scholarly journals Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock

2020 ◽  
Vol 13 (1) ◽  
pp. e233521 ◽  
Author(s):  
Antonio Mirijello ◽  
Maria Maddalena D'Errico ◽  
Pamela Piscitelli ◽  
Salvatore De Cosmo
Keyword(s):  
Allergic Reaction ◽  
Anaphylactic Shock ◽  
Systemic Disease ◽  
Severe Allergic Reaction ◽  
Amoxicillin Clavulanate ◽  
Ecg Alterations

Anaphylaxis represents a systemic disease occurring after the exposure to an allergen. Drugs for the treatment of anaphylactic reactions (ie, corticosteroids and adrenalin) could induce autonomic alterations, such as tachycardia, hyperthermia, tachypnoea and leucocytosis. We describe the case of a 52-year-old woman presenting with a severe allergic reaction after the ingestion of amoxicillin-clavulanate. The occurrence of ECG alterations, laboratory abnormalities and procalcitonin (PCT) elevation will be discussed with particular emphasis on the possible misleading role of PCT during anaphylactic shock.

scholarly journals Anaphylactic shock depends on endothelial Gq/G11

2009 ◽  
Vol 206 (2) ◽  
pp. 411-420 ◽  
Author(s):  
Hanna Korhonen ◽  
Beate Fisslthaler ◽  
Alexandra Moers ◽  
Angela Wirth ◽  
Daniel Habermehl ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Anaphylactic Shock ◽  
Platelet Activating Factor ◽  
Severe Allergic Reaction ◽  
Downstream Signaling ◽  
Systemic Anaphylaxis ◽  
Multiple Organs ◽  
Nitric Oxide Formation ◽  
G Protein Coupled

Anaphylactic shock is a severe allergic reaction involving multiple organs including the bronchial and cardiovascular system. Most anaphylactic mediators, like platelet-activating factor (PAF), histamine, and others, act through G protein–coupled receptors, which are linked to the heterotrimeric G proteins Gq/G11, G12/G13, and Gi. The role of downstream signaling pathways activated by anaphylactic mediators in defined organs during anaphylactic reactions is largely unknown. Using genetic mouse models that allow for the conditional abrogation of Gq/G11- and G12/G13-mediated signaling pathways by inducible Cre/loxP-mediated mutagenesis in endothelial cells (ECs), we show that Gq/G11-mediated signaling in ECs is required for the opening of the endothelial barrier and the stimulation of nitric oxide formation by various inflammatory mediators as well as by local anaphylaxis. The systemic effects of anaphylactic mediators like histamine and PAF, but not of bacterial lipopolysaccharide (LPS), are blunted in mice with endothelial Gαq/Gα11 deficiency. Mice with endothelium-specific Gαq/Gα11 deficiency, but not with Gα12/Gα13 deficiency, are protected against the fatal consequences of passive and active systemic anaphylaxis. This identifies endothelial Gq/G11-mediated signaling as a critical mediator of fatal systemic anaphylaxis and, hence, as a potential new target to prevent or treat anaphylactic reactions.

scholarly journals The role of glucocorticoids in the treatment of acute anaphylactic reaction

2021 ◽  
Vol 17 (3) ◽  
pp. 256-260
Author(s):  
Agnieszka Rustecka ◽  
Maria Węgrzynek ◽  
Agata Tomaszewska ◽  
Bolesław Kalicki
Keyword(s):  
Food Allergy ◽  
Allergic Reaction ◽  
Anaphylactic Reaction ◽  
Anaphylactic Shock ◽  
Early Response ◽  
Sudden Onset ◽  
Therapeutic Algorithms ◽  
Genomic Effects ◽  
High Doses

Food allergy is a growing health problem, which is particularly common among the youngest children. Anaphylaxis, which is defined as a sudden-onset and potentially fatal response to an allergen, is an indication for urgent treatment. Although intramuscular epinephrine is the treatment of choice, all therapeutic algorithms also recommend glucocorticoids. They play an important role in reducing the risk of late allergic reaction, and, due to their non-genomic effects, are also increasingly often mentioned in the context of early response to shock. This effect is directly proportional to the dose of the drug, and a reduced duration of the symptoms of anaphylactic shock is achieved with the use of high doses of glucocorticoids. The paper presents a case of a 3-month-old girl with an anaphylactic reaction after consuming a modified milk preparation. After systemic administration of glucocorticoids, a satisfactory therapeutic effect was observed in the child.

scholarly journals Acute Myocardial Infarction and Allergy, Causal or Casual Relationship?

2021 ◽  
Vol 4 (12) ◽  
pp. 01-04
Author(s):  
José Polavieja
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Allergic Reaction ◽  
Atherosclerotic Plaque ◽  
Anaphylactic Shock ◽  
Clinical Case ◽  
Severe Allergic Reaction ◽  
Optimal Management ◽  
Casual Relationship

A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. LEARNING OBJECTIVE An exceptional clinical case is presented illustrating an acute myocardial infarction related to a severe allergic reaction. In addition, a review of the optimal management of this entity is carried out. We intend to make this entity known, which should be suspected in the appropriate clinical setting

Covid-19 In Man: A Very Dangerous Affair.

2021 ◽  
Vol 21 ◽  
Author(s):  
Giuseppe Lisco ◽  
Vito A. Giagulli ◽  
Giovanni De Pergola ◽  
Anna De Tullio ◽  
Edoardo Guastamacchia ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Metabolic Diseases ◽  
Systemic Disease ◽  
Public Health Issue ◽  
Immune System Dysfunction ◽  
Data Support ◽  
Systemic Spread ◽  
The Impact

Background: The novel pandemic of Coronavirus disease 2019 (COVID-19) has becoming a public health issue since March 2020 considering that more than 30 million people were found to be infected worldwide. Particularly, recent evidences suggested that men may be considered as at higher risk of poor prognosis or death once the infection occurred and concerns surfaced in regard of the risk of a possible testicular injury due to SARS-CoV-2 infection. Results: Several data support the existence of a bivalent role of testosterone (T) in driving poor prognosis in patients with COVID-19. On one hand, this is attributable to the fact that T may facilitate SARS-CoV-2 entry in human cells by means of an enhanced expression of transmembrane serine-protease 2 (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2). At the same time, younger man with normal testicular function compared to women of similar age are prone to develop a blunted immune response against SARS-CoV-2, being exposed to less viral clearance and more viral shedding and systemic spread of the disease. Conversely, low levels of serum T observed in hypogonadal men predispose them to a greater background systemic inflammation, cardiovascular and metabolic diseases, and immune system dysfunction, hence driving harmful consequences once SARS-CoV-2 infection occurred. Finally, SARS-CoV-2, as a systemic disease, may also affect testicles with possible concerns for current and future testicular efficiency. Preliminary data suggested that SARS-CoV-2 genome is not normally found in gonads and gametes, therefore sex transmission could be excluded as a possible way to spread the COVID-19. Conclusion: Most data support a role of T as a bivalent risk factor for poor prognosis (high/normal in younger; lower in elderly) in COVID-19. However, the impact of medical treatment aimed to modify T homeostasis for improving the prognosis of affected patients is unknown in this clinical setting. In addition, testicular damage may be a harmful consequence of the infection even in case it occurred asymptomatically but no long-term evidences are currently available to confirm and quantify this phenomenon. Different authors excluded the presence of SARS-CoV-2 in sperm and oocytes, thus limiting worries about both a potential sexual and gamete-to-embryos transmission of COVID-19. Despite these evidence, long-term and well-designed studies are needed to clarify these issues.

scholarly journals ROLE OF IMMATURE/TOTAL NEUTROPHIL RATIO, LEUKOCYTE COUNT AND PROCALCITONIN IN DIAGNOSING NEONATAL SEPSIS

2018 ◽  
Vol 24 (2) ◽  
pp. 169
Author(s):  
I A Putri Wirawati1 ◽  
Aryati Aryati ◽  
A A Wiradewi Lestari
Keyword(s):  
Likelihood Ratio ◽  
Neonatal Sepsis ◽  
Leukocyte Count ◽  
Systemic Disease ◽  
Clinical Syndrome ◽  
Cross Sectional ◽  
Bacteria Growth ◽  
Long Time ◽  
Cross Sectional Design

Neonatal sepsis is a clinical syndrome of systemic disease, accompanied by bacteremia that occurs during infants in the first month of life. A late diagnosis might increase mortality. The presence of bacteria growth in blood cultures is a definitive diagnosis. Unfortunately, culture results are usually obtained of a long time. The study aimed to analyze sensitivity and specificity of the manual I/T ratio, automatic I/T ratio, leukocyte count and procalcitonin (PCT) to diagnose neonatal sepsis. This study used a cross-sectional design, from the NICU room in Sanglah General Hospital, Denpasar. There were 59 patients who met the study criteria. Along with blood culture as the gold standard in determining diagnosis of sepsis and with I/T ratio cut-off of 0.2, the sensitivity of manual I/T ratio was 69.2%, specificity 83.9%, PPV 63.9%, NPV 87% and likelihood ratio was 3.06. While the sensitivity of automatic I/T ratio was 47.6%, specificity 85.8%, PPV 55.1%, NPV 81.4% and likelihood ratio was 2.25. Based on the normal range of leukocyte count (9.1 - 34 x 103/μl), sensitivity of leukocyte count was 59%, specificity 71.5%, PPV 46.7%, NPV 80.9% and likelihood ratio was 1.59. With PCT cut-off 0.5 ng/mL, the obtained sensitivity of PCT was 64.3%, specificity 85.8%, PPV 64.3%, NPV 85.8% and likelihood ratio was 3.13. 

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