Evaluation of the Extracts From Rhizomes of Polygonum bistorta for the Median Lethal Dosages in Swiss Albino Mice

Background: Polygonum bistorta has been used as a remedy for jaundice, smallpox, pimples, measles, cholera, diarrhoea, dysentery, expelling worms, insect stings and snakebites. In this study, the crude extract from P. bistorta and two fractions viz. hexane and chloroform obtained from the crude extract were studied for their median Lethal Dosages (LD50) in Swiss albino mice. Methods: Powdered rhizomes of P. bistorta was macerated with chloroform and the crude extract was dissolved in a solvent mixture of methanol/water (95:5). The mixture was then subjected to solvent-solvent partition, first with hexane followed by chloroform. The crude extract and the hexane and chloroform fractions were evaluated for their LD50 in Swiss albino mice of both sexes. Results: The LD50 of the crude extract and the hexane and chloroform fractions were determined to be 142.82, 200 and 200.17mg per kg of the mice body weight, respectively. Conclusion: The LD50 values of the crude extract and the hexane and chloroform fractions from P. bistorta were determined. The crude extract of P. bistorta had greater lethality than the hexane and chloroform fractions. This is the first report on the LD50 values of Swiss albino mice for P. bistorta.

Efficacy of an adrenaline auto-injector diary for patients allergic to foods or insect stings

Background: Adrenaline auto-injectors (AAIs) are not used correctly by patients and their caregivers because of a lack of training. The aim of this study was to determine how to help patients maintain proper use of AAIs. Methods: Patients prescribed AAIs or their caregivers were recruited. At enrollment, they were asked to demonstrate use of a ‘trainer’ device, and they were given a calendar as a diary. They were asked to mark the days they practice for a year. After one year, their performance was re-evaluated. Their skills were evaluated in five steps that consisted of a) how to hold the AAI, b) removing the cap, c) selecting the mid-anterolateral thigh as the correct site of injection, d) holding firmly in place for 5 seconds, and e) massaging after injection. The primary endpoint was the percentage of participants that correctly used the AAI one year after enrollment. Results: A total of 102 participants were enrolled. At enrollment, of the 82 participants who had previous AAI prescriptions, 38 (46.3%) used it correctly. Except for evaluation items d) and e), 55 of 82 (67.1%) used it correctly. Ninety-seven participants could be confirmed after one year, and 81 of them (83.5%) used the AAI correctly. Conclusion: Distributing the diary was effective in maintaining AAI skill. It is thought that the diary helped participants maintain their motivation to practice using the AAI.

Anaphylaxis: Five Years’ Experience in the Emergency Rooms of Five University Hospitals in Korea

Background: Anaphylaxis is an allergic disease that requires special handling due to its potential fatality. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. However, actual data on the prevalence or causes of anaphylaxis in Korea are limited. Methods: The emergency room attendees diagnosed with anaphylaxis between 2011 and 2015 in five university hospitals were included. Medical records were reviewed retrospectively. Results: During the 5 years, a total of 505 subjects were diagnosed with anaphylaxis. Respiratory presentations were more common in children than in adults, while adults presented more frequently with cardiovascular symptoms. Intraoral angioedema was more often observed in the countryside than in the city. Insect stings/bites were more common in the countryside than in the city. Drugs were much more common in adults than in children. In the countryside, the frequency of anaphylaxis was higher in summer and autumn than in spring and winter. The use of corticosteroids was less common in children than in adults, while children more frequently got treatment with inhaled beta 2 agonist. Conclusions: The principal causes of anaphylaxis in Korean patients were food, drugs, and stings/bites. The cause, clinical features and management of anaphylaxis were significantly different depending on age and region. These real-world data on anaphylaxis could be helpful to deepen that understanding of this condition for physicians and patients.

Nephrotic syndrome after insect sting: a case report

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

Parvovirus Infection in a Child Presenting with Erythema Multiforme and Vasculitis after a Yellow Jacket Bee Sting

Parvovirus B19 has a wide spectrum of clinical manifestations. Erythema multiforme and vasculitis are rarely reported with parvovirus B19 infections. Reactions to insect stings can range from local swelling to life-threatening systemic reactions. There have been rare reports of unusual reactions, such as vasculitis, occurring in a temporal relationship with insect stings. We report an 8-year-old patient having Parvovirus B-19-related erythema multiforme and vasculitis after a yellow jacket bee sting.

Anaphylaxis

Anaphylaxis, a serious allergic reaction, is rapid in onset and marked by flushing, urticaria, angioedema, pruritus, bronchospasm, and abdominal cramping with nausea, vomiting, and diarrhea. It is not uncommon; approximate lifetime prevalence of anaphylaxis was estimated to be 0.5 to 2% or possibly higher due to the common academic belief that the incidence of anaphylactic reactions is underreported. Rarely, anaphylaxis may cause death, most commonly from drugs, foods, and insect stings. This review covers the epidemiology, etiology, pathogenesis, diagnosis, clinical manifestations, treatment, and prognosis. Figures show inflammatory pathways in allergic inflammation and mast cell degranulation and pathways of activation. This review contains 2 figures, 5 tables, and 72 references. Keywords: Anaphylaxis, allergy, shock, auto-injector epinephrine, inflammation, mast cell, venom