Evaluating the management of anaphylaxis in US emergency departments:Guidelines vs.practice

BACKGROUND:Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting.Current guidelines recommend:1) quick diagnosis using standard criteria;2) first-line treatment with epinephrine;and 3) discharge with a prescription for an epinephrine auto-injector,written instructions regarding long-term management,and a referral(preferably,allergy) for follow-up.However,studies suggest low concordance with guideline recommendations by emergency medicine(EM) providers.The study aimed to evaluate how emergency departments(EDs) in the United States(US) manage anaphylaxis in relation to guideline recommendations.METHODS:This was an online anonymous survey of a random sample of EM health providers in US EDs.RESULTS:Data analysis included 207 EM providers.For respondent EDs,approximately 9%reported using agreed-upon clinical criteria to diagnose anaphylaxis;42%reported administering epinephrine in the ED for most anaphylaxis episodes;and <50%provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge.Most provided some written materials,and follow-up with a primary care clinician was recommended.CONCLUSIONS:This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis,treatment,and follow-up of patients with anaphylaxis.The primary gaps are low(or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine.Prospective research is recommended.

Deposition of nanoparticles on school eyeglasses in urban and rural areas:A methodology for a more real assessment of the possible impacts

Because incomplete confirmation is available concerning the influential role of atmosphere contamination on conjunctivitis,myopia,asthma,and allergic rhinitis in Brazil,the focus of the present work is to explore the possible relations among atmosphere contamination and eye problems.Rather that a case study on eye diseases,by way of questionnaires supplemented by the investigation of nanoparticles(NPs)on eyeglasses,the study examines the mechanisms in which NPs and ultra-fine particles are deposited on the glasses of children up to 10 years of age in urban and rural area.The important connection between atmosphere contaminants and individual protection equipment justifies improving indoor school properties in order could protect children’s eyes,particularly in high-pollution/high-particulate areas.

BACTERIAL SWOLLEN STEM CANKER ON POPLAR:THE DISEASE AND ITS CAUSES

The bacterial swollen stem canker of poplar is prevalent in planted poplars of northeast China. Serious damage occurs in the form of necrosis, putridity, cankers, swollen stems and discolored wood of trunks and branches of young and mature trees. Tests of allergic reaction, pathogenicity, culture characteristic, Gram stain and anaerobic culture revealed that the pathogen is Erwinia sp. Its occurrence depends mainly on the predisposing factors of the disease among which the susceptibility of poplars is the most important one. The disease becomes widespread in association with low-lying and high-humidity terrain, frost injury, node wounds, insect damage, and pruning and other mechanical wounds. Harmful factors promote the disease.

Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections

Objective:To evaluate whether skin tests are suitable to predict the allergy reactions induced by Chinese herbal injections(CHIs).Methods:The skin tests including skin prick tests(SPT),intradermal tests(IDT)and provocation tests including subcutaneous tests and intravenous tests were administered to 249 healthy subjects and 180 allergic patients for 3 CHIs,including ginkgolide injection,diterpene ginkgolide meglumine injection and Salvianolate lyophilized injection.The results of the provocation tests were used as the"gold standard"to determine the sensitivity and specificity of the skin tests.Results:The results did not show any significant differences between the healthy and allergy groups in both skin tests and provocation tests(P>0.05).The specificities of SPT and IDT were 0.976 and 0.797,respectively,and the sensitivities of both SPT and IDT were 0.Conclusion:Skin tests are insufficient to predict the likelihood of allergic reactions resulting from CHIs.(ChiCTR-CPC-15006921)

Compound-honeysuckle-induced drug eruption with special manifestations:A case report

BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not been reported.CASE SUMMARY A 20-year-old man was admitted to our department of dermatology due to erythema and papules on the chest and abdomen with pruritus for 3 d.The next day after taking compound honeysuckle granules,the patient suddenly developed a rash and intense itching on his chest and abdomen.Physical examination revealed diffuse red needle-cap size macules and papules with welldefined borders on the chest and abdomen,and discoloration after finger pressure.No abnormality was observed in other areas of the skin.Back skin scratch was positive.White blood cells,eosinophil count and eosinophil ratio were higher than normal.Histopathological examination of the skin lesions on the left abdomen revealed intercellular edema,blurred focal basal cell layers,and focal lymphocyte infiltration in the superficial dermis and perivascular areas.Immunohistochemistry showed CD3+,CD4+and CD8+T lymphocytes.The diagnosis was drug eruption with special manifestations induced by compound honeysuckle.The skin lesions completely subsided without pruritus after 2 wk of antihistamine and hormone therapy.Follow-up for>1 mo showed no recurrence.CONCLUSION Chinese patent medicine compound honeysuckle granules can induce allergic reaction and rare skin damage.

Acute myocardial infarction due to Kounis syndrome:A case report

BACKGROUND Acute myocardial infarction(AMI)can be induced by several factors.However,AMI induced by Kounis syndrome(an allergic reaction)is extremely rare and is highly susceptible to misdiagnosis.CASE SUMMARY A 70-year-old man presented after suffering an allergic reaction that caused chest pain triggered upon eating ice cream.Troponin I was found to be elevated,and an electrocardiogram showed ST-segment elevation.The diagnosis was AMI.He underwent two coronary angiographies,with one intravascular ultrasound during hospitalization showing no evidence of atherosclerotic coronary artery disease.The final diagnosis was vasospastic myocardial infarction due to Kounis syndrome.The patient was then treated with hydrocortisone and intravenous antihistamines,and his chest pain symptoms resolved.CONCLUSION Allergic reactions(such as Kounis syndrome)can cause serious damage to the heart.Physicians should be alert to the consequences and avoid misdiagnosis.

Nail Cosmetics Can Cause Infection,Allergic Reaction

在美国田纳西州首府纳什维尔召开的美国皮肤病学会年会上,有一篇论文指出:修指甲或给指甲化妆是引起感染和过敏反应的两大因素。其最严重的后果可能是:the entire nail can be lost.本文出现的salons,不能理解为“沙龙”。它是beauty salon(美容院)的简称。

Studies on Treating Eczema by Chinese Herbal Medicine with Anti-Type Ⅳ Allergic Activity

Objective: To study Chinese herbal prescription for treatment of eczema on the basis of the suppressive effect of Chinese herbal medicine with type Ⅳ allergic reaction. Methods: Various formulae composed of Chinese herbal medicines possessing suppressive effect on murine allergic contact dermatitis were formed following the therapeutic principles of traditional Chinese medicine in treating eczema, and their effect on ear swelling, ear flake weight, dermal inflammatory infiltration cell count and plasma level of calcitonin gene related peptide ( CGRP) were examined in mice with dinitrofluorobenzene induced dermatitis. The prescription, Composite Poria Decoction was formulated and made into granule form, which was used to treat 63 cases of eczema (atopic dermatitis was excluded), and compared with 59 cases treated with antihistaminic that was aimed at the type I allergic reaction. Results: Experimental study showed that all the 4 Chinese prescriptions had the effect of anti type Ⅳ allergic reaction, among them, the formula for cooling blood and removing Heat, Wind and Dampness evil possessed the most potent effect in suppressing murine dermatitis, and it was also able to up regulate the plasma CGRP concentration. The clinical cure rate of Composite Poria Granule treatment was 47.6%, and that of the control was 22.0%. The difference was significant between the two groups ( u =2.9555, P <0.01). Conclusions: Chinese herbal medicine has the effect of anti type Ⅳ allergic reaction. Composite Poria Granule has good effect in treating eczema.