No abstract available.
Anaphylaxis* ; Diagnosis*

No abstract available.
Anaphylaxis* ; Diagnosis*

Anaphylaxis ; diagnosis ; therapy ; Humans

PURPOSE: This study investigates the utility of serum tryptase for the confirmation of shrimp-induced anaphylaxis. METHODS: Patients with a history of shrimp allergy and positive skin prick tests (SPT) to commercial shrimp extract were recruited for shrimp challenges. Serum total tryptase was obtained at baseline and 60 min (peak) after the onset of symptoms. RESULTS: Thirty-nine patients were challenged. There were 12 patients with anaphylaxis, 20 with mild reactions and 7 without symptoms (control group). Characteristic features and baseline tryptase were not different among the 3 groups. The peak tryptase levels were higher than the baseline in anaphylaxis and mild reaction groups (P<0.05). The delta-tryptase (peak minus baseline) and the tryptase ratio (peak divided by baseline) in the anaphylaxis group were higher than the mild reaction and control groups (P<0.01). The optimum cut-off for peak tryptase to confirm anaphylaxis was 2.99 microg/L with 50% sensitivity, 85% specificity, 3.33 positive likelihood ratio (LR) and 0.59 negative LR. The manufacturer's cut-off for peak tryptase was >11.4 microg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was > or =0.8 microg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was > or =1.5 with 92% sensitivity, 96% specificity, 23 positive LR and 0.08 negative LR. CONCLUSIONS: The peak tryptase level should be compared with the baseline value to confirm anaphylaxis. The tryptase ratio provide the best sensitivity, specificity, positive and negative LR than a single peak serum tryptase for the confirmation of shrimp-induced anaphylaxis.
Anaphylaxis* ; Diagnosis* ; Humans ; Hypersensitivity ; Skin ; Tryptases*

The high-pace rise in advanced computing and imaging systems has given rise to a new research dimension called computer-aided diagnosis (CAD) system for various biomedical purposes. CAD-based diabetic retinopathy (DR) can be of paramount significance to enable early disease detection and diagnosis decision. Considering the robustness of deep neural networks (DNNs) to solve highly intricate classification problems, in this paper, AlexNet DNN, which functions on the basis of convolutional neural network (CNN), has been applied to enable an optimal DR CAD solution. The DR model applies a multilevel optimization measure that incorporates pre-processing, adaptive-learning-based Gaussian mixture model (GMM)-based concept region segmentation, connected component-analysis-based region of interest (ROI) localization, AlexNet DNN-based highly dimensional feature extraction, principle component analysis (PCA)- and linear discriminant analysis (LDA)-based feature selection, and support-vector-machine-based classification to ensure optimal five-class DR classification. The simulation results with standard KAGGLE fundus datasets reveal that the proposed AlexNet DNN-based DR exhibits a better performance with LDA feature selection, where it exhibits a DR classification accuracy of 97.93% with FC7 features, whereas with PCA, it shows 95.26% accuracy. Comparative analysis with spatial invariant feature transform (SIFT) technique (accuracy—94.40%) based DR feature extraction also confirms that AlexNet DNN-based DR outperforms SIFT-based DR.
Classification ; Dataset ; Diabetic Retinopathy ; Diagnosis ; Passive Cutaneous Anaphylaxis

PURPOSE: Cow's milk-specific IgE (CM-IgE) has been proposed as one of the valuable markers for diagnosis of clinical cow's milk (CM) allergy. In this study, we evaluated the additional usefulness of casein-specific IgE (casein-IgE) and IgG (casein-IgG) for the diagnosis of clinical CM allergy. METHODS: Fifty-eight subjects, aged from 3 months to 154 months, were enrolled. Thirty-four patients showed immediate-type of clinical CM allergy, and 24 patients were atopic controls. The serum levels of CM-IgE, casein-IgE, and casein-IgG were measured. Patients were divided into 2 groups: those aged under 12 months and those aged 12 months or over. The diagnostic values of each antibody were analyzed and compared using the Mann-Whitney U-test and receiver operating characteristic curves. RESULTS: CM allergy had significantly higher levels of CM-IgE and casein-IgE, and lower levels of casein-IgG/IgE ratio when compared to atopic controls in both age groups (P<0.05). CM-IgE and casein-IgE were shown to be better predictive markers for immediate-type CM allergy in patients under 12 months, while casein-IgG/IgE ratio was a more useful marker in those aged 12 months or over. Considering 100% positive predictive values, cutoff points were 1.04 kU/L for CM-IgE, 0.11 kU/L for casein-IgE, 19.5 for casein-IgG/IgE ratio in patients aged under 12 months, and 7.1 kU/L for CM-IgE, 1.41 kU/L for casein-IgE, 12.51 for casein-IgG/IgE ratio in those aged 12 months or over. CONCLUSION: CM-IgE, casein-IgE, and casein-IgG/IgE ratio are useful markers for predicting immediate-type CM allergy. Further studies are needed on diagnostic decision points for CM allergy using combination of cutoff values of these 3 markers.
Anaphylaxis ; Antibodies* ; Caseins* ; Diagnosis ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Immunoglobulin G* ; Milk ; Milk Hypersensitivity* ; ROC Curve

Effective treatment of hypotension during induction of general anesthesia depends onhow well the many causes of the hypotension are understood. However, differential diagnosis of hypotension is by no means easy, especially when the prevalenceof hypotension is low or when the patient is asymptomatic. A 75 year-old female, upon induction of general anesthesia for open thoracic surgery, became hypotensive and showed generalized erythematous papules, therefore having to postpone the surgery. Upon further evaluation through skin prick tests, the hypotensive event was concluded to be caused by anaphylactic side effects of atracurium. Hence, atracurium was avoided and the surgery was successfully performed.
Anaphylaxis ; Anesthesia, General ; Atracurium ; Diagnosis, Differential ; Female ; Humans ; Hypotension ; Skin ; Thoracic Surgery

Recently fibrin glue, a hemostatic or adhesive material has been used worldwide in surgical procedures. There have been only limited numbers of reports on anaphylaxis following the topical use of fibrin glue. Here, we experienced an anaphylactoid reaction during transsphenoidal removal of pituitary tumor after local application of fibrin glue including aprotinin. Unexpected hypotension and erythematous eruptions on whole body developed suddenly after packing of it at operation field. Treatment with aggressive volume replacement with vasoactive agents and steroids were done immediately on the diagnosis of anaphylactoid reaction and patient recovered without any complications.
Adhesives ; Anaphylaxis ; Aprotinin* ; Diagnosis ; Fibrin Tissue Adhesive* ; Fibrin* ; Humans ; Hypotension ; Pituitary Neoplasms ; Steroids

Food-dependent exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening clinical reaction in which anaphylaxis develops when physical activity occurs within a few hours after ingesting a specific food. An 18-year-old girl experienced generalized urticaria, periorbital swelling, and dyspnea repeatedly by exercise after intake of a red ginseng health supplement. A confirmed diagnosis was established in this case by using an exercise challenge test after ingesting mixed-plant extract containing red ginseng health supplement. To the best of our knowledge, this is the first case of FDEIA caused by components in a red ginseng health supplement.
Adolescent ; Anaphylaxis* ; Diagnosis ; Dyspnea ; Female ; Humans ; Motor Activity ; Panax ; Plants* ; Urticaria

PURPOSE: Buckwheat is one of the most common allergen in food allergy, the pathomechanism is IgE-mediated, type I immune reaction. Antigenicity of Buckwheat is extremely strong, and hypersensitivity symptoms included asthmatic attacks, urticaria eruption, gastrointestinal disorders even anaphylactic shock. The purpose of this study is to evaluate diagnostic significance of allergy skin test and allergy history and analyze clinical features of buckwheat allergy confirmed by oral provocation test. METHODS: We carried out the retrospective study on 55 patients who had been performed oral buckwheat provocation test at Yonsei university children's allergic clinic. RESULTS: 1) 40 out of 55 cases(72.7%) showed positive buckwheat oral provocation test. 2) The most common clinical finding after oral provocation test was urticaria. 60% showed severe allergic reactions such as asthma attack or anaphylactic shock. 3) The rate which past history and positive skin test corresponded to oral provocation test was very high(86.1%). CONCLUSIONS: The most valuable diagnosis of food allergy is oral provocation test. However, predictive value of allergy skin test and past history was very high in buckwheat allergy. Our study suggest that the troblesome oral provocation test may be not needed in all cases of suspicious buckwheat allergy patients.
Anaphylaxis ; Asthma ; Diagnosis ; Fagopyrum* ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Retrospective Studies ; Skin Tests ; Urticaria