BACKGROUND: In the Emergency Department (ED), diagnosis and management of anaphylaxis are challenging with at least 50% of anaphylaxis episodes misdiagnosed when the diagnostic criteria of current guidelines are not used.OBJECTIVE: Objective of our study was to assess anaphylaxis diagnosis and management in patients presenting to the ED.METHODS: Retrospective chart review conducted on patients presenting to The Medical City Hospital ED, the Philippines from 2013–2015 was done. Cases were identified based on International Statistical Classification of Diseases, 10th revision coding for either anaphylaxis or other allergic related diagnosis. Cases fitting the definition of anaphylaxis as identified by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network (NIAID/FAAN) were included. Data collected included demographics, signs and symptoms, triggers and management.RESULTS: A total of 105 cases were evaluated. Incidence of anaphylaxis for the 3-year study period was 0.03%. Of the 105 cases, 35 (33%) were diagnosed as “urticaria” or “hypersensitivity reaction” despite fulfilling the NIAID/FAAN anaphylaxis criteria. There was a significant difference in epinephrine administration between those given the diagnosis of anaphylaxis versus misdiagnosed cases (61 [87%] vs. 12 [34%], χ² = 30.77, p < 0.01); and a significant difference in time interval from arrival at the ED to epinephrine administration, with those diagnosed as anaphylaxis (48%) receiving epinephrine within 10 minutes, versus ≥ 60 minutes for most of the misdiagnosed group (χ² = 52.97, p < 0.01).CONCLUSION: Despite current guidelines, anaphylaxis is still misdiagnosed in the ED. Having an ED diagnosis of anaphylaxis significantly increases the likelihood of epinephrine administration, and at a shorter time interval.
Anaphylaxis ; Classification ; Clinical Coding ; Communicable Diseases ; Demography ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Epinephrine ; Food Hypersensitivity ; Hospitals, Urban ; Humans ; Hypersensitivity ; Incidence ; Philippines ; Retrospective Studies ; Tertiary Care Centers

OBJECTIVES: The purpose of this study was to develop new meal planning tools for a nutritionally balanced diet. METHODS: Based on the food exchange list for diabetes, we adjusted the food group classification system to reflect the suggested nutritional factors for chronic disease prevention and health promotion. We developed a nutritionally balanced dietary profile for adults and compared it with the dietary reference intakes for Koreans (KDRIs) and the food pattern recommended by the Korean Diabetes Association. RESULTS: The newly developed menu planning tools are the LOHAS food exchange table and the LOHAS food pattern. Our recommended daily 1,800 kcal dietary composition for adults is as follows: The carbohydrate food group consists of 4 ‘whole grains’, 3 ‘refined grains’, 2 ‘sugars’, 9 ‘vegetables’, 3 ‘starchy vegetables’, 2 ‘fruits’ and 1 ‘high sugar fruits’. The protein food group includes 3 ‘plant protein foods’, 3 ‘animal protein foods (low-fat)’, and 1 ‘animal protein foods (high-fat)’. The fat food group consists of 2 ‘oils and nuts’ and 1 ‘solid fats’. The total number of calories is estimated at 1,840 kcal and the energy ratio is 62% carbohydrate, 18% protein, 20% fat, 6.8% saturated fat and 13.2% sugars. Using the LOHAS food exchange table, it is possible to estimate values of saturated fat, unsaturated fat, dietary fiber, and sugars besides carbohydrate, protein and fat. It is also possible to compose a dietary design considering carbohydrate, sugars, saturated fat and dietary fiber. The LOHAS food pattern provides benefits for the management of both institutional food services and individual meals, as it can help reduce the levels of saturated fat and sugar intake and help develop healthy meals rich in unsaturated fats and dietary fiber. CONCLUSIONS: The LOHAS food exchange table and LOHAS food pattern are expected to be practical tools for designing and evaluating nutritionally balanced diets.
Adult ; Carbohydrates ; Chronic Disease ; Classification ; Diet ; Dietary Fats ; Dietary Fiber ; Fats, Unsaturated ; Food Services ; Health Promotion ; Humans ; Meals ; Menu Planning ; Recommended Dietary Allowances

PURPOSE: This study aimed to investigate the current status of food service management in elementary care classes. METHODS: A focus group interview with seven care class managers and a survey with 101 care class managers using a self-administered questionnaire in Gyeonggi province were conducted. RESULTS: In the focus group interview, purchased meals and snacks were evaluated as low quality by the care class managers. Frequent use of frozen or processed food and products with low prices were also reported as problems. Care class managers were in charge of meal and snack planning without any guidelines or expert advices. The results of the survey show that most schools serve purchased snacks and meals. The average unit costs of one meal and snack were 4,062 and 1,463 Won, respectively. The average unit costs of snacks during semester (p = 0.015) and vacation (p = 0.039) were significantly lower in rural than urban areas. The percentages of schools that prepared nutrition standards for meal and snack planning in elementary care classes were only 7.4% and 10.9%, respectively. The meal menus were mostly provided by catering service companies, and the snack menus were planned mostly by the care class managers. Menu planning by the care class managers was more usual in rural than urban areas (p = 0.054 for meal planning and p = 0.008 for snack planning). Just 33.7% of schools introduced safety standards for food service in elementary care classes, and more than half of the respondents (56.4%) did not do a regular medical check-up. Only 33.7% of the respondents received education for food safety. CONCLUSION: These results show the necessity for establishment of detailed guidelines for food service in elementary care classes and for the introduction of a food safety and nutrition education program customized for care class managers.
Education ; Focus Groups ; Food Safety ; Food Services ; Gyeonggi-do* ; Humans ; Meals* ; Menu Planning ; Snacks* ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study was to develop new meal planning tools for a nutritionally balanced diet. METHODS: Based on the food exchange list for diabetes, we adjusted the food group classification system to reflect the suggested nutritional factors for chronic disease prevention and health promotion. We developed a nutritionally balanced dietary profile for adults and compared it with the dietary reference intakes for Koreans (KDRIs) and the food pattern recommended by the Korean Diabetes Association. RESULTS: The newly developed menu planning tools are the LOHAS food exchange table and the LOHAS food pattern. Our recommended daily 1,800 kcal dietary composition for adults is as follows: The carbohydrate food group consists of 4 ‘whole grains’, 3 ‘refined grains’, 2 ‘sugars’, 9 ‘vegetables’, 3 ‘starchy vegetables’, 2 ‘fruits’ and 1 ‘high sugar fruits’. The protein food group includes 3 ‘plant protein foods’, 3 ‘animal protein foods (low-fat)’, and 1 ‘animal protein foods (high-fat)’. The fat food group consists of 2 ‘oils and nuts’ and 1 ‘solid fats’. The total number of calories is estimated at 1,840 kcal and the energy ratio is 62% carbohydrate, 18% protein, 20% fat, 6.8% saturated fat and 13.2% sugars. Using the LOHAS food exchange table, it is possible to estimate values of saturated fat, unsaturated fat, dietary fiber, and sugars besides carbohydrate, protein and fat. It is also possible to compose a dietary design considering carbohydrate, sugars, saturated fat and dietary fiber. The LOHAS food pattern provides benefits for the management of both institutional food services and individual meals, as it can help reduce the levels of saturated fat and sugar intake and help develop healthy meals rich in unsaturated fats and dietary fiber. CONCLUSIONS: The LOHAS food exchange table and LOHAS food pattern are expected to be practical tools for designing and evaluating nutritionally balanced diets.
Adult ; Carbohydrates ; Chronic Disease ; Classification ; Diet ; Dietary Fats ; Dietary Fiber ; Fats, Unsaturated ; Food Services ; Health Promotion ; Humans ; Meals ; Menu Planning ; Recommended Dietary Allowances

Seafood is one of the common causes of food allergies to adults. The sea hare Aplysia kurodai is a marine mollusk which belongs to invertebrate gastropod that has been consumed as a food in Korea. Cases of acute toxic hepatitis after ingestion of sea hares have been reported, but few cases of allergic reactions to sea hare have been reported in the literature. A 33-year-old man was referred to our Emergency Department due to urticaria and periorbital/perioral swelling after eating sea hares. Approximately 10 years ago, he experienced similar allergic reactions to it. Skin prick and intradermal tests showed strong positive responses to crude sea hare allergen extract. He was diagnosed with food allergy to sea hares. We herein report the first case of sea hare allergy after ingestion.
Adult ; Angioedema* ; Aplysia ; Drug-Induced Liver Injury ; Eating* ; Emergency Service, Hospital ; Food Hypersensitivity ; Gastropoda ; Hares* ; Humans ; Hypersensitivity ; Intradermal Tests ; Invertebrates ; Korea ; Mollusca ; Seafood ; Skin ; Urticaria*

: Anaphylaxis is a predominantly childhood disease. Most of the literature on anaphylaxis has emerged from Western countries. This study aimed to describe the incidence, triggers and clinical presentation of anaphylaxis among children in Singapore, look for predictors for anaphylaxis with severe outcomes, and study the incidence of biphasic reactions.: We retrospectively reviewed records of children presenting with anaphylaxis to our paediatric emergency department from 1 January 2007 to 31 December 2014.: We identified 485 cases of anaphylaxis in 445 patients. Cutaneous symptoms (urticarial/angio-oedema) were the most common across all age groups (481 cases, 99%), followed by respiratory (412, 85%), gastrointestinal (118, 24%) and cardiovascular (35, 7.2%) symptoms. Central nervous system symptoms (drowsiness/ irritability) were rare across all age groups (11, 2.2%). Food was identified as the most common trigger across all age groups (45% to 63%). Seafood was the most common food trigger (57, 25%). A total of 420 (86.6%) children were treated with adrenaline, 451 (93%) received steroids and 411 (85%) received antihistamines. Sixty-three (13%) children fulfilled the criteria of severe anaphylaxis. There was no statistically significant association between severe anaphylaxis and the type of trigger (= 0.851), nor an overall past history of atopy (= 0.428). The only independent predictor for severe anaphylaxis was a previous drug allergy (= 0.016). A very low prevalence of biphasic reactions (0.6% of study population) was noted in our study.: We described the presentation and management of anaphylaxis in the Singapore population. A history of drug allergy is associated with severe presentation. Biphasic reactions are rare in our population.
Adolescent ; Adrenal Cortex Hormones ; therapeutic use ; Anaphylaxis ; drug therapy ; epidemiology ; etiology ; physiopathology ; Angioedema ; epidemiology ; etiology ; physiopathology ; Child ; Child, Preschool ; Drug Hypersensitivity ; epidemiology ; Emergency Service, Hospital ; Epinephrine ; therapeutic use ; Female ; Food Hypersensitivity ; complications ; epidemiology ; Gastrointestinal Diseases ; epidemiology ; etiology ; physiopathology ; Histamine Antagonists ; therapeutic use ; Humans ; Hypotension ; etiology ; physiopathology ; Incidence ; Infant ; Male ; Pediatrics ; Prevalence ; Respiratory Tract Diseases ; epidemiology ; etiology ; physiopathology ; Retrospective Studies ; Risk Factors ; Seafood ; Severity of Illness Index ; Singapore ; epidemiology ; Sympathomimetics ; therapeutic use ; Tertiary Care Centers ; Urticaria ; epidemiology ; etiology ; physiopathology

Abalone is popular seafood in Asia; however, allergy to abalone was rarely reported. We report a case of anaphylaxis after consumption of abalone. A 24-year-old female visited an Emergency Department, complaining of cough, dyspnea, rhinorrhea, generalized urticaria, facial edema, and wheezing that had developed 1 hour after consumption of abalone. She was discharged when her symptoms subsided after antihistamine and dexamethasone were given. One month later, she was referred to our outpatient clinic. We performed skin prick tests, measurement of serum specific IgE antibody level, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with IgE immunoblotting. Both skin prick and specific IgE antibody tests were positive for abalone crude extract. In SDS-PAGE with IgE immunoblotting, we identified possible antigens sized 55, 100, and 25 kDa, respectively. This is the first case of abalone-induced anaphylaxis in Korea.
Ambulatory Care Facilities ; Anaphylaxis* ; Asia ; Cough ; Dexamethasone ; Dyspnea ; Edema ; Electrophoresis ; Electrophoresis, Polyacrylamide Gel ; Emergency Service, Hospital ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Immunoblotting ; Immunoglobulin E ; Korea ; Respiratory Sounds ; Seafood ; Shellfish ; Skin ; Sodium ; Urticaria ; Young Adult

OBJECTIVE: Acute carbon monoxide poisoning has important clinical value because it can cause severe adverse cardiovascular effects and sudden death. Acute carbon monoxide poisoning due to charcoal is well reported worldwide, and increased use of charcoal in the restaurant industry raises concern for an increase in occupational health problems. We present a case of carbon monoxide poisoning induced cardiomyopathy in a 47-year-old restaurant worker. MATERIALS AND METHODS: A male patient was brought to the emergency department to syncope and complained of left chest pain. Cardiac angiography and electrocardiography were performed to rule out acute ischemic heart disease, and cardiac markers were checked. After relief of the symptoms and stabilization of the cardiac markers, the patient was discharged without any complications. RESULTS: Electrocardiography was normal, but cardiac angiography showed up to a 40% midsegmental stenosis of the right coronary artery with thrombotic plaque. The level of cardiac markers was elevated at least 5 to 10 times higher than the normal value, and the carboxyhemoglobin concentration was 35% measured at one hour after syncope. Following the diagnosis of acute carbon monoxide poisoning induced cardiomyopathy, the patient's medical history and work exposure history were examined. He was found to have been exposed to burning charcoal constantly during his work hours. CONCLUSIONS: Severe exposure to carbon monoxide was evident in the patient because of high carboxyhemoglobin concentration and highly elevated cardiac enzymes. We concluded that this exposure led to subsequent cardiac injury. He was diagnosed with acute carbon monoxide poisoning-induced cardiomyopathy due to an unsafe working environment. According to the results, the risk of exposure to noxious chemicals such as carbon monoxide by workers in the food service industry is potentially high, and workers in this sector should be educated and monitored by the occupational health service to prevent adverse effects.
Angiography ; Burns ; Carbon Monoxide Poisoning ; Carbon Monoxide* ; Carbon* ; Carboxyhemoglobin ; Cardiomyopathies* ; Charcoal* ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Death, Sudden ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Food Services ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; Occupational Health ; Occupational Health Services ; Reference Values ; Restaurants* ; Syncope

Eosinophilic gastroenteritis (EG) is a rare disease characterized by massive eosinophilic infiltration of gastrointestinal tissue, peripheral eosinophilia, and nonspecific gastrointestinal symptoms. The mucosal type of EG commonly presented with malabsorption and anemia. However, the role of food allergy as a stimulus to EG has not yet been clearly defined. A 27-year-old man was referred to the Emergency Department with dyspepsia and leg swelling. The initial laboratory test should as follows: hemoglobin level, 6.4 g/dL; white blood cell count, 7,400/microL with 24.4% of eosinophil fraction; serum total protein, 3.9 g/dL; albumin level, 2.8 g/dL. Gastric endoscopy ruled out gastrointestinal bleeding showed multiple nodular raised lesions on the gastric antrum, which revealed increased eosinophilic infiltration (above 100/high power field). He had experienced nausea whenever eating beef, porks or fish. High serum specific IgE levels to offending foods (beef, 0.82 kU/L; pork, 0.83 kU/L; egg white, 0.40 kU/L; egg yolk, 0.54 kU/L; milk, 0.81 kU/L) were noted. He was instructed strictly to avoid food allergens with oral prednisolone therapy. Approximately 6 months after offending food restriction, the eosinophil count fell down to 400/microL, the hemoglobin level was returned to 11.5 g/dL and the serum albumin level was increased to 4.1 g/dL. We report a case of EG caused by multiple food allergy which leads to malabsorption and iron-deficiency anemia.
Adult ; Allergens ; Anemia* ; Anemia, Iron-Deficiency ; Dyspepsia ; Eating ; Egg White ; Egg Yolk ; Emergency Service, Hospital ; Endoscopy ; Eosinophilia ; Eosinophils* ; Food Hypersensitivity* ; Gastroenteritis* ; Hemorrhage ; Humans ; Immunoglobulin E ; Leg ; Leukocyte Count ; Malabsorption Syndromes ; Milk ; Nausea ; Prednisolone ; Pyloric Antrum ; Rare Diseases ; Serum Albumin

Young radish (Raphanus sativus L), a member of the mustard family (Cruciferae), is a common ingredient of Kimchi. Although few reports have described anaphylaxis to cruciferous vegetables, we report the case of anaphylaxis induced by contact with young radish. A 46-year-old female with a history of contact allergy to metal presented to our emergency room (ER) with dizziness, generalized eruption and gastrointestinal upset. Her symptoms developed after re-exposure to young radish while chopping it. Hypotensive blood pressures were noted. Three days prior, the patient had experienced generalized urticaria with pruritus immediately after chopping the fresh young radish, which resolved spontaneously. In the ER, her symptoms improved by the administration of epinephrine (0.3 mL), antihistamine (chlorpheniramine) and isotonic saline hydration. A skin prick test with young radish extract showed positive reactivity. The same skin test was negative in five adult controls. IgE-mediated hypersensitivity could be an important immunologic mechanism in the development of young radish-induced anaphylaxis.
Adult ; Anaphylaxis* ; Dizziness ; Emergency Service, Hospital ; Epinephrine ; Female ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Middle Aged ; Mustard Plant ; Pruritus ; Raphanus* ; Skin ; Skin Tests ; Urticaria ; Vegetables