OJECTIVE: To explore the changes of serum IgE and tryptase caused by anaphylactic shock rats and discuss the relation to PMI and preservative environment of corpse and specimen. METHODS: Rats were used for establishing anaphylactic shock models and randomly divided into room temperature group, refrigeration group, frozen group, manual hemolysis group, specimen preservation group. And the control group was also established. The blood samples were collected after rats were sacrificed. The degree of hemolysis was graded according to the color of the upper layer of the serum. The mass concentration of IgE and tryptase in each group was detected by ELISA. RESULTS: The levels of serum IgE and tryptase in anaphylactic shock dead rats were higher than that of the control group. Room temperature and frozen made obviously differences on the levels of serum IgE and tryptase with various PMI. The levels of serum IgE and tryptase in refrigeration group showed relatively stable. The levels of serum tryptase and IgE were elevated with differently increasing hemolysis. The levels of serum IgE and tryptase showed no obvious changes during the specimen kept under different temperature conditions for 25 days. CONCLUSION Serum IgE and tryptase obviously increased in anaphylactic shock rats. However, the levels were influenced by PMI and environmental temperature, especially under the conditions of room temperature and frozen.
Anaphylaxis/blood* ; Animals ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Immunoglobulin E/blood* ; Rats ; Temperature ; Tryptases/blood*

OBJECTIVETo evaluate the sensitization effect of polysorbate 80 from different factories on Beagle dogs.

METHODBeagles dogs were randomly divided into 5 groups, 3 in each group, received respectively the intravenous infusion of polysorbate 80 made by four factories in the concentration of 0.5%, with the constant infusing speed of 5 mL x min(-1) and volume of 10 mL x kg(-1). Changes were observed before infusion and in the 24 h after infusion, time of symptom appearance and disappearance was recorded, and the grade of response was determined. Moreover, blood pressure and heart rates were tested by the machine of Bp-98E, blood samples of animals were collected before infusion and at 10 min after ending infusion for measuring histamine content in plasma using ELISA. Then the sensitization effect was comprehensively estimated by combined consideration of the responding grade and histamine level.

RESULTTypical symptoms of anaphylactoid reactions were found in sample 3 group, atypical symptoms were found in other polysorbate 80 groups. Different degrees of heart rate speeding and blood pressure downing were found in polysorbate 80 groups. No over 1-fold increase of plasma histamine level was found in all groups. The atypical anaphylactoid reactions and blood pressure of sample 2 group was lighter than other polysorbate 80 groups. Estimation showed that the sample 3 induced the suspicious anaphylactoid reactions, other test solutions did not induce the typical anaphylactoid reactions on Beagle dogs.

CONCLUSIONFor allergies and other special populations, there is still a certain risk to applicate polysorbate 80 in the concentration of 0.5%. Production process of polysorbate 80 have a certain influence on allergenicity, refined polysorbate 80 increase the security, but further reasearchs are needed to confirmed.

Anaphylaxis ; blood ; chemically induced ; physiopathology ; Animals ; Blood Pressure ; Dogs ; Dose-Response Relationship, Drug ; Drug Hypersensitivity ; blood ; physiopathology ; Histamine ; blood ; Male ; Polysorbates ; adverse effects

The detection of drug-induced anaphylactoid reactions remains a global challenge,still lacking mature and reliable animal models or test methods. Therefore,the purpose of this paper is to explore and establish the test methods and evaluation standards for anaphylactoid reactions that apply to injection drugs. Based on the anaphylactoid reaction symptoms of mice induced by intravenous injection drugs C48/40 and Tween 80,a list of systemic anaphylactoid reaction symptoms in mice was sorted out and an evaluation standard of anaphylactoid reactions symptoms was established by applying symptom intensity coefficient K( that can represent these verity of anaphylactoid reaction symptoms) and its calculation formula Accordingly,histamine,tryptase,and Ig E were selected as blood indicators of anaphylactoid reactions,so that a test method combining symptoms evaluation and blood makers detection was established.This test method could be used to evaluate the characteristics of anaphylactoid reactions: coefficient K,blood histamine levels were highly and positively correlated with C48/80 and Tween 80 dose; The log value of histamine was highly and positively correlated with K; tryptase level may rise,or remain steady,or drop,possibly associated with the characteristics of the tested object and time for blood taking; and Ig E level would drop or remain steady,but it would not rise,which can be clearly distinguished from type I allergic reactions. On this basis,tiohexol,iopromide,paclitaxel,Xuesaitong Injection,Shuanghuanglian Injection and Shengmai Injection were used to investigate the applicability. The testing results showed a high degree of consistency with the actual clinical situation. The results suggest that the method of systemic anaphylaxis test in mice has high sensitivity,specificity and good consistency with clinical practice.It is suggested to be further validated and popularized.
Anaphylaxis ; chemically induced ; diagnosis ; Animals ; Disease Models, Animal ; Drugs, Chinese Herbal ; toxicity ; Histamine ; blood ; Immunoglobulin E ; blood ; Injections, Intravenous ; Mice ; Shock ; chemically induced ; diagnosis ; Toxicity Tests ; Tryptases ; blood

Previous studies have shown that patient-controlled analgesia(PCA) provides effective pain control in the postoperative patient. To compare the effect of pain relief on postoperative sympathetic responses and myocardial oxygen consumption, 40 healthy female patients undergoing abdominal hysterectomy were chosen randomly. They underwent pain management with either intravenous patient-controlled analgesia(IV PCA) or intermittent intramuscular opioid(IM P.R.N) regimen. Pain intensity(VAS), heart rate, blood pressure, and rate pressure product(RPP) were measured at predetermined time intervals for postoperative 72 hours after measurement of preoperative baseline values. Comparisons were then made between the two groups and among individuals within each group. IV-PCA improved postoperative pain relief(P<0.05), but did not suppress efficiently the heart rate, blood pressure, and RPP indicating sympathetic responses and myocardial oxygen consumption when compared with M P.R.N regimen. These variables were increased immediately and/or 30 minutes following the operation in both groups when compared with preoperative baseline value (P<0.05). These results suggest that improved pain relief per se by IV PCA had no mjor influence on the suppression of sympathetic responses and myocardial oxygen consumption and these responses were exaggerated during first 30 minutes after abdominal hysterectomy.
Analgesia* ; Blood Pressure* ; Female ; Heart Rate* ; Heart* ; Humans ; Hysterectomy ; Oxygen Consumption ; Pain Management ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*

PURPOSE: This study was conducted to investigate the frequency and clinical characteristics of anaphylaxis patients who are registered inaccurately with other disease codes. METHODS: Study subjects presenting at the emergency department (ED) were retrospectively collected using disease codes to search for anaphylaxis patients in a previous studies. The study group was divided into an accurate and inaccurate group according to whether disease codes were accurately registered as anaphylaxis codes. RESULTS: Among 266 anaphylaxis patients, 144 patients (54%) received inaccurate codes. Cancer was the most common comorbidity, and the radio-contrast media was the most common cause of anaphylaxis in the accurate group. Cutaneous and respiratory symptoms manifested more frequently in the inaccurate group, while cardiovascular and neurological symptoms were more frequent in the accurate group. Blood pressure was lower, and shock and non-alert consciousness were more common in the accurate group. Administration of intravenous fluid and epinephrine use were more frequent in the accurate group. Anaphylaxis patients with a history of cancer, shock, and epinephrine use were more likely to be registered as anaphylaxis codes accurately, but patients with respiratory symptoms were more likely to be registered with other disease codes. CONCLUSION: In cases of anaphylaxis, the frequency of inaccurately registered disease codes was higher than that of accurately registered codes. Anaphylaxis patients who were not treated with epinephrine at the ED who did not have a history of cancer, but had respiratory symptoms were at increased risk of being registered with disease codes other than anaphylaxis codes.
Anaphylaxis* ; Blood Pressure ; Comorbidity ; Consciousness ; Emergencies* ; Emergency Service, Hospital* ; Epinephrine ; Humans ; International Classification of Diseases ; Retrospective Studies ; Shock

Anaphylaxis is a type I allergic reaction and its clinical features occur after re-exposure to the same allergen. Numerous types of drugs can cause anaphylaxis during general anesthesia. Topical bovine thrombin (TBT) is usually used for hemostasis during surgery. However, TBT can cause interruption of the normal blood coagulation pathways, delay wound repair, and lead to uncontrolled bleeding, anaphylaxis, or death. Anaphylaxis caused by TBT during the perioperative period is very rare. We report the case of a patient who developed severe hypotension, tachycardia, and bronchospasm while undergoing discectomy for herniated nucleus pulposus. Based on the symptoms and signs, anaphylaxis was considered most likely. Identification of the causative agents is important in these cases because it can be very helpful for the management and prevention of anaphylaxis.
Anaphylaxis* ; Anesthesia, General ; Blood Coagulation ; Bronchial Spasm ; Diskectomy ; Epinephrine ; Hemorrhage ; Hemostasis* ; Humans ; Hypersensitivity ; Hypotension ; Perioperative Period ; Tachycardia ; Thrombin* ; Wounds and Injuries

BACKGROUND: Neurocardiogenic syncope (NCS) is the most common type of neurally mediated syncopes. Though presyncopal symptoms may represent hypoperfusion in posterior circulation, studies for evaluating the cerebrovascular response of posterior circulation in patients with NCS were scanty. We evaluated the cerebrovascular response of the posterior circulation using transcranial Doppler monitoring in patients with NCS. METHODS: We measured the blood flow velocity (BFV) of the middle cerebral artery (MCA) and contralateral posterior cerebral artery (PCA) simultaneously in 11 patients with a diagnosis of NCS both at rest and during the head-up tilt test (HUT) for 5 minutes. The mean arterial pressure (MAP), pulse rate (PR), and end-tidal pCO2 (EtCO2) were also monitored. The obtained data were compared with those of 17 normal control subjects. RESULTS: The syncope patients showed a significantly larger decline in BFV of PCA (P<0.05) and a larger increase in pulsatility indexes of MCA and PCA during HUT compared to those of control subjects. In control subjects BFV of PCA decreased less than those of MCA. On the contrary, in patients with NCS, those of PCA decreased more. These different regional cerebrovascular responses to HUT were accompanied with neither presyncopal symptoms nor decrease in MBP. CONCLUSIONS: The regional cerebrovascular response to HUT in NCS patients was different in the PCA flow. Impairment of autonomic neural control of posterior circulation may play an important role in the pathophysiology of NCS.
Arterial Pressure ; Blood Flow Velocity ; Heart Rate ; Humans ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Syncope ; Syncope, Vasovagal

Anaphylaxis and anaphylactoid reactions that occur during anesthesia may range from minor systemic effects to life-threatening or fatal effects. A 88-yr-old man was scheduled for laparoscopic nephrectomy. He had no history of allergy and had never previously undergone general anesthesia, though several spinal anesthesias were performed for TUR-B using 0.5% heavy bupivacaine. General anesthesia was induced with alfentanil 0.5 mg, thiopental 250 mg, and rocuronium bromide 50 mg. After thiopental injection, the man became irritable, and after rocuronium injection ventilation became difficult and tachycardia appeared; blood pressure could not be checked. The operation was canceled and a skin prick test was performed. Seven weeks later, he underwent uneventful anesthesia with etomidate and vecuronium.
Alfentanil ; Anaphylaxis* ; Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Blood Pressure ; Bupivacaine ; Etomidate ; Hypersensitivity ; Nephrectomy ; Skin ; Tachycardia ; Thiopental* ; Vecuronium Bromide ; Ventilation

Blood flow velocity changes induced by the focal brain activation can be assessed by using Transcranial Doppler sonography (TCD). To explore the hemispheric dominant hemodynamic effect by performing calculation, we applied TCD technique to detect cerebral blood velocity asymmetry. METHODS Twenty healthy right-handed subjects were tested. We measured mean flow velocities (MFV) in the middle and posterior cerebral arteries (MCA, PCA). Photic stimulation was given separately as a control task for calculation. RESULTS While the photic stimulation increased the blood velocity only in PCAs, performing calculation increased the velocity in MCAs. Right-left difference was noted by performing calculation with greater increase in left MCA (right: 8.8 %; left: 21.2 %). CONCLUSION Application of TCD enabled us to measure the hemodynamic changes supporting the left hemispheric dominance of calculation task. Futhermore, increase in non-dominant right hemisphere suggests the functional interaction of cerebral activity.
Blood Flow Velocity* ; Brain ; Dominance, Cerebral ; Hemodynamics ; Passive Cutaneous Anaphylaxis ; Photic Stimulation ; Posterior Cerebral Artery ; Ultrasonography, Doppler, Transcranial