atopy... 

Too rapid of an administration of protamine can have serious side effects, including hypotension and anaphylaxis. Pulmonary hypertension, shortness of breath, flushing, and urticaria have all been associated with rapid administration. Patients with allergies to fish products may be allergic to protamine. 

Mitsuhata et al. (1994) induced systemic anaphylaxis in dogs sensitized to Ascaris suum by intravenous injection of the antigen and measured pulmonary resistance and dynamic pulmonary compliance. 

Bleomycin Nausea and vomiting fever anaphylaxis and other allergic reactions phlebitis ai in ecuon site Pneumonitis and pulmonary fibrosis rash and hyperpigmenwtion stomatitis alopecia Raynaud s phenomenon cavitating granulomas haemorrhagic cystitis... 

Methotrexate Nausea and vomiting diarrhoea fever anaphylaxis hepatic necrosis Oral and gastrointestinal ulceration, perforation may occur bone marrow depression hepatic toxicity including cirrhosis renal toxicity pulmonary infiltrates and fibrosis osteoporosis conjunctivFtis alopecia depigmentation menstrual dysfunction encephalopathy infertility lymphoma teratogenesis... 

Although thromboprophylaxis of microvascular anastomoses seems advisable theoretically, there is little clinical evidence to support the use of dextran for this purpose. The pulmonary edema in these cases was thought to be non-cardiogenic, similar to that caused by heroin, methadone, propoxyphene, and salicylates, due to a direct adverse effect on the pulmonary vasculature, rather than anaphylaxis, cardiac pump failure, or volume overload. 

This patient had all the features of anaphylactoid reactions, which include pulmonary and laryngeal edema and a massive rise in serum tryptase. The half-Ufe of tryptase is about 2 hours. Moderately raised post-mortem tryptase activity in the absence of anaphylaxis has been described. Therefore, only very high serum tryptase activity, as seen in this case, should be regarded as specific for fatal anaphylactoid reactions. 

Anaphylaxis and hypersensitivity reactions fever and flu-like symptoms mucositis pulmonary fibrosis secondary to oxygen free-radical formation low emetogenic potential alopecia not myelosuppressive... 

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