European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a Real-Life Clinical Assessment.

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European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a Real-Life Clinical Assessment.

Allergy. 2016 Oct 8;:

Authors: Calderón MA, Vidal C, Rodríguez Del Río P, Just J, Pfaar O, Tabar AI, Sánchez-Machín I, Bubel P, Borja J, Eberle P, Reiber R, Bouvier M, Lepelliez A, Klimek L, Demoly P, EASSI Doctors’ Group

Abstract
BACKGROUND: Outside clinical trials, data on systemic reactions (SRs) due to allergen immunotherapy (AIT) are scarce.
METHODS: A prospective, longitudinal, web-based survey of “real-life” respiratory allergen immunotherapy (AIT) clinical practice was conducted in France, Germany and Spain. SRs were recorded and coded according to the Medical Dictionary for Regulatory Activities (MedDRA) and risk factors associated with SRs were identified.
RESULTS: A total of 4,316 patients (corresponding to 4,363 ongoing courses of AIT) were included. 109 SRs were recorded, and 90 patients (2.1%) presented at least one SR. Most of the SRs occurred in subcutaneous allergen immunotherapy (SCIT) (89%, n=97). The most frequently reported symptoms were urticaria, rhinitis, dyspnoea and cough. Respiratory symptoms appeared before skin symptoms. Most SRs occurred during the up-dosing phase (75.8%) and were mild in severity (71.6%). Intramuscular adrenaline was administered in 17 SRs but only 65% of these were subsequently classified as anaphylaxis. Independent risk factors for SRs during SCIT were: the use of natural extracts (odds ratio (OR) [95% confidence interval (CI)]=2.74 [1.61-4.87]; p=0.001), the absence of symptomatic allergy medications (1.707 [1.008-2.892], p=0.047), asthma diagnosis (1.74 [1.05-2.88], p=0.03), sensitization to animal dander (1.93 [1.21-3.09]; p=0.006) or pollen (1.16 [1.03-1.30]; p=0.012), and cluster regimens (vs. rush) (4.18 [1.21-14.37]; p=0.023). A previous episode of anaphylaxis increased the risk for anaphylaxis in SCIT (OR [95%CI]=17.35 [1.91-157.28]; p=0.01).
CONCLUSION: AIT for respiratory allergy is safe, with a low number of SRs observed in real-life clinical practice. A personalized analysis of risk factors could be used to minimize SRs. This article is protected by copyright. All rights reserved.

PMID: 27718250 [PubMed – as supplied by publisher]

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Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions.

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Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions.

Am J Health Syst Pharm. 2015 Feb 1;72(3):198-202

Authors: Jones JM, Richter LM, Alonto A, Leedahl DD

Abstract
PURPOSE: The case of a patient with multiple medication hypersensitivity reactions and a methicillin-resistant Staphylococcus aureus (MRSA) infection who underwent desensitization to ceftaroline is reported.
SUMMARY: A 32-year-old Caucasian woman with asthma, gastroesophageal reflux disease, heart murmur, and major depression was admitted for MRSA cellulitis with a subcutaneous abscess along the left sternomanubrial joint and clavicular osteomyelitis secondary to port placement after gastric bypass surgery. The patient had an extensive history of hypersensitivity reactions. Pertinent documented allergies were as follows: penicillin (anaphylaxis), daptomycin (anaphylaxis), vancomycin (hives), linezolid (hives), ertapenem (rash), ciprofloxacin (rash), and tigecycline (rash). The patient also reported previous reactions to aztreonam (unknown) and gentamicin (hives). The pharmacy was consulted to develop a desensitization protocol for ceftaroline. The desensitization protocol used three serial dilutions of ceftaroline to make 14 sequential infusions with escalating doses. Intramuscular epinephrine, i.v. diphenhydramine, and i.v. methylprednisolone were ordered as needed for the development of immediate hypersensitivity reactions during or after administration of ceftaroline. The cumulative dose (574.94 mg) was administered intravenously over 225 minutes with no breakthrough symptoms reported during or after the desensitization protocol. Ceftaroline fosamil 600 mg i.v. every 12 hours was continued for six weeks.
CONCLUSION: Desensitization to ceftaroline was conducted for a patient with extensive history of hypersensitivity reactions to other drugs, including penicillin-induced anaphylaxis. Desensitization and subsequent treatment with full doses of ceftaroline were accomplished without apparent adverse effects.

PMID: 25596602 [PubMed – in process]

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Allergic reactions to anisakis found in fish.

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Allergic reactions to anisakis found in fish.

Curr Allergy Asthma Rep. 2014 Aug;14(8):455

Authors: Nieuwenhuizen NE, Lopata AL

Abstract
The food-borne parasite Anisakis is an important hidden food allergen. Anisakis is a parasitic nematode which has a third-stage larval form that infects mainly fish, and ingestion of contaminated seafood can result in severe allergic reactions. Symptoms experienced due to exposure to this parasite include gastrointestinal disorders, urticaria, dermatitis, asthma and even anaphylaxis. Accurate prevalence data of allergic sensitisation to Anisakis are difficult to estimate due to the lack of well-designed population-based studies. Current diagnostic approaches rely on the detection of serum IgE antibodies to allergenic proteins, which however demonstrate considerable immunological cross-reactivity to other invertebrate allergens. While exposure to this parasite seems to increase due to the increasing consumption of seafood worldwide, the immunology of infection and allergic sensitization is not fully understood.

PMID: 25039016 [PubMed – in process]

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Stress in Pregnant Women can Provoke Allergic Reactions Such as Asthma or … – MarketWatch (press release)

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Exposure to allergens during pregnancy will be a key topic during the EAACI Congress, as well as how stress provokes reactions such us as asthma or eczema in the newborn. Japanese researchers have found that anxiety in pregnant woman is associated with

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