scholarly journals Perioperative anaphylaxis: A five-year review in a tertiary paediatric hospital

2021 ◽  
Vol 49 (1) ◽  
pp. 44-51
Author(s):  
Theresa SW Toh ◽  
Sze Y Foo ◽  
Wenyin Loh ◽  
Kok W Chong ◽  
Anne EN Goh ◽  
...  
Keyword(s):  
New Zealand ◽  
Skin Tests ◽  
Hospital Data ◽  
Paediatric Hospital ◽  
Male Predominance ◽  
Severity Grade ◽  
Culprit Drug ◽  
Respiratory Change ◽  
Ige Mediated ◽  
Grade 3

Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four–15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin ( n = 3), atracurium ( n = 1) and rocuronium ( n = 1). Three patients (25.0%) had non–IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.

Outcome of rest with or without bandaging for treatment of carpal flexural contracture deformities in puppies: 47 puppies and 75 joints (2000–2018)

2021 ◽  
pp. 1-6
Author(s):  
Massimo Petazzoni ◽  
Carlo M. Mortellaro ◽  
Alessandro Esposito ◽  
Francesco Ferrari ◽  
Alessandro Piras ◽  
...  
Keyword(s):  
Treatment Option ◽  
Conservative Management ◽  
Medical Records ◽  
Clinical Relevance ◽  
Final Visit ◽  
Full Extension ◽  
Treatment Groups ◽  
Severity Grade ◽  
Grade 3 ◽  
Mean Time

Abstract OBJECTIVE To review outcome of dogs with carpal flexural contracture deformities treated with rest alone or with rest and bandaging. ANIMALS 47 dogs (75 joints). PROCEDURES Medical records of dogs with unilateral or bilateral carpal flexural contracture deformities were reviewed, and dogs were grouped according to deformity severity grade (graded on a scale from 1 to 3) at the time of diagnosis. Two treatment groups were compared: rest only and rest with a modified Robert-Jones bandage. All dogs were reevaluated weekly until recovery (ie, resolution of the deformity and lameness). RESULTS All dogs responded to conservative management, with all dogs regaining full extension of the antebrachiocarpal joint and ambulating normally at the time of the final visit. Mean ± SD time from initial diagnosis to recovery (ie, resolution of the deformity and lameness) was 2.9 ± 2.2 weeks (median, 2 weeks; range, 1 to 9 weeks). For dogs with grade 1 or 2 severity, mean time to recovery did not differ significantly between treatment groups. For dogs with grade 3 severity, however, mean time to recovery was significantly shorter for dogs treated with rest and bandaging than for dogs treated with rest alone. CLINICAL RELEVANCE Results suggested that conservative management (rest alone or rest and bandaging) was a successful treatment option for puppies with carpal flexural contracture deformity and that bandaging resulted in a shorter time to recovery for dogs that were severely affected.

scholarly journals Quantification of radiation exposure in the operating theatre during management of common fractures of the upper extremity in children

2016 ◽  
Vol 98 (7) ◽  
pp. 483-487 ◽  
Author(s):  
JF Maempel ◽  
OD Stone ◽  
AW Murray
Keyword(s):  
Radiation Exposure ◽  
Improve Patient Safety ◽  
Supracondylar Fracture ◽  
Paediatric Hospital ◽  
Dose Area Product ◽  
Flexible Nailing ◽  
Limb Trauma ◽  
Manipulation Under Anaesthesia ◽  
Grade 3 ◽  
Area Product

Introduction Surgical procedures to manage trauma to the wrist, forearm and elbow in children are very common. Image intensifiers are used routinely, yet studies/guidelines that quantify expected radiation exposure in such procedures are lacking. Methods Information on demographics, injury type, surgeon grade and dose area product (DAP) of radiation exposure per procedure was collected prospectively for 248 patients undergoing manipulation/fixation of injuries to the elbow, forearm or wrist at a paediatric hospital over 1 year. Results DAP exposure (in cGycm2) differed significantly across different procedures (p<0.001): wrist manipulation under anaesthesia (MUA; median, 0.39), wrist k-wiring (1.01), forearm MUA (0.50), flexible nailing of the forearm (2.67), supracondylar fracture MUA and k-wiring (2.23) and open reduction and internal fixation of the lateral humeral condyle (0.96). Fixation of a Gartland grade-3 supracondylar fracture (2.94cGycm2) was associated with higher exposure than grade-2 fixation (1.95cGycm2) (p=0.048). Fractures of the wrist or forearm necessitating metalwork fixation resulted in higher exposure than those requiring manipulation only (both p<0.001). For procedures undertaken by trainees, trainee seniority (between year-5 and year-8 and clinical fellow, p≥0.24) did not affect the DAP significantly. Conclusions The spectrum of radiation exposures for common procedures utilised in the management of paediatric upper limb trauma were quantified. These findings will be useful to surgeons auditing their practice and quantifying radiation-associated risks to patients. Our data may serve as a basis for implementing protocols designed to improve patient safety.

scholarly journals Neurologic autoimmunity and immune checkpoint inhibitors

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2442-e2452
Author(s):  
Elia Sechi ◽  
Svetomir N. Markovic ◽  
Andrew McKeon ◽  
Divyanshu Dubey ◽  
Teerin Liewluck ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Immune Checkpoint ◽  
Mayo Clinic ◽  
Checkpoint Inhibitors ◽  
Cns Involvement ◽  
Neurologic Symptom ◽  
Clinical Cohort ◽  
Severity Grade ◽  
Systemic Autoimmunity ◽  
Grade 3

ObjectiveTo describe neural autoantibody profiles and outcomes in patients with neurologic autoimmunity associated with immune checkpoint inhibitor (ICI) cancer immunotherapy.MethodsIn this retrospective descriptive study, 63 patients with ICI-related neurologic autoimmunity were included: 39 seen at the Mayo Clinic Neurology Department (clinical cohort) and 24 whose serum/CSF was referred to the Mayo Clinic Neuroimmunology Laboratory for autoantibody testing. Serum/CSF samples were tested for neural-specific autoantibodies. Predictors of unfavorable outcome (residual adverse event severity grade ≥3) were explored (logistic regression).ResultsMedian age at neurologic symptom onset was 65 years (range 31–86); 40% were female. Neurologic manifestations were CNS-restricted (n = 26), neuromuscular (n = 30), combined (n = 5), or isolated retinopathy (n = 2). Neural-specific autoantibodies were common in patients with CNS involvement (7/13 [54%] in the unbiased clinical cohort) and included known or unidentified neural-restricted specificities. Only 11/31 patients with CNS manifestations had neuroendocrine malignancies typically associated with paraneoplastic autoimmunity. Small-cell lung cancer (SCLC)–predictive antibodies were seen in 3 patients with non-neuroendocrine tumors (neuronal intermediate filament immunoglobulin G [IgG] and antineuronal nuclear antibody 1 with melanoma; amphiphysin IgG with non-SCLC). A median of 10 months from onset (range, 0.5–46), 14/39 in the clinical cohort (36%) had unfavorable outcomes; their characteristics were age ≥70 years, female, CNS involvement, lung cancer, higher initial severity grade, and lack of systemic autoimmunity. By multivariate analysis, only age remained independently associated with poor outcome (p = 0.01). Four of 5 patients with preexistent neurologic autoimmunity experienced irreversible worsening after ICI.ConclusionsNeural-specific autoantibodies are not uncommon in patients with ICI-related CNS neurologic autoimmunity. Outcomes mostly depend on the pre-ICI treatment characteristics and clinical phenotype.

scholarly journals Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Manzo Suzuki ◽  
Hajime Kawase ◽  
Azusa Ogita ◽  
Hiroyasu Bito
Keyword(s):  
General Anesthesia ◽  
Skin Testing ◽  
Blocking Agent ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Intradermal Test ◽  
Skin Tests ◽  
Prick Test ◽  
Causative Drug ◽  
Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

scholarly journals Anaphylaxis to patent blue dye in a 17-year-old boy

2019 ◽  
Vol 12 (1) ◽  
pp. e226191 ◽  
Author(s):  
Mélanie Leung ◽  
Christine McCusker ◽  
Moshe Ben-Shoshan
Keyword(s):  
Food Additive ◽  
Skin Tests ◽  
Blue Dye ◽  
Patent Blue ◽  
Paediatric Case ◽  
Biphasic Reaction ◽  
Life Threatening ◽  
Ige Mediated ◽  
Patent Blue V ◽  
Patent Blue Dye

Patent blue V dye (PBV) is frequently used as a perioperative drug for lymphangiography, as well as a food additive. Hypersensitivity to PBV is poorly documented in adults and had not been previously described in children. The diagnosis of PBV allergy depends on corroboration of history consistent with an IgE-mediated reaction and confirmatory skin tests. We present in this paper a paediatric case of PBV anaphylaxis and of biphasic reaction that exemplifies the challenges involved in diagnosing and managing this rare but potentially life-threatening allergic reaction.

scholarly journals Conflict in a paediatric hospital: a prospective mixed-method study

2015 ◽  
Vol 101 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Liz Forbat ◽  
Charlotte Sayer ◽  
Phillip McNamee ◽  
Esse Menson ◽  
Sarah Barclay
Keyword(s):  
Mixed Method ◽  
Qualitative Interviews ◽  
Data Interpretation ◽  
Staff Nurses ◽  
Semistructured Interview ◽  
Hospital Data ◽  
Paediatric Hospital ◽  
Communication Breakdown ◽  
Severity Rating ◽  
Common Causes

BackgroundConflict in healthcare is a well-recognised but under-examined phenomenon. Little is known about the prevalence and causes of conflict across paediatric specialties.ObjectiveTo report the frequency and characteristics of conflict in a paediatric hospital.Design and settingAn explanatory sequential mixed-method approach was adopted. A bespoke questionnaire recorded frequency, severity, cause and staff involved in conflict prospectively. Data were recorded for the same two 12-week periods in 2013 and 2014, in one UK children's teaching hospital. Data were analysed using descriptive statistics and correlation, the findings of which informed the construction of a semistructured interview schedule. Qualitative interviews were conducted with six key informant healthcare professionals to aid data interpretation; interviews were analysed thematically.Results136 individual episodes of conflict were reported. The three most common causes were ‘communication breakdown’, ‘disagreements about treatment’ and ‘unrealistic expectations’. Over 448 h of healthcare professional time was taken up by these conflicts; most often staff nurses, consultants, doctors in training and matrons. The mean severity rating was 4.9 out of 10. Qualitative interviews revealed consensus regarding whether conflicts were ranked as low, medium or high severity, and explanations regarding why neurology recorded the highest number of conflicts in the observed period.ConclusionsConflict is prevalent across paediatric specialties, and particularly in neurology, general paediatrics and neonatology. Considerable staff time is taken in managing conflict, indicating a need to focus resources on supporting staff to resolve conflict, notably managing communication breakdown.

scholarly journals Diagnostic usefulness of histamine release test (HRT) and skin tests in IgE-mediated allergy to clavulanic acid

2014 ◽  
Vol 4 (S3) ◽  
Author(s):  
Fernando Pineda ◽  
Adriana Ariza ◽  
Cristobalina Mayorga ◽  
Inmaculada Perez ◽  
Rosario Gonzalez-Mendiola ◽  
...  
Keyword(s):  
Histamine Release ◽  
Clavulanic Acid ◽  
Skin Tests ◽  
Release Test ◽  
Diagnostic Usefulness ◽  
Ige Mediated

IgE-mediated allergy to pristinamycin: the value of skin tests and basophil activation tests

Allergy ◽  
2009 ◽  
Vol 64 (11) ◽  
pp. 1694-1694 ◽  
Author(s):  
B. Bensaid ◽  
A. Rozieres ◽  
F. Berard ◽  
J. Bienvenu ◽  
J. F. Nicolas
Keyword(s):  
Basophil Activation ◽  
Skin Tests ◽  
Ige Mediated

Cetuximab-related hypersensitivity reactions associated with pre-existing cetuximab-specific IgE antibody

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9097-9097 ◽  
Author(s):  
C. H. Chung ◽  
E. Chan ◽  
J. Berlin ◽  
J. Gilbert ◽  
W. Yarbrough ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Growth Factor Receptor ◽  
Specific Ige ◽  
Chimeric Mouse ◽  
Hypersensitivity Reactions ◽  
Serum Samples ◽  
Ige Antibodies ◽  
Specific Ige Antibodies ◽  
Ige Mediated ◽  
Grade 3

9097 Background: Cetuximab is a chimeric (mouse/human) IgG1 monoclonal antibody against the epidermal growth factor receptor and is approved for use in patients (pts) with colorectal cancer and head and neck squamous cell carcinoma. Hypersensitivity reactions caused by cetuximab (C-HSR) have been reported; however, the mechanism underlying these reactions is unknown. We hypothesize that C-HSR are mediated by pre-existing cetuximab-specific IgE antibodies (C-IgE). Methods: A total of 140 serum samples were obtained under IRB approved protocols and retrospectively analyzed across 2 cohorts: 1) 71 pretreatment sera from cetuximab-treated pts collected from multiple centers (47 pts with no HSR and 24 pts with any grade HSR; samples were biased for HSR pts), and 2) 69 sera from healthy volunteers in the Nashville TN area. The samples were analyzed for total-, cetuximab-specific and mouse-specific IgE levels using a modified ImmunoCAP assay (Phadia US Inc.). Severe HSR was defined as grade 3/4 reactions during the first infusion by NCI CTC version 3.0 Allergic reaction/hypersensitivity criteria by a reviewer blinded to the immunoCAP assay results. Results: Of the 71 cetuximab-treated pts from cohort 1, 21 experienced severe HSR by retrospective evaluation. All C-IgE(+) pts (15/15) experienced severe HSR and were immediately discontinued from therapy. Of the remaining 6 severe HSR pts with C-IgE(-), 4 pts were re-challenged and completed their cetuximab infusion without any further reaction, suggestive of a non-IgE mediated mechanism, while 2 pts were not re-challenged. Also, the C- IgE(+) pts tended to have higher levels of total IgE compared to the C-IgE(-) pts. All 47 non-HSR pts were C-IgE(-). Mouse-specific IgE was not detected in any sera from the pts. Analysis of sera from healthy volunteers from the cohort 2 revealed that 15/69 (21.7%) were C-IgE(+), suggestive of pre-existing C-IgE; however, the association with C-HSR could not be made. Conclusion: Our data suggest that C-IgE antibodies are present prior to treatment and appears highly predictive of severe HSR during the first infusion; however, IgE-mediated reactions may not account for all cases of HSR. Prospective validation of the association between C-IgE and cetuximab-induced HSR is warranted. [Table: see text]

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