Camrelizumab-induced anaphylactic shock in an esophageal squamous cell carcinoma patient:A case report and review of literature

BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually increasing.Anaphylactic shock due to camrelizumab has not been reported previously,until now.We report here,for the first time,a case of anaphylactic shock associated with camrelizumab in a patient with esophageal squamous cell carcinoma.CASE SUMMARY An 84-year-old male esophageal cancer patient received radiotherapy and chemotherapy 11 years ago.He was diagnosed with advanced esophageal squamous cell carcinoma with liver metastasis(Tx N1 M1)and received the first immunotherapy(camrelizumab 200 mg/each time,once every 3 wk)dose in December 2020,with no adverse reactions.Three weeks later,a generalized rash was noted on the chest and upper limbs;palpitations and breathing difficulties with a sense of dying occurred 10 min after the patient had been administered with the second camrelizumab therapy.Electrocardiograph monitoring revealed a 70 beats/min pulse rate,69/24 mm Hg(1 mm Hg=0.133 k Pa)blood pressure,28 breaths/min respiratory rate,and 86%pulse oximetry in room air.The patient was diagnosed with anaphylactic shock and was managed with intravenous fluid,adrenaline,dexamethasone sodium phosphate,calcium glucosate,and noradrenaline.Approximately 2 h after treatment,the patient’s anaphylactic shock symptoms had been completely relieved.CONCLUSION Due to the widespread use of camrelizumab,attention should be paid to anti-programmed cell death 1 antibody therapy-associated hypersensitivity or anaphylactic shock.

Atezolizumab-induced anaphylactic shock in a patient with hepatocellular carcinoma undergoing immunotherapy:A case report

BACKGROUND Atezolizumab is a programmed death ligand 1(PD-L1)inhibitor,and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma(HCC).Treatment with immune checkpoint inhibitors(ICIs)can lead to hypersensitivity reactions;however,anaphylactic shock is rare.We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review.CASE SUMMARY A 75-year-old man was diagnosed with HCC recurrence after hepatectomy.He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1(PD-1)inhibitor.The patient showed a sudden onset of dizziness,numbness,and lack of consciousness with severe hypotension during atezolizumab infusion.The treatment was stopped immediately.The patient’s symptoms resolved after 5 mg dexamethasone was administered.Because of repeated hypersensitivity reactions to ICIs,treatment was changed to oral targeted regorafenib therapy.CONCLUSION Further research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.

Anaphylactic cardiovascular collapse during hemodialysis: Kounis syndrome in the dialysis room

Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forc-es and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as myocardial infarction with cardiovascular collapse that occurred in the dialysis room following an allergic reac-tion. The dialysis apparatus material of polyurethane, polyamide, polycarbonate, silicon rubber and polypro-pylene were incriminated causes. Physicians should be aware of the causality and existence of this disorder in order to achieve early and correct diagnosis and apply the appropriate therapeutic measures.

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.

35例胺碘酮注射液致过敏性休克病例报告分析

目的:探讨胺碘酮注射液致过敏性休克的用药特点及影响因素,确保安全用药。方法:检索中英文数据库中收录的胺碘酮注射液致过敏性休克的病例报告并进行统计分析。结果:共检索到28篇病例报告,共涉及35例患者。其中,女性患者多于男性;60岁及以上患者18例;29例(82.86%)患者的过敏性休克发生在用药后5min或用药量5ml以内;主要累及系统/器官为呼吸系统疾病、皮肤及皮肤附件疾病、心血管疾病、全身整体疾病等;临床表现以血压骤降、胸闷/气短为主。结论:医护人员应加强患者用药初期用药监护,预防或减少致死性事件的发生。

左氧氟沙星治疗口腔颌面部间隙感染致过敏性休克1例

口腔颌面部间隙感染(OMSI)多为混合感染,常需要抗需氧菌和抗厌氧菌药物联合治疗。左氧氟沙星等第三代喹诺酮类抗菌药物因肌腱断裂等严重不良反应限制了在OMSI中使用。该研究利用药品不良反应关联性评价方法和文献研究法,针对1例临床药师参与的OMSI患者使用左氧氟沙星后发生过敏性休克的病例进行分析,给出了合理用药和不良反应处理建议,为临床快速辨析不良反应及可疑药物、确定应对方案提供借鉴,完善OMSI用药选择,及时救治了休克,有效地治愈了OMSI。

1例艾司氯胺酮致围产期过敏性休克的病例分析

目的为临床工作者及时识别和治疗围产期过敏性休克提供参考。方法临床药师参与四川省妇幼保健院产科1例足月妊娠患者剖宫产麻醉中使用艾司氯胺酮致过敏性休克的救治过程,通过查阅药品说明书并检索相关文献,协助医师对过敏性休克与羊水栓塞进行区分鉴别,对所用药物与不良反应的关联性进行分析,并进行用药教育。结果该患者麻醉后出现低氧血症和低血压,且不存在凝血功能障碍,经肾上腺素对症处理后快速好转,故诊断为过敏性休克。根据该患者用药情况、不良反应发生特点,结合国家药品不良反应监测中心药物与不良反应关联性判定标准和Naranjo’s评估量表,综合判定引起过敏性休克的可疑致敏药物为艾司氯胺酮;临床药师告知患者后期就诊时务必告知医师此次严重过敏反应的相关药物。患者于剖宫产术后第6天痊愈出院。结论过敏性休克与羊水栓塞的临床表现相似,临床需要仔细鉴别。若患者发生了药物导致的全身过敏反应,临床应及时停用可疑药物,并立即采取有效的对症治疗措施,延缓或终止疾病进展,以保障患者的生命安全。

1例苯磺顺阿曲库铵致过敏性休克病例报道与分析

目的探讨某口腔专科医院1例疑似苯磺顺阿曲库铵致过敏性休克患者的治疗过程与流程规范性。方法回顾性分析该例患者的治疗经过,依据《药品不良反应报告与监测管理办法》中的药品不良反应(ADR)关联性评价标准,对过敏性休克与苯磺顺阿曲库铵的关联性进行评价,并总结过敏性休克抢救的规范性措施。结果经关联性评价,考虑为苯磺顺阿曲库铵所致过敏性休克。发生过敏性休克后,立刻予吸氧、补液、予以肾上腺素和氢化可的松等抢救措施进行治疗,患者的血压逐渐恢复正常,当日继续手术,且手术顺利,术后3 d出院,随访期间无不适。结论医护人员应高度重视围术期麻醉用药,避免发生过敏性休克。可通过完善肌肉松弛药与抢救药物的用药选择,加强围术期患者各项生命体征的监护,做好过敏反应的识别、判断、积极救治准备等措施,保障患者用药安全。

帕米膦酸二钠葡萄糖注射液致过敏性休克1例分析

目的探讨帕米膦酸二钠致过敏性休克的发生特点,为临床防治不良反应和安全用药提供参考。方法分析1例帕米膦酸二钠导致过敏性休克的病例,根据国家药品不良反应监测中心评价方法进行关联性评价,文献回顾帕米膦酸二钠常见不良反应和致过敏性休克的发病机制,讨论原因及防治措施。结果根据患者的临床表现及药物与用药时间的关联性,考虑帕米膦酸二钠导致过敏性休克可能性大,患者经积极救治后,过敏性休克症状得到缓解。结论临床应用帕米膦酸二钠应警惕发生过敏性休克的风险,用药期间加强不良反应监测,促进临床安全合理用药。

Identification and characterization of the causative triatomine bugs of anaphylactic shock in Zhanjiang,China

Background:Two health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces,and allergic reactions induced by triatomine bites.In the Southwestern United States,reduviid bugs bites commonly cause insect allergy.In South China,four cases of anaphylactic shock have been reported after this bite exposure.To further classify the species of these bugs and confirm the sensitization of the triatomine saliva,we caught triatomine bugs from the region where the bites occurred and performed phylogenetic and immunohistochemical(IHC)analysis.Methods:Triatomine bugs were collected in Donghai Island of Zhanjiang City in South China.The genomic DNA was extracted from three legs of the bugs.The fragments of mitochondrial 16S rRNA,cytochrome c oxidase subunit I(COI)gene and nuclear ribosomal 18S and 28S rRNA genes were obtained by PCR and sequenced.A phylogenetic tree was constructed based on the sequence of 16S rRNA gene using a maximum likelihood method with MEGA 7.0 software.Trypanosomal specific fragments and vertebrate COI genes were amplified from the fecal DNA to detect the infection of trypanosomes and analyze the blood feeding patterns,respectively.Paraffin-embedded sections were then prepared from adult triatomines and sent for IHC staining.Results:We collected two adult triatomine bugs in Donghai Island.Morphological and molecular analyses indicated that the triatomines were Triatoma rubrofasciata.No fragments of T.cruzi or other trypanosomes were detected from the fecal DNA.Mitochondrial gene segments of Homo sapiens and Mus musculus were successfully amplified.The allergens which induced specific IgE antibodies in human serum were localized in the triatomine saliva by IHC assay.Conclusions:The two triatomine bugs from Donghai Island were T.rubrofasciata.They had bitten humans and mice.Their saliva should contain the allergens related to the allergic symptoms and even anaphylactic shock of exposed residents.Great consideration should be given to this triatomine bugs due to their considerable distribution and potential threat to public health in South China.

多烯磷脂酰胆碱注射液致过敏性休克一例分析

目的分析1例使用多烯磷脂酰胆碱注射液出现过敏性休克的病例特点及治疗过程,为临床合理用药提供参考。方法报道1例91岁胆囊结石伴急性胆囊炎患者,分析其用药后致过敏性休克原因。结果患者输注完多烯磷脂酰胆碱注射液出现过敏性休克症状,考虑为多烯磷脂酰胆碱注射液导致的不良反应,经治疗后,症状好转。结论多烯磷脂酰胆碱注射液有致过敏性休克的风险,在用药过程中及用药后1h内应密切监测病情变化,一旦出现过敏现象,要考虑药物的可能性,及时停止用药。

儿童胆碱能性荨麻疹并发过敏性休克一例

报告1例胆碱能性荨麻疹并发过敏性休克患儿,女,13岁,诱发因素为剧烈运动.予肾上腺素、地塞米松抗炎抗过敏及生理盐水扩容等处理后病情缓解.

Study on the anaphylactic shock induced by hemocoagulase for injection based on logistic analysis

In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the adverse reactions induced by hemocoagulase for injection were collected in Chinese and foreign literatures. The clinical characteristics and influencing factors of anaphylactic shock induced by hemocoagulase for injection were evaluated by logistic regression analysis. In this study, 87 articles including 108 cases(68 cases of anaphylactic shock) were collected. Univariate logistic regression indicated that allergic constitution, daily dose, combined anesthesia, first drug delivery, post-dose time and course of treatment were positively associated with the incidence of anaphylactic shock caused by hemocoagulase for injection(P<0.05). The six above-mentioned factors were included in the multivariate logistic stepwise regression analysis to exclude the effects of confounding factors, and the results suggested that allergic constitution(P = 0.048, OR = 8.242), combined anesthesia(P = 0.024, OR = 22.675) and post-dose time(P = 0.006, OR = 20.255) were associated with the incidence of anaphylactic shock caused by hemocoagulase for injection. The clinicians should pay much more attention to risk factors that may cause anaphylactic shock, such as allergic constitution, combined anesthesia and post-dose time. The clinical pharmacists should strengthen pharmaceutical monitoring and improve the safety of medication.

1例利妥昔单抗致肾病综合征儿童过敏性休克的病例分析

目的:探讨利妥昔单抗(RTX)致儿童过敏性休克的高危因素及预防措施,为儿童安全使用RTX提供参考。方法:回顾性分析1例RTX致儿童过敏性休克的病例,通过查阅文献,对过敏性休克可能的发生机制、高危因素及预防措施进行分析。结果:RTX的初始使用年龄、输注速率是发生不良事件的危险因素,在使用RTX前应预先给予激素、解热镇痛药或抗组胺药等预防输液反应,使用中应注意滴注速度,使用后对患者进行密切监护,尤其是使用后的30~120min。结论:RTX是一种人鼠嵌合型单克隆抗体,不良事件发生率高,使用时临床药师要对其进行全程药学监护。

碘佛醇致儿童过敏性休克早期1例及防治措施探讨

目的:探讨碘佛醇致儿童过敏性休克早期的风险因素及防治措施,为国内儿童患者应用碘佛醇致过敏性休克提供相关警示和参考。方法:分析1例儿童患者应用碘佛醇发生过敏性休克早期的临床资料,并结合相关文献探讨防治措施。结果:医师发现患儿出现过敏性休克早期后,第一时间给予抗过敏、抗休克、升血压等对症治疗措施,患儿生命体征恢复平稳,避免了重大伤害的发生。结论:碘佛醇引起的不良反应发生率较低,但可能产生较严重后果。医务人员须重视并熟悉碘佛醇相关不良反应的预防和处理措施及选择合适的药物治疗。

口腔专科医院围手术期使用头孢西丁钠致过敏性休克1例

为临床安全使用注射用头孢西丁钠,本研究对本院口腔颌面外科1例双颌正颌患者围手术期使用注射用头孢西丁钠导致过敏性休克的发生与治疗过程进行介绍,为头孢西丁钠的临床合理用药和急症处理提供参考。本例患者发生过敏性休克后及时停药,采取吸氧、应用血管活性药物、糖皮质激素、补充血容量等一系列措施,最终抢救成功。该患者过敏性休克与注射用头孢西丁钠的关联性评价为“很可能”,使用头孢西丁钠前应当详细询问患者用药史及药物过敏史,临床药师对发生不良反应的患者要进行用药教育,避免患者今后再次重复使用该类药物。同时,加强口腔医生急救知识的培训和演练非常必要。

79例替雷利珠单抗相关不良反应分析

目的分析替雷利珠单抗相关药品不良反应(ADR)的发生规律及临床表现特点,为临床安全合理使用提供参考。方法回顾性分析本院上报的79例替雷利珠单抗相关ADR报告(2020年1月1日至2024年3月31日),对患者基本情况、药物使用情况、ADR发生时间、累及系统-器官、临床表现、严重程度、处置与转归、关联性评价等信息进行统计分析。结果79例替雷利珠单抗相关ADR报告中,88.61%的ADR发生在替雷利珠单抗治疗1~5个周期后,累及多个系统-器官,主要表现为骨髓抑制、皮肤毒性、甲状腺功能异常、肝功能异常、肌炎、肺炎等,其中重症肌无力样综合征和过敏性休克为说明书未载明的严重ADR。经停药和对症治疗后大部分ADR逐渐好转。结论替雷利珠单抗少数严重ADR可危及生命,临床应合理使用,加强用药监护,及时对症处理,减少严重ADR的发生。

豚鼠过敏性休克类胰蛋白酶活力测定

目的探索过敏性休克法医学客观诊断标准。方法建立豚鼠异种血清过敏性休克模型,采用专性底物对模型鼠的血清,肺,气管类胰蛋白酶活力进行测定。结果过敏性休克豚鼠血清,肺,气管类胰蛋白酶活力均增加,且三者增加的程度是平行的。结论过敏性休克时,血清,肺,气管类胰蛋白酶活力增加可作为法医检案客观诊断标准。

感染细粒棘球蚴绵羊诱发过敏性休克期间IgG、IgG1和IgE水平的探讨

目的 测定感染细粒棘球蚴 (E.g)绵羊诱发过敏性休克期间特异性 Ig G、Ig G1和 Ig E抗体水平。了解抗原B对人工感染 E.g绵羊 Ig G抗体的反应性。 方法 从绵羊 E.g囊液中制备抗原 B和 E.g囊液粗制抗原 ,EL ISA测定感染 E.g绵羊诱发休克期间特异性 Ig G、Ig G1和 Ig E抗体的动态变化。 结果 感染 E.g绵羊 6个月 ,特异性 Ig G、Ig G1和 Ig E抗体水平较正常绵羊显著升高 ;诱发休克后特异性 Ig E抗体水平显著下降 ,尤其因休克致死的绵羊下降更为明显 ;Ig G及 Ig G1抗体的衰减时间不同 ,趋势各不相同 ;抗原 B和 E.g囊液粗制抗原与血清 Ig G抗体反应阳性率分别为 91%、32 %。 结论 特异性 Ig E是导致棘球蚴病所致过敏性休克的主要抗体 ,而 Ig G和 Ig G1抗体也起着重要作用。抗原 B与感染 E.g绵羊 Ig G抗体的血清反应性较好 ,可作为一种血清免疫学诊断方法监测绵羊感染 E.g的状况。

过敏性休克急死豚鼠血清和肺组织内IgE的变化及法医学意义

目的研究过敏性休克急死豚鼠死后在4℃冷藏条件下血清IgE含量和肺组织内IgE的免疫表达随死后不同时间的变化,探讨过敏性休克急死的法医学鉴定的客观诊断指标。方法采用多人混合血清注射建立过敏性休克急死的动物模型。豚鼠40只,随机分为对照组和实验组,实验组又分为死后0、12、24和48h组,每组8只。采用酶联免疫吸附试验测定豚鼠血清IgE含量,采用免疫组化ABC法对豚鼠肺组织IgE进行免疫组化染色。结果实验组与对照组豚鼠血清IgE含量相比较有显著性差异(P<0.001);死后0、12、24和48组血清IgE含量相比较无显著性差异(P>0.05)。实验组豚鼠肺组织IgE有阳性表达,对照组豚鼠无IgE表达。结论过敏性休克急死豚鼠血清IgE含量显著升高;在4℃下冷藏,死后48h内血清IgE含量和肺组织中IgE无明显变化。本结果可为过敏性休克急死的法医学鉴定提供客观的诊断依据。