Anaphylaxis ; diagnosis ; therapy ; Humans

Anaphylaxis is the most severe allergic reaction, demanding immediate management by health care providers, which is currently underdiagnosed and undertreated in China. In addition to the classic IgE-mediated pathway, non-IgE dependent pathway has also been extensively studied in the pathogenesis of anaphylaxis. Recently, the atypical symptoms induced by widespread used monoclonal antibodies and biologics have been reported. The goal of this article is to recognize the phenotypes (triggers and presentation) and understand its characteristics through endotypes (mechanisms) of anaphylaxis. Ultimately, the aim is to help allergists and health care providers guide a precision approach to diagnose and manage of anaphylaxis.
Humans ; Anaphylaxis/therapy* ; Phenotype ; China ; Health Personnel

Anaphylaxis is the most severe allergic reaction, demanding immediate management by health care providers, which is currently underdiagnosed and undertreated in China. In addition to the classic IgE-mediated pathway, non-IgE dependent pathway has also been extensively studied in the pathogenesis of anaphylaxis. Recently, the atypical symptoms induced by widespread used monoclonal antibodies and biologics have been reported. The goal of this article is to recognize the phenotypes (triggers and presentation) and understand its characteristics through endotypes (mechanisms) of anaphylaxis. Ultimately, the aim is to help allergists and health care providers guide a precision approach to diagnose and manage of anaphylaxis.
Humans ; Anaphylaxis/therapy* ; Phenotype ; China ; Health Personnel

Drug-induced anaphylaxis is a big pitfall in patients receiving antineoplastic chemotherapy. We report a case of lung cancer patient who experienced two near-fatal anaphylactic reactions that resulted from paclitaxel and multivitamin, seperately. Recurrent severe reactions to different agents led to further investigation to which material the patient was hypersensitive. The skin prick test revealed sensitization to cremophor, which is a commonly used emulsifying agent. This case emphasizes the importance of correctly identifying the culprit drug of anaphylaxis to avoid potentially fatal reaction.
Anaphylaxis* ; Drug Therapy ; Humans ; Hypersensitivity ; Lung Neoplasms ; Paclitaxel ; Skin

Drug desensitization is procedure by which patients can be tolerized to medications that have previously induced hypersensitivity reactions. Initially used in treating hypersensitivity reactions to antibiotics, desensitization is now frequently used in the setting of allergy to chemotherapy drugs and biologics, thus widening the clinical applicability of this procedure which has been proven to be quite safe and effective in improving clinical outcomes, mainly by allowing patients to remain on preferred first-line therapy. This paper reviews the history, application, and safety studies of drug desensitization for chemotherapy and biologics.
Anaphylaxis ; Anti-Bacterial Agents ; Biological Products ; Drug Therapy ; Humans ; Hypersensitivity

OBJECTIVE: To select and define the clinical questions and outcomes of Guideline for the Emergency Treatment of Anaphylaxis. METHODS: A draft including clinical questions, which could be divided into foreground questions and background questions, and outcomes was drawn and revised by the secretary group for the guideline referring to the present guidelines with the guidance of a panel consisting of 7 experienced clinical medicine, pharmacy and nursing experts. Foreground questions and outcomes of the draft were voted into a final version after three rounds of counsels of 22 experienced medicine, pharmacy and nursing clinical experts using Delphi method including 3 rounds of inquiry. And the background questions were directly included in the guideline after the 22 experts' thorough revising. The research was carried out under the supervision of method ologists. Active coefficient, coefficient of variation and the frequencies of each score were calculated for quality control. RESULTS: The draft of 34 foreground questions, 6 background questions and 6 outcomes was finally drawn up after thorough selecting and consulting. The 6 background questions revised by the clinical experts were all included. After three rounds of Delphi method, 28 pivotal clinical questions covering the diagnosis, preparation for the treatment, treatment and administration after the treatment, and 6 outcomes were defined and included for the guideline. The rest of the foreground questions, 4 of which were recognized as essential and 2 as important, were excluded from the guideline and left for further revising or updating. As for the outcomes, 4 of them were recognized as critical and the rest as important. The experts contributing to the research were active as the active coefficient reached 100%, and the degree of consensus was fine as the frequencies of the feedback scoring equal to or greater than 4 for all the 28 foreground questions included were greater than 75% and the result was settled in the first round. And 2 outcomes, fatality rate and severity, reached a higher degree of consensus with coefficient of variation less than 15%. CONCLUSION After thorough and rigorous selecting, the clinical questions and outcomes to be included in the Guideline for the Emergency Treatment of Anaphylaxis were finally selected and defined via Delphi method, guiding the future development of the guidelines.
Anaphylaxis/therapy* ; Consensus ; Delphi Technique ; Emergency Treatment ; Humans ; Research Design

Anaphylaxis is one of the most common and harmful of all adverse effects of drugs. It has no direct relation to the toxicity and dosage of drugs, but belongs to the pathologic immune reaction, directly threatening patients' lives. At present, many important advances and breakthroughs have been achieved in the researches on drug anaphylaxis of the penis, but many researchers have gone hardly any further than reporting the symptoms and treatments of a few individual cases, but very few specific substantial researches on penis drug anaphylaxis.
Allergens ; adverse effects ; Anaphylaxis ; Drug Hypersensitivity ; etiology ; therapy ; Humans ; Male ; Penile Diseases ; chemically induced ; therapy

PURPOSE: The purpose of the study was to test the effects of music therapy on postoperative pain in patients with total hip replacement. METHOD: The research design was a nonequivalent control group pretest-posttest design. The subjects were composed of thirty patients with total hip replacement. Fifteen of them were assigned to the experimental group and fifteen to the control group. Fifteen minutes tailored music therapy was given to the experimental group during five consecutive days. The instruments used for this study were pain NRS(numerical rating scale). The data were analyzed using percent, mean, standard deviation, chi-square-test and repeated measure ANOVA using SPSS WIN 11.0. RESULTS: Hypothesis 1 "The score of pain NRS of experimental group will be lower than those of control group" was accepted(F=15.945, p<.001). Hypothesis 2 "The frequency of PCA analgesics of experimental group will be fewer than those of control group" was accepted (t=-2.312, p=.028). Hypothesis 3 "The vital signs(pulse, systolic BP and diastolic BP) of experimental group will be different from those of control group" was rejected. CONCLUSION: This music therapy can be recommended as an efficient nursing intervention to reduce postoperative pain in patients with total hip replacement.
Analgesics ; Arthroplasty, Replacement, Hip* ; Humans ; Music Therapy* ; Music* ; Nursing ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Research Design

The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients' symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.
Adult ; Allergens ; Anaphylaxis* ; Behavior Therapy ; Diagnosis ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Placebos ; Respiratory Sounds ; Skin Tests ; Vocal Cord Dysfunction

The purpose of this study was to identify side effects of the vesicant chemotherapy. The study was designed to be a descriptive survey. The subjects of this study were 88 patients with various types of cancer, primary lung cancer(25.0%), advanced gastric cancer(25.0%), breast cancer(20.5%), etc. The mean age was 44.8 years old(range: 16-68). The questionnaire was completed by nurses of the outpatient unit and chemotherapy ward, and intravenous nurse specialist. The results of the study were as follows: 1) Chemotherapy was administered with a 23G scalp needle and 24G insyte. Injection site was dorsum of hands (64.7%), cephalic vein(19.3%). Successful rate for the first attempt was 88.6%. The first & second cycle chemotherapy was 29.5% each.. Mainly used drugs were Navelbine(34.1%), Adriamycin(20.5%). 2) Venous problems after chemotherapy were pain(13.6%) incurred by venous, mainly due to the administration of Navelbine; redness at the inravenous site(12.5%) and itching sense 2.3%. Non-venous problems were nausea (18.2%), dullness(14.8%), vomiting(8.0%), facial flushing(6.8%), anxiety(5.7%). Subjective discomforts after chemotherapy were generalized arm pain at the injection side(14.8%), dizziness(6.8%), weakness(5.7%) and general bodyache (5.7%). Systemic anaphylactic reaction and extravasation did not occur. 3) Non-venous problem after chemotherapy were nausea, vomiting & anorexia. Frequency of chemotherapy related to side effects were itching, facial flushing, and nausea(p<0.05). Day of chemothe-rapy related to side effects were nausea & vomiting(p<0.05). Site of chemothe- rapy related to side effects were redness(p<0.05). Frequency of venipuncture related to side effects were redness(p<0.05). Conclusively, cancer chemotherapy patients have had some venous problem. They need appropriate venous access devices for chemotherapy. And other non-venous problem will be managed appropriately. Further research was required to identify the rate of venous complication or side effects of vesicant chemotherapy.
Anaphylaxis ; Anorexia ; Arm ; Breast ; Drug Therapy* ; Flushing ; Hand ; Humans ; Lung ; Nausea ; Needles ; Outpatients ; Phlebotomy ; Pruritus ; Surveys and Questionnaires ; Scalp ; Specialization ; Vomiting