СЮРПРИЗЫ ПИЩЕВОЙ АНАФИЛАКСИИ: СЛУЧАЙ ИЗ ПРАКТИКИ

2019 ◽  
Author(s):  
T.S. Lepeshkova ◽  
E.K. Beltyukov
Keyword(s):  
Clinical Case ◽  
Storage Proteins ◽  
Clinical Symptoms ◽  
Rapid Onset ◽  
Elimination Diet ◽  
Diagnostic Methods ◽  
Central Russia ◽  
Allergy Diagnostics ◽  
Molecular Allergy ◽  
Life Threatening

Анафилаксия - это тяжелая системная реакция гиперчувствительности, которая характеризуется быстрым началом и жизнеугрожающими проблемами со стороны дыхательных путей и кровообращения. В настоящей статье описан клинический случай развития у трехлетнего ребенка поливалентной аллергии с повторными эпизодами пищевой анафилаксии, родившегося и постоянно проживающего в средней полосе России, но имеющего необычный для жителя Урала профиль сенсибилизации. Клинический случай подробно описан с целью продемонстрировать этапы жизни ребенка, на которых, вероятно, сначала формировалась сенсибилизация, а в дальнейшем возникала манифестация клинических симптомов. Определение профиля сенсибилизации с использованием методов компонентной аллергодиагностики (ISAC, ImmunoCAP) показало, что мальчик сенсибилизирован к большому количеству пищевых аллергенов, в том числе к молочным и яичным протеинам белкам хранения арахиса, сои, фундука и кунжута протеинам, относящимся к nsLTP-белкам. Полученные результаты позволили распознать и дифференцировать истинную IgE-опосредованную сенсибилизацию, предложить оптимальную терапевтическую тактику и подобрать элиминационную диету. Применение методов молекулярной аллергодиагностики оказывается полезным в клинической практике в случае ведения пациентов, имеющих поливалентную сенсибилизацию и страдающих, по данным анамнеза, тяжелыми аллергическими реакциями.Anaphylaxis is a severe systemic hypersensitivity reaction that is characterized by rapid onset and life-threatening respiratory and blood circulation problems. We present to your attention a clinical case of the polyvalent allergy development in a three-year-old child with repeated episodes of food anaphylaxis. The child was born and he constantly lives in central Russia, but has a profile of sensitization unusual for a Ural resident. The clinical case is described in detail in order to demonstrate the stages of a childs life, on which sensitization was likely to be first formed, and later the manifestation of clinical symptoms arose. Determination of the sensitization profile by means of the component allergy diagnostics methods (ISAC, ImmunoCAP) showed that the boy is sensitized to a large number of food allergens, including milk and egg proteins storage proteins for peanuts, soy, hazelnuts and sesame proteins related to the nsLTP-proteins. The obtained results made it possible to recognize and differentiate true IgE-mediated sensitization, to propose the optimal therapeutic tactics and to select an elimination diet. Application of molecular allergy diagnostic methods is useful in clinical practice in case of patients with multivalent sensitization and a history of severe allergic reactions.

scholarly journals Molecular Allergy Diagnostics as an Adjunct to Conventional Diagnostics in a Secondary Pediatric Referral Center

2019 ◽  
Vol 13 (1) ◽  
pp. 73-76 ◽  
Author(s):  
Ole D. Wolthers
Keyword(s):  
Peanut Allergy ◽  
Clinical Symptoms ◽  
Birch Pollen ◽  
Pollen Allergy ◽  
Population Based ◽  
Diagnostic Methods ◽  
Specific Diagnosis ◽  
Referral Center ◽  
Molecular Allergy ◽  
Ige Mediated

Background: Several compositions for determination of specific molecular components in allergens have recently been patented. The role of Molecular Allergy (MA) diagnostics in suspected IgE mediated allergic conditions is currently debated. Guideline reports have concluded that population- based studies involving evaluation of the usefulness of MA diagnostics are needed. Objective: To evaluate the usefulness of MA diagnostics in a secondary pediatric referral center. Methods: A total of 961 children and adolescents aged 0.2-18.8 (mean 7.0) years was included in a prospective observational survey. Inclusion criterion was a suspected diagnosis of an IgE mediated condition based on history and clinical symptoms and signs. If a specific diagnosis could not be reached from conventional investigations suspected peanut allergy, birch pollen allergy and associated crossreactivity, insect allergy and triggering allergens for specific immunotherapy were assessed by MA diagnostics. Results: Based on conventional work-up a diagnostic conclusion was established in 946 patients (98.4%). MA diagnostics were performed in 15 individuals (1.6%), 7 girls and 8 boys aged 3.2 to 17.8 (mean 10.6) years. In 8 cases a specific diagnosis was established based on MA diagnostics; in 7 cases MA diagnostics could not improve diagnosis. MA were most frequently (N = 7 (14%)) used in children with peanut allergy (N = 50). Conclusions: Most patients in a secondary pediatric referral center with suspected IgE mediated allergy can be managed by conventional diagnostic methods. MA diagnostics may be useful in small and selected subgroups as in patients with suspected peanut allergy, however, may not be helpful in all cases.

scholarly journals Clinical case of asymptomatic perforation of right ventricle during permanent pacemaker implantation

2019 ◽  
Vol 23 (4) ◽  
pp. 91
Author(s):  
A. N. Verevetinov ◽  
E. S. Tarasyuk ◽  
I. E. Dorovskih ◽  
J. V. Vakhnenko ◽  
V. N. Nikitin ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Conflict Of Interest ◽  
Clinical Case ◽  
Clinical Symptoms ◽  
Pacemaker Implantation ◽  
Myocardial Damage ◽  
Left Hand ◽  
Heart Failure Progression ◽  
Life Threatening ◽  
The Right

<p>The present paper discusses one of the serious complications of electrocardiostimulator implantation: electrode perforation of the right ventricle wall, a condition that can occur in both the early and late postoperative periods. The latter occurs less frequently, and the patient may be asymptomatic; this results in an adverse effect on the patient’s quality of life and disease prognosis. Knowledge about the symptoms of late perforation and algorithms to examine patients suspected to have this complication contributes to timely surgical intervention as well as prevention of heart failure progression and fatal outcomes. This paper describes a clinical case of right ventricular perforation 1.5 years after electrocardiostimulator implantation, wherein, despite the absence of pronounced clinical symptoms, the patient was successfully diagnosed with pacemaker testing, Holter diagnostics, echocardiography and computed tomography of thoracic organs. Myocardial damage was accompanied by small left-hand bone-diaphragm hydrotorax and hydropericardium. The risk factors of perforation in the present case were low body weight and age. In the course of the surgical operation performed with the exact observance of the chosen technique, the integrity of the myocardium of the right ventricle and the function of the electrocardiostimulator were restored. Thus, the life-threatening consequences of the described complication were prevented.</p><p>Received 12 September 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Food labelling and food-induced anaphylaxis in children. Where are the intersection points?

2020 ◽  
Vol 18 (5) ◽  
pp. 23-29
Author(s):  
A.N. Pampura ◽  
◽  
T.S. Lepeshkova ◽  
E.V. Andronova ◽  
◽  
...  
Keyword(s):  
Real Life ◽  
Rapid Onset ◽  
Elimination Diet ◽  
Food Labelling ◽  
Food Allergens ◽  
Full Spectrum ◽  
Component Testing ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Anaphylaxis is an acute life-threatening condition affecting several body systems. It might have a rapid onset and lead to a lethal outcome. The major provoking factors for the development of anaphylactic reactions in childhood are food allergens. High hypersensitivity to one food allergen can make it difficult for a family to find a substitution for an allergenic product. Food-induced anaphylactic reaction to quite a number of food allergens is a serious problem for both the physician and the family of an allergic child necessitating organization of appropriate and safe nutrition. In real life, the standard recommendation for the patient – to strictly follow the rules of the elimination diet with exclusion of the causative allergen and all cross-reactive allergens – often becomes unrealizable. There is a serious risk of developing new allergic reactions due to accidental intake of the triggering allergens because of incorrect food labelling by manufacturers. The objective of the work is to present a clinical case report that demonstrates the importance of performing allergy component testing (ImmunoCAP ISAC-112,) for identification of the full spectrum of allergens with subsequent assessment of allergenic molecules as triggering allergens and shows serious difficulties in the elaboration of recommendations on a personalised diet that should be adequate and safe for a child with a history of recurrent episodes of food-induced anaphylaxis. Key words: children, life-threatening reactions, allergy component testing, food labelling, food-induced anaphylaxis, food allergens

scholarly journals Food allergies and acute allergic reactions: diagnostic options

2021 ◽  
Vol 20 (5) ◽  
pp. 63-67
Author(s):  
T. S. Lepeshkova ◽  
E. V. Andronova
Keyword(s):  
Rapid Onset ◽  
Elimination Diet ◽  
Food Allergies ◽  
Allergic Reactions ◽  
Acute Urticaria ◽  
Mucous Membranes ◽  
Life Threatening ◽  
To Come ◽  
Acute Condition ◽  
Food Anaphylaxis

Introduction. Anaphylaxis is a systemic potentially life-threatening hypersensitivity reaction featuring the rapid onset, manifestations of the respiratory tract and/or hemodynamics and usually, but not always, accompanied by changes in the skin and mucous membranes [1]. The cause of developing an acute generalized reaction in food anaphylaxis may be the minimum culprit product amount that has entered the patient's body through the mouth or through the skin/mucous membranes. Patients like these are, as a rule, first seen by a paediatrician, a related specialist, or a paramedic. Since the doctors often consider the symptoms of foodborne anaphylaxis separately, the latter does not cause proper suspicion: angioedema and/or acute urticaria accompanying rhinorrhea, acute bronchospasm or laryngitis developed extremely quickly or immediately after contact with an allergen.The aim of the work was to acquaint paediatricians and doctors of related specialties with the food anaphylaxis symptoms, to justify the need for an allergologist-immunologist to consult these patients in order to resolve the issue of required component-resolved diagnosis of allergy and development of an individual elimination diet, taking into account the patient's sensitization profile.Materials and methods. Clinical observation of a child (boy, age — 12 months) with symptoms of atopic dermatitis and episodes of food anaphylaxis in the anamnesis; general clinical examination and allergological examination of the patient by component allergodiagnostics were performed.Results. Sensitization to ovalbumin (Gald 2 -16.60 kU/l) and ovomucoid (Gald 1-9.01 kU/l) was established. The detected sensitization is a predictor of severe systemic allergic reactions to eggs.Discussion. Component diagnostics performed as prescribed by an allergologist not only confirms the causative allergen, but also evaluates the risks of developing acute reactions if the allergen is accidentally introduced to the child and the timing of the patient's tolerance formation. This sensitization will cause sudden systemic allergic reactions for years to come.Conclusion. It is important for a specialist to timely suspect food anaphylaxis, differentiate it from other emergency and urgent conditions, and give the patient the correct recommendations on the need for consultation with an allergologist-immunologist. Only a thoughtful, comprehensive medical approach to each acute condition in a child will significantly reduce the risk of repeated episodes of food anaphylaxis.

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

scholarly journals Enteric Fever Diagnosis: Current Challenges and Future Directions

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 410
Author(s):  
Durga P. Neupane ◽  
Hari P. Dulal ◽  
Jeongmin Song
Keyword(s):  
Diagnostic Tests ◽  
Enteric Fever ◽  
Asymptomatic Carrier ◽  
Diagnostic Methods ◽  
Effective Control ◽  
Future Directions ◽  
Clinical Presentations ◽  
Global Spread ◽  
Life Threatening ◽  
Pros And Cons

Enteric fever is a life-threatening systemic febrile disease caused by Salmonella enterica serovars Typhi and Paratyphi (S. Typhi and S. Paratyphi). Unfortunately, the burden of the disease remains high primarily due to the global spread of various drug-resistant Salmonella strains despite continuous advancement in the field. An accurate diagnosis is critical for effective control of the disease. However, enteric fever diagnosis based on clinical presentations is challenging due to overlapping symptoms with other febrile illnesses that are also prevalent in endemic areas. Current laboratory tests display suboptimal sensitivity and specificity, and no diagnostic methods are available for identifying asymptomatic carriers. Several research programs have employed systemic approaches to identify more specific biomarkers for early detection and asymptomatic carrier detection. This review discusses the pros and cons of currently available diagnostic tests for enteric fever, the advancement of research toward improved diagnostic tests, and the challenges of discovering new ideal biomarkers and tests.

scholarly journals Anaphylactic Death: A New Forensic Workflow for Diagnosis

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 117
Author(s):  
Massimiliano Esposito ◽  
Angelo Montana ◽  
Aldo Liberto ◽  
Veronica Filetti ◽  
Nunzio Di Nunno ◽  
...  
Keyword(s):  
Clinical History ◽  
Rapid Onset ◽  
Mean Value ◽  
Laryngeal Edema ◽  
Tryptase Level ◽  
Antibody Staining ◽  
Life Threatening ◽  
History Of ◽  
Immunohistochemical Techniques

Anaphylaxis is a life-threatening or fatal clinical emergency characterized by rapid onset, and death may be sudden. The margin of certainty about the diagnosis of anaphylactic death is not well established. The application of immunohistochemical techniques combined with the evaluation of blood tryptase concentrations opened up a new field of investigation into anaphylactic death. The present study investigated eleven autopsy cases of anaphylactic death, carried out between 2005 and 2017, by the Departments of Forensic Pathology of the Universities of Foggia and Catania (Italy). An analysis of the medical records was carried out in all autopsies. Seven autopsies were carried out on males and four on females. Of the eleven cases, one showed a history of asthma, one of food ingestion, two of oral administration of medications, six did not refer any allergy history, and one subject was unknown. All cases (100%) showed pulmonary congestion and edema; 7/11 (64%) of the cases had pharyngeal/laryngeal edema and mucus plugging in the airway; only one case (9%) had a skin reaction that was found during external examination. Serum tryptase concentration was measured in ten cases, and the mean value was 133.5 µg/L ± 177.9. The immunohistochemical examination using an anti-tryptase antibody on samples from the lungs, pharynx/larynx, and skin site of medication injection showed that all cases (100%) were strongly immunopositive for anti-tryptase antibody staining on lung samples; three cases (30%) were strongly immunopositive for anti-tryptase antibody staining on pharyngeal/laryngeal samples; and eight cases (80%) were strongly immunopositive for anti-tryptase antibody staining on skin samples. We conclude that a typical clinical history, blood tryptase level >40 µg/L, and strongly positive anti-tryptase antibody staining in the immunohistochemical investigation may represent reliable parameters in the determination of anaphylactic death with the accuracy needed for forensic purposes.

Cervicofacial Emphysema Secondary to Facebow Injury: A Case Report

2009 ◽  
Vol 33 (4) ◽  
pp. 333-336
Author(s):  
Marco Cicciù ◽  
Giovanni Battista Grossi ◽  
Mario Beretta ◽  
Davide Farronato ◽  
Concetta Scalfaro ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Subcutaneous Emphysema ◽  
Clinical Case ◽  
Dental Procedure ◽  
Life Threatening ◽  
Facial Area ◽  
Orthodontic Device ◽  
Physical Findings

Aim: To report the clinical case of a child with facial and periorbital emphysema caused by an orthodontic device. Case report: An 11-year-old child presented to our clinic showing moderate swelling of the left facial area. Based on his dental history, physical findings, and instrument examinations, the diagnosis of cervicofacial emphysema was established, caused by disengagement of the facebow. One week later, all swelling and crepitus had disappeared without complications. Most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling, which normally resolves spontaneously and without complications within a week. However, the spread of large amounts of air into the deeper spaces may cause life-threatening sequelae. Conclusions: Orthodontists should be aware that the use of extraoral traction applied via a facebow can cause soft tissue injures and emphysema of the cervicofacial region. It is important to avoid misdiagnosis and to appropriately inform patient and parents about this condition.

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