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Sample records for advocacy anaphylaxis diagnosis

  1. Anaphylaxis: diagnosis and management.

    PubMed

    Brown, Simon G A; Mullins, Raymond J; Gold, Michael S

    2006-09-01

    Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. Anaphylaxis in children is most often caused by food. Bronchospasm is a common symptom, and there is usually a background of atopy and asthma. Venom- and drug-induced anaphylaxis are more common in adults, in whom hypotension is more likely to occur. Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. The cornerstones of initial management are putting the patient in the supine position, administering intramuscular adrenaline into the lateral thigh, resuscitation with intravenous fluid, support of the airway and ventilation, and giving supplementary oxygen. If the response to initial management is inadequate, intravenous infusion of adrenaline should be commenced. Use of vasopressors should be considered if hypotension persists. The patient should be observed for at least 4 hours after symptom resolution and referred to an allergist to assist with diagnosis, allergen avoidance measures, risk assessment, preparation of an action plan and education on the use of self-injectable adrenaline. Provision of a MedicAlert bracelet should also be arranged. PMID:16948628

  2. Anaphylaxis and Anaphylactoid Reactions: Diagnosis and Management.

    PubMed

    Luskin, Allan T.; Luskin, Susan S.

    1996-07-01

    Anaphylaxis is an acute fatal or potentially fatal hypersensitivity reaction. Anaphylaxis represent a clinical diagnosis based on history and physical examination and includes symptoms of airway obstruction, generalized skin reactions, particularly flushing, itching, urticaria, angioedema cardiovascular symptoms including hypotension and gastrointestinal symptoms. These symptoms result from the action of mast cell mediators, especially histamine and lipid mediators such as leukotrienes and platelet activating factor on shock tissue. The shock tissue includes blood vessels, mucous glands, smooth muscle, and nerve endings. Anaphylaxis follows the typical immediate hypersensitivity time course, with a reaction beginning within minutes of antigen exposure. A late-phase reaction hours after the initial reaction may occur. Mast cell mediator release can be triggered by both IgE and non--IgE-mediated factors. Therefore, anaphylaxis may be termed anaphylaxis (IgE mediated) or anaphylactoid (non--IgE mediated). The most common IgE-mediated triggers are drugs, typically penicillin or other beta-lactam antibiotics, foods, most commonly nuts, peanuts, fish and shellfish, or hymenoptera stings. Non-IgE-mediated causes include factors causing marked complement activation such as plasma proteins or compounds which act directly on the mast cell membrane, such as vancomycin, quinolone antibiotics, or radiographic contrast media. The pathophysiology of some trigger factors, such as aspirin, remains unclear. Therapy of anaphylaxis revolves around patient education, avoidance, desensitization or pharmacologic pretreatment when agents causing anaphylaxis need to be readministered, and early recognition and prompt therapy of reactions should they occur.

  3. Anaphylaxis.

    PubMed

    Hernandez, Lorenzo; Papalia, Sarah; Pujalte, George G A

    2016-09-01

    Anaphylaxis is an acute, systemic reaction mediated by immunoglobulin E hypersensitivity. Release of bioactive factors causes vasodilation and bronchiole constriction that can lead to hypotensive shock and asphyxiation. Differential diagnosis includes acute asthma, localized angioedema, syncope, and anxiety/panic attacks. Diagnostic tests lack specificity. Clinical diagnosis is based on demonstration of specific airway or cardiovascular compromise within proximity of allergen exposure. Treatment includes epinephrine, antihistamines, fluid resuscitation, and airway management. Prevention focuses on awareness/avoidance of triggers, implementation of personalized action plans, as well as immune modulation by desensitization in a closely controlled setting where available. PMID:27545736

  4. Anaphylaxis

    MedlinePlus

    Anaphylactic reaction; Anaphylactic shock; Shock - anaphylactic; Allergic reaction - anaphylaxis ... Anaphylaxis is a severe, whole-body allergic reaction to a chemical ... that can cause an allergic reaction. After being exposed to ...

  5. Perioperative anaphylaxis: diagnosis, evaluation, and management.

    PubMed

    Kannan, Jennifer A; Bernstein, Jonathan A

    2015-05-01

    Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred. PMID:25841554

  6. Perioperative anaphylaxis: diagnosis, evaluation, and management.

    PubMed

    Kannan, Jennifer A; Bernstein, Jonathan A

    2015-05-01

    Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred.

  7. Anaphylaxis

    MedlinePlus

    ... products in your home Insect stings, especially from bees, wasps, hornets, yellow jackets, sawflies, and fire ants ... If you have had anaphylaxis because of a bee or wasp sting, desensitization shots are almost always ...

  8. Anaphylaxis

    MedlinePlus

    ... All » Peanut allergy prevention strategy does not impact growth or nutrition » Trends, characteristics, and incidence of anaphylaxis: A population-based study » Transcriptome analysis reveals clues into the ...

  9. Peri-operative anaphylaxis

    PubMed Central

    Nel, Linda; Eren, Efrem

    2011-01-01

    Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described. PMID:21235622

  10. Advocacy.

    ERIC Educational Resources Information Center

    Scarr, Margaret, Ed.; Varro, Tim, Ed.

    1993-01-01

    This theme issue presents art advocacy as a necessary means of bringing art and art education to an elevated status in the elementary secondary curriculum and educational system. Articles include: (1) "Editor's View" (Margaret Scarr); (2) "Art Education: Why Is It Important" (Arts Education Partnership Working Group); (3) "Why Art in Education and…

  11. Food-induced anaphylaxis.

    PubMed

    Cianferoni, Antonella; Muraro, Antonella

    2012-02-01

    Food-induced anaphylaxis (FIA) is a serious allergic reaction that may cause death rapidly in otherwise healthy individuals. There is no universal agreement on its definition or criteria for diagnosis. Hospital admissions for FIA have more than doubled in the last decade. Food is one of the most common causes of anaphylaxis, with most surveys indicating that food-induced reactions account for 30% to 50% of cases. The most commonly implicated foods are peanut, tree nuts, milk, eggs, sesame seeds, fish, and shellfish. The only life-saving treatment for anaphylaxis is allergen avoidance, and epinephrine injection if an anaphylactic event occurs.

  12. International consensus on (ICON) anaphylaxis

    PubMed Central

    2014-01-01

    ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. In addition to confirming the alignment of major anaphylaxis guidelines, ICON

  13. International consensus on (ICON) anaphylaxis.

    PubMed

    Simons, F Estelle R; Ardusso, Ledit Rf; Bilò, M Beatrice; Cardona, Victoria; Ebisawa, Motohiro; El-Gamal, Yehia M; Lieberman, Phil; Lockey, Richard F; Muraro, Antonella; Roberts, Graham; Sanchez-Borges, Mario; Sheikh, Aziz; Shek, Lynette P; Wallace, Dana V; Worm, Margitta

    2014-01-01

    ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction. They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice. For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences. ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available. ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research. IN ADDITION TO CONFIRMING THE ALIGNMENT OF MAJOR ANAPHYLAXIS GUIDELINES, ICON

  14. Food anaphylaxis.

    PubMed

    Sampson, H A

    2000-01-01

    Food anaphylaxis is now the leading single cause of anaphylactic reactions treated in emergency departments in Westernized countries. In the US, it is estimated that there are 29,000 anaphylactic reactions to foods treated in emergency departments and 125-150 deaths each year. Peanuts, tree nuts, fish and shellfish account for the vast majority of severe food anaphylactic reactions. Immunopathogenic mechanisms responsible for food anaphylaxis may differ somewhat from other forms of anaphylaxis, since elevation of serum tryptase is rarely seen following food anaphylactic reactions. Education regarding the strict avoidance of food allergens, the early recognition of anaphylactic symptoms, and the early use of self-injectable epinephrine remain the mainstays of therapy. However, clinical trials are now underway for the treatment of patients with peanut anaphylaxis utilizing anti-IgE antibody therapy and novel immunomodulatory therapies utilizing 'engineered' recombinant proteins, overlapping peptides, and immunostimulatory deoxyoligonucleotide sequences are being tested in animal models of anaphylaxis.

  15. Optimal treatment of anaphylaxis: antihistamines versus epinephrine.

    PubMed

    Fineman, Stanley M

    2014-07-01

    Anaphylaxis is a rapid, systemic, often unanticipated, and potentially life-threatening immune reaction occurring after exposure to certain foreign substances. The main immunologic triggers include food, insect venom, and medications. Multiple immunologic pathways underlie anaphylaxis, but most involve immune activation and release of immunomodulators. Anaphylaxis can be difficult to recognize clinically, making differential diagnosis key. The incidence of anaphylaxis has at least doubled during the past few decades, and in the United States alone, an estimated 1500 fatalities are attributed to anaphylaxis annually. The increasing incidence and potentially life-threatening nature of anaphylaxis coupled with diagnostic challenges make appropriate and timely treatment critical. Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome. Despite the evidence and guideline recommendations supporting its use for anaphylaxis, epinephrine remains underused. Data indicate that antihistamines are more commonly used to treat patients with anaphylaxis. Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock. Additionally, antihistamines do not act as rapidly as epinephrine; maximal plasma concentrations are reached between 1 and 3 hours for antihistamines compared with < 10 minutes for intramuscular epinephrine injection. This demonstrates the need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis.

  16. Management and Prevention of Anaphylaxis.

    PubMed

    Irani, Anne-Marie; Akl, Elias G

    2015-01-01

    Anaphylaxis prevalence has increased within the last few years. This may be due to a marked increase in allergic sensitization to foods especially in the pediatric population, as well as to an increase in outdoor recreational habits and the availability of new biologic medications.  Furthermore, guidelines for the diagnosis of anaphylaxis have been published, thus facilitating the recognition of this disorder. Diagnosis of anaphylaxis is mainly based on history and clinical criteria of organ system involvement. The serum tryptase assay is now commercially available and may be a helpful diagnostic tool in certain clinical situations involving hypotension, but not in the context of food-induced anaphylaxis. Treatment of anaphylaxis mainly involves the use of epinephrine as a first line medication for severe manifestations followed by  symptomatic management of specific  symptoms, such as antihistamines for urticaria and albuterol for wheezing. Although commonly practiced, treatment with systemic corticosteroids  is not supported by evidence-based literature. Observation in a medical facility for 4-6 hours is recommended to monitor for late phase reactions, although these rarely occur. Education is an essential component of management of a patient with a previous history of anaphylaxis, emphasizing early use of epinephrine and providing a written action plan. Referral to a board-certified allergist/immunologist is recommended to determine  the cause of the anaphylaxis as well as to rule out other potential conditions. In this review, our main focus will be on the treatment and prevention of anaphylaxis while providing our readers with a brief introduction to the diagnosis of anaphylaxis, its prevalence and its most common causes. PMID:26918144

  17. Management and Prevention of Anaphylaxis

    PubMed Central

    Irani, Anne-Marie; Akl, Elias G.

    2015-01-01

    Anaphylaxis prevalence has increased within the last few years. This may be due to a marked increase in allergic sensitization to foods especially in the pediatric population, as well as to an increase in outdoor recreational habits and the availability of new biologic medications.  Furthermore, guidelines for the diagnosis of anaphylaxis have been published, thus facilitating the recognition of this disorder. Diagnosis of anaphylaxis is mainly based on history and clinical criteria of organ system involvement. The serum tryptase assay is now commercially available and may be a helpful diagnostic tool in certain clinical situations involving hypotension, but not in the context of food-induced anaphylaxis. Treatment of anaphylaxis mainly involves the use of epinephrine as a first line medication for severe manifestations followed by  symptomatic management of specific  symptoms, such as antihistamines for urticaria and albuterol for wheezing. Although commonly practiced, treatment with systemic corticosteroids  is not supported by evidence-based literature. Observation in a medical facility for 4-6 hours is recommended to monitor for late phase reactions, although these rarely occur. Education is an essential component of management of a patient with a previous history of anaphylaxis, emphasizing early use of epinephrine and providing a written action plan. Referral to a board-certified allergist/immunologist is recommended to determine  the cause of the anaphylaxis as well as to rule out other potential conditions. In this review, our main focus will be on the treatment and prevention of anaphylaxis while providing our readers with a brief introduction to the diagnosis of anaphylaxis, its prevalence and its most common causes. PMID:26918144

  18. History and classification of anaphylaxis.

    PubMed

    Ring, Johannes; Brockow, Knut; Behrendt, Heidrun

    2004-01-01

    Anaphylaxis is the maximal variant of an acute allergic reaction involving several organ systems. The phenomenon itself is old, but it was recognized and named at the beginning of the 20th century by Richet and Portier. The clinical symptoms of anaphylaxis affect various organs, most commonly starting in the skin and proceeding to the respiratory tract, to gastrointestinal involvement and to cardiovascular symptoms, and finally to cardiac and/or respiratory arrest. Anaphylaxis stricto sensu is an immunological reaction, mostly mediated by IgE antibodies, but also by IgG or IgM antibodies (immune complex anaphylaxis). There are cases with similar clinical symptomatology without detectable immunological sensitization which are called pseudo-allergic or anaphylactoid reactions. In the newer nomenclature, some authors tend to include these under the heading of 'anaphylaxis' which has then to be defined as an acute systemic hypersensitivity reaction. The most common elicitors of anaphylaxis include drugs, foods, additives, but also other allergens as well as physical factors (cold, heat, UV radiation). The clinical outcome--the intensity of the reaction--is not only influenced by the degree of sensitization, but also by concomitant other factors: sometimes, individuals only develop anaphylaxis after simultaneous exposure to the allergen and an infection, physical exercise, psychological stress or concomitant medication (e.g. beta blockers). The term 'summation anaphylaxis' has been proposed for this phenomenon which probably underlies many cases of so-called idiopathic anaphylaxis. In patients with insect venom anaphylaxis, decreased levels of plasma angiotensin have been measured in inverse correlation to the severity of the reaction. Certain differential diagnoses have to be distinguished from anaphylaxis. Every patient with a history of anaphylaxis should undergo allergy diagnosis with the aim to detect the eliciting agent, characterize the relevant pathomechanism (e

  19. [Anaphylaxis: facts and fallacies].

    PubMed

    Brand, P L P

    2007-03-10

    The diagnosis and management of anaphylaxis is surrounded by many misunderstandings. The diagnosis may be made ifa patient develops respiratory or circulatory symptoms, in addition to skin symptoms, after exposure to a possibly relevant allergen. The most common causes ofanaphylaxis are food allergens, such as peanut and tree nuts, insect stings, and drugs, in particular antibiotics. Many patients with peanut or tree nut allergy show only mild allergic symptoms; only a minority develop anaphylaxis upon exposure. A large local reaction to an insect sting does not constitute insect sting allergy and does not increase the risk of anaphylaxis when stung again. Intramuscular epinephrine is the drug of choice in the treatment of anaphylaxis; antihistaminic agents and corticosteroids are supportive therapeutic agents which should only be considered after epinephrine has been administered. Prevention of recurrence ofanaphylaxis comprises identification and avoidance of the causative allergen, and administration of epinephrine autoinjector when the patient develops suggestive signs of recurrence. When prescribing an epinephrine autoinjector, the patient and all caregivers should be instructed carefully in its correct use; referral to an allergist is recommended.

  20. [Anaphylaxis as part of a clinical diagnosis of mastocytosi - case demonstration].

    PubMed

    Stobiecki, Marcin; Sacha, Małgorzata; Czarnobilska, Ewa

    2015-01-01

    Mastocytosis is a heterogeneous group of diseases characterized by excessive proliferation and accumulation of mast cells--in one or more organs. The number of symptoms and clinical prognosis vary depending on the disease. One of the most severe potential outcome of mastocytosis is anaphylactic shock. Early diagnosis and identification of triggers enables education and avoidance them. We describe the case of a 31-year-old woman with systemic mastocytosis (SM) without skin symptoms with multiple anaphylactic reactions, including two severe. Systemic mastocytosis was confirmed in bone marrow and genetic studies. We identify allergic triggers: latex and cefuroxime and also other non-immunological triggers as non-steroidal anti-inflammatory drugs (NSAIDs). The patient never had any allergic reaction after Hymenoptera stings. Only one result of serum tryptase was elevated. There was a need to determine the safety of antibiotic use and anesthetic drugs before cesarean. The moment when the disease was diagnosed and triggers were identifie, helped avoid further severe reactions. PMID:27024961

  1. Delayed Anaphylaxis to Red Meat Masquerading as Idiopathic Anaphylaxis

    PubMed Central

    Tripathi, Anubha; Commins, Scott P.; Heymann, Peter W.; Platts-Mills, Thomas A.E.

    2014-01-01

    Anaphylaxis is traditionally recognized as a rapidly developing combination of symptoms often including hives and hypotension or respiratory symptoms. Furthermore, when a specific cause is identified, exposure to this cause is usually noted to have occurred within minutes to 2 hours before the onset of symptoms. This case is of a 79 year-old female who developed a severe episode of anaphylaxis 3 hours after eating pork. Prior to 2012, she had not experienced any symptoms after ingestion of meat products. Delayed anaphylaxis to mammalian meat has many contrasting features to immediate food-induced anaphylaxis. The relevant IgE antibody is specific for the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), a blood group substance of non-primate mammals. Evidence from Australia, Sweden, and the U.S. demonstrates that the primary cause of this IgE antibody response is tick bites. These bites characteristically itch for ten days or more. Diagnosis can be made by the presence of specific IgE to beef, pork, lamb, and milk and lack of IgE to chicken, turkey, and fish. Prick skin tests (but not intradermal tests) are generally negative. Management of these cases, now common across the southeastern U.S., consists of education combined with avoidance of both red meat and further tick bites. PMID:24811014

  2. Anaphylaxis: lesson learned from five cases.

    PubMed

    Sundaru, Heru; Koesnoe, Sukamto; Tenggara, Jeffry Beta; Suryana, Ketut

    2008-07-01

    Anaphylaxis is a severe hypersensitivity reaction. Its clinical manifestations vary, affecting several organs at once. Skin symptom is the most frequent manifestation; however, diagnosis of anaphylaxis will only be established when involving one or both vital organs, which are cardiovascular and respiratory system. Other symptom, such as that involving central nervous system or gastrointestinal tract, may accompany. We present five cases of anaphylaxis which vary in onset of symptoms, allergen, degree of severity, therapeutic response and clinical manifestation. Anaphylactic reaction to drugs in these cases is mainly manifested as anaphylactic shock and reaction to food allergen causing obstruction of respiratory tract. Four anaphylactic events occurred at home and only one occurred in a hospital, thus education on anaphylaxis to general community is very important, especially for the patients and their families. Prompt medical assistance in patients with anaphylactic symptoms determines their therapeutic response. Skin test prior to administration of cephalosporin does not give negative predictive value toward anaphylactic event.

  3. Anaphylaxis: a payor's perspective on epinephrine autoinjectors.

    PubMed

    Dunn, Jeffrey D; Sclar, David A

    2014-01-01

    The scope of expenditures due to anaphylaxis likely is underestimated by health care payors because anaphylaxis is underdiagnosed and, when reported, most costs of anaphylaxis borne by payors relate to direct medical expenses. Direct costs of anaphylaxis have been estimated at $1.2 billion per year, with direct expenditures of $294 million for epinephrine, and indirect costs of $609 million. More accurate diagnostic coding will allow payors to improve their understanding of the full impact of anaphylaxis on health care plans, employers, patients, and their families. Similarly, more accurate diagnosis and treatment of anaphylaxis should have a direct effect on overall cost savings achieved in this disease state. This includes savings in both direct costs, such as emergency department visits, and indirect costs, such as lost productivity of patients and caregivers. Educating medical personnel on treatment guidelines regarding the specific use of appropriate epinephrine autoinjectors will contribute to cost savings. Even though the cost of autoinjectors has been increasing, evidence indicates that the cost of improper response to, and treatment of, anaphylaxis outweighs that increase. At this time, there are several branded epinephrine autoinjectors and one generic equivalent for one of these branded products available on the US market; the branded autoinjectors are not considered equivalents for substitution. Barriers to coverage and access, such as managed care organization tier classification, medication copay, and socioeconomic status of specific patients, need to be examined more closely and addressed. Education in the proper use of epinephrine autoinjectors, including regular checking of medication expiration dates, is critical for proper management of anaphylaxis and minimizing the costs of anaphylactic events. Managed care organizations can play a role in educational initiatives. PMID:24384137

  4. Anaphylaxis to insect stings.

    PubMed

    Golden, David B K

    2015-05-01

    Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent but rarely dangerous. The chance of a systemic reaction to a sting is 5% to 10% in large local reactors and in children with mild (cutaneous) systemic reactions, and varies between 30% and 65% in adults with previous systemic reactions, depending on the severity of previous sting reactions. Baseline serum tryptase level is increased in many patients with sting anaphylaxis. Venom immunotherapy is 75% to 98% effective in preventing sting anaphylaxis.

  5. Pathogenesis, newly recognized etiologies, and management of idiopathic anaphylaxis.

    PubMed

    Kuhlen, James L; Virkud, Yamini V

    2015-02-01

    Idiopathic anaphylaxis (IA) is a life-threatening allergic disease and the most common diagnosis given to patients following an anaphylactic event. The inability of the healthcare provider and the patient to identify the trigger for anaphylaxis makes standard allergen avoidance measures ineffectual. IA is diagnosed after other causes of anaphylaxis have been excluded. Mast cell activation syndromes (MCAS), mastocytosis, IgE to galactose-alpha-1,3-galactose (α-gal), and certain medications have recently been recognized as causes of anaphylaxis that were previously labeled idiopathic. This review will describe the epidemiology and proposed theories of pathogenesis for IA, its diagnostic approach, its clinical management, and examine newly recognized disorders that were previously labeled as idiopathic anaphylaxis.

  6. Exercise-induced anaphylaxis.

    PubMed

    Sheffer, A L; Austen, K F

    1980-08-01

    Sixteen patients were seen because of possibly life-threatening exercise-associated symptoms similar to anaphylactic reactions. Asthma attacks, cholinergic urticaria and angioedema, and cardiac arrythmias are recognized as exertion-related phenomena in predisposed patients but are distinct from the syndrome described here. A syndrome characterized by the exertion-related onset of cutaneous pruritus and warmth, the development of generalized urticaria, and the appearance of such additional manifestations as collapse in 12 patients, gastrointestinal tract symptoms in five patients, and upper respiratory distress in 10 patients has been designated exercise-induced anaphylaxis, because of the striking similarity of this symptom complex to the anaphylactic syndrome elicited by ingestion or injection of a foreign antigenic substance. There is a family history of atopic desease for 11 patients and cold urticaria for two others and a personal history of atopy in six. The size of the wheals, the failure to develop an attack with a warm bath or shower or a fever, and the prominence of syncope rule against the diagnosis of conventional cholinergic urticaria. There is no history or evidence of an encounter with an environmental source of antigen during the exercise period. PMID:7400473

  7. Epinephrine (adrenaline) in anaphylaxis.

    PubMed

    Simons, F Estelle R; Simons, Keith J

    2010-01-01

    Epinephrine (adrenaline) is universally recommended as the initial drug of choice for the treatment of anaphylaxis. No other medication has similar life-saving pharmacologic effects in multiple organ systems, including prevention and relief of both upper and lower airway obstruction, and of shock. Failure to inject epinephrine promptly contributes to anaphylaxis fatalities. It is most effective when given immediately after the onset of anaphylaxis symptoms. The initial recommended adult dose is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh. Injected by other routes, epinephrine appears to have a less satisfactory therapeutic window; for example, onset of action is potentially delayed when it is injected subcutaneously, and risk of adverse effects potentially increases when it is injected intravenously. The possibility of randomized, controlled trials of epinephrine in anaphylaxis should be considered. For ethical reasons, these trials will not be placebo-controlled. They might involve comparison of one epinephrine dose versus another, or one route of epinephrine administration versus another. For first-aid treatment of people with anaphylaxis in the community, novel epinephrine formulations are being developed. These include epinephrine autoinjectors that are safer and easier to use, and epinephrine formulations that can be administered through non-invasive routes.

  8. Anaphylaxis and emergency treatment.

    PubMed

    Sampson, Hugh A

    2003-06-01

    Food anaphylaxis is now the leading known cause of anaphylactic reactions treated in emergency departments in the United States. It is estimated that there are 30 000 anaphylactic reactions to foods treated in emergency departments and 150 to 200 deaths each year. Peanuts, tree nuts, fish, and shellfish account for most severe food anaphylactic reactions. Although clearly a form of immunoglobulin E-mediated hypersensitivity, the mechanistic details responsible for symptoms of food-induced anaphylaxis are not completely understood, and in some cases, symptoms are not seen unless the patient exercises within a few hours of the ingestion. At the present time, the mainstays of therapy include educating patients and their caregivers to strictly avoid food allergens, to recognize early symptoms of anaphylaxis, and to self-administer injectable epinephrine. However, clinical trials are now under way for the treatment of patients with peanut anaphylaxis using recombinant humanized anti-immunoglobulin E antibody therapy, and novel immunomodulatory therapies are being tested in animal models of peanut-induced anaphylaxis.

  9. Anaphylaxis: clinical aspects.

    PubMed

    Sheffer, Albert L

    2004-01-01

    Anaphylaxis is a rarely anticipated, potentially life-threatening systemic allergic reaction with symptoms ranging from mild flushing to upper respiratory obstruction with or without vascular collapse. Early recognition of symptoms with prompt institution of therapy is central to a successful outcome. Anaphylaxis is IgE mediated, whereas non-IgE mediated anaphylatic reactions are termed anaphylactoid. Food-induced anaphylactic reactions, particularly peanut, are being recognized with increasing frequency. Central to appropriate therapy of the acute reaction is adminstration of intramuscular adrenalin. However, with the advent of humanized anti-IgE monoclonal antibody, such reactions may be reduced in frequency and severity.

  10. Exercise-induced anaphylaxis.

    PubMed

    Shimizu, Taro; Tokuda, Yasuharu

    2012-01-01

    A 23-year-old man presented with acute flushing, pruritus and warmth followed by collapse after vigorous exercise in a gymnasium. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, he was finally stable. He admitted that he had a similar experience 5 years earlier during exercise. Based on the patient's history, his symptoms were attributed to exercise-induced anaphylaxis. None of his episodes was associated with any suspicious co-triggers of anaphylaxis. He was successfully discharged from hospital without any complications after receiving guidance on how to prevent this condition. PMID:22669856

  11. Exercise-induced anaphylaxis.

    PubMed

    Shimizu, Taro; Tokuda, Yasuharu

    2012-01-01

    A 23-year-old man presented with acute flushing, pruritus and warmth followed by collapse after vigorous exercise in a gymnasium. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, he was finally stable. He admitted that he had a similar experience 5 years earlier during exercise. Based on the patient's history, his symptoms were attributed to exercise-induced anaphylaxis. None of his episodes was associated with any suspicious co-triggers of anaphylaxis. He was successfully discharged from hospital without any complications after receiving guidance on how to prevent this condition.

  12. Marking nut anaphylaxis.

    PubMed

    Fok, Jie Shen; Kral, Anita Christine; Hayball, John; Smith, William B

    2016-07-01

    Marking nut Semecarpus anacardium, so-called because it contains a pigment that has been used in the past to mark fabrics, is a known cause of contact hypersensitivity. It may be ingested as an ingredient of some traditional Hindi foods. We describe the first reported case of anaphylaxis to marking nut. PMID:27489793

  13. Marking nut anaphylaxis.

    PubMed

    Fok, Jie Shen; Kral, Anita Christine; Hayball, John; Smith, William B

    2016-07-01

    Marking nut Semecarpus anacardium, so-called because it contains a pigment that has been used in the past to mark fabrics, is a known cause of contact hypersensitivity. It may be ingested as an ingredient of some traditional Hindi foods. We describe the first reported case of anaphylaxis to marking nut.

  14. Marking nut anaphylaxis

    PubMed Central

    Kral, Anita Christine; Hayball, John; Smith, William B

    2016-01-01

    Marking nut Semecarpus anacardium, so-called because it contains a pigment that has been used in the past to mark fabrics, is a known cause of contact hypersensitivity. It may be ingested as an ingredient of some traditional Hindi foods. We describe the first reported case of anaphylaxis to marking nut. PMID:27489793

  15. Library Advocacy

    ERIC Educational Resources Information Center

    Plunkett, Kate

    2010-01-01

    This paper is about the issue of advocacy. Standing at the vanguard of literacy, library media specialists have a unique role. However, it is time for media specialists to advocate their services in a proactive way. If library media specialists cannot, both individually and collectively, put advocacy at the forefront, then students will suffer the…

  16. Advocacy Simplified

    ERIC Educational Resources Information Center

    Dowd, Karen J.; Curva, Fely

    2008-01-01

    Most state professional associations promote and fund at some level, an advocacy program. These advocacy programs usually aim to support or plead for a program, policy, or proposal. They can range from simple communication to complex strategies, from daily interactions to annual productions, and from position papers to onsite, legislative visits.…

  17. Advocacy ABC's

    ERIC Educational Resources Information Center

    Sims, Sandra

    2008-01-01

    Advocacy is a continuous process that involves more than simply passing legislation. It is a year-round commitment that involves educating policymakers about the importance of achieving health and wellness in any state. As such, it is important for the advocacy group to have a plan, be organized, and work together toward a unified goal. Success is…

  18. Inadvertent advocacy.

    PubMed

    Wilhere, George F

    2012-02-01

    Policy advocacy is an issue regularly debated among conservation scientists. These debates have focused on intentional policy advocacy by scientists, but advocacy can also be unintentional. I define inadvertent policy advocacy as the act of unintentionally expressing personal policy preferences or ethical judgments in a way that is nearly indistinguishable from scientific judgments. A scientist may be well intentioned and intellectually honest but still inadvertently engage in policy advocacy. There are two ways to inadvertently engage in policy advocacy. First, a scientist expresses an opinion that she or he believes is a scientific judgment but it is actually an ethical judgment or personal policy preference. Second, a scientist expresses an opinion that he or she knows is an ethical judgment or personal policy preference but inadvertently fails to effectively communicate the nature of the opinion to policy makers or the public. I illustrate inadvertent advocacy with three examples: recovery criteria in recovery plans for species listed under the U.S. Endangered Species Act, a scientific peer review of a recovery plan for the Northern Spotted Owl (Strix occidentalis caurina), and the International Union for Conservation of Nature's definition of threatened. In each example, scientists expressed ethical judgments or policy preferences, but their value judgments were not identified as such, and, hence, their value judgments were opaque to policy makers and the public. Circumstances suggest their advocacy was inadvertent. I believe conservation scientists must become acutely aware of the line between science and policy and avoid inadvertent policy advocacy because it is professional negligence, erodes trust in scientists and science, and perpetuates an ethical vacuum that undermines the rational political discourse necessary for the evolution of society's values. The principal remedy for inadvertent advocacy is education of conservation scientists in an effort to

  19. [Cereal-dependent exercise-induced anaphylaxis].

    PubMed

    Seoane-Rodríguez, Marta; Caralli, María Elisa; Morales-Cabeza, Cristina; Micozzi, Sarah; De Barrio-Fernández, Manuel; Rojas Pérez-Ezquerra, Patricia

    2016-01-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is increasing. In vitro test such as omega-5-gliadin levels are useful in the diagnosis, while oral single blind challenge tests (OCT) with wheat plus exercise continuous being the gold standard diagnostic method. This paper reports the case of a 38-year-old woman, with several episodes of anaphylaxis after eating different foods and doing exercise after ingestion. An allergy study was performed with positive skin prick tests for wheat, barley and rye. Total IgE 238.0KU/L, positive specific IgE (>100KU/L) to wheat, barley and rye, and negative to rTri-a-19 omega-5 gliadin. OCT with bread and exercise was positive. In this case of wheat-dependent exerciseinduced anaphylaxis (WDEIA) with negative serum specific IgE to omega-5-gliadin, negative results with gamma, alpha, bheta y omega-gliadin doesn't exclude the diagnosis of WDEIA. PMID:26943835

  20. [Cereal-dependent exercise-induced anaphylaxis].

    PubMed

    Seoane-Rodríguez, Marta; Caralli, María Elisa; Morales-Cabeza, Cristina; Micozzi, Sarah; De Barrio-Fernández, Manuel; Rojas Pérez-Ezquerra, Patricia

    2016-01-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is increasing. In vitro test such as omega-5-gliadin levels are useful in the diagnosis, while oral single blind challenge tests (OCT) with wheat plus exercise continuous being the gold standard diagnostic method. This paper reports the case of a 38-year-old woman, with several episodes of anaphylaxis after eating different foods and doing exercise after ingestion. An allergy study was performed with positive skin prick tests for wheat, barley and rye. Total IgE 238.0KU/L, positive specific IgE (>100KU/L) to wheat, barley and rye, and negative to rTri-a-19 omega-5 gliadin. OCT with bread and exercise was positive. In this case of wheat-dependent exerciseinduced anaphylaxis (WDEIA) with negative serum specific IgE to omega-5-gliadin, negative results with gamma, alpha, bheta y omega-gliadin doesn't exclude the diagnosis of WDEIA.

  1. Exercise-induced anaphylaxis: A clinical view

    PubMed Central

    2012-01-01

    Exercise-induced anaphylaxis (EIA) is a distinct form of physical allergy. The development of anaphylaxis during exertion often requires the concomitant exposure to triggering factors such as intake of foods (food dependent exercise-induced anaphylaxis) or drugs prior to exercise, extreme environmental conditions. EIA is a rare, but serious disorder, which is often undetected or inadequately treated. This article summarizes current evidences on pathophysiology, diagnosis and management. We reviewed recent advances in factors triggering the release of mediators from mast cells which seems to play a pathogenetic role. A correct diagnosis is essential to avoid unnecessary restricted diet, to allow physical activity in subjects with EIA dependent from triggering factors such as food, and to manage attacks. An algorithm for diagnosing EIA based on medical history, IgE tests and exercise challenge test has been provided. In the long-term management of EIA, there is a need for educating patients and care-givers to avoid exposure to precipitating factors and to recognize and treat episodes. Future researches on existing questions are discussed. PMID:22980517

  2. Anaphylaxis/angioedema caused by honey ingestion.

    PubMed

    Vezir, Emine; Kaya, Ayşenur; Toyran, Müge; Azkur, Dilek; Dibek Mısırlıoğlu, Emine; Kocabaş, Can Naci

    2014-01-01

    Honey allergy is a very rare, but serious health condition. In this study, we presented six patients who described systemic allergic reactions after ingestion of honey. Three of the six patients had suffered from anaphylaxis. Honey-specific IgE was measured and skin-prick tests for honey were performed to diagnose honey allergy. The results of honey-specific IgE of all patients were positive. Four patients had high serum-specific IgE for honey bee venom and two of five patients had also experienced anaphylaxis due to bee stings. Skin-prick tests with honey and pollens were positive in five patients. Honey is one of the foods that can cause severe systemic reactions. Specific IgE and skin-prick tests are helpful for the diagnosis of honey allergy.

  3. World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

    PubMed Central

    Ardusso, Ledit R. F.; Bilò, M. Beatrice; El-Gamal, Yehia M.; Ledford, Dennis K.; Ring, Johannes; Sanchez-Borges, Mario; Senna, Gian Enrico; Sheikh, Aziz; Thong, Bernard Y.

    2011-01-01

    Abstract: The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. Uniquely, before they were developed, lack of worldwide availability of essentials for the diagnosis and treatment of anaphylaxis was documented. They incorporate contributions from more than 100 allergy/immunology specialists on 6 continents. Recommendations are based on the best evidence available, supported by references published to the end of December 2010. The Guidelines review patient risk factors for severe or fatal anaphylaxis, co-factors that amplify anaphylaxis, and anaphylaxis in vulnerable patients, including pregnant women, infants, the elderly, and those with cardiovascular disease. They focus on the supreme importance of making a prompt clinical diagnosis and on the basic initial treatment that is urgently needed and should be possible even in a low resource environment. This involves having a written emergency protocol and rehearsing it regularly; then, as soon as anaphylaxis is diagnosed, promptly and simultaneously calling for help, injecting epinephrine (adrenaline) intramuscularly, and placing the patient on the back or in a position of comfort with the lower extremities elevated. When indicated, additional critically important steps include administering supplemental oxygen and maintaining the airway, establishing intravenous access and giving fluid resuscitation, and initiating cardiopulmonary resuscitation with continuous chest compressions. Vital signs and cardiorespiratory status should be monitored frequently and regularly (preferably, continuously). The Guidelines briefly review management of anaphylaxis refractory to basic initial treatment. They also emphasize preparation of the patient for self-treatment of anaphylaxis recurrences in the community, confirmation of anaphylaxis triggers, and prevention of recurrences through trigger avoidance and immunomodulation. Novel strategies

  4. Anaphylaxis induced by lentil inhalation.

    PubMed

    Ayşenur, Kaya; Akan, Ayşegül; Mustafa, Erkoçoğlu; Müge, Toyran; Kocabaş, Can Naci

    2012-06-01

    Anaphylaxis is a rapid onset serious allergic reaction which may be fatal. Foods are the most common allergens leading to anaphylaxis especially for childhood. Most of the food-induced anaphylactic reactions take place after ingestion of the allergic food and only a few cases exist with anaphylactic reactions induced by inhalation of foods such as peanut, soybean and lupine. The case we present is unusual in that an 8 1/2-year-old boy developed anaphylaxis with the inhalation of steam from boiling lentils.

  5. Anaphylaxis Due to Head Injury

    PubMed Central

    Bruner, Heather C.; Bruner, David I.

    2015-01-01

    Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. PMID:25987924

  6. Munchausen stridor-a strong false alarm of anaphylaxis.

    PubMed

    Bahna, Sami L; Oldham, Jennifer L

    2014-11-01

    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. PMID:25374759

  7. Munchausen Stridor-A Strong False Alarm of Anaphylaxis

    PubMed Central

    Oldham, Jennifer L.

    2014-01-01

    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. PMID:25374759

  8. Clonal mast cell activation syndrome with anaphylaxis to sulfites.

    PubMed

    Cifuentes, Liliana; Ring, Johannes; Brockow, Knut

    2013-01-01

    Sulfites are rarely suspected as causative agents of immediate-type hypersensitivity. We report on a 49-year-old male patient who developed recurrent severe hypotension after food ingestion. A diagnosis of monoclonal mast cell activation syndrome was established. In the double-blind, placebo-controlled food challenge, the patient reacted to potassium metabisulfite with anaphylaxis.

  9. Caustic ingestions mimicking anaphylaxis: case studies and literature review.

    PubMed

    Sherenian, Michael G; Clee, Mark; Schondelmeyer, Amanda C; de Alarcón, Alessandro; Li, Jinzhu; Assa'ad, Amal; Risma, Kimberly

    2015-02-01

    Anaphylaxis presents in children with rapid involvement of typically 2 or more organ systems including cutaneous, gastrointestinal, and respiratory. Caustic ingestions (CI) may also present with acute involvement of cutaneous, gastrointestinal, and respiratory systems. We present 2 cases of "missed diagnosis" that illustrate how CI presenting with respiratory symptoms can be mistaken for anaphylaxis owing to these similarities. Both of these patients had delay in appropriate care for CI as a result. These cases demonstrate the importance of considering CI in children who have gastrointestinal symptoms, respiratory distress, and oropharyngeal edema.

  10. [Food-induced anaphylaxis - data from the anaphylaxis registry].

    PubMed

    Worm, Margitta; Grünhagen, Josefine; Dölle, Sabine

    2016-07-01

    Anaphylactic reactions due to food occur in the context of food allergy and, together with venom and drugs, are the most frequent elicitors of severe allergic reactions. In small children the most frequent elicitors of severe allergic reactions according to data from the anaphylaxis registry are hen's egg and milk, whereas in school children peanut and hazelnut are frequent elicitors of allergic reactions. Other frequent elicitors of anaphylactic reactions in childhood are wheat and soy. In adults the most frequent elicitors of severe allergic reactions due to food, based on data from the anaphylaxis registry, are wheat, soy, celery, shellfish and hazelnut. Rare elicitors of food-induced anaphylaxis in German-speaking countries are mustard and cabbage. However, the panel of rare elicitors of food-induced anaphylaxis show regional differences. As of March 2015, 17 cases of fatal anaphylaxis were registered and among these seven were food-induced. Co-factors can either trigger the elicitation of a severe allergic reaction or affect its severity. Among such co-factors are physical activity, the intake of certain drugs, and psychological stress. The data on the role of cofactors is sparse. The management of food-induced anaphylaxis includes acute management according to current guidelines, but also long-term management, which should include educational measures regarding treatment but also information about the food allergen in daily life.

  11. [Food-induced anaphylaxis - data from the anaphylaxis registry].

    PubMed

    Worm, Margitta; Grünhagen, Josefine; Dölle, Sabine

    2016-07-01

    Anaphylactic reactions due to food occur in the context of food allergy and, together with venom and drugs, are the most frequent elicitors of severe allergic reactions. In small children the most frequent elicitors of severe allergic reactions according to data from the anaphylaxis registry are hen's egg and milk, whereas in school children peanut and hazelnut are frequent elicitors of allergic reactions. Other frequent elicitors of anaphylactic reactions in childhood are wheat and soy. In adults the most frequent elicitors of severe allergic reactions due to food, based on data from the anaphylaxis registry, are wheat, soy, celery, shellfish and hazelnut. Rare elicitors of food-induced anaphylaxis in German-speaking countries are mustard and cabbage. However, the panel of rare elicitors of food-induced anaphylaxis show regional differences. As of March 2015, 17 cases of fatal anaphylaxis were registered and among these seven were food-induced. Co-factors can either trigger the elicitation of a severe allergic reaction or affect its severity. Among such co-factors are physical activity, the intake of certain drugs, and psychological stress. The data on the role of cofactors is sparse. The management of food-induced anaphylaxis includes acute management according to current guidelines, but also long-term management, which should include educational measures regarding treatment but also information about the food allergen in daily life. PMID:27255298

  12. Lessons about food anaphylaxis.

    PubMed

    Medveczky, Thomas

    2014-12-01

    Exercise-induced anaphylaxis (EIA) and its subtype food-dependent (FD)-EIA are uncommon and easily missed forms of physical allergy. The latter is triggered by exercise following the ingestion of specific food products. Treatment is identical to that for IgE-mediated allergic reactions. The disease is potentially fatal. In this case, 30-year-old woman was seen in the allergy clinic at the request of her general practitioner. She reported an episode when she had gone to a local park to exercise after dinner. Shortly thereafter, she collapsed with rash, lip swelling, and breathing difficulties. Upon admission to hospital, she was found to be hypotensive and required fluid resuscitation, systemic corticosteroids and adrenaline. She made a full and uneventful recovery. On the basis of the clinical story and specific allergy markers, her presentation was attributed to FD-EIA.

  13. Severe anaphylaxis: the secret ingredient.

    PubMed

    Buergi, Andreas; Jung, Barbara; Padevit, Christian; John, Hubert; Ganter, Michael T

    2014-02-01

    In this case report, we describe a healthy urological patient who suffered severe intraoperative anaphylaxis to chlorhexidine, an ingredient contained in frequently used lubricants (Instillagel, Endosgel). Chlorhexidine is a well-known skin disinfectant and antiseptic component in mouthwash or other over the counter antiseptic pharmaceuticals. There is little awareness that commonly used lubricants may contain hidden chlorhexidine. After severe intraoperative anaphylaxis, it is important to investigate all potential (including hidden) agents that might have caused this life-threatening reaction. PMID:25611155

  14. History and classification of anaphylaxis.

    PubMed

    Ring, Johannes; Behrendt, Heidrun; de Weck, Alain

    2010-01-01

    Anaphylaxis as the maximal variant of an acute systemic hypersensitivity reaction can involve several organ systems, particularly the skin, respiratory tract, gastrointestinal tract and the cardiovascular system. The severity of anaphylactic reaction is variable and can be classified into severity grades I-IV. Some reactions are fatal. Most frequent elicitors of anaphylaxis are foods in childhood, later insect stings and drugs. The phenomenon itself has been described in ancient medical literature, but was actually recognized and named at the beginning of the 20th century by Charles Richet and Paul Portier. In the course of experiments starting on the yacht of the Prince of Monaco and continued in the laboratory in Paris, they tried to immunize dogs with extracts of Physalia species in an attempt to develop an antitoxin to the venom of the Portuguese man-of-war. While Charles Richet believed that anaphylaxis was a 'lack of protection', it has become clear that an exaggerated immune reaction, especially involving immunoglobulin E antibodies, is the underlying pathomechanism in allergic anaphylaxis besides immune complex reactions. Non-immunologically mediated reactions leading to similar clinical symptomatology have been called 'anaphylactoid' or 'pseudo-allergic'--especially by Paul Kallos--and are now called 'non-immune anaphylaxis' according to a consensus of the World Allergy Organization (WAO). The distinction of different pathophysiological processes is important since non-immune anaphylaxis cannot be detected by skin test or in vitro allergy diagnostic procedures. History and provocation tests are crucial. The intensity of the reaction is not only influenced by the degree of sensitization but also by concomitant other factors as age, simultaneous exposure to other allergens, underlying infection, physical exercise or psychological stress or concomitant medication (e.g. beta-blockers, NSAIDs); this phenomenon has been called augmentation or summation

  15. The epidemiology of anaphylaxis in Europe: protocol for a systematic review

    PubMed Central

    2013-01-01

    Background The European Academy of Allergy and Clinical Immunology is in the process of developing its Guideline for Food Allergy and Anaphylaxis, and this systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management and impact on quality of life, which will be used to inform clinical recommendations. The aims of this systematic review will be to understand and describe the epidemiology of anaphylaxis, i.e. frequency, risk factors and outcomes of anaphylaxis, and describe how these characteristics vary by person, place and time. Methods A highly sensitive search strategy has been designed to retrieve all articles combining the concepts of anaphylaxis and epidemiology from electronic bibliographic databases. Discussion This review will aim to provide some estimates of the incidence and prevalence of anaphylaxis in Europe. The occurrence of anaphylaxis can have a profound effect on the quality of life of the sufferer and their family. Estimates of disease frequency will help us to ascertain the burden of anaphylaxis and provide useful comparators for management strategies. PMID:23537345

  16. Evaluation of Advocacy Models.

    ERIC Educational Resources Information Center

    Bradley, Valerie J.

    The paper describes approaches and findings of an evaluation of 10 advocacy projects providing services to developmentally disabled and mentally ill persons across the country. The projects included internal rights protection organizations, independent legal advocacy mechanisms, self-advocacy training centers, and legal advocacy providers in…

  17. Fatal anaphylaxis in the United States 1999-2010: temporal patterns and demographic associations

    PubMed Central

    Jerschow, Elina; Lin, Robert Y.; Scaperotti, Moira M.; McGinn, Aileen P.

    2014-01-01

    Background Anaphylaxis-related deaths in the United States (US) have not been well characterized in recent years. Objectives To define epidemiological features and time trends of fatal anaphylaxis in the US from 1999 to 2010. Methods Anaphylaxis-related deaths were identified by the 10th clinical modification of the International Classification of Diseases (ICD-10) system diagnostic codes on death certificates from the US National Mortality Database. Rates were calculated using census population estimates. Results There were a total of 2,458 anaphylaxis deaths in the US from 1999 to 2010. Medications were the most common cause (58.8%), followed by unspecified anaphylaxis (19.3%), venom (15.2%), and food (6.7%). There was a significant increase in fatal drug anaphylaxis over twelve years: from 0.27 (95%CI: 0.23-0.30) in 1999-2001 to 0.51 (95%CI: 0.47-0.56) per million in 2008-2010, P<0.001. Fatal anaphylaxis due to medications, food, and unspecified allergens was significantly associated with African-American race and older age, P<0.001. Fatal anaphylaxis to venom was significantly associated with White race, older age, and male gender, P<0.001. The rates of fatal anaphylaxis to foods in African-American males increased from 0.06 (95%CI 0.01-0.17) in 1999-2001 to 0.21 (95%CI 0.11-0.37) per million in 2008-2010, P<0.001. The rates of unspecified fatal anaphylaxis decreased overtime from 0.30 (95%CI: 0.26-0.34) in 1999-2001 to 0.09 (95%CI: 0.07-0.11) per million in 2008-2010, P<0.001. Conclusion There are strong and disparate associations between race and specific classes of anaphylaxis mortality in the United States. The increase in medication-related anaphylaxis deaths likely relates to increased medication and radiocontrast use, enhanced diagnosis, and coding changes. PMID:25280385

  18. Anaphylaxis attributed to exercise: considerations for sports medicine specialists.

    PubMed

    Bennett, John R

    2015-02-01

    Anaphylaxis is an unanticipated, acute, and sometimes life-threatening systemic reaction with variable clinical presentations that is typically mediated by immunoglobulin E and causes degranulation of mast cells and basophils. The onset of symptoms can occur within minutes or hours after exposure to a known or suspected trigger, and reactions sometimes progress very rapidly, which can lead to death. One trigger of anaphylaxis in younger adults is moderately intense physical exercise, which has been termed exercise-induced anaphylaxis (EIA). Although rare, EIA should be recognized as a distinct and potentially life-threatening form of physical allergy, and is often undetected or inadequately treated. The ingestion of specific foods, including seafood, tree nuts, and wheat, or a nonspecific meal consisting of multiple food components shortly before or after physical exertion, is sometimes, but not always, the principal precipitant of EIA. This article briefly explores the current hypotheses on the role of immunoglobulin E, response mediators, and physiologic changes that bring on EIA, and discusses the current recommendations for diagnosis, including allergen challenge and laboratory testing, emergency care, and long-term prevention and patient follow-up. Accurate diagnosis of EIA is critical to providing lifesaving therapy and care plans to patients at risk. With respect to the medical management of EIA, mainstay therapy with epinephrine is described. For those with a known history of EIA, a comprehensive anaphylaxis action plan is central to successful patient management. Furthermore, patient education is necessary to heighten awareness of the signs and symptoms of EIA and appropriate strategies for allergen avoidance and self-management of anaphylactic episodes with self-injectable epinephrine.

  19. Food-dependent exercise-induced anaphylaxis due to wheat in a young woman.

    PubMed

    Ahanchian, Hamid; Farid, Reza; Ansari, Elham; Kianifar, Hamid Reza; Jabbari Azad, Farahzad; Jafari, Seyed Ali; Purreza, Reza; Noorizadeh, Shadi

    2013-03-01

    Food Dependent Exercise-Induced Allergy is a rare condition. However, the occurrence of anaphylaxis is increasing especially in young people. The diagnosis of anaphylaxis is based on clinical criteria and can be supported by laboratory tests such as serum tryptase and positive skin test results for specific IgE to potential triggering allergens. Anaphylaxis prevention needs strict avoidance of confirmed relevant allergen. Food-exercise challenge test may be an acceptable method for diagnosis of Food Dependent Exercise-Induced Allergy and dietary elimination of food is recommended to manage it. In this study, a 32 year-old woman visited the allergy clinic with a history of several episodes of hives since 11 years ago and 3 life-threatening attacks of anaphylaxis during the previous 6 months. The onsets of majority of these attacks were due to physical activity after breakfast. On Blood RAST test, the panel of common food Allergens was used and she had positive test only to wheat flour. On skin prick tests for common food allergens she showed a 6 millimeter wheal with 14 mm flare to Wheat Extract. The rest of allergens were negative.The patient was diagnosed as wheat-dependent exercise-induced, and all foods containing wheat were omitted from her diet. In this report we emphasized on the importance of careful history taking in anaphylaxis diagnosis.

  20. [Self-Advocacy.

    ERIC Educational Resources Information Center

    Carr, Theresa, Ed.

    1994-01-01

    This theme issue presents personal perspectives and approaches to self-advocacy from individuals who are deaf-blind. Individual articles are: (1) "Self-Advocacy: Attaining Personal Stature" by Michelle J. Smithdas; (2) "The American Association of the Deaf-Blind: A National Consumer Advocacy Organization" by Jeffrey S. Bohrman; (3) a description…

  1. The syndrome of thyroid autoimmunity and idiopathic chronic urticaria and angioedema presenting as anaphylaxis.

    PubMed

    Dreyfus, David H; Fraser, Barbara; Randolph, Chris C

    2003-01-01

    Previous observations have shown that the syndrome of thyroid autoimmunity and idiopathic urticaria and angioedema (ICUA) can be associated with a marked worsening of reactive airway disease. Possibly, mediators released in this syndrome may contribute to acute bronchospasm and associated respiratory symptoms in some patients. In this study, two patients presenting with overlapping clinical presentations of the syndrome of thyroid immunity and ICUA are described in whom a diagnosis of anaphylaxis to food and antibiotics, respectively, was initially suspected but ruled out by testing and challenges. These cases illustrate clinical overlap between presentations of ICUA and anaphylaxis. We suggest that patients with idiopathic anaphylaxis be evaluated for the presence of antithyroid microsomal (peroxidase) antibodies or antithyroglobulin antibodies, particularly because the diagnosis of thyroid antibody-positive ICUA may suggest additional therapeutic options.

  2. Venom immunotherapy in patients with mastocytosis and hymenoptera venom anaphylaxis.

    PubMed

    González-de-Olano, David; Alvarez-Twose, Iván; Vega, Arantza; Orfao, Alberto; Escribano, Luis

    2011-05-01

    Systemic mastocytosis (SM) is typically suspected in patients with cutaneous mastocytosis (CM). In recent years, the presence of clonal mast cells (MCs) in a subset of patients with systemic symptoms associated with MC activation in the absence of CM has been reported and termed monoclonal MC activation syndromes or clonal systemic MC activation syndromes. In these cases, bone marrow (BM) MC numbers are usually lower than in SM with CM, there are no detectable BM MC aggregates, and serum baseline tryptase is often <20 µg/l; thus, diagnosis of SM in these patients should be based on careful evaluation of other minor WHO criteria for SM in reference centers, where highly sensitive techniques for immunophenotypic analysis and investigation of KIT mutations on fluorescence-activated cell sorter-purified BM MCs are routinely performed. The prevalence of hymenoptera venom anaphylaxis (HVA) among SM patients is higher than among the normal population and it has been reported to be approximately 5%. In SM patients with IgE-mediated HVA, venom immunotherapy is safe and effective and it should be prescribed lifelong. Severe adverse reactions to hymenoptera stings or venom immunotherapy have been associated with increased serum baseline tryptase; however, presence of clonal MC has not been ruled out in most reports and thus both SM and clonal MC activation syndrome might be underdiagnosed in such patients. In fact, clonal BM MC appears to be a relevant risk factor for both HVA and severe reactions to venom immunotherapy, while the increase in serum baseline tryptase by itself should be considered as a powerful surrogate marker for anaphylaxis. The Spanish Network on Mastocytosis has developed a scoring system based on patient gender, the clinical symptoms observed during anaphylaxis and serum baseline tryptase to predict for the presence of both MC clonality and SM among individuals who suffer from anaphylaxis.

  3. Case Fatality and Population Mortality Associated with Anaphylaxis in the United States

    PubMed Central

    Ma, Liyuan (Larry); Danoff, Theodore M.; Borish, Larry

    2013-01-01

    Background Anaphylaxis is a serious allergic reaction that may cause death; however, the actual risk of death is unclear. Objective To estimate the case fatality rate (CFR) among hospitalizations or emergency department (ED) presentations for anaphylaxis and the mortality rate associated with anaphylaxis for the general population. Methods This was a population-based epidemiologic study using 3 national databases: Nationwide Inpatient Sample (NIS, 1999-2009), Nationwide Emergency Department Sample (NEDS, 2006-2009), and Multiple Cause of Death Data (MCDD, 1999-2009). Sources for these databases are hospital, ED discharge records and death certificates, respectively. Results CFRs were between 0.25% and 0.33% among hospitalizations or ED presentations with anaphylaxis as the principal diagnosis (NIS+NEDS, 2006-2009). These rates represent 63 to 99 deaths per year in the United States, approximately 77% of which occurred in hospitalized patients. Rate of anaphylaxis hospitalizations rose from 21.0 to 25.1 per million population between 1999 and 2009 (annual percent change 2.23%; 95% CI: 1.52%–2.94%), contrasting with a declining CFR among hospitalizations (annual percent change –2.35%; 95% CI: –4.98% to 0.34%). Overall mortality rates ranged from 0.63 to 0.76 per million population (186 to 225 deaths per year, MCDD), and appeared stable in the last decade (annual percent change: –0.31%; 95% CI, –1.54% to 0.93%). Conclusion From 2006 to 2009, the overwhelming majority of hospitalizations or ED presentations for anaphylaxis did not result in death, with an average CFR of 0.3%. Anaphylaxis-related hospitalizations rose steadily in the last decade (1999-2009), but this increase was offset by the declining CFR among those hospitalized; both inpatient and overall mortality rates associated with anaphylaxis appeared stable and were well under 1 per million population. Although anaphylactic reactions are potentially life threatening, the probability of dying is

  4. Measuring Local Anaphylaxis in Mice

    PubMed Central

    Evans, Holly; Killoran, Kristin E.; Mitre, Edward

    2014-01-01

    Allergic responses are the result of the activation of mast cells and basophils, and the subsequent release of vasoactive and proinflammatory mediators. Exposure to an allergen in a sensitized individual can result in clinical symptoms that vary from minor erythema to life threatening anaphylaxis. In the laboratory, various animal models have been developed to understand the mechanisms driving allergic responses. Herein, we describe a detailed method for measuring changes in vascular permeability to quantify localized allergic responses. The local anaphylaxis assay was first reported in the 1920s, and has been adapted from the technique published by Kojima et al. in 20071. In this assay, mice sensitized to OVA are challenged in the left ear with vehicle and in the right ear with OVA. This is followed by an intravenous injection of Evans Blue dye. Ten min after injecting Evans Blue, the animal is euthanized and the dye that has extravasated into the ears is extracted overnight in formamide. The absorbance of the extracted dye is then quantified with a spectrophotometer. This method reliably results in a visual and quantifiable manifestation of a local allergic response. PMID:25350839

  5. Mechanisms of Anaphylaxis Beyond IgE.

    PubMed

    Muñoz-Cano, R; Picado, C; Valero, A; Bartra, J

    2016-01-01

    Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators derived from mast cells and basophils. Food allergens are the main triggers of anaphylaxis, accounting for 33%-56% of all cases and up to 81% of cases of anaphylaxis in children. Human anaphylaxis is generally thought to be mediated by IgE, with mast cells and basophils as key players, although alternative mechanisms have been proposed. Neutrophils and macrophages have also been implicated in anaphylactic reactions, as have IgG-dependent, complement, and contact system activation. Not all allergic reactions are anaphylactic, and the presence of the so-called accompanying factors (cofactors or augmenting factors) may explain why some conditions lead to anaphylaxis, while in other cases the allergen elicits a milder reaction or is even tolerated. In the presence of these factors, allergic reactions may be induced at lower doses of allergen or become more severe. Cofactors are reported to be relevant in up to 30% of anaphylactic episodes. Nonsteroidal anti-inflammatory drugs and exercise are the best-documented cofactors, although estrogens, angiotensin-converting enzyme inhibitors, β-blockers, lipid-lowering drugs, and alcohol have also been involved. The mechanisms underlying anaphylaxis are complex and involve several interrelated pathways. Some of these pathways may be key to the development of anaphylaxis, while others may only modulate the severity of the reaction. An understanding of predisposing and augmenting factors could lead to the development of new prophylactic and therapeutic approaches. PMID:27164622

  6. Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods

    PubMed Central

    Mobayed, Hassan M.S.; Ali Al-Nesf, Maryam

    2014-01-01

    Food-dependent exercise-induced anaphylaxis (FDEIA) is one of the severe allergic reactions in which symptoms develop only if exercise takes place within a few hours of eating a specific food. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s). We herein report the first two cases of FDEIA in the Middle East. The first one is induced by wheat, while the other by peanut. The pathophysiology, predisposing factors, diagnosis, and treatment of FDEIA are also summarized here. PMID:24551018

  7. Wheat-dependent exercise-induced anaphylaxis.

    PubMed

    Scherf, K A; Brockow, K; Biedermann, T; Koehler, P; Wieser, H

    2016-01-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare, but potentially severe food allergy exclusively occurring when wheat ingestion is accompanied by augmenting cofactors. It is clinically characterized by anaphylactic reactions ranging from urticaria and angioedema to dyspnoea, hypotension, collapse, and shock. WDEIA usually develops after ingestion of wheat products followed by physical exercise. Other cofactors are acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, alcohol, and infections. The precise mechanisms of WDEIA remain unclear; exercise and other cofactors might increase gastrointestinal allergen permeability and osmolality, redistribute blood flow, or lower the threshold for IgE-mediated mast cell degranulation. Among wheat proteins, ω5-gliadin and high-molecular-weight glutenin subunits have been reported to be the major allergens. In some patients, WDEIA has been discussed to be caused by epicutaneous sensitization with hydrolysed wheat gluten included in cosmetics. Diagnosis is made based on the patient's history in combination with allergy skin testing, determination of wheat-specific IgE serum antibodies, basophil activation test, histamine release test, and/or exercise challenge test. Acute treatment includes application of adrenaline or antihistamines. The most reliable prophylaxis of WDEIA is a gluten-free diet. In less severe cases, a strict limitation of wheat ingestion before exercise and avoidance of other cofactors may be sufficient.

  8. [Anaphylaxis secondary to prick-to-prick tests to foods and its risk factors].

    PubMed

    Galindo-Pacheco, Lucy Vania; O'Farrill-Romanillos, Patricia María; Amaya-Mejía, Adela Sisy; Almeraya-García, Priscilla; López-Rocha, Eunice

    2014-01-01

    The diagnosis of food allergy requires a proper anamnesis and diagnostic testing with skin prick tests with fresh foods and/or standardized allergen, or specific IgE tests. The risk of systemic reactions is of 15-23 per 100,000 skin tests performed by prick method, specifically anaphylaxis at 0.02%. This paper reports the case of four patients, who while performing prick to prick test with fresh food presented anaphylactic reaction. Implicated foods were fruits of the Rosaceae, Anacardiaceae and Caricaceae families. The severity of anaphylaxis was: two patients with grade 4, one patient grade 2 and one grade 3, all with appropriate response to drug treatment. The risk factors identified were: female sex, personal history of atopy, previous systemic reaction to Hymenoptera venom, prior anaphylaxis to prick tests to aeroallergens. We found that a history of positive skin test for Betulla v, can be a risk factor for anaphylaxis in patients with oral syndrome. During testing prick to prick with food anaphylaxis can occur, so it should be made with aerial red team on hand. The history of positivity Betulla v is an additional risk factor in these patients. PMID:24912999

  9. [Anaphylaxis secondary to prick-to-prick tests to foods and its risk factors].

    PubMed

    Galindo-Pacheco, Lucy Vania; O'Farrill-Romanillos, Patricia María; Amaya-Mejía, Adela Sisy; Almeraya-García, Priscilla; López-Rocha, Eunice

    2014-01-01

    The diagnosis of food allergy requires a proper anamnesis and diagnostic testing with skin prick tests with fresh foods and/or standardized allergen, or specific IgE tests. The risk of systemic reactions is of 15-23 per 100,000 skin tests performed by prick method, specifically anaphylaxis at 0.02%. This paper reports the case of four patients, who while performing prick to prick test with fresh food presented anaphylactic reaction. Implicated foods were fruits of the Rosaceae, Anacardiaceae and Caricaceae families. The severity of anaphylaxis was: two patients with grade 4, one patient grade 2 and one grade 3, all with appropriate response to drug treatment. The risk factors identified were: female sex, personal history of atopy, previous systemic reaction to Hymenoptera venom, prior anaphylaxis to prick tests to aeroallergens. We found that a history of positive skin test for Betulla v, can be a risk factor for anaphylaxis in patients with oral syndrome. During testing prick to prick with food anaphylaxis can occur, so it should be made with aerial red team on hand. The history of positivity Betulla v is an additional risk factor in these patients.

  10. Allergy evaluation after emergency treatment: anaphylaxis to the over‐the‐counter medication clobutinol

    PubMed Central

    Seitz, Cornelia S; Bröcker, Eva‐B; Trautmann, Axel

    2007-01-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life‐threatening allergy. Considering the high frequency of clobutinol application, IgE‐mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection‐associated urticaria and angioedema as well as non‐specific summation effects. Accidental re‐exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non‐proprietary and trade names of the culprit drug. PMID:17351213

  11. Allergy evaluation after emergency treatment: anaphylaxis to the over-the-counter medication clobutinol.

    PubMed

    Seitz, Cornelia S; Bröcker, Eva-B; Trautmann, Axel

    2007-03-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life-threatening allergy. Considering the high frequency of clobutinol application, IgE-mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection-associated urticaria and angioedema as well as non-specific summation effects. Accidental re-exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non-proprietary and trade names of the culprit drug.

  12. Allergy evaluation after emergency treatment: anaphylaxis to the over-the-counter medication clobutinol.

    PubMed

    Seitz, Cornelia S; Bröcker, Eva-B; Trautmann, Axel

    2007-03-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life-threatening allergy. Considering the high frequency of clobutinol application, IgE-mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection-associated urticaria and angioedema as well as non-specific summation effects. Accidental re-exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non-proprietary and trade names of the culprit drug. PMID:17351213

  13. A case of anaphylaxis to oral minocycline.

    PubMed

    Jang, Ji Woong; Bae, Yun-Jeong; Kim, Yong Giun; Jin, Young-Joo; Park, Kyung Sun; Cho, You Sook; Moon, Hee-Bom; Kim, Tae-Bum

    2010-08-01

    Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

  14. Fatal food-induced anaphylaxis.

    PubMed

    Yunginger, J W; Sweeney, K G; Sturner, W Q; Giannandrea, L A; Teigland, J D; Bray, M; Benson, P A; York, J A; Biedrzycki, L; Squillace, D L

    1988-09-01

    Fatal food-induced anaphylaxis is rarely reported. In 16 months, we identified seven such cases involving five males and two females, aged 11 to 43 years. All victims were atopic with multiple prior anaphylactic episodes after ingestion of the incriminated food (peanut, four; pecan, one; crab, one; fish, one). In six cases the allergenic food was ingested away from home. Factors contributing to the severity of individual reactions included denial of symptoms, concomitant intake of alcohol, reliance on oral antihistamines alone to treat symptoms, and adrenal suppression by chronic glucocorticoid therapy for coexisting asthma. In no case was epinephrine administered immediately after onset of symptoms. Premortem or postmortem serum samples were available from six victims; in each case elevated levels of IgE antibodies to the incriminated food were demonstrated. Food-sensitive individuals must self-administer epinephrine promptly at the first sign of systemic reaction. Emergency care providers should be aware of cricothyrotomy as a life-saving procedure.

  15. Kinins, airway obstruction, and anaphylaxis.

    PubMed

    Kaplan, Allen P

    2010-01-01

    Anaphylaxis is a term that implies symptoms that are present in many organs, some of which are potentially fatal. The pathogenic process can either be IgE-dependent or non-IgE-dependent; the latter circumstance may be referred to as anaphylactoid. Bradykinin is frequently responsible for the manifestations of IgE-independent reactions. Blood levels may increase because of overproduction; diseases such as the various forms of C1 inhibitor deficiency (hereditary or acquired) or hereditary angioedema with normal C1 inhibitor are examples in this category. Blood levels may also increase because of an abnormality in bradykinin metabolism; the angioedema due to ACE inhibitors is a commonly encountered example. Angioedema due to bradykinin has the potential to cause airway obstruction and asphyxia as well as severe gastrointestinal symptoms simulating an acute abdomen. Formation of bradykinin in plasma is a result of a complex interaction among proteins such as factor XII, prekallikrein, and high molecular weight kininogen (HK) resulting in HK cleavage and liberation of bradykinin. These proteins also assemble along the surface of endothelial cells via zinc-dependent interactions with gC1qR, cytokeratin 1, and u-PAR. Endothelial cell expression (or secretion) of heat-shock protein 90 or prolylcarboxypeptidase can activate the prekallikrein-HK complex to generate bradykinin in the absence of factor XII, however factor XII is then secondarily activated by the kallikrein that results. Bradykinin is destroyed by carboxypeptidase N and angiotensin-converting enzyme. The hypotension associated with IgE-dependent anaphylaxis maybe mediated, in part, by massive proteolytic digestion of HK by kallikreins (tissue or plasma-derived) or other cell-derived kininogenases. PMID:20519882

  16. Anaphylaxis

    MedlinePlus

    ... ins and viewers Order publications Related Links Allergic Diseases Environmental Allergies Food Allergy ​​​​​​ Javascript Error Your browser JavaScript is turned off causing certain features of the NIAID Institute of Allergy and Infectious Diseases web site to work incorrectly. Please visit your ...

  17. [Emergency treatment and management of anaphylaxis].

    PubMed

    Brockow, K; Ring, J

    2013-02-01

    Anaphylaxis, the maximal manifestation of an immediate allergic reaction, is a life-threatening systemic reaction. The immediate therapy is chosen according to the clinical manifestations and new German guidelines are in preparation. Required measures include immediate removal of allergen, adequate positioning, assessment of severity and organ involvement and activation of emergency medical services. In anaphylaxis with primarily cardiovascular involvement, epinephrine is the treatment of choice and given together with volume substitution, oxygen, H(1)-antihistamines and corticosteroids. Obstruction of the airways is treated with intramuscular and inhaled epinephrine, or alternatively β(2)-sympathicomimetics, and oxygen. Abdominal or cutaneous involvement, such as generalized urticaria, usually can be treated with intravenous H(1)-antihistamines, glucocorticoids and surveillance. In patients with anaphylaxis, the elicitor of the reaction has to be diagnosed by allergy testing. Patients with sustained risk for anaphylaxis should receive a self-medication kit and should be educated about behavioral patterns needed for prophylaxis and therapy of anaphylactic reactions. Patient educational intervention increases knowledge about anaphylaxis, and practical competence and thus, is a basis of a successful management of anaphylaxis. PMID:23385622

  18. Anaphylaxis on reperfusion during liver transplantation with coagulopathy.

    PubMed

    Woehlck, Harvey J; Johnson, Christopher P; Roza, Allan M; Gottschall, Jerome L; Brumwell, Melanie; Cronin, David C

    2012-09-01

    We present a case in which anaphylaxis on hepatic reperfusion during liver transplantation presented only with hypotension and coagulopathy. There were no cutaneous manifestations or clinical features distinguishing anaphylaxis from postreperfusion syndrome. The recipient regularly consumed seafood, and the organ donor died of anaphylaxis to shellfish. The trigger for anaphylaxis was postulated to be passive transfer of immunoglobulin to the recipient. Anesthesiologists should be notified of donor factors to anticipate anaphylaxis. In this report, we discuss coagulopathy of anaphylaxis and contrast it with disseminated intravascular coagulation.

  19. A History of Music Education Advocacy.

    ERIC Educational Resources Information Center

    Mark, Michael L.

    2002-01-01

    Provides a history of advocacy in music education discussing when formal advocacy started as well as advocacy with government agencies, the state level, and other types of advocacy. Includes a bibliography of resources related to music advocacy. (CMK)

  20. Community health advocacy

    PubMed Central

    Loue, Sana

    2006-01-01

    Competing health needs of diverse populations and ever shrinking resources available to support these needs often serve as the impetus for the initiation of advocacy efforts to improve community health. However, perceptions of what constitutes a community differ, as do approaches to advocacy itself. This glossary addresses five key questions: (1) What is advocacy?; (2) What is meant by community?; (3) What are the different approaches to community health advocacy?; (4) How are priorities established in the face of competing health advocacy goals?; (5) How can community health advocacy efforts be evaluated?; and (6) What challenges may be encountered in advocating for community health? Each of these issues could serve as the basis for a text on that subject alone. Accordingly, this article is not meant to be comprehensive text on these issues but is, instead, intended to highlight key foundational issues. And, although advocacy efforts can be conducted by individuals, this article focuses specifically on advocacy efforts of communities, however they may be defined and characterised. PMID:16698972

  1. Philosophy + Advocacy = Success

    ERIC Educational Resources Information Center

    Tutt, Kevin; Townley, Marc

    2011-01-01

    Knowledge about music advocacy strategies has long been promoted as important for music educators, not only for the benefit of their individual programs but also for the specific benefit of music students and the general public. This article suggests an approach to advocacy grounded in the teacher's professional beliefs, phrased in terms…

  2. Advocacy and Institutional Racism.

    ERIC Educational Resources Information Center

    Brophy, Michael C.; And Others

    The purpose of this paper is to provide a perspective on advocacy and advocate counseling for participants in the University of Maryland Sixth Annual Community-Clinical Workshop, 1976. It attempts to define relevant terms and outline a method of self-advocacy which can, if utilized properly, lessen the impact of institutional racism. The terms,…

  3. Arts Advocacy Roundtable.

    ERIC Educational Resources Information Center

    Costa, Ann Marie; Green, Sharon; Haedicke, Susan; Mardirosian, Gail Humphries; Martin, Deborah; Schildcrout, Jordan; Spencer, Jenny; Weinberg, Mark

    2001-01-01

    Records discussion of an arts advocacy roundtable began at the August 2000 meeting of the Association for Theatre in Higher Education and continued online. Explains how theatre departments have found themselves defending their very existence in the past decade. Includes discussions of the meaning of arts advocacy; how to incorporate arts advocacy…

  4. Advocacy & Lobbying: Influencing Policy.

    ERIC Educational Resources Information Center

    ASPBAE Courier, 1994

    1994-01-01

    This issue contains nine papers dealing with influencing public policy through advocacy and lobbying. "Influencing Public Policy" (Rajesh Tandon) looks at opportunities nongovernmental organizations (NGOs) have for influencing public policy and constraints to advocacy. "Recent Changes in the Global Aid Environment" (Sunimal Fernando) considers…

  5. Handbook for Rehabilitation Advocacy.

    ERIC Educational Resources Information Center

    National Rehabilitation Association, Alexandria, VA.

    This handbook is intended to help advocates for persons with disabilities organize for advocacy, build effective coalitions, frame key issues, package critical information, and use the media to advance the cause. Individual sections address the following topics: how to change public policy; myths about advocacy; what makes politicians tick;…

  6. The myth of advocacy.

    PubMed

    Stone, A A

    1979-12-01

    In an era in which advocacy has become a buzzword, both psychiatry and the legal profession have climbed aboard the advocacy bandwagon. Yet the American Psychiatric Association's notion of advocacy--championing the medical needs of patients--is often in direct conflict with the lawyers' notion of advocacy--championing the legal rights of their clients. The author observes that psychiatry has proved to be a weak adversary for patients' legal advocates; the result has been a one-sided advocacy system that has advanced patients' rights at the expense of their needs. He believes that if the APA is to become an effective advocate for patients, it must hire lawyers and work with them to reverse the trend of turning rights into needs.

  7. Anaphylaxis in the young adult population.

    PubMed

    Gupta, Ruchi S

    2014-01-01

    It is critical that clinicians treating young adults understand the presentation and management of anaphylaxis. The most common trigger for anaphylaxis in this population is food. The prevalence of food allergy is growing, with 8% of US children and adolescents affected. All patients at risk for anaphylaxis should be prescribed epinephrine autoinjectors, as epinephrine is the only life-saving medication for a severe anaphylactic reaction. The presentation of anaphylaxis can involve multiple organ systems (eg, mucocutaneous, respiratory, cardiovascular, gastrointestinal) and, as such, patient education is needed to assist in prompt recognition. Appropriate training of patients and caregivers about how to identify anaphylaxis and what to do in an emergency is critical. Training of school and college staff also is essential, as 1 in 4 first-time reactions occurs outside the home. Additional counseling for adolescents at risk for anaphylactic reactions should address increased risk-taking behavior, decreased adult supervision, dating, and the transition of disease management from an adult to the patient.

  8. A trust-wide strategy for the management of anaphylaxis.

    PubMed

    Moor, Jackie; Jennison, Neil

    Anaphylaxis is a life-threatening medical emergency. Although it is uncommon, when it does occur prompt recognition and appropriate treatment are essential. This article describes how a multidisciplinary working party review of practices concerning the management of anaphylaxis in an acute hospital trust led to the introduction of standardised anaphylaxis emergency boxes.

  9. Chlorpheniramine-induced anaphylaxis diagnosed by basophil activation test.

    PubMed

    Lee, Hyun-Seung; Song, Woo-Jung; Lee, Ji-Won; Cho, Young-Yoon; Park, Han-Ki; Kang, Min-Gyu; Cho, Sang-Heon; Sohn, Seong-Wook

    2015-07-01

    Chlorpheniramine is a widely prescribed H1-antihistamine for relieving urticaria or histamine-mediated allergic reactions. However, although rare, it may cause immediate hypersensitivity reactions. The diagnosis is usually made by provocation test, but its application is often limited due to comorbidities or potential risk of severe reactions. In those cases, skin tests and basophil activation tests can be considered as additional diagnostic tests for the drug allergy. Here, we report a 33-year-old female with underlying chronic urticaria, who recurrently developed anaphylaxis after chlorpheniramine administration. Intradermal test showed positive responses in the patient at 0.02 mg/mL of chlorpheniramine, but not in healthy controls. Basophil activation test showed significant up-regulation of CD63 and CD203c by chlorpheniramine. The present case reminds the rare but potential allergic risk of chlorpheniramine, and also suggests the potential utility of basophil activation test in making the diagnosis.

  10. Exercise-induced anaphylaxis and antileukotriene montelukast

    PubMed Central

    Gajbhiye, Sapna; Agrawal, Rajendra Prasad; Atal, Shubham; Tiwari, Vikalp; Phadnis, Pradeep

    2015-01-01

    We report a rare case of exercise-induced anaphylaxis (EIA), occurring exclusively with exercise, without any other associated trigger, detected in the prodromal phase, and prevented from additional anaphylaxis episodes by treatment with cetirizine and 10 mg daily of antileukotriene montelukast to date. EIA is a syndrome in which patients experience a spectrum of the symptoms of anaphylaxis ranging from mild cutaneous signs to severe systemic manifestations such as hypotension, syncope, and even death after increased physical activity. Many people have triggers, such as, a variety of foods, various medications, alcohol, cold weather, humidity, and seasonal and hormonal changes along with exercise that cause the symptoms. Typically, either exercise or the specific trigger alone will rarely cause symptoms. It is differentiated from cholinergic urticaria by the absence of response to passive body warming and emotional stress. PMID:26312002

  11. Exercise-induced anaphylaxis and antileukotriene montelukast.

    PubMed

    Gajbhiye, Sapna; Agrawal, Rajendra Prasad; Atal, Shubham; Tiwari, Vikalp; Phadnis, Pradeep

    2015-01-01

    We report a rare case of exercise-induced anaphylaxis (EIA), occurring exclusively with exercise, without any other associated trigger, detected in the prodromal phase, and prevented from additional anaphylaxis episodes by treatment with cetirizine and 10 mg daily of antileukotriene montelukast to date. EIA is a syndrome in which patients experience a spectrum of the symptoms of anaphylaxis ranging from mild cutaneous signs to severe systemic manifestations such as hypotension, syncope, and even death after increased physical activity. Many people have triggers, such as, a variety of foods, various medications, alcohol, cold weather, humidity, and seasonal and hormonal changes along with exercise that cause the symptoms. Typically, either exercise or the specific trigger alone will rarely cause symptoms. It is differentiated from cholinergic urticaria by the absence of response to passive body warming and emotional stress. PMID:26312002

  12. Jackfruit anaphylaxis in a latex allergic patient.

    PubMed

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

    2015-03-01

    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens. PMID:25840636

  13. Jackfruit anaphylaxis in a latex allergic patient.

    PubMed

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

    2015-03-01

    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

  14. Bladder Cancer Advocacy Network

    MedlinePlus

    ... future bladder cancer research through the Patient Survey Network. Read More... The JPB Foundation 2016 Bladder Cancer ... 2016 Young Investigator Awardees The Bladder Cancer Advocacy Network (BCAN) has announced the recipients of the 2016 ...

  15. Advocacy and technology assessment

    NASA Technical Reports Server (NTRS)

    Jones, E. M.

    1975-01-01

    A highly structured treatment is presented of adversarial systems as they apply to technology assessment. One approach to the problem of adequate criteria of assessment focuses upon the internal operations of assessment entities; operations include problem perception, problem formulation, selection, utilization, determination, and evaluation. Potential contributions of advocacy as a mode of inquiry in technology are discussed; advocacy is evaluated by representative sets of criteria of adequate assessment which include participant criteria, perspectives criteria, situations criteria, base values criteria, and strategies criteria.

  16. An unexpected cause of anaphylaxis: potato.

    PubMed

    Eke Gungor, H; Uytun, S; Murat Sahiner, U; Altuner Torun, Y

    2016-07-01

    Immediate reactions against contact to raw potato has been reported in adults with generally being in the form of an oral contact dermatitis or contact urticaria, but it may also manifest as rhinitis symptoms, wheezing or even anaphylaxis. Cooked or raw potato allergy has been rarely reported in children as some is being immediate and others being late reactions, and it usually results from ingestion. Herein, we report two cases with a background of allergic diseases developed anaphylaxis one with cooked potato and the other one with raw potato. PMID:27425172

  17. Anaphylaxis avoidance and management: educating patients and their caregivers

    PubMed Central

    Järvinen, Kirsi M; Celestin, Jocelyn

    2014-01-01

    Anaphylaxis is an increasingly prevalent problem in westernized countries. Therefore, it is of utmost importance that the increasing numbers of patients at risk for anaphylaxis receive proper education on the etiology and risk factors as well as appropriate treatment of anaphylaxis with epinephrine. The physician’s role is crucial in order to educate the patients and care takers on effective measures to prevent anaphylaxis and empower them to take charge of early recognition and proper management of an anaphylactic reaction to prevent poor outcomes. This review summarizes the clinical presentation, triggers, avoidance, and management of anaphylaxis. PMID:25031541

  18. Anaphylaxis presentations to an emergency department in Hong Kong: incidence and predictors of biphasic reactions.

    PubMed

    Smit, De Villiers; Cameron, Peter A; Rainer, Timothy H

    2005-05-01

    We describe the epidemiology, clinical features and management of anaphylaxis in a population in Hong Kong, including the features associated with progression to biphasic reactions and the nature of these reactions. A retrospective review was undertaken of patients of all age groups, presenting consecutively to the resuscitation room of a large Hong Kong emergency department with the diagnosis of anaphylaxis, from March 1999 to February 2003. There were 282 patients included. Median age was 28 years, with 59% male. A precipitant was identified in 89%, with 19% of patients claiming a known allergy to the precipitant. Seafood was responsible for 71% of all food-related reactions. More patients reacted to nonsteroidal anti-inflammatory drugs rather than antibiotics. Cutaneous features were present in 79%, and 12% presented with hypotension. Ninety-five percent received H1 antagonist, and 67% received epinephrine. Biphasic reactions were reported in 15 (5.3%) cases with 20% of these patients having unstable vital signs. The mean time from treatment to onset of biphasic reaction was 8 h (range 1-23). Patients with respiratory features on initial presentation were less likely to develop biphasic reactions. It is concluded that prolonged observation of patients with anaphylaxis is important, because of the risk of biphasic reactions. Better education could prevent recurrent anaphylaxis. PMID:15837017

  19. Wheat-Induced Anaphylaxis in Korean Adults: A Report of 6 Cases

    PubMed Central

    Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Kim, Sae-Hoon

    2013-01-01

    Wheat is a common cause of food allergy. Wheat-induced anaphylaxis (WIA) and wheat-dependent exercise induced anaphylaxis (WDEIA) are severe forms of immunoglobulin E (IgE) mediated allergic reaction to wheat protein. As the diagnosis of WIA or WDEIA is not easy because of the risk of oral challenge, identification of specific IgE of various wheat proteins is helpful for diagnosis. In Korea, there are only a few reports on WIA in adults. We report six cases of WIA diagnosed on the basis of clinical history and specific IgE of wheat proteins or provocation test. For immunologic evaluation of severe wheat allergy including WIA and WDEIA, it is important to measure specific IgE to each component of wheat including gluten and ω-5 gliadin not just measuring wheat-specific IgE. PMID:23429235

  20. Preparedness for Students and Staff with Anaphylaxis

    ERIC Educational Resources Information Center

    Morris, Patty; Baker, Dian; Belot, Carol; Edwards, Audrey

    2011-01-01

    Background: Schools are responsible for handling life-threatening events due to a variety of conditions, including anaphylaxis. California is one of a few states that permits school districts to stock emergency epinephrine auto-injectors and to train unlicensed assistive personnel to administer epinephrine for a life-threatening event. We surveyed…

  1. Anaphylaxis: How Do You Live with It?

    ERIC Educational Resources Information Center

    Mandell, Deena; Curtis, Ruth; Gold, Milton; Hardie, Susan

    2005-01-01

    This article reports on a study of the needs of families coping with life-threatening allergies in a child. Due to the scarcity of publications on the psychosocial dimensions of anaphylaxis, the authors draw on selected literature on family coping with chronic illness, asthma, and allergy to provide a conceptual context for the research and…

  2. Pediatric Anaphylaxis Management in the Prehospital Setting

    PubMed Central

    Arnold, Linda; Cone, David C.; Langhan, Melissa

    2013-01-01

    Purpose Anaphylaxis is a life-threatening systemic allergic reaction that occurs after contact with an allergy-causing substance. Timely administration of intramuscular epinephrine is the treatment of choice for controlling symptoms and decreasing fatalities. Our purpose was to investigate the prehospital management of anaphylaxis among patients receiving care in an urban tertiary care pediatric emergency department (PED). Methods We performed a retrospective chart review from May, 2008 to January, 2010 of patients 18 years or younger who received care in the PED for anaphylaxis. Data were extracted by one investigator and included demographic information, patient symptoms, past medical history, medications administered (including route and provider), and final disposition. Results We reviewed 218 cases of anaphylaxis in 202 children. Mean age of patients was 7.4 years; 56% of patients were male. Two hundred and fourteen (98%) manifested symptoms in the skin/mucosal system, 68% had respiratory symptoms, 44% had gastrointestinal symptoms, and 2% had hypotension. Sixty-seven percent had a previous history of allergic reaction and 38% had a history of asthma. Seventy-six percent of the patients presented with anaphylaxis to food products, 8% to medications, 1% to stings, and 16% to unknown allergens. Reactions occurred at home or with family members 87% of the time, and at school 12% of the time. Only 36% of the patients who met criteria for anaphylaxis had epinephrine administered by emergency medical services (EMS). Among 26 patients with anaphylactic reactions at school, 69% received epinephrine by the school nurse. Of the 117 patients with known allergies who were with their parents at the time of anaphylactic reaction, 41% received epinephrine. Thirteen patients were seen by a physician prior to coming to the PED; all received epinephrine at the physician’s office. In total, epinephrine was given to 41% (89) of the 218 cases prior to coming to the PED

  3. Common Causes of Anaphylaxis in Children: The First Report of Anaphylaxis Registry in Iran

    PubMed Central

    2010-01-01

    Background Anaphylaxis is an acute, systemic, and potentially fatal allergic reaction. Many things can cause anaphylaxis potentially but some agents are more common like some foods (milk, egg, soy, wheat, peanut, tree nut, shellfish, and fish), insect stings, medications, latex, and food-dependent exercise-induced anaphylaxis. The goal of this study is to show the common causes of anaphylaxis among the children with anaphylaxis history who were referred to the Immunology, Asthma and Allergy Research Institute (IAARI) during a 4-year period (2005-2009). Methods and Materials During those 4 years, we registered all children (<14 years old) with a history of anaphylactic reaction. To prove the cause of anaphylaxis, we performed skin prick tests with suspected agents according to their history and measured specific IgE against them by the ImmunoCAP test. Recognition of common allergens was based on having a positive history for 1 allergen and positive skin prick test or specific IgE for that at the same time, or having positive results from both tests when the allergen was unclear. Idiopathic anaphylaxis was a reaction when any known allergen and positive tests were not obtained. Results One hundred ninety-three nonfatal anaphylactic attacks among 63 children were recognized. In total, the most current cause of anaphylaxis in children was food (89.7%). Milk (49.3%) and wheat (26.1%) were the most common. Other foods were egg (8.7%), nuts (2.8%), and spices (2.8%). Six children (8.7%) were sensitive to multiple food allergens like milk, egg, and wheat. Five (7.1%) of 63 patients had anaphylactic attack because of stinging. Wasp was the trigger in 3 (4.3%) of them and honeybee was the cause in 1 (1.4%). The last one was because of unknown hymenoptera. There were 2 idiopathic cases of all 63 patients. Conclusions Food allergens, especially milk and wheat, are the most common cause of anaphylaxis in children. Because anaphylaxis can be fatal, it is advisable to recognize

  4. Social Justice Advocacy: Community Collaboration and Systems Advocacy

    ERIC Educational Resources Information Center

    Lopez-Baez, Sandra I.; Paylo, Matthew J.

    2009-01-01

    This article discusses the community collaboration and systems advocacy domains of the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). A case illustration is presented, and the 8 Advocacy Competencies within each domain are applied to the case study.

  5. About the role and underlying mechanisms of cofactors in anaphylaxis.

    PubMed

    Wölbing, F; Fischer, J; Köberle, M; Kaesler, S; Biedermann, T

    2013-09-01

    Anaphylaxis is the systemic and most severe presentation of type I allergy. A number of conditions were identified that modulate the onset of anaphylaxis such as co- or augmentation factors, which significantly lower the allergen dose necessary for triggering anaphylaxis. Next to physical exercise or alcohol consumption, co-administration of nonsteroidal anti-inflammatory drugs (NSAID) or concomitant infectious diseases are well-documented cofactors of anaphylaxis. Registries for anaphylaxis document a role for cofactors in about 30% of anaphylactic reactions. Some disease entities such as 'wheat-dependent exercise-induced anaphylaxis' (WDEIA) are explicitly characterized by elicitation of anaphylaxis only in the presence of at least one such cofactor. Using WDEIA as a model disease, studies demonstrated that exercise increases skin prick test reactivity to and bioavailability of the allergen. Additional data indicate that alcohol consumption and NSAID administration display similar effects. Modulation of the cellular activation threshold is another mechanism underlying cofactor-induced anaphylaxis, most likely also functional when infectious diseases orchestrate elicitation of anaphylaxis. Cofactors are increasingly accepted to play a fundamental role in eliciting anaphylaxis. Consequently, to improve patient management modalities, a better understanding of the underlying mechanisms is warranted. This review aims to update clinicians and clinical scientists on recent developments.

  6. Anaphylaxis to muscle relaxants: rational for skin tests.

    PubMed

    Moneret-Vautrin, D A; Kanny, G

    2002-09-01

    IgE-dependent allergy to muscle relaxants (MR) has an estimated prevalence of 1 out of 6500 General Anesthesias (GA). 62% of anaphylaxis during surgery are due to MR anaphylaxis. All the molecules are divalent, carrying two NH4+ epitopes (quaternary ammonium ions), either structurally or after rapid in vivo protonization (vecuronium). The excellent overall performance of skin test makes them the golden standard for the diagnosis of anaphylactoid reactions. Techniques include intradermal tests and prick-tests. The current localizations are the forearm and the back. Positivity criteria are 3 mm for prick-tests. For IDTs, the criterium is the doubling of the size of the injection papula, when 0.02 to 0.04 ml is injected: 8 mm. The recommended concentrations are not falsely negative. Commercial concentrations can be tested by prick tests, except for mivacurium and atracurium tested of 1:10 dilution. A scale of concentrations is advised for IDT starting with 1:10,000, up to a normally non reactive concentration that is: 100 micrograms/ml (succinylcholine), 200 micrograms/ml (gallamine), 10 micrograms/ml (atracurium), 2 micrograms/ml (mivacurium), 200 micrograms/ml (pancuronium), 400 micrograms/ml (vecuronium), 1,000 micrograms/ml (rocuronium), 200 micrograms/ml (cis atracurium). The specificity and sensitivity of the skin tests to MRs are greater than 95%. The reproducibility over years is 88%. The overall concordance of PT and IDR is 97%. Both types of tests can be used for the diagnosis. IDT have to be carried out for the search of the cross sensitization. 84% of patients do have cross sensitization to MRs but only 16% react to all MRs. The further use of MRs selected by negative IDTs has been proved to be safe.

  7. Anaphylaxis related to avocado ingestion: a case and review

    PubMed Central

    2011-01-01

    Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex. PMID:21663642

  8. Public health and media advocacy.

    PubMed

    Dorfman, Lori; Krasnow, Ingrid Daffner

    2014-01-01

    Media advocacy blends communications, science, politics, and advocacy to advance public health goals. In this article, we explain how media advocacy supports the social justice grounding of public health while addressing public health's "wicked problems" in the context of American politics. We outline media advocacy's theoretical foundations in agenda setting and framing and describe its practical application, from the layers of strategy to storytelling, which can illuminate public health solutions for journalists, policy makers, and the general public. Finally, we describe the challenges in evaluating media advocacy campaigns.

  9. Advocacy for eye care

    PubMed Central

    Ravilla, Thulasiraj D; Ramasamy, Dhivya

    2012-01-01

    The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services – such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support – either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy. PMID:22944745

  10. Acute treatment of anaphylaxis in children

    PubMed Central

    Goldman, Ran D.

    2013-01-01

    Abstract Question A 3-year-old was rushed to my office after eating a friend’s chocolate bar that contained nuts. He immediately developed urticaria on his face and swelling of his lips, and he had a persistent cough. What is the best treatment for a child with anaphylaxis? Should this family receive a prescription for an epinephrine autoinjector device? Answer Intramuscular epinephrine injection is a safe and effective treatment of anaphylaxis in children. Children with systemic allergic reactions should carry epinephrine autoinjectors at all times, and should certainly have one with them at school. In order for epinephrine autoinjectors to be effective, children and their families need to be educated on how to properly use the devices, as well as keep in mind the product’s expiration date. PMID:23851537

  11. Hypothesis: Hemolytic Transfusion Reactions Represent an Alternative Type of Anaphylaxis

    PubMed Central

    Hod, Eldad A.; Sokol, Set A.; Zimring, James C.; Spitalnik, Steven L.

    2009-01-01

    Classical anaphylaxis is the most severe, and potentially fatal, type of allergic reaction, manifested by hypotension, bronchoconstriction, and vascular permeability. Similarly, a hemolytic transfusion reaction (HTR) is the most feared consequence of blood transfusion. Evidence for the existence of an alternative, IgG-mediated pathway of anaphylaxis may be relevant for explaining the pathophysiology of IgG-mediated-HTRs. The purpose of this review is to summarize the evidence for this alternative pathway of anaphylaxis and to present the hypothesis that an IgG-mediated HTR is one example of this type of anaphylaxis. PMID:18830382

  12. A case of trimebutine-induced anaphylaxis.

    PubMed

    Lee, Suh-Young; Kim, Mi-Yeong; Kang, Sung-Yoon; Song, Woo-Jung; Kang, Hye-Ryun

    2011-12-01

    Trimebutine maleate [2-dimethylamino-2-phenylbutyl 3,4,5-trimethoxybenzoic acid] has been demonstrated to be active for relieving abdominal pain and it is widely used for patients with irritable bowel syndrome. Adverse drug reactions are mostly mild and well-tolerated. To our knowledge, only two cases of trimebutine induced hypersensitivity have been reported, and both were delayed type reactions. Here, we report the first case of trimebutine maleate-induced anaphylaxis. PMID:22113162

  13. [A case of anaphylaxis caused by abalone diagosed with prick by prick test].

    PubMed

    Suzuki, Shintaro; Nakamura, Yoichi; Nishioka, Kiyoshi; Adachi, Mitsuru

    2007-06-01

    A 30-year-old man exhibited systemic edema, dyspnea and wheal immediately after eating raw fish and cuttlefish served on an abalone shell. He had history of anaphylaxis after eating abalone and beef 4 years ago and had avoided shellfish including abalone since then. He also had past history of bronchial asthma and anaphylaxis due to shrimp. CAP-FEIA was performed to determine the allergen and was positive for scallop and oyster. Refined extracts made from abalone are not commercially available in Japan. Therefore, we purchased several kinds of shellfish, which are commonly consumed by Japanese, and used them, as is, for skin testing. Prick-by-prick tests were conduced using these shellfish, and yielded positive results for abalone and effluent from washing the abalone shell. Consequently, he was diagnosed with anaphylaxis caused by abalone extracts attached to the surface of raw fish. In our case, prick-by-prick test with shellfish was useful for the diagnosis of type I food allergy. If there are no commercial reagents of suspected food allergens for skin testing or challenge-test is not available, prick-by-prick tests might be performed for the diagnosis of food allergy.

  14. Anaphylaxis to topically applied sodium fusidate.

    PubMed

    Park, Mi-Ran; Kim, Do-Soo; Kim, Jihyun; Ahn, Kangmo

    2013-03-01

    Fusidic acid is a bacteriostatic antibiotic that is effective primarily on gram-positive bacteria, such as Staphylococcus and Corynebacterium species. It is often topically applied to the skin, but is also given systemically as a tablet or injection. Allergic contact dermatitis, or urticaria, has been reported as a side effect of fusidic acid treatment, whereas anaphylaxis to topically administered fusidic acid has not been reported previously. A 16-year-old boy visited an outpatient clinic for further evaluation of anaphylaxis. He suffered abrasions on his arms during exercise, which were treated with a topical ointment containing sodium fusidate. Within 30 minutes, he developed urticaria and eyelid swelling, followed by a cough and respiratory difficulty. His symptoms were relieved by emergency treatment in a nearby hospital. To investigate the etiology, oral provocation with fusidate was performed. After 125 mg (1/2 tablet) of sodium fusidate was administered, he developed a cough and itching of the throat within 30 minutes, which was followed by chest discomfort and urticaria. Forced expiratory volume in 1 second (FEV1) dropped from 4.09 L at baseline to 3.50 L after challenge, although wheezing was not heard in his chest. After management with an inhaled bronchodilator using a nebulizer, chest discomfort was relieved and FEV1 rose to 3.86 L. The patient was directed not to use fusidate, especially on abrasions. Here we report the first case of anaphylaxis resulting from topical fusidic acid application to abrasions. PMID:23450038

  15. Systemic mastocytosis presenting as intraoperative anaphylaxis with atypical features: a report of two cases.

    PubMed

    Bridgman, D E; Clarke, R; Sadleir, P H M; Stedmon, J J; Platt, P

    2013-01-01

    Two cases of perioperative cardiovascular collapse are presented that were associated with markedly elevated mast cell tryptase levels shortly after the event, leading to the assumption that an immunoglobin E-mediated, drug-induced anaphylaxis had occurred. However, the clinical picture in both cases was atypical and subsequent skin testing failed to identify a triggering drug. Further blood tests, some weeks later, revealed persistently elevated baseline levels of mast cell tryptase. In both cases bone marrow biopsy and genetic testing confirmed the diagnosis of mastocytosis. We present evidence and speculate that mast cell degranulation was triggered by tourniquet release in the first case and by exposure to peanuts in the second. An atypical presentation of anaphylaxis should alert the anaesthetist to the possibility of previously undiagnosed mastocytosis. PMID:23362901

  16. Galactose-α-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children

    PubMed Central

    Kennedy, Joshua L.; Stallings, Amy P.; Platts-Mills, Thomas A.E.; Oliveira, Walter M.; Workman, Lisa; James, Haley R.; Tripathi, Anubha; Lane, Charles J.; Matos, Luis; Heymann, Peter W.

    2013-01-01

    BACKGROUND AND OBJECTIVE: Despite a thorough history and comprehensive testing, many children who present with recurrent symptoms consistent with allergic reactions elude diagnosis. Recent research has identified a novel cause for “idiopathic” allergic reactions; immunoglobulin E (IgE) antibody specific for the carbohydrate galactose-α-1,3-galactose (α-Gal) has been associated with delayed urticaria and anaphylaxis that occurs 3 to 6 hours after eating beef, pork, or lamb. We sought to determine whether IgE antibody to α-Gal was present in sera of pediatric patients who reported idiopathic anaphylaxis or urticaria. METHODS: Patients aged 4 to 17 were enrolled in an institutional review board–approved protocol at the University of Virginia and private practice allergy offices in Lynchburg, VA. Sera was obtained and analyzed by ImmunoCAP for total IgE and specific IgE to α-Gal, beef, pork, cat epithelium and dander, Fel d 1, dog dander, and milk. RESULTS: Forty-five pediatric patients were identified who had both clinical histories supporting delayed anaphylaxis or urticaria to mammalian meat and IgE antibody specific for α-Gal. In addition, most of these cases had a history of tick bites within the past year, which itched and persisted. CONCLUSIONS: A novel form of anaphylaxis and urticaria that occurs 3 to 6 hours after eating mammalian meat is not uncommon among children in our area. Identification of these cases may not be straightforward and diagnosis is best confirmed by specific testing, which should certainly be considered for children living in the area where the Lone Star tick is common. PMID:23569097

  17. Implementation of Anaphylaxis Management Guidelines: A Register-Based Study

    PubMed Central

    Grabenhenrich, Linus; Hompes, Stephanie; Gough, Hannah; Ruëff, Franziska; Scherer, Kathrin; Pföhler, Claudia; Treudler, Regina; Mahler, Vera; Hawranek, Thomas; Nemat, Katja; Koehli, Alice; Keil, Thomas; Worm, Margitta

    2012-01-01

    Background Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. Methods Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. Results 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. Conclusion There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted. PMID:22590513

  18. A case of anaphylaxis apparently induced by sugammadex and rocuronium in successive surgeries.

    PubMed

    Yamada, Yuko; Yamamoto, Takuji; Tanabe, Kumiko; Fukuoka, Naokazu; Takenaka, Motoyasu; Iida, Hiroki

    2016-08-01

    Rocuronium is the agent most frequently involved in perioperative anaphylaxis, and sugammadex has also been known to induce anaphylactic reactions. We describe a case of successive anaphylactic episodes that seemed to be induced by clinical doses of rocuronium and sugammadex. The patient was a 19-year-old woman who had a medical history of asthma, but no history of surgery. She had been injured in a fall, and several surgeries were scheduled for multiple bone fractures. At the first surgery under general anesthesia, she developed anaphylaxis 5 min after sugammadex administration. A second general anesthesia for treatment of calcaneal fracture was induced uneventfully without neuromuscular blockade after 10 days. A third general anesthesia was scheduled to reinforce the spinal column 12 days after the first surgery. She developed anaphylaxis 8 min after rocuronium administration. The level of plasma histamine was elevated, but serum tryptase level remained normal. This surgery was canceled and rescheduled without use of a neuromuscular blockade. Skin tests were performed in a later investigation. The patient showed positive results on intradermal tests for sugammadex and rocuronium, supporting a diagnosis of allergic reactions to both drugs. Clinicians must be aware that anaphylactic reactions can be induced by both sugammadex and rocuronium. PMID:27290941

  19. Proposed new mechanism for food and exercise induced anaphylaxis based on case studies

    PubMed Central

    2013-01-01

    We present two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients’ allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. We review the current proposed mechanisms for food and exercise induced anaphylaxis to oral allergens and propose a novel and more biologically plausible mechanism. We hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants. PMID:23509907

  20. A Simple Allergist-Led Intervention Improves Resident Training in Anaphylaxis

    PubMed Central

    Jongco, Artemio M.; Bina, Sheila; Sporter, Robert J.; Cavuoto Petrizzo, Marie A.; Kaplan, Blanka; Kline, Myriam; Schuval, Susan J.

    2016-01-01

    Physicians underrecognize and undertreat anaphylaxis. Effective interventions are needed to improve physician knowledge and competency regarding evidence-based anaphylaxis diagnosis and management (ADAM). We designed and evaluated an educational program to improve ADAM in pediatrics, internal medicine, and emergency medicine residents from two academic medical centers. Anonymous questionnaires queried participants' demographics, prior ADAM clinical experience, competency, and comfort. A pretest assessing baseline knowledge preceded a 45-minute allergist-led evidence-based presentation, including practice with epinephrine autoinjectors, immediately followed by a posttest. A follow-up test assessed long-term knowledge retention twelve weeks later. 159 residents participated in the pretest, 152 participated in the posttest, and 86 participated in the follow-up test. There were no significant differences by specialty or site. With a possible score of 10, the mean pretest score (7.31 ± 1.50) was lower than the posttest score (8.79 ± 1.29) and follow-up score (8.17 ± 1.72) (P < 0.001 for both). Although participants' perceived confidence in diagnosing or managing anaphylaxis improved from baseline to follow-up (P < 0.001 for both), participants' self-reported clinical experience with ADAM or autoinjector use was unchanged. Allergist-led face-to-face educational intervention improves residents' short-term knowledge and perceived confidence in ADAM. Limited clinical experience or reinforcement contributes to the observed decreased knowledge. PMID:26997960

  1. Anaphylaxis in an emergency department: a 2-year study in a tertiary-care hospital.

    PubMed

    Piromrat, Kanika; Chinratanapisit, Sasawan; Trathong, Sommai

    2008-01-01

    The aim of this study was to estimate the incidence of anaphylaxis in the emergency department of a tertiary-care hospital, describe the clinical features and the management of the patients and determine those with mild manifestations. A retrospective study was conducted from 2005 to 2006 using anaphylaxis-related ICD-10 terms. Two different sets of criteria for the diagnosis of anaphylaxis were applied, first the criteria previously accepted by emergency practice, followed by the recent criteria set forth at the 2005 international meeting. Sixty-four patients fulfilled the previous criteria with an average incidence of 52.5 per 100,000 patients per year with a shift towards females in 2006. The most common presentations were cutaneous, followed by respiratory symptoms. Food allergy was the most common cause, especially prawn. After applying the recent criteria, 13 patients (20.4%) were excluded, which reduced the incidence to 42.2 per 100,000 patients per year. Long term follow up is suggested for the possible or mild cases that were re-categorized.

  2. A case of anaphylaxis to peppermint

    PubMed Central

    2014-01-01

    Background Anaphylaxis, a form of IgE mediated hypersensitivity, arises when mast cells and possibly basophils are provoked to secrete mediators with potent vasoactive and smooth muscle contractile activities that evoke a systemic response. We report a case of IgE mediated anaphylaxis to peppermint (Mentha piperita) in a male shortly after sucking on a candy. Case presentation A 69 year old male developed sudden onset of lip and tongue swelling, throat tightness and shortness of breath within five minutes of sucking on a peppermint candy. He denied lightheadedness, weakness, nausea, vomiting, or urticaria. He took 25 mg of diphenhydramine, but his symptoms progressed to onset of cough, wheeze and difficulty with talking and swallowing. He was rushed to the nearest emergency department, where he was treated with intramuscular epinephrine, antihistamines and steroids. On history, he reported recent onset of mouth itchiness and mild tongue and lip swelling after using Colgate peppermint toothpaste. He denied previous history of asthma, allergic rhinitis, food or drug allergies. His past medical history was remarkable for hypercholesterolemia, gastroesophageal reflux and gout. He was on simvastatin, omeprazole, aspirin, and was carrying a self-injectable epinephrine device. He moved to current residence three years ago and cultivated mint plants in his backyard. He admitted to develop nasal congestion, cough and wheeze when gardening. Physical examination was unremarkable apart from slightly swollen pale inferior turbinates. Skin prick test (SPT) was strongly positive to a slurry of peppermint candy and fresh peppermint leaf, with appropriate controls. Same tests performed on five healthy volunteers yielded negative results. Skin testing to common inhalants including molds and main allergenic foods was positive to dust mites. Strict avoidance of mint containing items was advised. Upon reassessment, he had removed mint plants from his garden which led to resolution of

  3. Patient's perspective and public policy regarding anaphylaxis.

    PubMed

    Muñoz-Furlong, Anne

    2004-01-01

    It is estimated that dose to 7 million Americans have food allergy. The incidence of food allergy, particularly peanut allergy, is believed to be on the rise. Several studies have shown that in spite of a patient's best efforts to avoid ingesting the allergy-causing food, reactions will occur. These reactions occur from incorrect ingredient information in food service or restaurant settings, incorrect product labels, or mistakes in label reading. In the hospital setting, patients are sometimes treated for an anaphylactic reaction in the emergency room but are not given instructions to see a specialist to determine the cause of their reaction, nor are they given a prescription for epinephrine to arm them to treat future allergic emergencies. Two studies of fatal and near fatal allergic reactions concluded that a delay in administration of epinephrine could have been a factor in the fatal outcomes. However, schools often do not have written emergency action plans in place for children with documented food allergy, and patients and caregivers often report not knowing when to use the epinephrine kit or how to use it. Until there is a cure for food allergy and anaphylaxis, avoidance of the allergen is key. There is much work to be done in education and public policy regarding anaphylaxis.

  4. A review of perioperative anaphylaxis at a Singapore tertiary hospital

    PubMed Central

    Chen, Xuanxuan; Thong, Sze Ying; Chong, Yong Yeow; Ng, Shin Yi

    2016-01-01

    INTRODUCTION Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution. METHODS We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012. RESULTS After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients. CONCLUSION To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis. PMID:26996282

  5. Anaphylaxis: a history with emphasis on food allergy

    PubMed Central

    Boden, Stephen R.; Burks, A. Wesley

    2011-01-01

    Summary In the century since Paul Portier and Charles Richet described their landmark findings of severe fatal reactions in dogs re-exposed to venom after vaccination with sea anemone venom, treatment for anaphylaxis continues to evolve. The incidence of anaphylaxis continues to be difficult to measure. Underreporting due to patients not seeking medical care as well as failure to identify anaphylaxis affects our understanding of the magnitude of the disease. Treatment with intramuscular epinephrine continues to be the recommended first line therapy although studies indicate that education of both the patients and the medical community is needed. Adverse food reactions continue to be the leading cause of anaphylaxis presenting for emergency care. Current therapy for food-induced anaphylaxis is built on the foundation of strict dietary avoidance, rapid access to injectable epinephrine, and education to recognize signs and symptoms of anaphylaxis. Investigation into therapy with oral and sublingual immunotherapy as well as other modalities holds hope for improved treatment of food-induced anaphylaxis. PMID:21682750

  6. [Management of anaphylaxis : part 2: treatment and emergency equipment].

    PubMed

    Klimek, L; Goebel, U; Glowania, A

    2012-12-01

    Anaphylaxis is an extreme form of allergic reaction that can be life-threatening. Early treatment of circulatory and pulmonary disturbances is decisive for prognosis. Initial management of anaphylaxis comprises, where possible, interrupting allergen exposure; ensuring a stable airway; summoning emergency services; placing the patient in a safe position, obtaining venous access and monitoring vital signs. Adrenaline, histamine-antagonists and glucocorticoids have proven effective, as has administration of oxygen and volume substitutes. Many anaphylaxis patients are unable to successfully avoid the elicitor and the feasibility of self-treatment is limited if the patient is inadequately informed. An educational program for adult patients and parents of children with a high risk of anaphylaxis has been developed by the German Working Group for Anaphylaxis Training and Education (AGATE). This program aims to help prevent anaphylactic attacks, foster optimal first-line treatment and offer psychological and social support for anaphylaxis patients. Preliminary results confirm the efficacy of the AGATE approach. This article presents an overview of the stage-wise management of anaphylaxis in accordance with the S2 position paper of the German allergological societies and international guidelines. PMID:23202869

  7. [Management of anaphylaxis : part 2: treatment and emergency equipment].

    PubMed

    Klimek, L; Goebel, U; Glowania, A

    2012-12-01

    Anaphylaxis is an extreme form of allergic reaction that can be life-threatening. Early treatment of circulatory and pulmonary disturbances is decisive for prognosis. Initial management of anaphylaxis comprises, where possible, interrupting allergen exposure; ensuring a stable airway; summoning emergency services; placing the patient in a safe position, obtaining venous access and monitoring vital signs. Adrenaline, histamine-antagonists and glucocorticoids have proven effective, as has administration of oxygen and volume substitutes. Many anaphylaxis patients are unable to successfully avoid the elicitor and the feasibility of self-treatment is limited if the patient is inadequately informed. An educational program for adult patients and parents of children with a high risk of anaphylaxis has been developed by the German Working Group for Anaphylaxis Training and Education (AGATE). This program aims to help prevent anaphylactic attacks, foster optimal first-line treatment and offer psychological and social support for anaphylaxis patients. Preliminary results confirm the efficacy of the AGATE approach. This article presents an overview of the stage-wise management of anaphylaxis in accordance with the S2 position paper of the German allergological societies and international guidelines.

  8. Food-induced anaphylaxis: who, what, why, and where?

    PubMed

    Shah, Ekta; Pongracic, Jacqueline

    2008-08-01

    Food-induced anaphylaxis is a leading cause of anaphylaxis treated in emergency departments and hospitals around the world. Peanuts, tree nuts, fish, and shellfish are the most commonly implicated foods. Food-induced anaphylaxis may occur in any age group and with any food. However, food-induced anaphylaxis fatalities disproportionately affect adolescents and young adults with peanut and tree nut allergy. Individuals who have both IgE-mediated food allergy and asthma are at a higher risk for food-induced anaphylaxis fatality. Delayed administration of epinephrine is also associated with fatal outcome. Often, in fatal reactions, the food allergen is unknowingly ingested away from home, in settings such as restaurants and schools. Although avoidance of food allergens is critical, timely administration of epinephrine is also of great importance in the treatment of food-induced anaphylaxis. Patients, families, and caregivers must be well educated regarding the signs, symptoms and risk factors for anaphylaxis. They must also be counseled on the importance of strict food avoidance of the implicated food allergens, compliance with having self-injectable epinephrine available at all times, and the importance of timely administration of epinephrine, even when cutaneous symptoms are lacking.

  9. Media Advocacy. Technical Assistance Packet.

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

    Media advocacy is an environmental strategy that can be used to support alcohol and other drug prevention and policy development efforts. It helps shift the focus from understanding public health issues as individual problems to understanding them as social conditions that require collective behavior changes. Successful media advocacy uses the…

  10. Anaphylaxis cases presenting to primary care paramedics in Quebec.

    PubMed

    Kimchi, Nofar; Clarke, Ann; Moisan, Jocelyn; Lachaine, Colette; La Vieille, Sebastien; Asai, Yuka; Joseph, Lawrence; Mill, Chris; Ben-Shoshan, Moshe

    2015-12-01

    Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom-induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger. PMID:26734462

  11. Severe allergic reaction: management of anaphylaxis in hospital.

    PubMed

    Jevon, Phil

    Anaphylaxis is an acute, severe, hypersensitivity reaction that can lead to asphyxia, cardiovascular collapse and cardiac arrest. This reaction is sudden, severe, and involves the whole body. Common causes include foods such as nuts, shellfish, dairy products and eggs. Non-food causes include bee/wasp stings, latex and drugs, e.g. penicillin. Common clinical features include urticaria, angioedema, respiratory distress and shock. Summoning expert help, reclining the patient flat, administering high concentration oxygen, and administering intramuscular adrenaline are key aspects of the nursing management of anaphylaxis in hospital. The aim of this article is to understand the management of anaphylaxis in hospital, with particular reference to national consensus guidelines.

  12. [Fatal anaphylaxis after eating wild boar meat in a patient with pork-cat syndrome].

    PubMed

    Drouet, M; Sabbah, A; Le Sellin, J; Bonneau, J C; Gay, G; Dubois-Gosnet, C

    2001-04-01

    Crossed allergy between pork and cat epithelia was described by us in 1994. It is due to serum albumin. Nowadays, other bio-chemical observations allow "completion" of the syndrome by extension of the crossed reactivity between other mammal meats and other epithelia of dog and horse. The authors report an observation of the pork-cat syndrome (developing in the form of anaphylaxis, and then ending in the death of the patient), following consumption of wild boar meat. Co-factors, such as effort, taking alcohol or hormonal condition may complicate the picture to make diagnosis more difficult.

  13. Food allergy and anaphylaxis in pediatrics: update 2010-2012.

    PubMed

    Santos, Alexandra F; Lack, Gideon

    2012-12-01

    This review highlights the progress made in food allergy (FA) and anaphylaxis research in pediatrics published in the journal Pediatric Allergy and Immunology since 2010. Putative risk factors for FA are as follows: a family history of allergic disease, particularly in the mother, low birth order, season of birth, and severe atopic eczema. Obstetric practices, antibiotic use, and home environment are factors deserving further research. Diagnostic decision levels and component-specific IgE are useful in the diagnosis of FA; however, oral food challenges remain the gold standard and may also be a means to reduce parental anxiety and to improve education. Oral immunotherapy studies show promise in increasing the threshold of reactivity of allergic patients and therefore improving their quality of life. In single-nut-allergic patients, introduction of other nuts allows broadening the diet and thus reducing the psychological impact of allergen avoidance. Nutritional deficiencies are not uncommon in food-allergic children and should be specifically assessed. The prescription of injectable adrenaline is still insufficient and not consistent among practitioners, requiring improved training and implementation of guidelines. Current research into the epidemiology and immunological mechanisms of FA and tolerance will enable us to devise strategies to both prevent and treat food allergies.

  14. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2012.

    PubMed

    Sicherer, Scott H; Leung, Donald Y M

    2013-01-01

    This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2012. Studies support an increase in peanut allergy prevalence in children and exposure to the antibacterial agent triclosan and having filaggrin (FLG) loss-of-function mutations as risk factors for food sensitization. The role of specific foods in causing eosinophilic esophagitis is elucidated by several studies, and microRNA analysis is identified as a possible noninvasive disease biomarker. Studies on food allergy diagnosis emphasize the utility of component testing and the possibility of improved diagnosis through stepped approaches, epitope-binding analysis, and bioinformatics. Treatment studies of food allergy show promise for oral immunotherapy, but tolerance induction remains elusive, and additional therapies are under study. Studies on anaphylaxis suggest an important role for platelet-activating factor and its relationship to the need for prompt treatment with epinephrine. Insights on the pathophysiology and diagnosis of non-IgE-mediated drug allergy are offered, with novel data regarding the interaction of drugs with HLA molecules. Numerous studies support influenza vaccination of persons with egg allergy using modest precautions. Evidence continues to mount that there is cross-talk between skin barrier defects and immune responses in patients with atopic dermatitis. Augmentation of the skin barrier with reduction in skin inflammatory responses will likely lead to the most effective intervention in patients with this common skin disease.

  15. Occurrence of multiphasic anaphylaxis during a transcontinental air flight.

    PubMed

    Brady, W J; Bright, H L

    1999-11-01

    Anaphylaxis, a multisystem allergic reaction, represents a true medical emergency. Anaphylaxis is characterized by a combination of the following: urticaria, angioedema, distributive shock, and respiratory failure. Most often, the patient is rapidly treated with prompt resolution of the anaphylaxis in either the out-of-hospital or emergency department (ED) setting. Infrequently, recurrent, or multiphasic, anaphylaxis is encountered, involving a reappearance of allergic phenomena after complete resolution of the original reaction. Recurrence may involve nuisance-level issues such as urticaria; alternatively, multiphasic reactions may be characterized by cardiovascular collapse and/or respiratory compromise. Initially aggressive pharmacological therapy followed by prolonged observation in either the ED or the in-hospital setting is strongly recommended to monitor for potential recurrence.

  16. Long-term Effectiveness of Online Anaphylaxis Education for Pharmacists

    PubMed Central

    Vale, Sandra; Sanfilippo, Frank M; Loh, Richard; Clifford, Rhonda M

    2014-01-01

    Objective. To evaluate the long-term effectiveness of an Australasian Society of Clinical Immunology and Allergy (ASCIA) anaphylaxis e-learning program compared to lectures or no training. Design. A controlled interrupted-time-series study of Australian pharmacists and pharmacy students who completed ASCIA anaphylaxis e-learning or lecture programs was conducted during 2011-2013. Effectiveness was measured using a validated test administered pretraining, posttraining, and 3 and 7 months after training. Assessment. All learning groups performed significantly better on all posttests compared to the pretest, and compared to a control group (p<0.001). The proportion of e-learners achieving the minimum standard for anaphylaxis knowledge improved from 45% at pretest to 87% at 7 months. Conclusion. The ASCIA e-learning program significantly increased anaphylaxis knowledge. The high proportion of participants achieving the minimum standard at 7 months indicates long-term knowledge change. PMID:25258441

  17. Anaphylaxis to annatto dye: a case report.

    PubMed

    Nish, W A; Whisman, B A; Goetz, D W; Ramirez, D A

    1991-02-01

    Annatto dye is an orange-yellow food coloring extracted from the seeds of the tree Bixa orellana. It is commonly used in cheeses, snack foods, beverages, and cereals. Previously reported adverse reactions associated with annatto dye have included urticaria and angioedema. We present a patient who developed urticaria, angioedema, and severe hypotension within 20 minutes following ingestion of milk and Fiber One cereal, which contained annatto dye. Subsequent skin tests to milk, wheat, and corn were negative. The patient had a strong positive skin test to annatto dye, while controls had no response. The nondialyzable fraction of annatto dye on SDS-PAGE demonstrated two protein staining bands in the range of 50 kD. Immunoblotting demonstrated patient IgE-specific for one of these bands, while controls showed no binding. Annatto dye may contain contaminating or residual seed proteins to which our patient developed IgE hypersensitivity. Annatto dye is a potential rare cause of anaphylaxis. PMID:1994783

  18. [Intraoperative anaphylaxis caused by latex surgical gloves].

    PubMed

    Tomita, S; Sugawara, K; Tamakawa, S; Saitoh, Y

    1998-02-01

    A 17-year-old male encountered anaphylaxis caused by latex surgical gloves during emergency surgery under general anesthesia. He had undergone multiple surgical procedures, bladder catheterization and was suffering from atopic dermatitis. The patient developed bronchospasm and circulatory collapse 20 minutes after the start of surgery. Administration of dopamine, aminophylline and methylprednisolone helped to normalize airway pressure and blood pressure. Latex allergy occurs in persons considered at high risk including patient with spina bifida, urogenital abnormalities, atopic dermatitis, health care workers and rubber industry workers. These persons may develop hypersensitivity to latex products. If patients who are suspected to be latex allergy undergo surgical procedures, anesthesiologist should check past history and sensitivity to rubber in detail. In patients known to be allergic to latex, we must avoid latex products, such as surgical gloves, or anesthetic and surgical equipments. PMID:9513338

  19. Advocacy: exploring the concept.

    PubMed

    Mardell, A

    1996-10-01

    The concept of the nurse as the patient's advocate is one that has become popular in the last fifteen years or so in both North America and the United Kingdom, having its basis in nursing theory. The UKCC first embraced the concept, stating in the Code of Professional Conduct that nurses must; 'act always in such a manner so as to promote and safeguard the interests and well being of patients and clients'. This is a laudable principle and one that nurses cannot dispute as there are many members of our society who are weak and vulnerable and may be unable to speak up for themselves. But are nurses always in a position to be an advocate for their patients? As the nature of nursing is so diverse then the nature of advocacy will be different in the multifarious settings in which nurses practise. Can theatre nurses ever be in a position to act as an advocate for a patient who is often anaesthetised? What precisely is advocacy and is the Concise Oxford Dictionary definition of 'one who pleads for another' appropriate in the nursing context? Then there is the position of nurses in the healthcare organisation in which they practise. In advocating for their patients, nurses may find they are pleading a case for a patient, or a group of patients, that could bring the nurse into conflict with their medical colleagues or with the management of the organisation by whom they are employed. Additionally, they may not posses the skills and knowledge to advocate effectively under such circumstances. Nursing is littered with the casualties of such conflicts over the years, the most publicised of whom, in the UK, was probably Graham Pink who lost his job as a charge nurse after drawing public attention to what he considered to be an unacceptable standard of care in the hospital in which he worked. PMID:8974516

  20. Advocacy: exploring the concept.

    PubMed

    Mardell, A

    1996-10-01

    The concept of the nurse as the patient's advocate is one that has become popular in the last fifteen years or so in both North America and the United Kingdom, having its basis in nursing theory. The UKCC first embraced the concept, stating in the Code of Professional Conduct that nurses must; 'act always in such a manner so as to promote and safeguard the interests and well being of patients and clients'. This is a laudable principle and one that nurses cannot dispute as there are many members of our society who are weak and vulnerable and may be unable to speak up for themselves. But are nurses always in a position to be an advocate for their patients? As the nature of nursing is so diverse then the nature of advocacy will be different in the multifarious settings in which nurses practise. Can theatre nurses ever be in a position to act as an advocate for a patient who is often anaesthetised? What precisely is advocacy and is the Concise Oxford Dictionary definition of 'one who pleads for another' appropriate in the nursing context? Then there is the position of nurses in the healthcare organisation in which they practise. In advocating for their patients, nurses may find they are pleading a case for a patient, or a group of patients, that could bring the nurse into conflict with their medical colleagues or with the management of the organisation by whom they are employed. Additionally, they may not posses the skills and knowledge to advocate effectively under such circumstances. Nursing is littered with the casualties of such conflicts over the years, the most publicised of whom, in the UK, was probably Graham Pink who lost his job as a charge nurse after drawing public attention to what he considered to be an unacceptable standard of care in the hospital in which he worked.

  1. Anaphylaxis in Israel: experience with 92 hospitalized children.

    PubMed

    Hoffer, V; Scheuerman, O; Marcus, N; Levy, Y; Segal, N; Lagovsky, I; Monselise, Y; Garty, B Z

    2011-03-01

    Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved. PMID:20536784

  2. Anaphylaxis in Israel: experience with 92 hospitalized children.

    PubMed

    Hoffer, V; Scheuerman, O; Marcus, N; Levy, Y; Segal, N; Lagovsky, I; Monselise, Y; Garty, B Z

    2011-03-01

    Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.

  3. CLINICAL FACTORS FOR DEVELOPING SHOCK IN RADIOCONTRAST MEDIA INDUCED ANAPHYLAXIS.

    PubMed

    Kim, Sang Min; Ko, Byuk Sung; Kim, Ji Yeon; Ha, Sang Ook; Ahn, Shin; Sohn, Chang Hwan; Seo, Dong Woo; Kim, Tae-Bum; Kim, Won Young

    2016-03-01

    The aim of this study was to investigate the time interval between radiocontrast media (RCM) administration and the development of anaphylactic shock, and risk factors associated with RCM-induced anaphylactic shock. We reviewed the medical records of 154 patients with RCM-induced anaphylaxis presenting to the emergency department of a tertiary care hospital between January 2005 and December 2014. Clinical features of RCM-induced anaphylaxis were analyzed, and patients were categorized into shock and non-shock groups to identify associated factors in affected patients. Of the 154 cases of RCM-induced anaphylaxis, 101 (65.9%) patients experienced shock. The median time between RCM exposure and the onset of shock was 11 min (interquartile range, 7.0-18.8). In patients with RCM-induced anaphylaxis accompanying shock, the median time from RCM to the first symptom onset was 6 min (interquartile range, 5.0-10.0). In the multivariate analysis, age, neurological manifestations, and allergy history except RCM were associated with the development of shock. RCM-induced anaphylaxis was commonly accompanied with shock, and the time interval between RCM exposure and the onset of shock was short. Physicians should pay attention to the development of potential cardiovascular collapse in anaphylaxis patients of old age and with neurologic manifestations. PMID:26506069

  4. Diagnosis and emergent management of anaphylaxis in children.

    PubMed

    Wiener, Ethan S; Bajaj, Lalit

    2005-01-01

    Anaphylactic and anaphylactoid reactions are serious, potentially life-threatening reactions with well-described clinical manifestations. Although the pathophysiology of these reactions varies with the offending agent and route of exposure, the treatment remains the same. Attention to airway, breathing, and circulation and the prompt administration of epinephrine remain the mainstays of therapy. Once an at-risk individual is identified, the proper instruction on the avoidance of the offending agent, the use of the EpiPen, and referral to a specialist in the treatment of allergic reactions may be instrumental in the future health and safety of that patient. PMID:16124341

  5. Haeme oxygenase-1 and cardiac anaphylaxis.

    PubMed

    Ndisang, J F; Wang, R; Vannacci, A; Marzocca, C; Fantappiè, O; Mazzanti, R; Mannaioni, P F; Masini, E

    2001-12-01

    1. Haeme oxygenase (HO) is an enzyme mainly localized in the smooth endoplasmic reticulum and involved in haeme degradation and in the generation of carbon monoxide (CO). Here we investigate (1) whether the inducible isoform of HO (HO-1) is expressed in the isolated heart of the guinea-pig and (2) the functional significance of HO-1 on the response to antigen in isolated hearts taken from actively sensitized guinea-pigs. 2. Both the HO-1 expression and activity are consistently increased in hearts from guinea-pigs pretreated with hemin, an HO-1 inducer (4 mg kg(-1) i.p., 18 h before antigen challenge). The administration of the HO-1 inhibitor zinc-protoporphyrin IX (ZnPP-IX, 50 micromol kg(-1), i.p., 6 h before hemin) abolished the increase of both the HO-1 expression and activity. 3. In vitro challenge with the specific antigen of hearts from actively sensitized animals evokes a positive inotropic and chronotropic effect, a coronary constriction followed by dilation and an increase in the amount of histamine in the perfusates. In hearts from hemin-pretreated animals, antigen challenge did not modify the heart rate and the force of contraction; the coronary outflow was significantly increased and a diminution of the release of histamine was observed. The patterns of cardiac anaphylaxis were fully restored in hearts from animals treated with ZnPP-IX 6 h before hemin. 4. In isolated hearts perfused with a Tyrode solution gassed with 100% CO for 5 min and successively reoxygenated, the response to antigen was similar to that observed in hearts from hemin-pretreated animals. 5. Pretreatment with hemin or the exposure to exogenous CO were linked to an increase in cardiac cyclic GMP levels and to a decrease of tissue Ca(2+) levels. 6. The study demonstrates that overexpression of HO-1 inhibits cardiac anaphylaxis through the generation of CO which, in turn, decreases the release of histamine through a cyclic GMP- and Ca(2+)-dependent mechanism. PMID:11739245

  6. Haeme oxygenase-1 and cardiac anaphylaxis

    PubMed Central

    Ndisang, Joseph Fomusi; Wang, Rui; Vannacci, Alfredo; Marzocca, Cosimo; Fantappiè, Ornella; Mazzanti, Roberto; Mannaioni, Pier Francesco; Masini, Emanuela

    2001-01-01

    Haeme oxygenase (HO) is an enzyme mainly localized in the smooth endoplasmic reticulum and involved in haeme degradation and in the generation of carbon monoxide (CO). Here we investigate (1) whether the inducible isoform of HO (HO-1) is expressed in the isolated heart of the guinea-pig and (2) the functional significance of HO-1 on the response to antigen in isolated hearts taken from actively sensitized guinea-pigs. Both the HO-1 expression and activity are consistently increased in hearts from guinea-pigs pretreated with hemin, an HO-1 inducer (4 mg kg−1 i.p., 18 h before antigen challenge). The administration of the HO-1 inhibitor zinc-protoporphyrin IX (ZnPP-IX, 50 μmol kg−1, i.p., 6 h before hemin) abolished the increase of both the HO-1 expression and activity. In vitro challenge with the specific antigen of hearts from actively sensitized animals evokes a positive inotropic and chronotropic effect, a coronary constriction followed by dilation and an increase in the amount of histamine in the perfusates. In hearts from hemin-pretreated animals, antigen challenge did not modify the heart rate and the force of contraction; the coronary outflow was significantly increased and a diminution of the release of histamine was observed. The patterns of cardiac anaphylaxis were fully restored in hearts from animals treated with ZnPP-IX 6 h before hemin. In isolated hearts perfused with a Tyrode solution gassed with 100% CO for 5 min and successively reoxygenated, the response to antigen was similar to that observed in hearts from hemin-pretreated animals. Pretreatment with hemin or the exposure to exogenous CO were linked to an increase in cardiac cyclic GMP levels and to a decrease of tissue Ca2+ levels. The study demonstrates that overexpression of HO-1 inhibits cardiac anaphylaxis through the generation of CO which, in turn, decreases the release of histamine through a cyclic GMP- and Ca2+-dependent mechanism. PMID:11739245

  7. Patient advocacy: the role of the nurse.

    PubMed

    Choi, Pin Pin

    2015-06-10

    The role of nurses as patient advocates is well recognised by healthcare professionals, yet the processes and practices involved in patient advocacy are not clearly understood. A suboptimal level of advocacy is often apparent in the literature, encompassing paternalistic concepts of protecting patients from harm. This article examines the concept of patient advocacy and its relevance to nursing, associated goals and outcomes of advocacy and the processes and practices involved. It provides insights into how nurses practise patient advocacy in healthcare settings and how they may develop this role further, through formal education, workplace learning, role modelling by expert nurses and promoting an organisational culture conducive to patient advocacy.

  8. Patient advocacy: the role of the nurse.

    PubMed

    Choi, Pin Pin

    2015-06-10

    The role of nurses as patient advocates is well recognised by healthcare professionals, yet the processes and practices involved in patient advocacy are not clearly understood. A suboptimal level of advocacy is often apparent in the literature, encompassing paternalistic concepts of protecting patients from harm. This article examines the concept of patient advocacy and its relevance to nursing, associated goals and outcomes of advocacy and the processes and practices involved. It provides insights into how nurses practise patient advocacy in healthcare settings and how they may develop this role further, through formal education, workplace learning, role modelling by expert nurses and promoting an organisational culture conducive to patient advocacy. PMID:26058653

  9. Sesame allergy in Britain: a questionnaire survey of members of the Anaphylaxis Campaign.

    PubMed

    Derby, C J; Gowland, M H; Hourihane, J O'B

    2005-03-01

    Sesame is a major allergen in countries where it is a common food. It was noted that an increasing number of members of the UK charity, the anaphylaxis campaign, were reporting allergy to sesame. This study, sought to examine features of sesame allergy among members of the Anaphylaxis Campaign (which supports those at potentially life-threatening risk from allergies) focusing on clinical symptoms and features of the foods implicated. A physician-designed questionnaire was sent by post to 400 members of the Anaphylaxis Campaign who reported avoidance of sesame. Two hundred and eighty replies were received (70%). Twenty-three replies (7%) were excluded and 96 replies (24%) came from subjects who avoided sesame but had never reacted to it. One hundred and fifty people (54%) reported 288 reactions to sesame. 89% of reactive subjects reported other atopic diseases and notably 84% were also nut/peanut allergic. One in six (17%) had suffered potentially life-threatening symptoms, with 65% of severe reactions happening on first known exposure. The age of first reaction ranged from 6 months to 65 yr. The majority of reactions reported (91%) involved foods or dishes which had sesame as a deliberate ingredient, rather than sesame as an accidental contaminant. Respondents represented a well-informed and highly selected group of people at risk from potentially life-threatening allergies. Sesame should be identified clearly as an ingredient and separately from nuts and peanuts when it may be an allergen contaminant. People at potential risk need clear allergy diagnosis and informed guidance to enable them to avoid this key allergen more easily.

  10. Buckwheat anaphylaxis: an unusual allergen in Taiwan.

    PubMed

    Wang, Tsung-Chi; Shyur, Shyh-Dar; Wen, Da-Chin; Kao, Yu-Hsuan; Huang, Li-Hsin

    2006-01-01

    IgE-mediated hypersensitivity to buckwheat is common in Korea, Japan, and some other Asian countries. However, buckwheat is not a common allergen in Taiwan. We report a woman with asthma who had anaphylactic shock, generalized urticaria, and an acute exacerbation of asthma five minutes after ingesting buckwheat. The patient underwent skin prick and Pharmacia CAP testing (Uppsala, Sweden) for specific IgE to buckwheat, white sesame and soybean as well as other common allergens in Taiwan including Dermatophagoides pteronyssinus (Dp), D. farinae (Df), cat and dog dander, cockroach, egg white, cow milk and codfish. The patient had a strongly positive skin prick test response to buckwheat and positive reactions to Dp and latex. Specific IgE results were class 6 for buckwheat, class 4 for Dp and Df, and class 2 for dog dander, wheat, sesame and soybean. Results of an open food challenge with white sesame and soybean were negative. Although buckwheat is a rare allergen in Taiwan, it can cause extremely serious reactions and should be considered in patients presenting with anaphylaxis after exposure to buckwheat. PMID:17136883

  11. Guidelines for the Diagnosis and Management of Food Allergy in the United States

    PubMed Central

    Boyce, Joshua A.; Assa'ad, Amal; Burks, A. Wesley; Jones, Stacie M.; Sampson, Hugh A.; Wood, Robert A.; Plaut, Marshall; Cooper, Susan F.; Fenton, Matthew J.; Arshad, S. Hasan; Bahna, Sami L.; Beck, Lisa A.; Byrd-Bredbenner, Carol; Camargo, Carlos A.; Eichenfield, Lawrence; Furuta, Glenn T.; Hanifin, Jon M.; Jones, Carol; Kraft, Monica; Levy, Bruce D.; Lieberman, Phil; Luccioli, Stefano; McCall, Kathleen M.; Schneider, Lynda C.; Simon, Ronald A.; Simons, F. Estelle R.; Teach, Stephen J.; Yawn, Barbara P.; Schwaninger, Julie M.

    2014-01-01

    Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research. PMID:21134576

  12. Early skin and challenge testing after rocuronium anaphylaxis.

    PubMed

    Schulberg, E M; Webb, A R; Kolawole, H

    2016-05-01

    We present a case of early skin and challenge testing in a patient following severe anaphylaxis to rocuronium. The patient presented for semi-elective laparoscopic cholecystectomy and developed anaphylaxis with severe cardiovascular collapse after induction of anaesthesia. Surgery was cancelled but was considered necessary before the recommended four to six weeks for formal allergy testing. Limited skin and challenge testing was performed to rocuronium and cisatracurium while the patient was in the intensive care unit to identify a safe neuromuscular blocking drug for subsequent early surgery. The subsequent surgery, 48 hours after the initial reaction, was uneventful. The case highlights the difficulties when anaesthetising patients with recent anaphylaxis who have not yet had formal allergy testing and presents a potential management strategy involving early skin testing. PMID:27246945

  13. [A case study of anaphylaxis in a pregnant woman].

    PubMed

    Ferreres-García, Karla; de León-Luis, Juan; Seoane, Elena; García-Marqués, Enrique; Sanjuan, Cristina; Ortiz-Quintana, Luis

    2014-03-01

    We report a case of anaphylaxis in a 35+5 week of pregnancy patient who came to the Emergency Room with shortness of breath, hypotension and loss on fetal wellbeing. Due to her medical history and given the clinical picture at that time, an anaphylactic shock was suggested as the most probable diagnose. The administration of dexchlorpheniramine and methylprednisolone resulted in an immediate and positive reaction. Simultaneously, an improvement in the fetus cardiotocographic record was objectified. The patient was hospitalized for 48 hours, after which she was discharged. In case of suspicion of anaphylaxis in a pregnant woman, four aspects should be handled: the severity of the anaphylaxis chart, individual complications regarding a pregnant woman, unfavorable effects of the regularly used treatment during that specific gestation, and the need of fetal extraction based of gestational age.

  14. Resident guide to advocacy in dermatology.

    PubMed

    Park, Kelly K

    2015-12-01

    Many opportunities exist for residents to get involved in advocacy in dermatology, from national to grassroots levels. Residents also should be aware of opportunities to get involved in patient advocacy and become familiar with the myriad of patient advocacy groups that exist. These groups offer support and education for patients and initiate research efforts for specific dermatologic conditions that provide support for patients beyond what can be offered during a standard office visit. The value of resident involvement in advocacy also is discussed.

  15. Advocacy and Age: Issues, Experiences, Strategies.

    ERIC Educational Resources Information Center

    Kerschner, Paul A., Ed.

    This monograph seeks to bring understanding to one component of the advocacy field, that of advocacy and the aged, by overviewing this component through a series of articles. (Advocacy is an activity by which changes can be effected in a power structure to improve a subgroup's situation.) There are four parts to the document: part 1, entitled…

  16. Practitioner Perceptions of School Library Advocacy

    ERIC Educational Resources Information Center

    Burns, Elizabeth

    2015-01-01

    School library advocacy is increasingly important due to decreases in funding and staff. National organizations attempt to engage school librarians in advocacy and have developed resources and tools to assist with this task. However, there is little research examining how practicing school librarians engage in advocacy and how their advocacy…

  17. Approaches to Advocacy for Health Educators.

    ERIC Educational Resources Information Center

    Mahoney, Beverly Saxton, Ed.; Brown, Kelli McCormack, Ed.

    1999-01-01

    This monograph provides a collection of articles on health educators' approaches to advocacy: "The Role of Health Education Advocacy in Removing Disparities in Health Care" (John P. Allegrante, Donald E. Morisky, and Behjat A. Sharif); "The Role of Health Education Associations in Advocacy" (M. Elaine Auld and Eleanor Dixon-Terry); "What…

  18. Every Voice Matters: The Importance of Advocacy

    ERIC Educational Resources Information Center

    Royea, Amber J.; Appl, Dolores J.

    2009-01-01

    Over the years parents, professionals, and politicians have come together to advocate on behalf of children's rights. Advocacy can occur individually, collectively, or a combination of both. Although some advocacy efforts are more successful than others, it is the process of the advocacy and voices behind it that matter most. In this guest…

  19. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2013.

    PubMed

    Sicherer, Scott H; Leung, Donald Y M

    2014-02-01

    This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2013. Studies on food allergy suggest that (1) 7.6% of the US population is affected, (2) a "healthy" early diet might prevent food allergy, (3) the skin might be an important route of sensitization, (4) allergen component testing might aid diagnosis, (5) the prognosis of milk allergy might be predictable through early testing, (6) oral or sublingual immunotherapy show promise but also have caveats, and (7) preclinical studies show promising alternative modes of immunotherapy and desensitization. Studies on eosinophilic esophagitis show a relationship to connective tissue disorders and that dietary management is an effective treatment for adults. Markers of anaphylaxis severity have been determined and might inform potential diagnostics and therapeutic targets. Insights on serum tests for drug and insect sting allergy might result in improved diagnostics. Genetic and immune-mediated defects in skin epithelial differentiation contribute to the severity of atopic dermatitis. Novel management approaches to treatment of chronic urticaria, including use of omalizumab, are being identified.

  20. Wheat-dependent exercise-induced anaphylaxis sensitized with hydrolyzed wheat protein in soap.

    PubMed

    Chinuki, Yuko; Morita, Eishin

    2012-12-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a specific form of wheat allergy typically induced by exercise after ingestion of wheat products. Wheat ω-5 gliadin is a major allergen associated with conventional WDEIA, and detection of serum immunoglobulin E (IgE) specific to recombinant ω-5 gliadin is a reliable method for its diagnosis. Recently, an increased incidence of a new subtype of WDEIA, which is likely to be sensitized via a percutaneous and/or rhinoconjunctival route to hydrolyzed wheat protein (HWP), has been observed. All of the patients with this new subtype had used the same brand of soap, which contained HWP. Approximately half of these patients developed contact allergy several months later and subsequently developed WDEIA. In each of these patients, contact allergy with soap exposure preceded food ingestion-induced reactions. Other patients directly developed generalized symptoms upon ingestion of wheat products. The predominant observed symptom of the new WDEIA subtype was angioedema of the eyelids; a number of patients developed anaphylaxis. This new subtype of WDEIA has little serum ω-5 gliadin-specific serum IgE.

  1. Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France.

    PubMed

    Picaud, J; Beaudouin, E; Renaudin, J M; Pirson, F; Metz-Favre, C; Dron-Gonzalvez, M; Moneret-Vautrin, D A

    2014-10-01

    Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.

  2. A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine

    PubMed Central

    Park, Kyung Hee; Yun, Il Seon; Choi, Soo-Young; Lee, Jae-Hyun; Hong, Chein-Soo

    2013-01-01

    We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA). PMID:23225830

  3. Caustic Ingestions Mimicking Anaphylaxis: Case Studies and Literature Review

    PubMed Central

    Sherenian, Michael G.; Clee, Mark; Schondelmeyer, Amanda C.; de Alarcón, Alessandro; Li, Jinzhu; Assa’ad, Amal

    2015-01-01

    Anaphylaxis presents in children with rapid involvement of typically 2 or more organ systems including cutaneous, gastrointestinal, and respiratory. Caustic ingestions (CI) may also present with acute involvement of cutaneous, gastrointestinal, and respiratory systems. We present 2 cases of “missed diagnosis” that illustrate how CI presenting with respiratory symptoms can be mistaken for anaphylaxis owing to these similarities. Both of these patients had delay in appropriate care for CI as a result. These cases demonstrate the importance of considering CI in children who have gastrointestinal symptoms, respiratory distress, and oropharyngeal edema. PMID:25583920

  4. Fatal and near-fatal anaphylaxis: factors that can worsen or contribute to fatal outcomes.

    PubMed

    Greenberger, Paul A

    2015-05-01

    Anaphylaxis implies a risk of death even in patients whose prior episodes have been considered mild and managed easily. Anaphylaxis occurs in all age groups, from infants to the elderly, but most deaths occur in adults. Factors or circumstances associated with near-fatal or fatal anaphylaxis are reviewed from the following 10 perspectives: accidents and mishaps, adulterated products, age, allergens, atopy, comorbidities, Munchausen syndrome or contrived anaphylaxis, patient factors, route of administration, and treatment-related issues. There are no absolute contraindications to self-injectable epinephrine, and epinephrine can be administered for anaphylaxis to elderly patients or to those patients receiving beta-adrenergic blockers. PMID:25841558

  5. Applying Buddhist Practices to Advocacy: The Advocacy-Serving Model

    ERIC Educational Resources Information Center

    Warren, Jane; Klepper, Konja K.; Lambert, Serena; Nunez, Johnna; Williams, Susan

    2011-01-01

    Creating and retaining empathic connections with the most disenfranchised among us can take a toll on the wellness of counselor advocates. The Advocacy-Serving Model is introduced as a creative approach to strengthening the ability of advocates to serve through enhancing awareness, focusing actions, and connecting to community. The model…

  6. Front-Line Advocacy: Advocacy Based on Effective Relationships

    ERIC Educational Resources Information Center

    Gooden, Benny L.

    2012-01-01

    When American Association of School Administrators (AASA) and other membership organizations try to engage individuals in advocacy, a frequent exhortation is "Contact your representatives in Congress." Professional membership groups also stress that written communication is more powerful than phone calls to a representative's office, and they…

  7. ANAPHYLAXIS IN CHOPPED GUINEA PIG LUNG

    PubMed Central

    Austen, K. F.; Brocklehurst, W. E.

    1961-01-01

    The quantitative release of histamine by specific antigen from perfused, chopped, sensitized guinea pig lung has been used to study the effect of peptidase substrates and inhibitors on the anaphylactic reaction. The anaphylactic release of histamine is prevented by chymotrypsin substrates and inhibitors but not by trypsin, carboxypeptidase, or leucine aminopeptidase substrates or the soybean trypsin inhibitor. The chymotrypsin substrates and inhibitors appear to be acting on an antigen-antibody-activated step because these substances fail to inhibit if the tissue is washed free of them prior to antigen addition, and because there is complete desensitization of the tissue without histamine release when the antigen is added in the presence of these inhibitors. The inhibitors work equally well in tissue from passively sensitized animals or in tissue from animals actively sensitized with either ovalbumin or bovine gamma globulin. These observations suggest that activation of a chymotrypsin-like enzyme is a necessary condition for the anaphylactic release of histamine in guinea pig lung. Diisopropylfluophosphate is inhibitory when present at the time of antigen addition but not when the tissue is washed free of unfixed diisopropylfluophosphate prior to adding antigen. This indicates that diisopropylfluophosphate must be acting exclusively on an enzyme which exists in lung tissue in a precursor form resistant to diisopropylfluophosphate until activated by the antigen-antibody interaction. Thiol alkylating or oxidizing agents also prevent the anaphylactic release of histamine, but in contrast to the situation with diisopropylfluophosphate and the other chymotrypsin inhibitors, the phase of the anaphylactic reaction inhibited by N-ethylmaleimide is available prior to the antigen-antibody interaction. The similarities and differences between immune hemolysis and anaphylaxis in chopped guinea pig lung are considered in detail. PMID:13685194

  8. Teacher Advocacy in Bilingual Programs

    ERIC Educational Resources Information Center

    Dubetz, Nancy E.; de Jong, Ester J.

    2011-01-01

    As a consequence of changes in federal and state policies in education, educators who believe in the value and importance of bilingualism find themselves in a contested environment where their notions of best practices for emergent bilinguals contradict those espoused in such policies. In this context, acts of advocacy that support bilingual…

  9. CEC Special Education Advocacy Handbook.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.

    This handbook, for individuals working with people who have disabilities, is designed to empower them to be a force for meeting the policy challenges in the communities in which they live and work. It is designed to help in channeling one's strength, commitment, and knowledge of the special education field into effective advocacy efforts. The…

  10. Beta-blocker therapy and the risk of anaphylaxis.

    PubMed Central

    Toogood, J H

    1987-01-01

    Beta-blocker therapy is associated with an increase in the severity and, possibly, the incidence of acute anaphylaxis. The population at risk consists of people with allergic conditions who are given a beta-blocker for an unrelated condition. Anaphylaxis under these conditions may be severe, protracted and resistant to conventional treatment because of the beta-adrenergic blockade. Severe or fatal attacks have been triggered by insect stings, the ingestion of allergenic foods or drugs, and injections of radiocontrast media, antisera or immunotherapy antigens. These occurrences are probably infrequent, but their incidence is unknown. At least two fatal cases have recently occurred in Canada. Clinical allergists, internists and family practitioners in particular should be aware of the need for aggressive and prolonged support in patients who experience anaphylaxis while receiving beta-blocker therapy and should report all such occurrences to the federal registry of adverse drug reactions. Allergy skin testing or immunotherapy is inadvisable in patients who take a beta-blocker orally or in the form of ophthalmic eyedrops. The list of relative contraindications to beta-blocker use should be extended to include susceptibility to recurrent anaphylaxis, whether it is idiopathic or due to an identifiable cause. PMID:2882832

  11. Management of hymenoptera sting anaphylaxis: a preventive medicine survey.

    PubMed

    McDougle, L; Klein, G L; Hoehler, F K

    1995-01-01

    The evaluation of aftercare instructions given to patients suffering from hymenoptera sting anaphylaxis was the objective of the study. Part of this evaluation included asking the physicians questions to examine the knowledge on which they based their aftercare instructions. Survey questionnaires were completed by 124 of 174 (71%) physicians who worked in an emergency department or urgent care center. Fifty-eight percent of the physicians never provided written avoidance instructions, 24% provided or prescribed anaphylaxis ID bracelets, 44% referred all of their patients to an allergist for further evaluation, and 73% reported prescribing an Epi-pen or Ana-kit to all hymenoptera sting anaphylaxis victims. Twenty-four percent of physicians did not know where to obtain anaphylaxis identification bracelets. This survey demonstrates that a substantial number of physicians practicing emergency medicine are not providing appropriate aftercare instructions to patients, and substantiates the need for educational efforts to increase the awareness of physicians concerning the implications of hymenoptera allergy and the value of proper preventive measures. PMID:7782631

  12. Omalizumab: Practical considerations regarding the risk of anaphylaxis.

    PubMed

    Kim, Harold L; Leigh, Richard; Becker, Allan

    2010-01-01

    Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis.In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.2%. Other researchers, including the American Omalizumab Joint Task Force (OJTF), have suggested a lower overall frequency of 0.09%.This paper provides a summary of the epidemiologic research carried out to date and presents a concise, practical set of recommendations for the prevention, monitoring and management of omalizumab-associated anaphylaxis. Prevention tips include advice on patient education measures, concomitant medications and optimal administration. For the first three injections, the recommendation is to monitor in clinic for two hours after the omalizumab injection; for subsequent injections, the monitoring period should be 30 minutes or an appropriate time agreed upon by the individual patient and healthcare professional.In the event that a patient does experience omalizumab-associated anaphylaxis, the paper provides recommendations for handling the situation in-clinic and recommendations on how to counsel patients to recognize the potential signs and symptoms in the community and react appropriately. PMID:21129189

  13. Anaphylaxis challenges on the front line: perspectives from community medicine.

    PubMed

    Bennett, John R; Fromer, Leonard; Hayden, Mary Lou

    2014-01-01

    This report reflects a discussion from the multidisciplinary Partnership for Anaphylaxis Round Table meeting, held in November 2012, in Dallas, Texas. Community medicine participants included John R. Bennett, MD, an internist who practiced in Cumming, Georgia, and whose patients were adults; Leonard Fromer, MD, a family practitioner in Los Angeles, California, who was the medical director of a network of 600 medical groups, including pediatricians, internists, and family physicians, and who in his previous practice treated children and adults, many of them with severe allergies; and Mary Lou Hayden, MS, RN, FNP-BC, AE-C, a nurse practitioner who treated adults in a university employee health clinic and in an allergy clinic in Charlottesville, Virginia, and whose prior practice focused on allergy and immunology in children and adults. This discussion was moderated by Dr Bennett. Participants provided their perspectives as primary care providers (PCPs) concerning anaphylaxis, which has become a major public health concern. The rising prevalence of severe allergies and incidence of anaphylaxis and other severe allergic reactions among children and adults is shifting more care to PCPs. This discussion provides insights into challenges faced by PCPs in treating patients at risk for anaphylaxis in the community setting and provides potential solutions to those challenges.

  14. PERI-ANESTHESIA ANAPHYLAXIS (PAA): WE STILL HAVE NOT STARTED POST-PAA TESTING FOR INCITING ANESTHESIA-RELATED ALLERGENS.

    PubMed

    Alshaeri, Taghreed; Gupta, Deepak; Nagabhushana, Ananthamurthy

    2016-02-01

    Anaphylaxis during anesthesia is uncommon. Diagnosis of peri-anesthesia anaphylaxis (PAA) requires anesthesia providers' vigilance for prompt diagnosis and treatment. In this case report, we present a challenging case with suspected PAA including its perioperative management, intensive care unit (ICU) course, and post-discharge follow-up. A 44-year-old female (body mass index = 26) presented for elective abdominal panniculectomy. Post-intubation, severe bronchospasm occurred that was non-responsive to nebulized albuterol and intravenous epinephrine. Continuous infusion of epinephrine was initiated. After aborting surgical procedure, the patient was transferred to ICU on continuous intravenous infusion of epinephrine. Venous blood sampling showed elevated troponin level. Echocardiography revealed ejection fraction of 25% suspicious of Takotsubo cardiomyopathy (mid cavitary variant). Tracheal extubation was only possible after three days. Subsequently, patient was discharged home with a cardiology follow-up appointment and a referral to an allergy specialist. Unfortunately at our institution (an academic university hospital in United States) along with neighboring institutions in near-by areas, the only allergy skin tests available are for local anesthetics and antibiotics, while neuromuscular blocking agents (NMBAs) cannot be tested (the suspected anaphylactic agent in our case was presumably rocuronium). In summary, PAA requires and responds to emergent diagnosis and immediate treatment; however there is still a long way to go to ensure post-PAA testing for inciting anesthesia-related allergens. PMID:27382817

  15. Patient advocacy and arthritis: moving forward.

    PubMed Central

    Leong, Amye L.; Euller-Ziegler, Liana

    2004-01-01

    Patient advocacy is based on the premise that people have the right to make their own choices about their health care. Personal advocacy is centred on the experiential expertise of the individual affected by the condition, whereas group advocacy is grounded on patient-centred strategies and actions. The first patient advocacy groups for arthritis were set up over 20 years ago in the USA and have subsequently spread to many other countries. This paper discusses the growth and impact of personal advocacy as well as recent developments in group advocacy in the Asia-Pacific region, Europe, and North America, in terms of arthritis awareness, research, corporate partnerships, and the Bone and Joint Decade global initiative. PMID:15042233

  16. Diagnosis of anaphylactic death in forensics: Review and future perspectives.

    PubMed

    Cecchi, Rossana

    2016-09-01

    The diagnosis of anaphylaxis in a pre- or post-mortal phase involves the formulation of problems not yet solved by the international scientific literature, due to the complexity of pathogenic factors and pathophysiological processes that characterizes it. For forensic autopsies, further problems of differential diagnosis arise and often leave the forensic pathologist unable to express an opinion of certainty, as a result of lack of case history, circumstantial and autoptical-histopathological data. Nevertheless, in routine cases the postmortem diagnosis of anaphylactic death continues to be based on exclusion and circumstantial evidence. The author, after an extensive review of the literature relating to deaths from anaphylaxis of forensic pathological interest, and a discussion of the microscopical and biochemical findings, proposes a diagnostic protocol for forensic purposes and evaluates the diagnostic perspectives enabled by the newly available analytic techniques and markers. Maybe, the application of omics methodologies could help in the future for anaphylaxis diagnosis. PMID:27591544

  17. Research to practice: developing an integrated anaphylaxis education curriculum for school nurses.

    PubMed

    Cavanaugh, Rebecca; Strickland, C June

    2011-06-01

    The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for anaphylaxis. School nurses require resources to assist them in providing health training for school staff on how to manage potentially life-threatening health conditions for children in their school, however, resources to address this training are limited. A search for and content analysis of currently available literature and resources about anaphylaxis and anaphylaxis training curricula revealed a lack of an integrated curriculum to train school staff. This article presents a discussion of the development of a train-the-trainer anaphylaxis education program providing school nurses with curriculum, lesson plans, teaching-learning activities, and resources for anaphylaxis education of all school staff. PMID:21444745

  18. Anaphylaxis after administration of amikacin containing sodium metabisulfite in a premature newborn.

    PubMed

    Kendigelen, Pinar; BaktirClinic Of Anesthesiology And Reanimation Afşin State Hospital Afşin Kahramanmaraş Tureky, Mehmet; Sucu, Asena; Kaya, Guner

    2016-06-01

    Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction.

  19. Research to practice: developing an integrated anaphylaxis education curriculum for school nurses.

    PubMed

    Cavanaugh, Rebecca; Strickland, C June

    2011-06-01

    The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for anaphylaxis. School nurses require resources to assist them in providing health training for school staff on how to manage potentially life-threatening health conditions for children in their school, however, resources to address this training are limited. A search for and content analysis of currently available literature and resources about anaphylaxis and anaphylaxis training curricula revealed a lack of an integrated curriculum to train school staff. This article presents a discussion of the development of a train-the-trainer anaphylaxis education program providing school nurses with curriculum, lesson plans, teaching-learning activities, and resources for anaphylaxis education of all school staff.

  20. Patient Advocacy in an Obstetric Setting.

    PubMed

    Heelan-Fancher, Lisa M

    2016-10-01

    A correlation study design was used to examine the interrelatedness of power, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with a labor and delivery nurse's attitude toward patient advocacy using the conceptual framework of the science of unitary human beings. The linear combination of the three independent variables was significantly correlated to attitude toward patient advocacy and power as knowing participation in change had the greatest impact on patient advocacy.

  1. Patient Advocacy in an Obstetric Setting.

    PubMed

    Heelan-Fancher, Lisa M

    2016-10-01

    A correlation study design was used to examine the interrelatedness of power, attitudes regarding intermittent fetal monitoring, and perceived barriers to research utilization with a labor and delivery nurse's attitude toward patient advocacy using the conceptual framework of the science of unitary human beings. The linear combination of the three independent variables was significantly correlated to attitude toward patient advocacy and power as knowing participation in change had the greatest impact on patient advocacy. PMID:27641281

  2. Anaphylaxis to chemotherapy and monoclonal antibodies.

    PubMed

    Castells, Mariana C

    2015-05-01

    Hypersensitivity reactions are increasingly prevalent, although underrecognized and underreported. Platins induce immunoglobulin E-mediated sensitization; taxenes and some monoclonal antibodies can induce reactions at first exposure. Severe hypersensitivity can preclude first-line therapy. Tryptase level at the time of a reaction is a useful diagnostic tool. Skin testing provides a specific diagnosis. Newer tests are promising diagnostic tools to help identify patients at risk before first exposure. Safe management includes rapid drug desensitization. This review provides information regarding the scope of hypersensitivity and anaphylactic reactions induced by chemotherapy and biological drugs, as well as diagnosis, management, and treatment options. PMID:25841555

  3. Advocacy 201: Incorporating Advocacy Training in Health Education Professional Preparation Programs

    ERIC Educational Resources Information Center

    Thompson, Amy; Kerr, Dianne; Dowling, Jamie; Wagner, Laurie

    2012-01-01

    Involvement in advocacy is a responsibility of health educators, as identified by the National Commission on Health Education Credentialing. Of all the professional responsibilities, participation in advocacy-related activity is often neglected. This lack of participation may be due to the absence of advocacy and policy skills training in health…

  4. Higher latitude and lower solar radiation influence on anaphylaxis in Chilean children

    PubMed Central

    Hoyos-Bachiloglu, Rodrigo; Morales, Pamela S.; Cerda, Jaime; Talesnik, Eduardo; González, Gilberto; Camargo, Carlos A.; Borzutzky, Arturo

    2014-01-01

    Background Recent studies suggest an association between higher latitude, a proxy of vitamin D (VD) status, and allergic diseases. Chile provides an ideal setting to study this association due to its latitude span and high rates of VD deficiency in southern regions. The aim of this study is to explore the associations of latitude and solar radiation with anaphylaxis admission rates. Methods We reviewed anaphylaxis admissions in Chile’s hospital discharge database between 2001 and 2010 and investigated associations with latitude and solar radiation. Results 2316 anaphylaxis admissions were registered. Median age of patients was 41 years; 53% were female. National anaphylaxis admission rate was 1.41 per 100,000 persons per year. We observed a strong north-south increasing gradient of anaphylaxis admissions (β 0.04, P=0.01), with increasing rates south of latitude 34°S. A significant association was also observed between solar radiation and anaphylaxis admissions (β −0.11, P=0.009). Latitude was associated with food-induced (β 0.05, P=0.02), but not drug-induced (β −0.002, P=0.27), anaphylaxis. The association between latitude and food-induced anaphylaxis was significant in children (β 0.01, P=0.006), but not adults (β 0.003, P=0.16). Anaphylaxis admissions were not associated with regional sociodemographic factors like poverty, rurality, educational level, ethnicity, or physician density. Conclusions Anaphylaxis admission rates in Chile are highest at higher latitudes and lower solar radiation, used as proxies of VD status. The associations appear driven by food-induced anaphylaxis. Our data support a possible role of VD deficiency as an etiological factor in the high anaphylaxis admission rates found in southern Chile. PMID:24628618

  5. 78 FR 73587 - Taxpayer Advocacy Panel; Meeting Cancellation.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-06

    ... Internal Revenue Service Taxpayer Advocacy Panel; Meeting Cancellation. AGENCY: Internal Revenue Service... cancellation of the open meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee..., Acting Director, Taxpayer Advocacy Panel. BILLING CODE 4830-01-P...

  6. 78 FR 73586 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-06

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel Taxpayer Assistance Center Improvements Project..., Taxpayer Advocacy Panel. BILLING CODE 4830-01-P...

  7. 78 FR 73587 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-06

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel Tax Forms and Publications Project Committee scheduled... Advocacy Panel. BILLING CODE 4830-01-P...

  8. 78 FR 73587 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-06

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project Committee scheduled... Advocacy Panel. BILLING CODE 4830-01-P...

  9. 78 FR 73587 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-06

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel Toll-Free Phone Line Project Committee scheduled for... Advocacy Panel. BILLING CODE 4830-01-P...

  10. Recurrent perioperative anaphylaxis in a 54-year-old man.

    PubMed

    Franxman, Timothy J; Greenhawt, Matthew J; Baldwin, James L

    2013-01-01

    Reports suggest that perioperative anaphylaxis in patients undergoing general anesthesia range from 1 in 5000 to 1 in 20,000 with mortality rates as high as 9%. Because of the variety of medications that are used for general anesthesia and the rapid succession in which they are administered, it is often difficult to determine the etiology of a severe allergic episode in this setting. Antibiotics and anesthetics are notorious for precipitating allergic reactions and are often implicated. Other perioperative exposures and patient risk factors must also be considered. In this article, we describe the case of a patient who exhibited recurrent anaphylaxis episodes while trying to undergo a vital cardiac surgery. PMID:23883604

  11. Exercise-induced anaphylaxis related to specific foods.

    PubMed

    Tilles, S; Schocket, A; Milgrom, H

    1995-10-01

    We describe the case, documented by challenge results, of a 16-year-old girl with exercise-induced anaphylaxis associated with eating pizza and a cheese sandwich. Patients in whom a specific coprecipitating food has been identified should avoid it for at least 12 hours before exercise. All patients should be instructed to avoid eating 6 to 8 hours before exercise, discontinue exercise at the first sign of symptoms, and exercise only with a companion prepared to administer epinephrine.

  12. Food-dependent exercise-induced anaphylaxis: is wheat unique?

    PubMed

    Wong, Gabriel K; Krishna, Mamidipudi T

    2013-12-01

    This review draws comparisons between wheat-dependent exercise-induced anaphylaxis (WDEIA) and other food-dependent exercise-induced anaphylaxis (FDEIAs) and discusses the importance of co-factors in its pathophysiology. FDEIA remains an enigmatic condition since it was first described 30 years ago. The sporadic and unpredictable nature of its reactions has puzzled clinicians and scientists for decades, but recent studies on WDEIA have enlightened us about the pathophysiology of this condition. The identification of defined allergic epitopes such as Tri a 19, α-gliadin, β-gliadin and γ-gliadin in WDEIA enables it to become the perfect model for studying FDEIA, but WDEIA is by no means a unique condition. On a larger scale, FDEIA represents a crucial link between IgE-mediated and anaphylactoid reactions and provides supportive evidence for the concept of 'summation anaphylaxis' and the need to overcome the 'allergen threshold'. Future work should focus on identifying more of the FDEIA epitopes and understanding their distinct molecular properties. The development of a biomarker in order to identify patients susceptible to co-factor influences would be invaluable.

  13. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2008.

    PubMed

    Sicherer, Scott H; Leung, Donald Y M

    2009-02-01

    This review highlights some of the research advances in anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in anaphylaxis in a population-based study and lower rates of peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in food allergy diagnosis include IgE epitope mapping that discloses the likelihood and severity of allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline angiotensin-converting enzyme level may be associated with having pharyngeal edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and egg allergy tolerate these proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral immunotherapy to treat milk allergy and sublingual immunotherapy for honey bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and bacterial infection. New therapeutic approaches to AD, urticaria, and angioedema have been reported including use of probiotics, biologics, vitamin D, and skin barrier creams.

  14. Increasing aging and advocacy competency: the intergenerational advocacy pilot project.

    PubMed

    Hermoso, Joyce; Rosen, Anita L; Overly, Libby; Tompkins, Catherine J

    2006-01-01

    The Council on Social Work Education's (CSWE) Strengthening Aging and Gerontology Education for Social Work (SAGE-SW) project, funded by the John A. Hartford Foundation partnered with the National Committee to Preserve Social Security and Medicare (NCPSSM) to develop an Intergenerational Policy and Advocacy Project (IAP). This curriculum pilot project, based on a community organization model, was conducted with 13 baccalaureate social work (BSW) and master's social work (MSW) programs across the country and 122 students. The project was one method to pursue CSWE SAGE-SW's efforts to infuse aging content into social work foundation curricula, to support intergenerational teaching, to strengthen social work advocacy skills, and to provide social work students with positive experiences working with older adults. Pilot sites were asked to carry out the project as part of an existing course foundation or field practicum course. Project activities included collaboration with a variety of community agencies, holding issues or "town hall" forums in order to educate community members about critical policy issues affecting older adults; making contacts and establishing relationships with local, state and/or federal legislators; and conducting assessments of the service needs of older adults in the students' communities. Questionnaires, feedback, pre-post evaluations as well as brief accounts of each project are presented. Participants considered the IAP to be a successful project in terms of the objectives of increasing awareness and competency among social work students of aging issues and of promoting intergenerational linkages between older people and social work students. PMID:17200078

  15. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA)

    PubMed Central

    Solé, Dirceu; Ivancevich, Juan Carlos; Borges, Mario Sánchez; Coelho, Magna Adaci; Rosário, Nelson A; Ardusso, Ledit Ramón Francisco; Bernd, Luis Antônio Guerra

    2011-01-01

    OBJECTIVES: The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n = 634). RESULTS: Of all patients, 68.5% were older than 18 years, 41.6% were male, and 65.4% experienced the allergic reaction at home. The etiologic agent was identified in 87.4% of cases and predominantly consisted of drugs (31.2%), foods (23.3%), and insect stings (14.9%). The main symptom categories observed during the acute episodes were cutaneous (94.0%) and respiratory (79.0%). The majority of patients (71.6%) were treated initially by a physician (office/emergency room) within the first hour after the reaction occurred (60.2%), and 43.5% recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3% received parenteral epinephrine alone or associated with other medication. However, 80.5% and 70.2% were treated with corticosteroids or antihistamines (alone or in association), respectively. A total of 12.9% of the patients underwent reanimation maneuvers, and 15.2% were hospitalized. Only 5.8% of the patients returned to the emergency room after discharge, with 21.7% returning in the first 6 hours after initial treatment. CONCLUSION: The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2%), foods (23.3% and insect stings (14.9%) in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency. PMID:21808856

  16. Professor Brand Advocacy: Do Brand Relationships Matter?

    ERIC Educational Resources Information Center

    Jillapalli, Ravi K.; Wilcox, James B.

    2010-01-01

    The trend among students to advocate their professors online continues to generate interest within marketing academia. Brand advocacy in products and services has played a vital role in marketing. However, no known research to date has embraced the idea of brand advocacy in marketing education. This research builds on the recent human brand…

  17. Autism Advocacy: A Network Striving for Equity

    ERIC Educational Resources Information Center

    Itkonen, Tiina; Ream, Robert

    2013-01-01

    In this exploratory case study, we examine the rise of autism on the policy agenda and the new generation of autism advocacy. We focus especially on interconnections between the rhetoric about autism in the media and the emergence and political effectiveness of Autism Speaks, the nation's largest autism advocacy group. We portray how…

  18. Broadening the Discussion about Evaluator Advocacy

    ERIC Educational Resources Information Center

    Hendricks, Michael

    2014-01-01

    This issue of "American Journal of Evaluation" presents commentaries by evaluation leaders, George Grob and Rakesh Mohan, which draw upon their wealth of practical experience to address questions about evaluator advocacy, including What is meant by the word "advocacy"? Should evaluators ever advocate? If so, when and how? What…

  19. Health Advocacy--Counting the Costs

    ERIC Educational Resources Information Center

    Dyall, Lorna; Marama, Maria

    2010-01-01

    Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

  20. Corporate Advocacy Advertising and Political Influence.

    ERIC Educational Resources Information Center

    Waltzer, Herbert

    1988-01-01

    Offers an operational definition and typology of advocacy and image advertising as complementary forms of institutional advertising. Examines two of the more important forms of advocacy advertising--paid print editorials appearing on the "op-ed" page of the "New York Times" and the "advertorials" in two principal professional journals of the…

  1. Advocacy in Counseling: Counselors, Clients, & Community.

    ERIC Educational Resources Information Center

    Lewis, Judy, Ed.; Bradley, Loretta, Ed.

    The sixteen chapters in this volume were selected from advocacy theme papers written by members of the American Counseling Association. They examine the role of the counselor as advocate for different groups of people, as follows: (1) "Developing a Common Language and Framework for Understanding Advocacy in Counseling," (R. L. Toporek); (2)…

  2. School Board Advocacy: Ready, Aim, Inspire!

    ERIC Educational Resources Information Center

    Dowd, Karen

    2010-01-01

    It is said that "all politics are local," and the same can be said about advocacy and school boards. Advocacy is essential for retaining the progress that's been made in the past, and for building a foundation and network for the future. Advocating for preferred programs, curricula and initiatives has always been important. As a starting point,…

  3. Effective Advocacy and Communication with Legislators.

    ERIC Educational Resources Information Center

    American Counseling Association, Office of Public Policy and Information, Alexandria, VA.

    This pamphlet attempts to make communicating with legislators easy. Each section includes a brief paragraph and several bullet points that present techniques or advice for simplifying communication. It begins with "Rules for Effective Advocacy," which presents a core set of basic advocacy principles, followed by "What Makes Politicians Tick?" and…

  4. Advocacy: AASL Puts the Puzzle Together

    ERIC Educational Resources Information Center

    Johns, Sara Kelly

    2007-01-01

    School librarians work with people of all ages, abilities, and personalities; those people are the puzzle pieces that make advocacy for libraries effective. School librarians contribute to and use the resources of their state and national organizations' advocacy efforts. The completed picture of the puzzle is an excellent program with…

  5. Building Evidence for Music Education Advocacy

    ERIC Educational Resources Information Center

    Shorner-Johnson, Kevin

    2013-01-01

    The economic challenges facing public schools and music education are immense. In this context, music teachers and supporters will need to engage in persuasive advocacy to protect resource allocations to music programs. It is worthwhile to consider the model of music education advocacy that allowed music to be adopted into the Boston Public…

  6. Political Advocacy Handbook: Activating Grassroots Involvement.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.; Warger, Cynthia L.

    This handbook is designed to assist special education advocates in developing the capacity to mount an effective advocacy campaign at the state and federal levels. It is divided into the following four separate training modules: (1) "Introduction to Advocacy"; (2) "Understanding the Governmental Process"; (3) "Changing Public Policy"; and (4)…

  7. Recognition and Treatment of Anaphylaxis in the School Setting: The Essential Role of the School Nurse

    ERIC Educational Resources Information Center

    Schoessler, Sally; White, Martha V.

    2013-01-01

    Since anaphylaxis is unpredictable, rapid in onset, and potentially life threatening, it is critical for school staff to recognize and respond to its symptoms quickly. The symptoms of anaphylaxis can be challenging to differentiate, particularly in school-age children who may have trouble explaining what they are experiencing. School staff must…

  8. A case of the first documented fire ant anaphylaxis in Canada

    PubMed Central

    2013-01-01

    The first documented confirmed case of an imported fire ant causing anaphylaxis in Canada is herein reported. In a patient with anaphylaxis to ants a physician in Canada should be aware that an allergic reaction to fire ant is a possibility. PMID:23837799

  9. Cashew nut allergy is associated with a high risk of anaphylaxis.

    PubMed

    Davoren, M; Peake, J

    2005-10-01

    Cashew allergy is an evolving clinical problem. A retrospective chart review of 213 children with peanut or tree nut allergy was undertaken over a 42 month period. Anaphylaxis to cashew nut was more common than to peanut (74.1% v 30.5%). Children with cashew allergy are at risk of anaphylaxis. PMID:16177166

  10. Anaphylaxis Preparedness among Preschool Staff before and after an Educational Intervention

    PubMed Central

    Foster, Ashley A.; Campbell, Ronna L.; Lee, Sangil; Anderson, Jana L.

    2015-01-01

    Introduction. Children with severe food allergies may spend many hours in the preschool setting. Little is known about anaphylaxis recognition and management preparedness among preschool staff. The objective of this study was to assess anaphylaxis preparedness among preschool staff. Methods. Anonymous questionnaires were administered before and after a 40-minute educational seminar on anaphylaxis recognition and management. Results. In total, 181 individuals participated in the preintervention survey and 171 participated in the postintervention survey. The comfort level with recognizing anaphylaxis and administering an epinephrine autoinjector significantly increased after the intervention (P < .001 for both). Of the 5 steps needed to administer an epinephrine autoinjector, staff named a mean (SD) of 3 (1.3) steps in the correct order compared with 4.2 (1.1) steps after the educational intervention (P < .001). Conclusion. This study shows that a brief education intervention can significantly increase caregiver comfort regarding identifying anaphylaxis and administering an epinephrine autoinjector. PMID:26300926

  11. Anaphylaxis in the allergist's office: preparing your office and staff for medical emergencies.

    PubMed

    Wallace, Dana V

    2013-01-01

    All allergists who administer subcutaneous immunotherapy (SCIT) experience anaphylaxis in their offices and must devote proper planning, preparation, and practice to ensure that all staff members recognize the early signs and symptoms of anaphylaxis and can respond appropriately. Educating staff and patients, preparing an anaphylaxis emergency cart, developing and following selection criteria for SCIT and high-risk procedures, and customizing an "Action Plan for Anaphylaxis Management" create the foundation for mounting an adequate response to anaphylaxis. Strategies to prevent near-fatal and fatal reactions include (1) avoiding, when possible, the administration of SCIT to patients on beta-blockers; (2) using a preinjection questionnaire to review changes in the patient's medical condition, e.g., episodes of asthma since the previous injection; (3) using standardized forms and procedures for SCIT; (4) one might also consider an objective measure of airway function (e.g., peak flow measurement) for the asthmatic patient before allergy injections; (5) insisting on a 30-minute waiting time after SCIT; and (6) giving consideration to prescribing a dual-pack epinephrine autoinjector to all SCIT patients. Treatment of anaphylaxis should start with epinephrine administered intramuscularly at the first sign of anaphylaxis. Oxygen and i.v. fluids may be needed for moderate-to-severe anaphylaxis or anaphylaxis that is quickly developing or unresponsive to the first injection of epinephrine. Emergency medical services should be called for all patients who are experiencing moderate-to-severe (grade 2 or higher) anaphylaxis, if they require more than 1 dose of epinephrine and/or i.v. fluids, or if they do not immediately respond to treatment.

  12. Chloramine-induced anaphylaxis while showering: a case report

    PubMed Central

    2012-01-01

    Introduction Sodium-N-chlorine-p-toluene sulfonamide, commonly known as chloramine-T, is a derivative of chlorine which is widely used as a disinfectant. For many years, chloramine-T has been described as a cause of immediate-type hypersensitivity, especially with regard to asthma and rhinitis, and as a cause of occupational dermatoses in cleaning personnel in hospitals, although no anaphylactic reaction has yet been reported. Hence, to the best of our knowledge we present the first case of anaphylaxis to chloramine-T with evidence of specific immunoglobulin E antibodies. Case presentation We describe the case of a 25-year-old Caucasian woman who was in good health and with a negative history for atopy, including no respiratory symptoms of rhinitis or asthma, and with no professional exposure to chloramine-T. She, while showering, applied a chloramine-T solution to a skin area with folliculitis on her leg, and within a few minutes developed generalized urticaria and angioedema, followed by vomiting and collapse with loss of consciousness. A skin prick test with a chloramine-T solution at 10mg/mL concentration was positive, and specific immunoglobulin E to chloramine-T was quantified at a value of 2.9 optical density as measured by the enzyme allergosorbent test technique. Conclusion The strict cause-effect relationship and the results of the skin test and the in vitro test make certain the causative role of chloramine-T in this case of anaphylaxis. This suggests that chloramine-T, based on its wide use as a disinfectant, should be considered a possible cause in anaphylaxis of unknown origin. PMID:23009577

  13. Community health nursing advocacy: a concept analysis.

    PubMed

    Ezeonwu, Mabel C

    2015-01-01

    The purpose of this article is to present an in-depth analysis of the concept of community health nursing (CHN) advocacy. Walker and Avant's (2010) 8-step concept analysis methodology was used. A broad inquiry into the literature between 1994 and 2014 resulted in the identification of the uses, defining attributes, empirical referents, antecedents, and consequences, as well as the articulation of an operational definition of CHN advocacy. Model and contrary cases were identified to demonstrate the concept's application and to clarify its meaning. This analysis contributes to the advancement of knowledge of CHN advocacy and provides nurse clinicians, educators, and researchers with some conceptual clarity to help improve community health outcomes.

  14. Preliminary report: complement activation in wasp-sting anaphylaxis.

    PubMed

    van der Linden, P W; Hack, C E; Kerckhaert, J A; Struyvenberg, A; van der Zwan, J C

    1990-10-13

    The generation of the anaphylatoxin C3a was measured after a wasp-sting challenge in eight patients with previous anaphylactic reactions to wasp stings. Whereas there was no change in C3a in one patient who showed no reaction and only a slight rise in three patients with mild reactions, C3a rose substantially in the four patients with severe anaphylactic reactions. This complement activation is the first in-vitro variable which correlates with the severity of wasp-sting anaphylactic reactions. A role for complement activation in the pathophysiology of wasp-sting anaphylaxis is therefore suggested.

  15. Anaphylaxis induced by pine nuts in two young girls.

    PubMed

    Ibáñez, M Dolores; Lombardero, Manuel; San Ireneo, Mercedes Martinez; Muñoz, M Carmen

    2003-08-01

    Pine nuts are the seeds of Pinus pinea. There are few reported cases of allergy to pine nut. We describe two young girls with anaphylaxis caused by small amounts of pine nuts. Specific IgE to pine nut was demonstrated by skin prick tests and RAST but no IgE to other nuts and pine pollen was detected. The patients had IgE against a pine nut protein band with apparent molecular weights of approximately 17 kDa that could be considered as the main allergen. Our patients were monosensitized to pine nut and the 17-kDa protein could be correlated with the severe clinical symptoms.

  16. Advocacy in disability policy: parents and consumers as advocates.

    PubMed

    Cunconan-Lahr, R; Brotherson, M J

    1996-12-01

    Advocacy for change, which stems from commitment and vision, should be a collaborative process among parents and consumers in partnership with professionals. Using surveys, interactive focus groups, and telephone interviews, we explored the concept and activities of advocacy experienced by parents and individuals with disabilities. Participants were identified through an advocacy and leadership training program, Partners in Policymaking. Advocacy activities and supports and barriers to successful advocacy both for parents and consumers were identified. Suggestions for further research and action were proposed.

  17. Community Health Worker Professional Advocacy: Voices of Action from the 2014 National Community Health Worker Advocacy Survey.

    PubMed

    Sabo, Samantha; Wennerstrom, Ashley; Phillips, David; Haywoord, Catherine; Redondo, Floribella; Bell, Melanie L; Ingram, Maia

    2015-01-01

    This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.

  18. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities....

  19. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities....

  20. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities....

  1. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities....

  2. 45 CFR 1321.13 - Advocacy responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.13 Advocacy responsibilities....

  3. Participatory advocacy: a counter to media imperialism.

    PubMed

    Brown, M

    1996-01-01

    Western media have a history of defining news worldwide, presenting news from a Western perspective which distorts and denies the truth as perceived from developing countries. Western news coverage of developing countries seems to emphasize countries' fragility, instability, and corruption, leading people to believe that the economic problems of developing countries are due to internal failures. That view is then transferred back to indigenous peoples and communities through major Western news agencies and mass media. Participatory communication is based upon the notion that people have the right to decide how they want themselves and their situations to be portrayed, to decide what information is useful to them and their community, and to be integral players in the communication process. With regard to media imperialism, the author discusses implications for advocacy activities, participatory communication approaches, participatory advocacy, participatory advocacy in South Asia, girl child drama in Nepal, drug abuse television drama in Nepal, and the advocacy challenge.

  4. Factors for success in mental health advocacy

    PubMed Central

    Hann, Katrina; Pearson, Heather; Campbell, Doris; Sesay, Daniel; Eaton, Julian

    2015-01-01

    Background Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition – Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. Design The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. Results Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. Conclusions The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings. PMID:26689456

  5. Bortezomib treatment diminishes hazelnut-induced intestinal anaphylaxis in mice.

    PubMed

    Mudnakudu Nagaraju, Kiran Kumar; Babina, Magda; Weise, Christin; Kühl, Anja; Schulzke, Joerg; Worm, Margitta

    2016-07-01

    Food allergy is a common health problem and can cause anaphylaxis. Avoidance of the offending food allergen is still the mainstay therapeutic approach. In this study, we investigated the role of plasma cell reduction by proteasome inhibition in a murine model of food allergy and examined the impact of this treatment on the systemic and local immune response. For this purpose, intestinal anaphylaxis was induced in BALB/c mice with the food allergen hazelnut, in conjunction with different adjuvants (alum and Staphylococcal enterotoxin B SEB) and different administration routes (oral and intraperitoneal). In both models, allergy symptoms were observed, but the clinical severity was more pronounced in the hazelnut-alum model than in the hazelnut-SEB model. Accordingly, allergen-specific immunoglobulin E (IgE) against hazelnut was detectable, and mast cell protease-1 in serum was increased after allergen provocation. Treatment with the proteasome inhibitor bortezomib reduced plasma cells and resulted in an abolishment of hazelnut allergen-specific IgE, which was associated with amelioration of clinical symptoms as well as a significant decrease in both CD19(+) and follicular B lymphocytes. Our data demonstrate the importance of allergen-specific IgE in food allergy and point to B cells as potential therapeutic targets for its treatment. PMID:27111856

  6. Combined effects of food and exercise on anaphylaxis.

    PubMed

    Kim, Cheol Woo; Figueroa, Arturo; Park, Chan Ho; Kwak, Yi Sub; Kim, Kwi Baek; Seo, Dae Yun; Lee, Hyung Rock

    2013-10-01

    Food-dependent exercise-induced anaphylaxis (FDEIAn) is induced by different types and various intensities of physical activity, and is distinct from food allergies. It has been shown that consumption of allergenic food followed by exercise causes FDEIAn symptoms. Intake of allergenic food or medication before exercise is a major predisposing factor for FDEIAn. Urticaria and severe allergic reactions are general symptoms of FDEIAn. Dermatological tests and serum IgE assays are the typical prescreening methods, and have been used for several decades. However, these screening tests are not sufficient for detecting or preventing FDEIAn. It has been found that exercise may stimulate the release of mediators from IgE-dependent mast cells that can result in FDEIAn when a certain threshold level has been exceeded. Mast cell degradation might be a major factor to induce FDEIAn but this has not been determined. A number of foods have been reported to be involved in the onset of FDEIAn including wheat, eggs, chicken, shrimp, shellfish, nuts, fruits, and vegetables. It is also known that aspirin increases the occurrence of type I allergy symptoms when combined with specific foods. Moreover, high intensity and frequent exercise are more likely to provoke an attack than low intensity and less frequent exercise. In this paper, we present the current views of the pathophysiological mechanisms underlying FDEIAn within the context of exercise immunology. We also present a detailed FDEIAn definition along with etiologic factors and medical treatment for cholinergic urticaria (UC) and exercise-induced anaphylaxis (EIA).

  7. A Multicenter Retrospective Case Study of Anaphylaxis Triggers by Age in Korean Children

    PubMed Central

    Lee, So-Yeon; Ahn, Kangmo; Kim, Jihyun; Jang, Gwang Cheon; Min, Taek Ki; Yang, Hyeon-Jong; Pyun, Bok Yang; Kwon, Ji-Won; Sohn, Myung Hyun; Kim, Kyung Won; Kim, Kyu-Earn; Yu, Jinho; Hong, Soo-Jong; Kwon, Jung Hyun; Kim, Sung-Won; Song, Tae Won; Kim, Woo Kyung; Kim, Hyung Young; Jeon, You Hoon; Lee, Yong Ju; Lee, Hae Ran; Kim, Hye-Young; Ahn, Youngmin; Yum, Hye Yung; Suh, Dong In; Kim, Hyun Hee; Kim, Jin-Tack; Kim, Jeong Hee; Park, Yong Mean

    2016-01-01

    Purpose Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. Methods We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. Results A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. Conclusions The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age. PMID:27582405

  8. Advocacy evaluation: challenges and emerging trends.

    PubMed

    Devlin-Foltz, David; Fagen, Michael C; Reed, Ehren; Medina, Robert; Neiger, Brad L

    2012-09-01

    Devising, promoting, and implementing changes in policies and regulations are important components of population-level health promotion. Whether advocating for changes in school meal nutrition standards or restrictions on secondhand smoke, policy change can create environments conducive to healthier choices. Such policy changes often result from complex advocacy efforts that do not lend themselves to traditional evaluation approaches. In a challenging fiscal environment, allocating scarce resources to policy advocacy may be particularly difficult. A well-designed evaluation that moves beyond inventorying advocacy activities can help make the case for funding advocacy and policy change efforts. Although it is one thing to catalog meetings held, position papers drafted, and pamphlets distributed, it is quite another to demonstrate that these outputs resulted in useful policy change outcomes. This is where the emerging field of advocacy evaluation fits in by assessing (among other things) strategic learning, capacity building, and community organizing. Based on recent developments, this article highlights several challenges advocacy evaluators are currently facing and provides new resources for addressing them. PMID:22773623

  9. Pharmacists’ response to anaphylaxis in the community (PRAC): a randomised, simulated patient study of pharmacist practice

    PubMed Central

    Salter, Sandra M; Delfante, Brock; de Klerk, Sarah; Sanfilippo, Frank M; Clifford, Rhonda M

    2014-01-01

    Objective To evaluate how community pharmacists manage patients with anaphylaxis. Design A randomised, cross-sectional, simulated patient study of community pharmacist practice. Setting 300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen. Participants 300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen). Outcome measures Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis). Methods Simulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement). Results The mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, p<0.001, respectively). Overall, 17.3% of pharmacists correctly demonstrated the epinephrine autoinjector. The mean anaphylaxis engagement score was 3.11 points (SD 1.73). Scores for new-look EpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001). Conclusions Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis

  10. Advocacy for Health Equity: A Synthesis Review

    PubMed Central

    Farrer, Linden; Marinetti, Claudia; Cavaco, Yoline Kuipers; Costongs, Caroline

    2015-01-01

    Context Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short

  11. Litigation as TB Rights Advocacy

    PubMed Central

    2016-01-01

    Abstract One thousand people die every day in India as a result of TB, a preventable and treatable disease, even though the Constitution of India, government schemes, and international law guarantee available, accessible, acceptable, quality health care. Failure to address the spread of TB and to provide quality treatment to all affected populations constitutes a public health and human rights emergency that demands action and accountability. As part of a broader strategy, health activists in India employ Public Interest Litigation (PIL) to hold the state accountable for rights violations and to demand new legislation, standards for patient care, accountability for under-spending, improvements in services at individual facilities, and access to government entitlements in marginalized communities. Taking inspiration from right to health PIL cases (PILs), lawyers in a New Delhi-based rights organization used desk research, fact-findings, and the Right To Information Act to build a TB PIL for the Delhi High Court, Sanjai Sharma v. NCT of Delhi and Others (2015). The case argues that inadequate implementation of government TB schemes violates the Constitutional rights to life, health, food, and equality. Although PILs face substantial challenges, this paper concludes that litigation can be a crucial advocacy and accountability tool for people living with TB and their allies. PMID:27781000

  12. Anaphylaxis caused by stings from the Solenopsis invicta, lava-pés ant or red imported fi re ant*

    PubMed Central

    Haddad Junior, Vidal; Larsson, Carlos Eduardo

    2015-01-01

    Ants are social insects with species of medical interest, such as the fi re ants (Solenopsis sp.). The sting causes inflammation, vesicles and sterile pustules, which may cause allergic phenomena and even anaphylactic shock. We describe a patient who suffered a large number of stings and an episode of syncope with fall in blood pressure and complete regression of symptoms after resuscitation and medication for anaphylaxis. Considering the clinical manifestations and images of wheals and blisters on the patient’s feet at the time of syncope, this report should serve as a warning for the diagnosis and treatment of this condition and even for counseling and prevention regarding patients exposed to this risk. PMID:26312665

  13. Spontaneous rupture of a splenic hydatid cyst with anaphylaxis in a patient with multi-organ hydatid disease.

    PubMed

    Constantin, V; Popa, F; Socea, B; Carâp, A; Bălălău, C; Motofei, I; Banu, P; Costea, D

    2014-01-01

    Hidatid cysts of the spleen are a rare occurrence, the spleen being the third most common organ for the development of Echinococcus Granulosus. Splenic hydatid cysts are commonly part of multi-organ hydatid disease. Diagnosis is often established when investigating a splenomegaly or by chance during an unrelated consult. It can also be diagnosed after rupture, be it following trauma (the most common occurrence)or spontaneous. Splenic hydatid cyst rupture requires immediate action and is a life-threatening condition. It results, most often, in splenectomy. We present the case of a patient with multi-organ hydatid disease that presented with a ruptured splenic cyst and developed anaphylaxis. The case was resolved by splenectomy and recovered well. PMID:24956347

  14. Anaphylaxis to Spirulina confirmed by skin prick test with ingredients of Spirulina tablets.

    PubMed

    Le, Thuy-My; Knulst, André C; Röckmann, Heike

    2014-12-01

    Spirulina (Arthrospira platensis), blue-green microalgae, has high content in proteins, γ-linoleic acid and vitamins and therefore gained popularity as food supplement. According to the Food and Agriculture Organization of the United Nations Spirulina is also an interesting alternative and sustainable protein source with the growing world population. We present a case of a 17-year-old male, who developed anaphylaxis the first time he ingested a Spirulina tablet. Skin prick test with diluted Spirulina tablet was positive. Further skin prick testing with separated ingredients (Spirulina platensis algae, silicon dioxide, inulin and magnesium stearate) was only positive for Spirulina platensis algae and negative in controls, confirming the allergy was caused by Spirulina and not by one of the additives. This case report shows that diagnosis of Spirulina allergy can safely be made by skin prick test with dilutions of the A. platensis or even more simple by skin prick test with the diluted tablet. Since Spirulina has gained popularity as food and nutritional supplement, it is important to realize the potential risk of this dietary supplement. Before Spirulina is produced and consumed on a wider scale, allergenicity risk assessment should be performed, including investigation of potential crossreactivity with well-known inhalant allergens and foods.

  15. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2010.

    PubMed

    Sicherer, Scott H; Leung, Donald Y M

    2011-02-01

    This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin disease that were reported in the Journal in 2010. Key epidemiologic observations include an apparent increase in peanut allergy, with more than 1% of children affected, and increasing evidence that early food allergen exposure, rather than avoidance, might improve allergy outcomes. Advances in food allergy diagnosis include improved insights into prognosis and estimation of severity through component-resolved diagnostics and characterization of IgE binding to specific epitopes. Regarding treatment, oral and epicutaneous immunotherapy show promise. Studies of drug allergies show insights into pathophysiology, and studies on insect hypersensitivity reveal improved diagnostic methods. Genetic and functional studies have revealed the important role of epidermal differentiation products in the pathogenesis of atopic dermatitis. Cross-talk between the atopic immune response with the innate immune response have also been found to predispose to infection in patients with atopic dermatitis. New therapeutic approaches to control chronic urticaria have also been identified during the past year.

  16. [SIX CASES OF WHEAT-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS IN CHILDREN].

    PubMed

    Nakagawa, Tomoko; Sakai, Kazunori; Hayashi, Naofumi; Sato, Arisa; Sasaki, Kemal; Matsui, Teruaki; Sugiura, Shiro; Kando, Naoyuki; Ito, Komei

    2015-08-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is often reported in adults for whom the specific IgE to ω-5 gliadin can be a useful diagnostic test. However, few cases of WDEIA in children have been reported. We herein report six cases (aged 7-16 years) of children with WDEIA, who had no clinical history of immediate-type wheat allergy but who were diagnosed by a wheat ingestion + exercise provocation test. The specific IgE to wheat ranged <0.35-3.49 (median 1.64) UA/ml. Skin prick tests using wheat extract were performed on 3 patients who showed either a negative or low specific IgE titer to wheat, and all of them resulted in negative findings. The specific IgE to ω-5 gliadin was below the detection limit in all cases. Aspirin-supplemented provocation tests were performed to 4 cases who had negative results in the wheat + exercise test. All of these resulted in a positive reaction, and two of them provoked the occurrence of anaphylactic shock, which was relieved by the intramuscular injection of adrenaline. WDEIA in children cannot be ruled out by serological tests alone. On the other hand, severe symptoms might be provoked by the provocation test. Therefore, a safe procedure is warranted for the diagnosis of WDEIA in children.

  17. Anaphylaxis after hymenoptera sting: is it venom allergy, a clonal disorder, or both?

    PubMed

    Castells, Mariana C; Hornick, Jason L; Akin, Cem

    2015-01-01

    A 47-year-old man presented with loss of consciousness 5 minutes after being stung by a yellow jacket in his backyard. Epinephrine and fluids were required for resuscitation. Allergy evaluation revealed specific IgE to yellow jacket and honeybee, and the patient was started on venom immunotherapy. He had systemic reactions during buildup and a severe anaphylactic episode requiring 3 doses of intramuscular epinephrine at maintenance doses. Immunotherapy was discontinued. Serum tryptase level after 1 such episode was 29 ng/mL, with a baseline level of 25 ng/mL 4 weeks later. The physical examination was unremarkable including no skin lesions of cutaneous mastocytosis. Because of elevated baseline tryptase level, a bone marrow biopsy was performed, which revealed multifocal dense infiltrates of mast cells. A diagnosis of systemic mastocytosis was made. The patient was treated with omalizumab and was able to tolerate immunotherapy and is currently maintained on lifelong immunotherapy. He was restung in the field and has not had anaphylaxis.

  18. [A case of food-dependent exercise-induced anaphylaxis caused by ingestion of orange].

    PubMed

    Ono, Rintaro; Motomura, Chikako; Takamatsu, Nobue; Kondo, Yasuto; Akamine, Yuko; Matsuzaki, Hiroshi; Murakami, Yoko; Amimoto, Yuko; Taba, Naohiko; Honjyo, Satoshi; Shibata, Rumiko; Odajima, Hiroshi

    2015-02-01

    The patient was a 10-year-old girl who presented with a history of anaphylactic episodes on three occasions, that developed in association with exercise after she ate citrus fruit. She underwent tolerance tests, as food-dependent exercise-induced anaphylaxis (FDEIA) induced by citrus fruit was suspected. The result of the test for the combination of intake of oranges and exercise was negative. The patient presented with swollen eyelid and wheezing following combined intake of orange and aspirin, based on which she was diagnosed as having FDEIA. Many patients developing an allergic reaction to fruit are diagnosed as having oral allergy syndrome (OAS), and only few cases of FDEIA are reported. Immunoblot tests revealed antigens of 9 kDa, 39 kDa and 53 kDa in this patient, and an inhibition study with oranges revealed that the 39 kDa and 53 kDa antigens were probably antigen-specific allergens. Although the studied patient showed a strongly positive result for IgE antibodies specifically directed at cedar pollen, no common antigenicity with cedar pollen could be recognized. The final diagnosis was a type of FDEIA caused by 39 kDa and 53 kDa proteins, which are different from antigens previously identified in patients with citrus fruits allergy. It should be the first report of such a case. PMID:25924908

  19. [SIX CASES OF WHEAT-DEPENDENT EXERCISE-INDUCED ANAPHYLAXIS IN CHILDREN].

    PubMed

    Nakagawa, Tomoko; Sakai, Kazunori; Hayashi, Naofumi; Sato, Arisa; Sasaki, Kemal; Matsui, Teruaki; Sugiura, Shiro; Kando, Naoyuki; Ito, Komei

    2015-08-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is often reported in adults for whom the specific IgE to ω-5 gliadin can be a useful diagnostic test. However, few cases of WDEIA in children have been reported. We herein report six cases (aged 7-16 years) of children with WDEIA, who had no clinical history of immediate-type wheat allergy but who were diagnosed by a wheat ingestion + exercise provocation test. The specific IgE to wheat ranged <0.35-3.49 (median 1.64) UA/ml. Skin prick tests using wheat extract were performed on 3 patients who showed either a negative or low specific IgE titer to wheat, and all of them resulted in negative findings. The specific IgE to ω-5 gliadin was below the detection limit in all cases. Aspirin-supplemented provocation tests were performed to 4 cases who had negative results in the wheat + exercise test. All of these resulted in a positive reaction, and two of them provoked the occurrence of anaphylactic shock, which was relieved by the intramuscular injection of adrenaline. WDEIA in children cannot be ruled out by serological tests alone. On the other hand, severe symptoms might be provoked by the provocation test. Therefore, a safe procedure is warranted for the diagnosis of WDEIA in children. PMID:26522419

  20. Anaphylaxis to scorpion antivenin and its management following envenomation by Indian red scorpion, Mesobuthus tamulus.

    PubMed

    Bhoite, Rahul Ramesh; Bhoite, Girija Ramesh; Bagdure, Dayanand N; Bawaskar, Himmatrao S

    2015-09-01

    Mesobuthus tamulus is an Indian red scorpion that is responsible for numerous cases of scorpion stings in the Indian subcontinent. Antivenin, vasodilators, and benzodiazepines are medications of choice in the treatment of scorpion bites. Adverse reactions such as anaphylaxis to antivenin have been infrequently described in the literature. We, herein, present a case of a 42-year-old man stung by Indian red scorpion while gardening at home in India, who presented with extreme pain at the sting site and signs of cardio-toxicity. He was treated with scorpion antivenin and vasodilators but developed anaphylaxis to antivenin. We discuss management strategies. Anaphylaxis to antivenin should be on the differential during management of scorpion bites because classical signs of anaphylaxis may be absent. PMID:26430342

  1. CD4-Blockade Can Induce Protection from Peanut-Induced Anaphylaxis

    PubMed Central

    Duarte, Joana; Caridade, Marta; Graca, Luis

    2011-01-01

    Monoclonal antibodies (mAb) have been shown effective in inducing immune tolerance in a range of animal models of autoimmunity, allergy, and transplantation. We investigated whether CD4-blockade, effective in inducing transplantation tolerance, could prevent systemic immune responses leading to anaphylaxis. We found that treatment with a non-depleting anti-CD4 mAb could prevent peanut-induced anaphylaxis following subsequent systemic exposure to crude peanut extract (CPE). Furthermore, the effect of CD4-blockade did not interfere with overall immune competence, as anti-CD4 treated mice remained fully competent to respond to unrelated antigens. Protection from anaphylaxis correlated with increased frequency of Foxp3+ regulatory T cells (Treg), and was abrogated following Treg depletion. Taken together our data suggest that activation of T cells by CPE in presence of CD4-blockade leads to Treg expansion that can prevent peanut-induced anaphylaxis. PMID:22566846

  2. Managing nut-induced anaphylaxis: challenges and solutions.

    PubMed

    Lomas, Jeanne M; Järvinen, Kirsi M

    2015-01-01

    The prevalence of peanut and tree nut allergy in the USA has increased, especially in the pediatric population. Nut allergy remains the leading cause of fatal anaphylactic reactions. Management of anaphylaxis includes not only treatment of symptoms during a reaction, but strict dietary avoidance and education on potential situations, which may place the patient at high risk for accidental exposure. Cross-reactivity between various nuts along with various cross-contamination sources should be discussed with all nut-allergic individuals. Exciting research continues to emerge on other potential treatments for patients allergic to nuts, including allergen immunotherapy. Results of such interventions have been encouraging, though further studies are needed regarding safety and long-term outcomes before these can be applied to clinical practice.

  3. Managing nut-induced anaphylaxis: challenges and solutions

    PubMed Central

    Lomas, Jeanne M; Järvinen, Kirsi M

    2015-01-01

    The prevalence of peanut and tree nut allergy in the USA has increased, especially in the pediatric population. Nut allergy remains the leading cause of fatal anaphylactic reactions. Management of anaphylaxis includes not only treatment of symptoms during a reaction, but strict dietary avoidance and education on potential situations, which may place the patient at high risk for accidental exposure. Cross-reactivity between various nuts along with various cross-contamination sources should be discussed with all nut-allergic individuals. Exciting research continues to emerge on other potential treatments for patients allergic to nuts, including allergen immunotherapy. Results of such interventions have been encouraging, though further studies are needed regarding safety and long-term outcomes before these can be applied to clinical practice. PMID:26604803

  4. A case of taurine-containing drink induced anaphylaxis.

    PubMed

    Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Yang, Min-Suk; Chang, Yoon-Seok; Kim, Sae-Hoon

    2013-01-01

    Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine. Skin prick test and basophil activation test with the synthetic taurine were negative. To our knowledge, there has been no report of taurine-induced hypersensitivity reactions. We herein report the first case of taurine-containing drink induced anaphylaxis, especially by synthetic taurine.

  5. Anaphylaxis caused by tipepidine hibenzate, a central antitussive drug

    PubMed Central

    Mochizuki, Eisuke; Shirai, Toshihiro; Noguchi, Rie; Mitsui, Chihiro; Taniguchi, Masami; Suda, Takafumi

    2015-01-01

    Tipepidine hibenzate, a central antitussive drug, is widely used in the management of cough and is generally safe and well tolerated. We present here a case of anaphylaxis caused by this drug. When the patient had caught a cold over the previous 10 years, she had received medications, including tipepidine hibenzate, from her family doctor. However, this time, she developed dyspnea, skin eruption, and anaphylactic shock after taking a Chinese herbal medicine and this drug. After her conditions improved due to adequate treatment, she was referred to our hospital to confirm the causative drug. Double-blind placebo-controlled oral challenge tests were performed after obtaining informed consent. Oral challenge with one-third tablet dose of tipepidine hibenzate caused a positive reaction. Urinary leukotriene E4 rose during the challenge with tipepidine hibenzate, but not with control. Clinicians should keep in mind that common antitussive drug use can cause anaphylactic reactions in very rare cases and can be harmful. PMID:25802739

  6. A case of taurine-containing drink induced anaphylaxis.

    PubMed

    Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Yang, Min-Suk; Chang, Yoon-Seok; Kim, Sae-Hoon

    2013-01-01

    Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine. Skin prick test and basophil activation test with the synthetic taurine were negative. To our knowledge, there has been no report of taurine-induced hypersensitivity reactions. We herein report the first case of taurine-containing drink induced anaphylaxis, especially by synthetic taurine. PMID:23404176

  7. Hymenoptera Anaphylaxis and C-kit Mutations: An Unexpected Association.

    PubMed

    Bonadonna, Patrizia; Bonifacio, Massimiliano; Lombardo, Carla; Zanotti, Roberta

    2015-08-01

    Clinical manifestations of mastocytosis in adults comprise signs and symptoms linked to mast cell (MC) activation, including anaphylaxis. Depending on MC burden, adults can be diagnosed with systemic mastocytosis, when the WHO criteria are fulfilled, or with other clonal MC disorders, characterized by MC mediator symptoms and demonstration of activating KIT mutations and/or expression of CD25 on MCs. There is a specific link between mastocytosis and hymenoptera venom allergy (HVA): the reported frequency of HVA in mastocytosis is 20-50 % and raises to 60-80 % in patients affected by indolent systemic mastocytosis without skin lesions. The presentation of HVA characterized by severe hypotension in the absence of urticarial or angioedema is typical in patient with an underlying MC disorder, even in the presence of normal baseline serum tryptase levels.

  8. Making the grade with asthma, allergies, and anaphylaxis.

    PubMed

    Sander, Nancy

    2002-01-01

    For some students with asthma, allergies, or anaphylaxis, school attendance can be risky. School administrators and educators are ill prepared to address medical challenges of students with chronic illness. Yet, the number of school nurses employed in the United States and the nurse-student ratio is uncertain. An unknown number of schools restrict children's rights to carry prescribed lifesaving medications while at or traveling to and from school or on field trips. Additionally, school indoor air quality is often poor and adversely affects students' health. Nurses are natural educators and advocates. Both of these roles are instrumental in empowering families to ensure the health of their children with asthma and allergies while in school.

  9. The Northland fluoridation advocacy programme: an evaluation.

    PubMed

    Gowda, Sunitha; Thomas, David R

    2008-12-01

    On 20 July 2006, the Far North District Council resolved to fluoridate Kaitaia and Kaikohe. This was the first such initiative by any Territorial Local Authority (TLA) in New Zealand for 23 years, and resulted from a fluoridation advocacy programme. This paper describes the programme implementation, assesses its consistency with the principles of the Treaty of Waitangi, and critically examines the collaboration between the fluoride advocate and the key stakeholders. Process evaluation identified three main categories of programme implementation: policy advocacy, community action projects, and media advocacy. The collaboration of iwi, Maori health providers and the community suggests that the programme was consistent with the principles (partnership, participation and protection) ofthe Treaty ofWaitangi. Media advocacy played an important role in reflecting and engaging community views on fluoridation, and it influenced decision-making by the Far North District Council. The simultaneous, combined 'top-down and bottom-up' approach was an effective and successful strategy for fluoridation advocacy in the community. Less integrated approaches implemented on their own (such as the 'top down' approach in Whangarei and the 'bottom-up' approach in Dargaville) were not effective. PMID:19180864

  10. Gender and advocacy in Indonesia.

    PubMed

    Ray-ross, S

    1997-01-01

    The Centre for Development and Population Activities (CEDPA) and the Indonesian Midwives Association (IBI) have developed a two-phase training program regarding gender issues for the association's midwives. The first phase focuses on the leadership, management, and advocacy skills necessary to articulate program needs and to take part in making decisions regarding family planning and reproductive health. The second phase concerns the integration of gender into project design. Proposals developed by the midwives include the following: 1) to improve counseling services for women in a district where 70% of the women using contraception do not decide for themselves which methods to use; 2) to reduce maternal mortality in a district where it has increased by 20% and where women have died while waiting for husbands or fathers-in-law to make the decision to bring them to hospitals; 3) to develop gender-sensitive materials concerning HIV/AIDS; and 4) to expand gender training to all levels of IBI, to provide follow-up technical support, and to integrate gender into the mission statement of the organization. Dr. Nafsiah Mboi (member of Parliament and vice chair of the Global Commission on Women's Health), Dr. Widyastuti Wibisana (director of community participation in the Ministry of Health), Dr. Kokila Vaidya (WHO Medical Officer), Carla Bianpoen (gender specialist with the World Bank), and Titi Sumbung (director of the Melati Foundation) helped to develop and to conduct the program. IBI, which has 65,000 members, provides family planning, reproductive health, and maternal and child health services throughout Indonesia. PMID:12292791

  11. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance

    PubMed Central

    2015-01-01

    Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide where ticks are endemic. Sensitisation to galactose-α-1,3-galactose (α-Gal) has been shown to be the mechanism of allergic reaction in mammalian meat allergy following tick bite. Whilst other carbohydrate allergens have been identified, this allergen is unique amongst carbohydrate food allergens in provoking anaphylaxis. Treatment of mammalian meat anaphylaxis involves avoidance of mammalian meat and mammalian derived products in those who also react to gelatine and mammalian milks. Before initiating treatment with certain therapeutic agents (e.g., cetuximab, gelatine-containing substances), a careful assessment of the risk of anaphylaxis, including serological analysis for α-Gal specific-IgE, should be undertaken in any individual who works, lives, volunteers or recreates in a tick endemic area. Prevention of tick bites may ameliorate mammalian meat allergy. Tick anaphylaxis is rare in countries other than Australia. Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis. Recognition of the association between mammalian meat allergy and tick bites has established a novel cause and effect relationship between an environmental exposure and subsequent development of a food allergy, directing us towards examining environmental exposures as provoking factors pivotal to the development of other food allergies and refocusing our attention upon causation of allergy in general. PMID:25653915

  12. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance.

    PubMed

    van Nunen, Sheryl

    2015-01-01

    Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide where ticks are endemic. Sensitisation to galactose-α-1,3-galactose (α-Gal) has been shown to be the mechanism of allergic reaction in mammalian meat allergy following tick bite. Whilst other carbohydrate allergens have been identified, this allergen is unique amongst carbohydrate food allergens in provoking anaphylaxis. Treatment of mammalian meat anaphylaxis involves avoidance of mammalian meat and mammalian derived products in those who also react to gelatine and mammalian milks. Before initiating treatment with certain therapeutic agents (e.g., cetuximab, gelatine-containing substances), a careful assessment of the risk of anaphylaxis, including serological analysis for α-Gal specific-IgE, should be undertaken in any individual who works, lives, volunteers or recreates in a tick endemic area. Prevention of tick bites may ameliorate mammalian meat allergy. Tick anaphylaxis is rare in countries other than Australia. Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis. Recognition of the association between mammalian meat allergy and tick bites has established a novel cause and effect relationship between an environmental exposure and subsequent development of a food allergy, directing us towards examining environmental exposures as provoking factors pivotal to the development of other food allergies and refocusing our attention upon causation of allergy in general. PMID:25653915

  13. First study of pattern of anaphylaxis in a large tertiary care hospital in Saudi Arabia

    PubMed Central

    Amin, Rashid; Rehan Khaliq, Agha M.; Al Otaibi, Talal; Al Hashim, Samia; Al Gazlan, Sulaiman

    2015-01-01

    Background Anaphylaxis is a serious allergic reaction that may cause death. The signs and symptoms of anaphylaxis have not been examined in the Saudi population before. Objective The present study examined the signs, symptoms, triggers, and demographic patterns of patients treated for anaphylaxis at a large tertiary care hospital in Riyadh, Saudi Arabia. Methods All the patients who were prescribed new prescriptions of adrenaline auto-injectors (AAs) between February 1, 2010 and December 31, 2011 were included in this study. Information was collected using a standardized form. Results There were 238 patients who were analyzed. The median age at the time of first AA prescription was 15.5 years. Female to male ratio was 52:48 and 54% of the subjects were more than 18 years of age. There were some differences in the presenting signs and symptoms observed in our study compared with similar studies from around the world. Urticaria and angioedema were the most common at about 70% across all ages, followed by shortness of breath at 28%. Some triggers were found to be more common in our region. Food was the commonest trigger for anaphylaxis including tree nuts, egg, and sesame. Drug allergy was also a common trigger, with penicillins and nonsteroidal anti-inflammatory drugs being the commonest. Regarding insect allergy, samsam ant was the commonest trigger in our study. Conclusion To our knowledge, this is the first study on anaphylaxis in Saudi Arabia. Some of the manifestations of anaphylaxis are significantly different in our population study compared to previously published data from other parts of the world. While managing anaphylaxis, we should be mindful of these differences. This improved understanding should help reduce the morbidity and mortality associated with anaphylaxis in our region. PMID:26539404

  14. Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011

    PubMed Central

    2014-01-01

    Background Examining deaths caused by anaphylaxis may help identify factors that may decrease the risk of these unfortunate events. However, information on fatal anaphylaxis is limited. The objectives of our study were to examine all cases of fatal anaphylaxis in Ontario to determine cause of death, associated features, co factors and trends in mortality. The identification of these factors is important for developing effective strategies to overcome gaps in monitoring and treatment of patients with food allergies and risk for anaphylaxis. Methods This was a retrospective case-series analysis of all causes of anaphylaxis-related deaths using data from the Ontario Coroner’s database between 1986 and 2011. Quantitative data (e.g. demographic) were analyzed using descriptive statistics and frequency analysis using SPSS. Qualitative data were analyzed using content analysis of grounded theory methodology. Results We found 92 deaths in the last 26 years related to anaphylaxis. Causes of death, in order of decreasing frequency, included food (40 cases), insect venom (30 cases), iatrogenic (16 cases), and idiopathic (6 cases). Overall, there appears to be a decline in the frequency of food related deaths, but an increase in iatrogenic causes of fatalities. We found factors associated with fatal anaphylaxis included: delayed epinephrine administration, asthma, allergy to peanut, food ingestion outside the home, and teenagers with food allergies. Conclusions Our findings indicate the need to improve epinephrine auto-injector use in acute reactions, particularly for teens and asthmatics with food allergies. In addition, education can be improved among food service workers and food industry in order to help food allergic patients avoid potentially fatal allergens. The increasing trend in iatrogenic related anaphylaxis is concerning, and requires monitoring and more investigation. PMID:25670935

  15. A dangerous exercise lessons from food-dependent anaphylaxis for the physician.

    PubMed

    Medveczky, Thomas

    2014-10-01

    Exercise-induced anaphylaxis (EIA) and its subtype, food dependent exercise-induced anaphylaxis are uncommon and therefore underdiagnosed forms of physical allergy. Triggers include various degrees of exercise in combination with ingestion of specific food products. Treatment remains identical to that of IgE-mediated allergic reactions. The presentation is commonly underdiagnosed and caries significant fatality risk, and this case should raise the awareness of the attending physician.

  16. [Bupivacaine-induced Anaphylaxis in a Parturient Undergoing Cesarean Section].

    PubMed

    Iwasaki, Mitsuo; Tachibana, Kazuya; Mitsuda, Nobuaki; Kinouchi, Keiko

    2015-02-01

    We describe a case of anaphylaxis that occurred in a 33-year-old gravida 1, para 1 term woman scheduled for cesarean delivery for breech presentation. Her past history was unremarkable except for orciprenaline allergy. Spinal anesthesia was performed at L3-4 using 2.5 ml of 0.5% hyperbaric bupivacaine and 0.1 mg morphine. Seven minutes after spinal anesthesia, she complained of hoarseness and difficulty in breathing and 3 minutes later, blood pressure decreased to 76/51 mmHg, and oxygen saturation to 87% with supplemental oxygen. Skin flushing was noted in the face and trunk of the body and anaphylaxis was diagnosed. She was treated with a rapid intravenous infusion and iv administration of phenylephrine (total dose 0.4 mg), ephedrine (total dose 25 mg), hydrocortisone and famotidine. Cesarean section was started 23 minutes after spinal anesthesia when blood pressure and oxygen saturation recovered. A male infant was delivered (18 minutes after the onset of anaphylactic event) with Apgar scores of 2 and 5 at 1 and 5 min, respectively and resuscitated with mask ventilation. Umbilical artery blood gas analysis revealed pH 6.85, base excess -20.3 mmol x l (-1) and lactate 109 mg x dl (-1). The mother was discharged from the hospital on the 6th postoperative day. The baby's electroencephalogram, however, demonstrated a pattern consistent with mild hypoxic-ischemic encephalopathy. Lymphocyte stimulation test revealed that she was allergic to bupivacaine. If maternal hypotension persists, i.m. or i.v. adrenaline should be administered immediately because maternal hypotension and hypoxemia may cause significant fetal morbidity and mortality and prompt cesarean section should be considered. PMID:26121818

  17. Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant

    PubMed Central

    Commins, Scott P.; Platts-Mills, Thomas A. E.

    2009-01-01

    Anaphylaxis is a severe allergic reaction that can be rapidly progressing and occasionally fatal. In instances where the triggering allergen is not obvious, establishing the etiology of anaphylaxis is pivotal to long-term management. Assigning etiology is limited, however, by the number of known exposures associated with anaphylaxis. Therefore, identification of novel causative agents can provide an important step forward in facilitating new, allergen specific approaches to management. In contrast to the view that carbohydrate-directed IgE has minimal, if any, clinical significance, recent data suggests that IgE antibodies to carbohydrate epitopes can be an important factor in anaphylaxis that may otherwise appear to be idiopathic. Specifically, IgE antibodies to the carbohydrate galactose-α-1,3-galactose (alpha-gal) were found to be capable of eliciting serious, even fatal, reactions to the monoclonal antibody (ab) cetuximab.1 Moreover, alpha-gal has recently been identified as a novel food allergen.2 Patients who have IgE to alpha-gal report delayed anaphylaxis or urticaria occurring 3-6 hours after eating beef, pork or lamb. Here, we review the evidence relating to carbohydrates in food allergy and anaphylaxis and discuss the implications of a new mammalian cross-reactive carbohydrate determinant (CCD). PMID:19815111

  18. Systematic review of outcome measures in trials of pediatric anaphylaxis treatment

    PubMed Central

    2014-01-01

    Background Considerable heterogeneity has been observed in the selection and reporting of disease-specific pediatric outcome measures in randomized controlled trials (RCTs). This makes interpretation of results and comparison across trials challenging. Outcome measures in pediatric anaphylaxis trials have never previously been systematically assessed. This systematic review (SR) identified and assessed outcome measures used in RCTs of anaphylaxis treatment in children. As a secondary objective, this SR assessed the evidence for current treatment modalities for anaphylaxis in the pediatric population. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL from 2001 until December 2012. We also searched websites listing ongoing trials. We included randomized and controlled trials of anaphylaxis treatment in patients 0–18 years of age. Two authors independently assessed articles for inclusion. Results No published studies fulfilled the inclusion criteria. Conclusions There is an alarming absence of RCTs evaluating the treatments for anaphylaxis in children. High quality studies are needed and are possible to design, despite the severe and acute nature of this condition. Consensus about the selection and validation of appropriate outcome measures will enhance the quality of research and improve the care of children with anaphylaxis. Trial registration CRD42012002685 PMID:24950840

  19. Platelets in the immune response: Revisiting platelet-activating factor in anaphylaxis.

    PubMed

    Gill, Parwinder; Jindal, Nina Lakhani; Jagdis, Amanda; Vadas, Peter

    2015-06-01

    Anaphylaxis is an acute, severe, life-threatening multisystem allergic reaction resulting from the sudden systemic release of biochemical mediators and chemotactic substances. Release of both preformed granule-associated mediators and newly generated lipid-derived mediators contributes to the amplification and prolongation of anaphylaxis. Platelet-activating factor (PAF) is a potent phospholipid-derived mediator the central role of which has been well established in experimental models of both immune-mediated and non-immune mediated anaphylaxis. It is produced and secreted by several types of cells, including mast cells, monocytes, tissue macrophages, platelets, eosinophils, endothelial cells, and neutrophils. PAF is implicated in platelet aggregation and activation through release of vasoactive amines in the inflammatory response, resulting in increased vascular permeability, circulatory collapse, decreased cardiac output, and various other biological effects. PAF is rapidly hydrolyzed and degraded to an inactive metabolite, lysoPAF, by the enzyme PAF acetylhydrolase, the activity of which has shown to correlate inversely with PAF levels and predispose to severe anaphylaxis. In addition to its role in anaphylaxis, PAF has also been implicated as a mediator in both allergic and nonallergic inflammatory diseases, including allergic rhinitis, sepsis, atherosclerotic disease, and malignancy, in which PAF signaling has an established role. The therapeutic role of PAF antagonism has been investigated for several diseases, with variable results thus far. Further investigation of its role in pathology and therapeutic modulation is highly anticipated because of the pressing need for more selective and targeted therapy for the management of severe anaphylaxis.

  20. Advocacy Evaluation: A Model for Internal Evaluation Offices.

    ERIC Educational Resources Information Center

    Sonnichsen, Richard C.

    1988-01-01

    As evaluations are more often implemented by internal staff, internal evaluators must begin to assume decision-making and advocacy tasks. This advocacy evaluation concept is described using the Federal Bureau of Investigation evaluation staff as a model. (TJH)

  1. Community stakeholder responses to advocacy advertising

    SciTech Connect

    Miller, B.; Sinclair, J.

    2009-07-01

    Focus group research was used to examine how community stakeholders, a group with local industry experience, responded to coal industry advocacy messages. The stakeholders expressed beliefs about both the advertiser and the coal industry, and while their knowledge led to critical consideration of the industry campaign, they also expressed a desire to identify with positive messages about their community. Applying a postpositivist research perspective, a new model is introduced to integrate these beliefs in terms of advertiser trust and industry accountability under the existing theoretical framework of persuasion knowledge. Agent and topic knowledge are combined in this model based on responses to the industry advocacy campaign. In doing so, this study integrates a priori theory within a new context, extending the current theoretical framework to include an understanding of how community stakeholders - a common target for marketplace advocacy - interpret industry messages.

  2. A Pharmacy Political Advocacy Elective Course

    PubMed Central

    Powell, Patricia H.

    2011-01-01

    Objective. To develop and implement an elective course to increase pharmacy students’ awareness of legislation that might affect the pharmacy profession and to promote advocacy for the profession. Design. Students participated in class discussions regarding current legislative issues and methods to advocate for the pharmacy profession. Assignments included a student-led presentation of the advocacy agendas for various pharmacy organizations, a take-home examination, participation in class debates, and a legislative presentation. Assessment. Forty-eight students enrolled in the elective course over 3 years. Assignments and class participation were assessed using grading rubrics. At the end of the semester, students completed a questionnaire to assess the overall benefit of the course. Conclusions. Participation in an elective course devoted to pharmacy political advocacy increased awareness of legislation and the desire to become involved in pharmacy organizations to promote the pharmacy profession. PMID:21969723

  3. Political advocacy in pharmacy: challenges and opportunities

    PubMed Central

    Apollonio, Dorie E

    2015-01-01

    Many pharmacists have expressed a desire to become more involved in patient care, in part by being compensated for patient counseling, as well as by providing services traditionally offered by physicians and nurse practitioners. Recent efforts to develop collaborative care models, as well as major restructurings of US health insurance coverage, provide a unique opportunity for pharmacists to become recognized as independent health care providers and be reimbursed as primary care providers. Achieving that goal would require addressing advocacy challenges familiar to other health care professionals who have achieved provider status under existing reimbursement rules. Historically, political advocacy has not been a major part of pharmacy practice, or even viewed as necessary. However, pharmacists would be more politically effective with a single organization to speak for them as a profession, and with further education in advocacy. PMID:26301185

  4. 77 FR 13390 - Recruitment Notice for the Taxpayer Advocacy Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-06

    ... Internal Revenue Service Recruitment Notice for the Taxpayer Advocacy Panel AGENCY: Internal Revenue... Advocacy Panel (TAP) Members. DATES: March 19, 2012 through April 27, 2012. FOR FURTHER INFORMATION CONTACT... nation's tax agency by applying to be members of the Taxpayer Advocacy Panel (TAP). The mission of...

  5. Promoting Self-Advocacy among Minority Students in School Counseling

    ERIC Educational Resources Information Center

    Astramovich, Randall L.; Harris, Katrina R.

    2007-01-01

    This article presents self-advocacy competencies developed to promote the academic, career, and personal/social success of minority students. The authors discuss challenges faced by minority students in today's educational environment and review principles of self advocacy. Competencies for developing self-advocacy awareness, knowledge, and skills…

  6. 76 FR 75951 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel scheduled for Tuesday, December 6, 2011, and Wednesday.... ] Dated: November 30, 2011. Shawn Collins, Director, Taxpayer Advocacy Panel. BILLING CODE 4830-01-P...

  7. 75 FR 9028 - Recruitment Notice for the Taxpayer Advocacy Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-26

    ... Internal Revenue Service Recruitment Notice for the Taxpayer Advocacy Panel AGENCY: Internal Revenue... Advocacy Panel (TAP) Members. DATES: March 15, 2010 through April 30, 2010. FOR FURTHER INFORMATION CONTACT... nation's tax agency by applying to be members of the Taxpayer Advocacy Panel (TAP). The mission of...

  8. 77 FR 16895 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-22

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... the open meeting of the Taxpayer Advocacy Panel Taxpayer Burden Reduction Project Committee scheduled... cancelled pending renewal of the Taxpayer Advocacy Panel Charter. FOR FURTHER INFORMATION CONTACT: Audrey...

  9. 76 FR 12418 - Recruitment Notice for the Taxpayer Advocacy Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-07

    ... Internal Revenue Service Recruitment Notice for the Taxpayer Advocacy Panel AGENCY: Internal Revenue... Advocacy Panel (TAP) Members. DATES: March 14, 2011 through April 29, 2011. FOR FURTHER INFORMATION CONTACT... nation's tax agency by applying to be members of the Taxpayer Advocacy Panel (TAP). The mission of...

  10. 77 FR 16895 - Taxpayer Advocacy Panel Meeting Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-22

    ... Internal Revenue Service Taxpayer Advocacy Panel Meeting Cancellation AGENCY: Internal Revenue Service (IRS... open meeting of the Taxpayer Advocacy Panel Small Business/Self-Employed Decreasing Non-Filers Project... meeting is cancelled pending renewal of the Taxpayer Advocacy Panel Charter. FOR FURTHER...

  11. Development and Assessment of the Social Issues Advocacy Scale

    ERIC Educational Resources Information Center

    Nilsson, Johanna E.; Marszalek, Jacob M.; Linnemeyer, Rachel M.; Bahner, Angela D.; Misialek, Leah Hanson

    2011-01-01

    This article describes the development and the initial psychometric evaluation of the Social Issues Advocacy Scale in two studies. In the first study, an exploratory factor analysis (n = 278) revealed a four-factor scale, accounting for 71.4% of the variance, measuring different aspects of social issue advocacy: Political and Social Advocacy,…

  12. Examining School Counselors' Commitments to Social Justice Advocacy

    ERIC Educational Resources Information Center

    Feldwisch, Rachel P.

    2016-01-01

    Many school counselors endorse using social justice advocacy to close achievement gaps. In this study, school counselors from a single state scored in the moderate to high range on the Social Issues Advocacy Scale. Results showed alignment between school counselors' self-endorsement of social justice advocacy and scores on the Advocacy…

  13. Aging Action: A Course in Senior Advocacy in Kansas.

    ERIC Educational Resources Information Center

    Kansas State Advisory Council on Aging, Topeka.

    Skills useful in advocacy of senior citizens' needs are discussed in this manual. The topics included are: (1) the meaning of advocacy; (2) assertiveness training for aging-action; (3) identifying issues; (4) choosing issues; (5) developing a plan of action; (6) organizing; (7) legislative advocacy; (8) criteria to evaluate potential legislative…

  14. Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach.

    PubMed

    De Swert, Liliane F A; Bullens, Dominique; Raes, Marc; Dermaux, Anna-Maria

    2008-11-01

    Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available. PMID:18204859

  15. Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach.

    PubMed

    De Swert, Liliane F A; Bullens, Dominique; Raes, Marc; Dermaux, Anna-Maria

    2008-11-01

    Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

  16. Clinical and laboratory features, and quality of life assessment in wheat dependent exercise-induced anaphylaxis patients from central China.

    PubMed

    Chen, Hao; Huang, Nan; Li, Wen-Jing; Dong, Xiang; Qi, Shan-Shan; Wang, You-Na; Liu, Guang-Hui; Zhu, Rong-Fei

    2016-06-01

    Wheat dependent exercise-induced anaphylaxis (WDEIA) is a rare but potentially severe food allergy caused by the combination of wheat ingestion and physical exercise. The impact of WDEIA on quality of life (QOL) is unclear. This study characterized the clinical and laboratory features and investigated the QOL in WDEIA patients from Central China. Twenty-eight WDEIA patients were analyzed, and QOL was measured by validated Chinese version Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) and Food Allergy Independent Measure (FAIM) after obtaining the diagnosis. The results showed that half of the patients were females. The median onset age was 37 years old. The symptoms occurred within 1 h after wheat ingestion (26/28). Symptoms of anaphylaxis included cutaneous (26/28), respiratory (11/28), gastro-intestinal (5/28) and cardiovascular manifestations (27/28). Skin prick tests were positive to salt soluble (89.3%) and salt insoluble wheat allergen extracts (100%). Positive rate to wheat, gluten and omega-5 gliadin specific IgE was 64.3%, 92.9% and 92.9% respectively. Specific IgE to omega-5 gliadin with a cut-off value 0.83 KU/L offered highly efficient diagnostic criterion for WDEIA (sensitivity: 89.3%; and specificity: 88.9%). The mean scores of FAQLQ-AF and FAIM were 4.70 and 4.98 respectively and level of anti-omega-5 gliadin IgE had positive correlations with FAQLQ scores. Thereby, WDEIA is commonly found in mid-age adults. In most cases, multi-organs especially skin and cardiovascular systems are involved. Salt insoluble wheat allergen skin test and serum specific IgE to gluten and omega-5 gliadin help to diagnose WDEIA. QOL in WDEIA patients is severely impaired. PMID:27376813

  17. Clinical and laboratory features, and quality of life assessment in wheat dependent exercise-induced anaphylaxis patients from central China.

    PubMed

    Chen, Hao; Huang, Nan; Li, Wen-Jing; Dong, Xiang; Qi, Shan-Shan; Wang, You-Na; Liu, Guang-Hui; Zhu, Rong-Fei

    2016-06-01

    Wheat dependent exercise-induced anaphylaxis (WDEIA) is a rare but potentially severe food allergy caused by the combination of wheat ingestion and physical exercise. The impact of WDEIA on quality of life (QOL) is unclear. This study characterized the clinical and laboratory features and investigated the QOL in WDEIA patients from Central China. Twenty-eight WDEIA patients were analyzed, and QOL was measured by validated Chinese version Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) and Food Allergy Independent Measure (FAIM) after obtaining the diagnosis. The results showed that half of the patients were females. The median onset age was 37 years old. The symptoms occurred within 1 h after wheat ingestion (26/28). Symptoms of anaphylaxis included cutaneous (26/28), respiratory (11/28), gastro-intestinal (5/28) and cardiovascular manifestations (27/28). Skin prick tests were positive to salt soluble (89.3%) and salt insoluble wheat allergen extracts (100%). Positive rate to wheat, gluten and omega-5 gliadin specific IgE was 64.3%, 92.9% and 92.9% respectively. Specific IgE to omega-5 gliadin with a cut-off value 0.83 KU/L offered highly efficient diagnostic criterion for WDEIA (sensitivity: 89.3%; and specificity: 88.9%). The mean scores of FAQLQ-AF and FAIM were 4.70 and 4.98 respectively and level of anti-omega-5 gliadin IgE had positive correlations with FAQLQ scores. Thereby, WDEIA is commonly found in mid-age adults. In most cases, multi-organs especially skin and cardiovascular systems are involved. Salt insoluble wheat allergen skin test and serum specific IgE to gluten and omega-5 gliadin help to diagnose WDEIA. QOL in WDEIA patients is severely impaired.

  18. A multifaceted intervention increases epinephrine use in adult emergency department anaphylaxis patients

    PubMed Central

    Manivannan, Veena; Hess, Erik P.; Bellamkonda, Venkatesh R.; Nestler, David M.; Bellolio, M. Fernanda; Hagan, John B.; Sunga, Kharmene L.; Decker, Wyatt W.; Li, James T.C.; Scanlan-Hanson, Lori N.; Vukov, Samuel C.; Campbell, Ronna L.

    2014-01-01

    Background Studies have documented inconsistent emergency anaphylaxis care and low compliance with published guidelines. Objective To evaluate anaphylaxis management before and after implementation of an emergency department (ED) anaphylaxis order set and introduction of epinephrine auto-injectors and to measure the effect on anaphylaxis guideline adherence. Methods A cohort study was conducted from April 29, 2008-August 9, 2012. Adult ED patients diagnosed with anaphylaxis were included. ED management, disposition, self-injectable epinephrine prescriptions, allergy follow-up and incidence of biphasic reactions were evaluated. Results The study included 202 patients. Median age of patients was 45.3 years (IQR 31.3 – 56.4); 139 (69%) were female. Patients who presented after order set implementation were more likely to be treated with epinephrine (51% vs. 33%, OR 2.05, 95%CI 1.04- 4.04) and admitted to ED observation unit (EDOU) (65% vs. 44%, OR 2.38, 95%CI 1.23-4.60) and less likely to be dismissed home directly from ED (16% vs. 29%, OR: 0.47, 95%CI 0.22- 1.00). Eleven patients (5%) had a biphasic reaction. Of these, five (46%) had the biphasic reaction in EDOU; one patient was admitted to intensive care unit (ICU). Six patients (55%) had reactions within 6 hours of initial symptom resolution of whom two were admitted to ICU. Conclusion Significantly greater proportions of anaphylaxis patients received epinephrine and were admitted to EDOU after introduction of epinephrine auto-injectors and order set implementation. Slightly over half of the biphasic reactions occurred within recommended observation time of 4-6 hours. These data suggest that the multifaceted approach to changing anaphylaxis management described here improved guideline adherence. PMID:24811020

  19. Do we take self-advocacy seriously?

    PubMed

    Dawson, P

    A training pack has been developed to help staff introduce the concept of self-advocacy to patients who are disabled or have learning difficulties so that they may challenge service providers. It should be possible to provide working and living environments in which respect for one another's humanity can be shared.

  20. Parental Advocacy for Students with Autism

    ERIC Educational Resources Information Center

    Barclift, Coriann

    2010-01-01

    Students attending schools in the United States who have autism would benefit from increased parental involvement to enhance their learning. There is a lack of research regarding parental advocacy on behalf of students with autism. The purpose of this phenomenological study was to examine the lived experiences and perceptions of parents who have…

  1. Advocacy: the role of health professional associations.

    PubMed

    Shaw, Dorothy

    2014-10-01

    The FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health was developed on the premise that organizational capacity strengthening in eight low- and middle-income countries would result in improved ability of member associations to take a leadership role in engaging a range of stakeholders in the health sector to discuss evidence and facilitate policy change and clinical practice in maternal and newborn health. Definitions of relevant terms, principles, and a framework for an advocacy plan are presented. The term advocacy is typically not well understood by health professionals, nor generally thought to be part of their role as a clinician, researcher, or educator. "Influence" based on expertise is often more consonant with a clinician's reality, especially where advocacy is perceived as a more political process that may present a barrier in some countries. The organizational capacity development of the FIGO member associations was integral to their ability to exert influence based on evidence, both internally in their associations and with other stakeholders, including the Ministry of Health. Examples of advocacy from each of the eight LOGIC countries are provided, noting that evaluation of impact can be challenging.

  2. Electronic Advocacy and Social Welfare Policy Education

    ERIC Educational Resources Information Center

    Moon, Sung Seek; DeWeaver, Kevin L.

    2005-01-01

    The rapid increase in the number of low-cost computers, the proliferation of user-friendly software, and the development of electronic networks have created the "informatics era." The Internet is a rapidly growing communication resource that is becoming mainstream in the American society. Computer-based electronic political advocacy by social…

  3. Advocacy on Issues Related to Addictions.

    ERIC Educational Resources Information Center

    Taleff, Michael J.

    Advocating for a population with an addictive disorder holds extraordinary challenges, but it also offers extraordinary rewards. The challenge is to embrace a cause with which most people in the United States hold little sympathy. The primary reward is that once advocacy has begun it can help ignite an addicted person's self-respect. This paper…

  4. Strengthening Music Programs While Avoiding Advocacy Pitfalls

    ERIC Educational Resources Information Center

    West, Chad; Clauhs, Matthew

    2015-01-01

    This article examines ways in which music education advocacy efforts have become disconnected from the unified visions and declarations of music educators espoused in the Tanglewood and Housewright declarations and are thus reifying the disconnect between what we value and what we say we value. We first analyze the policies posited by the recently…

  5. The state of advocacy in cancer.

    PubMed

    Maxwell, G Larry

    2015-12-01

    Non-profit advocacy organizations have been important in raising public awareness, promoting education, and enhancing political activism for issues related to cancer. Grassroots efforts aimed at fund-raising have substantially augmented federal funding for community outreach and research. The objective of this review was to evaluate successful accomplishments of several major non-profit organizations that are focused on cancer. A review of news media, medical literature, and financial records (using GuideStar) was performed to access the organizational structure and productivity of several successful cancer advocacy organizations. Compared to other cancer advocacy groups, the American Cancer Society is the oldest (>100years old) and worth the most with net assets of over $1.25 billion dollars and an annual total revenue of over $900 million dollars. The ACS also has the highest overhead at 41%. Most of the gynecologic cancer advocacy groups are approximately 20years old and have collective total annual revenue of over $17M dollars. The Ovarian Cancer Research Fund has been the most successful at raising funds and building net assets to date while maintaining an overhead of <10%. The most active and financially successful cancer organizations tend to be older, have higher overhead, spend less on total administration, spend more on fund-raising, have more events (rather than a limited number), and use aggressive social media strategies.

  6. Composite Indicators between Analysis and Advocacy

    ERIC Educational Resources Information Center

    Saltelli, Andrea

    2007-01-01

    We explore to what extent composite indicators, capable of aggregating multi-dimensional processes into simplified, stylised concepts, are up to the task of underpinning the development of data-based narratives for political advocacy. A recent OECD working paper (Nardo et al., 2005, Handbook on constructing composite indicators: methodology and…

  7. Organizing Your Parents for Effective Advocacy

    ERIC Educational Resources Information Center

    Elpus, Kenneth

    2008-01-01

    In today's world of restrictive school budgets and increasing property taxes, it is an unfortunate reality that many school districts will be faced with a budget crunch crisis that unenlightened school boards may try to solve by cutting or eliminating funds for music. At the crisis stage, it is often only the effective advocacy of an organized…

  8. Child Care Advocacy: Making a Difference.

    ERIC Educational Resources Information Center

    Working for Change, 1995

    1995-01-01

    This journal issue highlights examples of state and local child care advocacy strategies that have resulted in positive legislative change or increased funding for low-income child care. Legal constraints on lobbying by nonprofit or public agencies due to limitations imposed by the U.S. Internal Revenue Service and public and private funding…

  9. The Dance of Leadership and Advocacy

    ERIC Educational Resources Information Center

    Stripling, Barbara

    2007-01-01

    Leadership and advocacy often resemble a dance more than a straight-line march toward a goal. At times the leader advocate must work the process and lead the dance; at other times, the leader must stand back and let the process work, always ready to add a step or two to the dance when necessary. In this article, the author describes how librarians…

  10. Self-Advocacy Skills: A Portfolio Approach.

    ERIC Educational Resources Information Center

    Krebs, Cathryn S.

    2002-01-01

    This article describes how an educator used a portfolio approach to teach self-advocacy skills to four middle school students with visual impairments. Students wrote about their visual impairment and learning needs, compiled lists of specific words and definitions related to their individual impairments, and wrote letters to their ninth-grade…

  11. Enhancing Advocacy Skills of Teacher Candidates

    ERIC Educational Resources Information Center

    Holmes, Melissa A.; Herrera, Socorro G.

    2009-01-01

    This case study explores the dynamics of enhancing the capacities of teacher candidates in the Bilingual/Bicultural Education Students Interacting to Obtain Success (BESITOS) recruitment and retention program to advocate for culturally and linguistically diverse (CLD) students. Herrera and Murry's advocacy framework provides the theoretical…

  12. Be Proactive with Parent Advocacy Groups

    ERIC Educational Resources Information Center

    Willis, Mariam

    2012-01-01

    This article elaborates on parent advocacy groups, a key component in meeting the needs of gifted children. The case for parent groups couldn't be stronger--or more urgent. According to Nancy Green, Executive Director of the National Association for Gifted Children, "Quality gifted education exists in places where there are strong parent groups."…

  13. Obama Team's Advocacy Boosts Charter Momentum

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2009-01-01

    President Barack Obama and U.S. Secretary of Education Arne Duncan have been championing charter schools for months, creating what some advocates believe is the most forceful national momentum to expand the largely independent public schools since the first charter opened nearly 20 years ago. That high-profile advocacy is being matched, moreover,…

  14. Higher Education Alumni Associations and Political Advocacy

    ERIC Educational Resources Information Center

    Buchli, Richard N.

    2015-01-01

    Political advocacy is comprised of speaking on the behalf of a cause or participating as part of a political action group (Weerts, Cabrera, & Sanford, 2010). Because state financial support for public higher education has not been maintained at previous levels, higher education (HE) institutions have been recruiting alumni in an attempt to win…

  15. CEC Handbook for Strengthening Grassroots Advocacy.

    ERIC Educational Resources Information Center

    Bootel, Jaclyn A.

    This handbook is designed: (1) to empower individuals working with people who have disabilities to be a force for meeting the policy challenges in the communities in which they live and work; and (2) to help them to channel their strength, commitment, and knowledge of the special education field into effective advocacy efforts. The handbook…

  16. Science Advocacy in a Shifting Policy Landscape

    NASA Astrophysics Data System (ADS)

    Bickford, E. E.

    2013-12-01

    In the last 50 years, federal investment in research as a share of total spending has declined from a little more than 10% in 1963 to less than 4% in 2013 (AAAS, 2013). In an era of sequestration and shrinking budgets, more and more scientists are advocating directly to policymakers (and their staff) to gain support for research programs and funding. The best advocates understand the political and policy processes, and anticipate policy shifts that may affect them. While scientists are trained with the technical skills to conduct their science, teach it to others, and market their work in order to win grants and publish papers, the policy advocacy arena is unfamiliar territory to many. Acquiring yet another area of expertise mid-career can be daunting, but science advocacy need not require another academic degree. Connecting with policymakers is the first step, and then an understanding of each policymaker's issue history and top priorities will inform the sales pitch. Here, I present some experiences on both the pitching and receiving ends of science advocacy from my year in the US Senate as an AGU/AAAS Congressional Science Fellow, and some guidance for meeting with policymakers and successful science advocacy.

  17. Educational Expertise, Advocacy, and Media Influence

    ERIC Educational Resources Information Center

    Malin, Joel R.; Lubienski, Christopher

    2015-01-01

    The efforts of many advocacy organizations to advance their preferred policies despite conflicting evidence of the effectiveness of these policies raise questions about factors that shape successful policy promotion. While many may like to think that expertise on an issue in question is an essential prerequisite for influence in public policy…

  18. 467 Clinical Case. Bee Venom Anaphylaxis

    PubMed Central

    Barreto-Sosa, Adriana; Velasco-Medina, Andrea Aida; Burbano-Ceron, Andres-Leonardo; Gonzalez-Carsolio, Aida; Velázquez-Sámano, Guillermo

    2012-01-01

    Background Skin testing remains the principal confirmatory test for sensitization to hymenopteravenoms. Mechanisms on how venom induces vascular permeability in the skinfollowing intradermal testing are elucidated and how tolerance is induced followinghigh-dose venom exposure. For management, venom immunotherapy remains the mosteffective treatment. Use of immunotherapy in large local reactors to reduce morbidity is discussed. Baseline serum tryptase levels have been identified as one potential markerfor severe systemic reactions to a subsequent sting. Bee venom immunotherapy is effective in most patients immediately after the conventionalmaintenance dose has been reached. In the minority of patients who are not protected withthis dose, an increased maintenance dose will provide appropriate protection immediately after itis achieved usually by 3 to 6 months withstandarding protocols. Thus, the dosage of the maintenance dose seems to be the major factor affectingprotection from re-stings rather than the accumulated venom dose or the durationon the Maintenance Dose. A rush protocol would be recommendedif the patient's risk of being stung againbefore standard immunotherapy could work wereconsidered high. Although immunotherapy is oftenadministered by allergists, it may be deliveredby any practitioner who is willing to observe the patientand to treat anaphylaxis if it should occur. Methods A 17-year-old man reported being stung by a bee in his workplace. He had been stung several times before, with no clinical manifestations. This last time, he developed face edema, respiratory distress, dyspnea, vomiting recieveing treatment with hydrocortisone. Some time later, he was stung another time, presenting more severe symptoms including dyspnea, stridor, altered mental status, hives, so he was taken to a local clinic where he received epinephrine, dextrose, was hospitalized 4 hours until clinical remission. How should his case be managed subsequently? Results Intradermal test

  19. A holistic model of advocacy: factors that influence its use.

    PubMed

    Kubsch, Sylvia M; Sternard, Marsha J; Hovarter, Rebecca; Matzke, Vicki

    2004-02-01

    Although advocacy is embraced by nursing as an essential component of holistic philosophy, its scope is often limited in practice. In this article, a research study that examined the use of an expanded definition of advocacy is described. A link to the role of advocacy as a complementary therapy and in relation to facilitating the use of complementary therapies by patients is provided. Fifty-two registered nurses completed a researcher developed advocacy research instrument that assessed the use of moral-ethical, legal, political, spiritual, and substitutive advocacy along with various factors thought to influence the use of advocacy including moral development, perceived assertiveness, and perceived job security. An additional 40 RN-BSN students generated case studies of advocacy enacted in practice that were used as examples of the five categories of advocacy and to support the findings of the survey. Results indicated that moral-ethical advocacy was used more often than the other four categories. Moral stage development had a significant effect on substitutive advocacy but assertiveness and job security were not significant factors influencing any category of advocacy. PMID:14744505

  20. A holistic model of advocacy: factors that influence its use.

    PubMed

    Kubsch, Sylvia M; Sternard, Marsha J; Hovarter, Rebecca; Matzke, Vicki

    2004-02-01

    Although advocacy is embraced by nursing as an essential component of holistic philosophy, its scope is often limited in practice. In this article, a research study that examined the use of an expanded definition of advocacy is described. A link to the role of advocacy as a complementary therapy and in relation to facilitating the use of complementary therapies by patients is provided. Fifty-two registered nurses completed a researcher developed advocacy research instrument that assessed the use of moral-ethical, legal, political, spiritual, and substitutive advocacy along with various factors thought to influence the use of advocacy including moral development, perceived assertiveness, and perceived job security. An additional 40 RN-BSN students generated case studies of advocacy enacted in practice that were used as examples of the five categories of advocacy and to support the findings of the survey. Results indicated that moral-ethical advocacy was used more often than the other four categories. Moral stage development had a significant effect on substitutive advocacy but assertiveness and job security were not significant factors influencing any category of advocacy.

  1. Independent donor ethical assessment: aiming to standardize donor advocacy.

    PubMed

    Choudhury, Devasmita; Jotterand, Fabrice; Casenave, Gerald; Smith-Morris, Carolyn

    2014-06-01

    Living organ donation has become more common across the world. To ensure an informed consent process, given the complex issues involved with organ donation, independent donor advocacy is required. The choice of how donor advocacy is administered is left up to each transplant center. This article presents the experience and process of donor advocacy at University of Texas Southwestern Medical Center administered by a multidisciplinary team consisting of physicians, surgeons, psychologists, medical ethicists and anthropologists, lawyers, a chaplain, a living kidney donor, and a kidney transplant recipient. To ensure that advocacy remains fair and consistent for all donors being considered, the donor advocacy team at University of Texas Southwestern Medical Center developed the Independent Donor Ethical Assessment, a tool that may be useful to others in rendering donor advocacy. In addition, the tool may be modified as circumstances arise to improve donor advocacy and maintain uniformity in decision making.

  2. Independent donor ethical assessment: aiming to standardize donor advocacy.

    PubMed

    Choudhury, Devasmita; Jotterand, Fabrice; Casenave, Gerald; Smith-Morris, Carolyn

    2014-06-01

    Living organ donation has become more common across the world. To ensure an informed consent process, given the complex issues involved with organ donation, independent donor advocacy is required. The choice of how donor advocacy is administered is left up to each transplant center. This article presents the experience and process of donor advocacy at University of Texas Southwestern Medical Center administered by a multidisciplinary team consisting of physicians, surgeons, psychologists, medical ethicists and anthropologists, lawyers, a chaplain, a living kidney donor, and a kidney transplant recipient. To ensure that advocacy remains fair and consistent for all donors being considered, the donor advocacy team at University of Texas Southwestern Medical Center developed the Independent Donor Ethical Assessment, a tool that may be useful to others in rendering donor advocacy. In addition, the tool may be modified as circumstances arise to improve donor advocacy and maintain uniformity in decision making. PMID:24919733

  3. Recognizing new opportunities: reconceptualizing policy advocacy in everyday organizational practice.

    PubMed

    Mosley, Jennifer

    2013-07-01

    Policy advocacy is a concept that is of both practical and historical importance to the profession of social work. To keep up with developments in how advocacy is practiced at the ground level, however, social work research on advocacy needs to expand in scope. Changes in government contracting and public management practices have reshaped the opportunity structure for policy advocacy, incentivizing a kind of advocacy that is routine, professionalized, and collaborative. At the same time, these practices have raised questions about democratic representation and the degree to which social work advocacy adequately reflects client concerns. This article presents a model for how policy advocacy can be usefully reconceptualized to account for changes in the policy and funding environment and concludes by suggesting ways that social work research and theory can better reflect practice realities.

  4. Recognizing new opportunities: reconceptualizing policy advocacy in everyday organizational practice.

    PubMed

    Mosley, Jennifer

    2013-07-01

    Policy advocacy is a concept that is of both practical and historical importance to the profession of social work. To keep up with developments in how advocacy is practiced at the ground level, however, social work research on advocacy needs to expand in scope. Changes in government contracting and public management practices have reshaped the opportunity structure for policy advocacy, incentivizing a kind of advocacy that is routine, professionalized, and collaborative. At the same time, these practices have raised questions about democratic representation and the degree to which social work advocacy adequately reflects client concerns. This article presents a model for how policy advocacy can be usefully reconceptualized to account for changes in the policy and funding environment and concludes by suggesting ways that social work research and theory can better reflect practice realities. PMID:24032304

  5. [Morphine-induced Anaphylaxis before Induction of Anesthesia].

    PubMed

    Takahashi, Kei; Suzuki, Hiroaki; Arai, Takero; Okuda, Yasuhisa

    2016-04-01

    We describe a case of anaphylaxia that occurred in a 67-year-old man. He was planned to have an operation on mitral valve prolapse (MVP) for mitral regurgitation (MR). Morphine 5 mg was injected intramusculaly 45 min before operation. Since then, he felt itchy sensation around his inguinal region. After he came to the operating room, he felt itchy sensation all over the body. Initially, his vatal signs were stable. We started to give extracellular fluid including ulinastatin 300,000 U, methylprednisolone 2 g, and ranitidine 50 mg. A few minutes later, he had nettle rash all over the body and his blood pressure decreased to 40/20 mmHg, and the heart rate increased to 120 beats x min(-1). Soon after, he had pulseless electric activity (PEA). We started chest compression and tracheal intubation. We injected adrenaline 1 mg. After doing the continuous chest compression for 2 min, he revived. He had continuous medications including dopamine 5 μg x kg(-1) x min(-1), dobutamine 5 μg x kg(-1) x min(-1), noradrenaline 0.05 μg x kg(-1) x min(-1). We cancelled the operation, and he was transfered to the high care unit (HCU), where his blood pressure was 120/65 mmHg, and heart rate 120 beats x min(-1). After 24 hours, we extubated his trachea. In this case, morphine was considered to be the most likely cause for anaphylaxis. PMID:27188106

  6. Anaphylaxis and generalized urticaria from eating Chinese bayberry fruit*

    PubMed Central

    Wang, Hui-ying; Gao, Zhong-shan; Yang, Zhao-wei; Shao, Jing-xin; Zhao, Xiu-zhen; Dai, Yu; Van Ree, Ronald

    2012-01-01

    Chinese bayberry myrica rubra is a very popular fruit in southeastern China. In spite of its wide consumption, no allergies to this fruit have been reported previously. Here we report on a 40-year-old woman suffering from anaphylaxis to Chinese bayberry fruit. Prick-prick skin tests revealed strong reactions to fresh Chinese bayberry fruits as well as to peach, and weaker reactions to some other fruits including apple, melon, and banana. ImmunoCAP analysis revealed identical titers of specific IgE (4.3 kUA/L) to peach extract and its lipid transfer protein (LTP, rPru p 3), which was confirmed by detection of a 9 kD band following immunoblotting. Immunoblot analysis with Chinese bayberry extract gave bands of 22, 45, and 90 kD, but no 9 kD band was recognized. There was also no evidence of LTP recognition for loquat (36 kD) or melon (24 kD). This first report of a severe allergic reaction to Chinese bayberry fruit in a patient with LTP-mediated peach allergy indicates that other as yet unidentified non-pollen related fruit allergens are involved in this new severe fruit allergy. PMID:23024053

  7. Anaphylaxis to pine nut: cross-reactivity to Artemisia vulgaris?

    PubMed

    Rodrigues-Alves, R; Pregal, A; Pereira-Santos, M C; Branco-Ferreira, M; Lundberg, M; Oman, H; Pereira-Barbosa, M

    2008-01-01

    The use of pine nuts, the seeds of Pinus pinea, is on the increasing in the modern Mediterranean diet. Little more than 20 cases of allergy to this tree nut have been published, and cross-reactivity with pine pollen, peanut and almond has already been reported. We describe the case of a young boy with several episodes of anaphylaxis after pine nut ingestion. Specific IgE to pine nut and Artemisia vulgaris was demonstrated by skin prick tests and in vitro determination of specific IgE, although no IgE to pine pollen or other nuts was detected. Immunoblotting of Artemisia vulgaris and pine nut revealed two matching diffuse bands, just below 14 kDa and 30 kDa. The ImmunoCAP inhibition assays showed complete inhibition of pine nut specific IgE after serum incubation with Artemisia vulgaris extract. As far as we know, this is the first reported case of documented cross-reactivity between pine nut and Artemisia vulgaris.

  8. Anaphylaxis to polyvinylpyrrolidone after vaginal application of povidone-iodine.

    PubMed

    Adachi, Atsuko; Fukunaga, Atsushi; Hayashi, Kazuhiro; Kunisada, Makoto; Horikawa, Tatsuya

    2003-03-01

    A 59-year-old woman who had had several episodes of contact urticaria after hair treatment, developed anaphylaxis after vaginal application of povidone-iodine solution for disinfection. Prick tests showed wheal-and-flare responses to both povidone-iodine (0.1% aqueous) and polyvinylpyrrolidone (povidone, PVP) (0.001% aq.), but not to iodine or polyoxy-ethyrenenonylphenyl ether, both of which are also contained in povidone-iodine solution. We confirmed that basophils from her peripheral blood released considerable amounts of histamine on stimulation by PVPs. It appeared that both the shampoo and the permanent-wave solution contained polyvinylpyrrolidone N, N-dimethyl aminoethyl methacrylic acid copolymer diethyl sulphate solution and polyvinylpyrrolidone styrene-copolymer emulsion. Both these agents in the hair care products provoked an immediate skin response on prick testing. We speculate that sensitization to PVP had been established by these hair care products at a beauty parlor. She was recommended to avoid PVP-containing products and remained free from symptoms thereafter.

  9. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting.

    PubMed

    Palgan, K; Bartuzi, Z; Gotz-Zbikowska, M

    2014-01-01

    Hymenoptera venom anaphylaxis after bee or wasp sting is a common problem that affects about 1.2 percent to 3.5 percent of the general population. Venom-specific immunotherapy (VIT) is an established mode of treatment for immunoglobulin (Ig) E-mediated Hymenoptera venom allergy. However, VIT may often be associated with immediate anaphylaxis which can lead to treatment withdrawal. Several cases published in recent years suggest that omalizumab, used as add-on therapy may be able to prevent anaphylaxis during VIT. We report the case of a 30-year-old woman, suffering from mild persistent asthma, who had a history of severe anaphylactic reactions after yellow jacket sting, and after eating peanuts, contact with guinea pig hair, and i.v. administration of dexamethasone natrium phosphate. Initial specific immunotherapy had to be stopped due to severe anaphylaxis (hypotension, dyspnea, and angioedema). The immunotherapy was reintroduced accompanied by the anti-immunoglobulin (Ig) E monoclonal antibody omalizumab. Subcutaneous omalizumab 150 mg was initiated 4 weeks after the anaphylaxis incident and 1 day before the resumption of VIT. Rush treatment was uneventful, and the usual cumulative dose of 111.1 microg was successfully reached. The combination of omalizumab and VIT is a valid option of therapy for these patients and could reduce asthma and food allergy symptoms.

  10. Anaphylaxis to peanut in a patient predominantly sensitized to Ara h 6.

    PubMed

    Asarnoj, A; Glaumann, S; Elfström, L; Lilja, G; Lidholm, J; Nilsson, C; Wickman, M

    2012-01-01

    Diagnosis of peanut allergy has improved thanks to component-resolved diagnostics. Peanut allergen component Ara h 2 is considered to indicate true peanut allergy. The component Ara h 6 is structurally similar to Ara h 2, but the diagnostic value of analyzing IgE antibodies to Ara h 6 is unclear. A boy sensitized (≥0.35 kU(A)/l) to Ara h 8 but not to Ara h 1, Ara h 2 and Ara h 3 was challenged with peanut and developed grade II anaphylaxis. In serum collected at the time of challenge a doubling of IgE to the peanut allergen extract was observed compared to allergy testing 9 months earlier. In contrast, IgE levels to Ara h 1, Ara h 2, Ara h 3 and to Ara h 8 were rather unchanged. After another 2 months, Ara h 6 was analyzed and revealed a level of 24 kU(A)/l whilst Ara h 2 was 0.12 kU(A)/l. We suggest that IgE sensitization to Ara h 6 caused the reaction and conclude that analyses of IgE levels to peanut and peanut components should be performed in connection with a challenge. Furthermore, levels to Ara h 2 below 0.35 kU(A)/l may still indicate a risk of severe reaction at the time of challenge since in rare cases, Ara h 6 IgE antibodies may be present without occurrence of IgE antibodies to Ara h 2.

  11. Glucagon effects on 3H-histamine uptake by the isolated guinea-pig heart during anaphylaxis.

    PubMed

    Rosic, Mirko; Parodi, Oberdan; Jakovljevic, Vladimir; Colic, Maja; Zivkovic, Vladimir; Jokovic, Vuk; Pantovic, Suzana

    2014-01-01

    We estimated the influence of acute glucagon applications on (3)H-histamine uptake by the isolated guinea-pig heart, during a single (3)H-histamine passage through the coronary circulation, before and during anaphylaxis, and the influence of glucagon on level of histamine, NO, O2 (-), and H2O2 in the venous effluent during anaphylaxis. Before anaphylaxis, glucagon pretreatment does not change (3)H-histamine Umax and the level of endogenous histamine. At the same time, in the presence of glucagon, (3)H-histamine Unet is increased and backflux is decreased when compared to the corresponding values in the absence of glucagon. During anaphylaxis, in the presence of glucagon, the values of (3)H-histamine Umax and Unet are significantly higher and backflux is significantly lower in the presence of glucagon when compared to the corresponding values in the absence of glucagon. The level of endogenous histamine during anaphylaxis in the presence of glucagon (6.9-7.38 × 10(-8) μM) is significantly lower than the histamine level in the absence of glucagon (10.35-10.45 × 10(-8) μM). Glucagon pretreatment leads to a significant increase in NO release (5.69 nmol/mL) in comparison with the period before glucagon administration (2.49 nmol/mL). Then, in the presence of glucagon, O2 (-) level fails to increase during anaphylaxis. Also, our results show no significant differences in H2O2 levels before, during, and after anaphylaxis in the presence of glucagon, but these values are significantly lower than the corresponding values in the absence of glucagon. In conclusion, our results show that glucagon increases NO release and prevents the increased release of free radicals during anaphylaxis, and decreases histamine level in the venous effluent during cardiac anaphylaxis, which may be a consequence of decreased histamine release and/or intensified histamine capturing by the heart during anaphylaxis.

  12. Nursing advocacy during a military operation.

    PubMed

    Foley, B J; Minick, P; Kee, C

    2000-06-01

    Advocacy is an essential component of the registered nurse's professional role, yet experts provide no consistent definition of advocacy. The purpose of this study was to explore the experiences of military nurses as they engage in advocating practices and to describe their shared practices and common meanings. Heideggerian hermeneutic phenomenology, provided the framework and method for this study. Twenty-four U.S. Army nurses were individually interviewed and the researcher kept interview observational notes. The constant comparative method of analysis was used. The stories of these nurses revealed one constitutive pattern--safeguarding--and four related themes. The themes were advocating as protecting, advocating as attending the whole person, advocating as being the patient's voice, and advocating as preserving personhood. One conclusion was that military nurses must be prepared for the important safe-guarding role. They must be coached in how to deal with other members of the health team on the patient's behalf. PMID:10826256

  13. Food-dependent exercise-induced anaphylaxis with a high level of plasma noradrenaline.

    PubMed

    Kato, Yukihiko; Nagai, Ayako; Saito, Masuyoshi; Ito, Tomonobu; Koga, Michiyuki; Tsuboi, Ryoji

    2007-02-01

    Ingesting certain foods sometimes triggers anaphylaxis when followed by exercise (food-dependent exercise-induced anaphylaxis, FDEIA). Specific food-induced mucocutaneous urticaria may also progress to anaphylaxis (oral allergy syndrome, OAS). A positive skin test and/or radioallergosorbent test (RAST) to the foods suggest involvement of immunoglobulin (Ig)E-anaphylaxis in both disorders. The triggering foods and initial target organs are usually different in each case. In the present study, a 32-year-old male reported dyspnea accompanied by wheals, and symptoms of low blood pressure while walking after eating Chinese noodles and donuts. He also reported uncomfortable sensations in his mouth and throat after ingesting melon. Exercise challenge tests were administered. Serum histamine, plasma adrenaline, noradrenaline and dopamine were measured pre- and post-test. No symptoms were induced by exercise or by the ingestion of any single food item before exercise. However, numerous wheals appeared when exercise followed the combined ingestion of foods. Likewise, the sequence of eating pancakes and then exercising resulted in numerous wheals and anaphylaxis. Olopatadine hydrochloride and ketotifen fumarate completely inhibited this anaphylaxis. The skin prick tests resulted in fruit-induced erythema and wheals. The results of these tests with wheat, butter and sugar were negative, and no symptoms were induced by the exercise test after ingestion of watermelon, melon or apple. The anaphylactoid symptoms were accompanied by a significant increase of plasma noradrenaline. In this case, not only wheat, but sugar and butter may induce the onset of FDEIA. There was no significant correlation between the intensity of the symptoms and the serum histamine levels in the present case. Noradrenaline may be involved in the onset of FDEIA, since noradrenaline may selectively inhibit T-helper (Th)1 functions while favoring Th2 responses. The tests showed no cross-reactivity between the

  14. Prison health advocacy and its changing boundaries.

    PubMed

    Awofeso, Niyi

    2008-01-01

    Advocacy is an important tool for translating population health objectives and research findings into policy and practice, as well as for enhancing stakeholder support for programmes and activities with a potential to improve the health of populations. At the inception of modern prisons, health advocacy approaches focused on appealing to humanitarian and religious sentiments of stakeholders to improve the well-being of prisoners. This approach achieved limited results, not least because of persistent apathy of custodial authorities and the public to prisoners' wellbeing. From the mid twentieth century onwards, a constitutional and human rights approach evolved, with courts becoming actively involved in mandating minimum health standards in prisons. Penal populism eroded public support for a judicial recourse to improving prison health services, and encouraged governments to institute procedural barriers to prisoner-initiated litigation. The author proposes an approach premised on public health principles as an appropriate platform to advocate for improvements in prison health services in this era. Such an advocacy platform combines the altruistic goals of the humanitarian and constitutional rights approaches with an appeal to community's self-interest by alerting the public to the social, financial and health implications inherent in released prisoners suffering from major communicable and chronic diseases re-entering the community. PMID:19061060

  15. Prison health advocacy and its changing boundaries.

    PubMed

    Awofeso, Niyi

    2008-01-01

    Advocacy is an important tool for translating population health objectives and research findings into policy and practice, as well as for enhancing stakeholder support for programmes and activities with a potential to improve the health of populations. At the inception of modern prisons, health advocacy approaches focused on appealing to humanitarian and religious sentiments of stakeholders to improve the well-being of prisoners. This approach achieved limited results, not least because of persistent apathy of custodial authorities and the public to prisoners' wellbeing. From the mid twentieth century onwards, a constitutional and human rights approach evolved, with courts becoming actively involved in mandating minimum health standards in prisons. Penal populism eroded public support for a judicial recourse to improving prison health services, and encouraged governments to institute procedural barriers to prisoner-initiated litigation. The author proposes an approach premised on public health principles as an appropriate platform to advocate for improvements in prison health services in this era. Such an advocacy platform combines the altruistic goals of the humanitarian and constitutional rights approaches with an appeal to community's self-interest by alerting the public to the social, financial and health implications inherent in released prisoners suffering from major communicable and chronic diseases re-entering the community.

  16. Protracted anaphylaxis developed after peginterferon α-2a administration for chronic hepatitis C

    PubMed Central

    Sakatani, Akihiko; Doi, Yoshinori; Matsuda, Takaaki; Sasai, Yasutaka; Nishida, Naohiro; Sakamoto, Megumi; Uenoyama, Naoto; Matsumoto, Yoshiya; Kinoshita, Kazuo

    2015-01-01

    Peginterferon is a key drug used to treat chronic viral hepatitis that is known for causing various side effects. Side effects occurring immediately after administration include headache, nausea, and influenza-like symptoms, such as fever and joint pain. However, reports of anaphylactic shock are extremely rare. Here we report a patient with protracted anaphylaxis who suffered shock symptoms after peginterferon α-2a administration for chronic hepatitis C. Although the patient improved temporarily with shock treatment, symptoms of anaphylaxis recurred. As peginterferon is often administered on an outpatient basis, it is important to recognize life-threatening side effects that may develop in a protracted manner. PMID:25759556

  17. Acridanone alkaloid in Baliospermum montanum--evaluation of its effect against anaphylaxis.

    PubMed

    Venkatesh, Pichairajan; Mukherjee, Pulok K; Pal, Bikas C

    2011-11-01

    Baliospermum montanum leaves yielded 3-hydroxy-2,4-dimethoxy-10-methyl-9-acridanone (1), an alkaloid from the CHCl₃ fraction. Spectroscopic analysis was performed to assign the structure of the new compound (1) and its absolute configuration. The compound was evaluated for its effect in anaphylaxis by estimation of the release of histamine in systemic anaphylaxis model. The acridanone alkaloid significantly inhibited the degranulation of mast cells up to 65.22 % and 75.12 % at a dose of 50 and 75 mg/kg, respectively. PMID:21678235

  18. Epicutaneous sensitization results in IgE-dependent intestinal mast cell expansion and food anaphylaxis

    PubMed Central

    Bartnikas, Lisa M.; Gurish, Michael F.; Burton, Oliver T.; Leisten, Sabine; Janssen, Erin; Oettgen, Hans C.; Beaupré, Jacqueline; Lewis, Christopher N.; Austen, K. Frank; Schulte, Stephanie; Hornick, Jason L.; Geha, Raif S.; Oyoshi, Michiko K.

    2013-01-01

    Background Sensitization to food antigen may occur through cutaneous exposure. Objective Test the hypothesis that epicutaneous (EC) sensitization with food antigen predisposes to IgE-mediated anaphylaxis upon oral allergen challenge. Methods BALB/c mice were EC sensitized by repeated application of ovalbumin (OVA) to tape-stripped skin over 7 weeks, or orally immunized with OVA and cholera toxin (CT) weekly for 8 weeks, then orally challenged with OVA. Body temperature was monitored and serum mouse mast cell protease 1 (mMCP-1) level was determined following challenge. Tissue mast cells (MCs) were examined by chloroacetate esterase (CAE) staining. Serum OVA-specific IgE and IgG1 antibodies, and cytokines in supernatants of OVA-stimulated splenocytes, were measured by ELISA. Serum interleukin-4 (IL-4) levels were measured using an in vivo cytokine capture assay (IVCCA). Results EC sensitized mice exhibited expansion of connective tissue MC in the jejunum, increased serum IL-4 levels, and systemic anaphylaxis following oral challenge, as evidenced by decreased body temperature and increased serum mMCP-1 level. Intestinal MC expansion and anaphylaxis were IgE-dependent, as they did not occur in EC sensitized IgE−/− mice. Mice orally immunized with OVA+CT failed to increase serum IL-4 levels, expand their intestinal MCs, or develop anaphylaxis following oral challenge, despite OVA-specific IgE levels and splenocyte cytokine production in response to OVA stimulation, which were comparable to those of EC sensitized mice. Conclusion EC sensitized mice, but not mice orally immunized with antigen+CT, develop expansion of intestinal MCs and IgE-mediated anaphylaxis following single oral antigen challenge. IgE is necessary but not sufficient for food anaphylaxis, and MC expansion in the gut may play an important role in the development of anaphylaxis. Clinical Implications The skin may be an important route of sensitization to food antigens. Avoidance of cutaneous

  19. Advocacy to address disabling diseases: TDR holds brainstorming session.

    PubMed

    1998-06-01

    The UN Development Program/World Bank/World Health Organization's Special Program for Research and Training in Tropical Diseases hosted a meeting in January 1998 to discuss new ways of generating sustained commitment to combat disabling tropical diseases, such as filariasis and onchocerciasis. The participants agreed that advocacy should be targeted to a wider audience than the health sector, including international donors, industry, national governments, and endemic communities themselves. Advocacy efforts will be supported by development of a standard protocol that will 1) identify and present the type of evidence that generates sustainable commitment, 2) develop and use appropriate messages for each audience, 3) evaluate new advocacy approaches for their impact on behavioral change and disease control, and 4) evaluate advocacy campaigns. Advocacy about lymphatic filariasis will target all levels, while advocacy about onchocerciasis will target national and local levels.

  20. Pre-exposure to vasopressin potentiates the vasoconstrictive effect of epinephrine in rat aorta isolated during late anaphylaxis.

    PubMed

    Dewachter, Pascale; Emala, Charles W

    2010-06-01

    Clinical guidelines for anaphylaxis recommend epinephrine as first-line therapy but do not distinguish between early and late stages of anaphylaxis. The delay between the onset of anaphylaxis and initiation of treatment may influence the choice of the optimal vasoconstrictor (epinephrine versus arginine vasopressin [AVP]). Anesthetized rats were allocated into control and three anaphylaxis groups (n = 6 per group). The aortas were removed at 5 min (control) and at 5, 15, or 30 min during anaphylaxis and were contracted in organ baths by increasing concentrations of epinephrine or AVP. After washout of the initial agonist, each ring was contracted with the alternative drug. Separately, aortic rings removed during early versus late anaphylaxis were contracted by AVP +/- pretreatment with N(G)-nitro-L-arginine methyl ester (L-NAME) (10 M), a NOS inhibitor. Aortic rings removed during late versus early anaphylaxis were less responsive to epinephrine (EC50 at 5 min, 8.4 nM [4.9 - 11.8]; EC50 at 30 min, 18.2 nM [11.9 - 24.4]; P = 0.04) and AVP (EC50 at 5 min, 8.1 nM [4.9 - 11.3]; EC50 at 30 min, 19.7 nM [10.9 - 28.6]; P = 0.02). Pre-exposure to AVP enhanced the subsequent contractile effect of epinephrine in aortic rings removed during late anaphylaxis (maximal contractile effect, 1.02 g [0.76 - 1.28]) versus early anaphylaxis (maximal contractile effect, 0.44 g [0.28 - 0.59]; P = 0.005). In contrast to early anaphylaxis, pretreatment with L-NAME decreased responsiveness to AVP during late anaphylaxis (EC50, 2.47 nM [1.79 - 3.16], 1.55 nM [1.11 - 1.98] for +/- L-NAME, respectively; P = 0.03). During anaphylaxis, the vasoconstrictive effects of AVP or epinephrine were time dependent. Arginine vasopressin might have beneficial effects during late anaphylaxis via mechanisms involving NO.

  1. New focus on advocacy in South Asia. Advocacy for reproductive health: South Asia.

    PubMed

    Kapoor, I

    1996-01-01

    Initiatives like Vision 2000, the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing have focused attention on the activities of regional family planning associations (FPAs) in South Asia. These activities include male acceptance of the responsibility for family life, youth involvement in program design and implementation, the promotion of gender equality, and increased public awareness about the value of the female child. The Beijing conference also directed attention to the problem of not allocating resources to problems recognized by governments. In the South Asia region funding levels have been falling, which impacts the maintenance of current programs. The South Asia Regional Bureau began to coordinate an information, education, and communication (IEC) and Advocacy Working Group in the region with the participation of IEC officers from all regional FPAs. The group will be planning IEC and advocacy activities based on the regional FPAs' goals and aspirations. The IEC and advocacy activities will be examined to identify existing skills and experiences of group participants. The group will also try to identify the activities of each FPA. The information gathered will point out the similarities in IEC and advocacy activities serving as a common ground for the region. Problems of IEC and advocacy comprise their subordinate structure and the failure to evaluate to show the impact of the activities. Better planning and organization and more holistic evaluation of program components should be achieved. The group will be self-directed responding to the IEC and advocacy needs, while also developing the professional and personal capacity of FPA staff to meet these needs.

  2. Patient advocacy in the USA: key communication role functions.

    PubMed

    Martin, Donald R; Tipton, Bryan K

    2007-09-01

    Researchers have long documented the importance of patient advocacy programs as a means of providing customer service in health-care organizations. Yet, while effective communication is often acknowledged as key to effective patient advocacy, knowledge of the specific communication role functions enacted by patient advocates remains limited, as does our understanding of the function of patient advocacy at the organizational level. This qualitative investigation not only provides a typology of communication roles enacted by patient advocates while solving problems on behalf of patients and their family members, but also integrates scholarly research on "boundary-spanning" as a means of theoretically contextualizing the advocacy role at the organizational level. PMID:17688476

  3. 75 FR 33893 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Project Committee

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  9. Risk of Anaphylaxis with Repeated Courses of Rasburicase: A Research on Adverse Drug Events and Reports (RADAR) Project

    PubMed Central

    Allen, Katherine C.; Champlain, Amanda H.; Cotliar, Jonathan A.; Belknap, Steven M.; West, Dennis P.; Mehta, Jayesh; Trifilio, Steven M.

    2015-01-01

    Background Rasburicase, a recombinant urate oxidase, is used to rapidly metabolize uric acid in patients with hyperuricaemia. Rasburicase is an immunogenic therapeutic protein, which has been shown to elicit antibody response in 64 % of healthy volunteers within 1–6 weeks after the initial course, with persistent antibodies for over 1 year. Drug labelling indicates that anaphylaxis rarely occurs (in <1 % of patients) after a single course of therapy with rasburicase, but there are no data available on the incidence of anaphylaxis in patients receiving a subsequent rasburicase course. Objective To determine the incidence of anaphylaxis after multiple treatment courses of rasburicase. Methods A retrospective chart review was performed on 97 consecutively treated patients who received repeated courses of rasburicase for hyperuricaemia, to determine whether the risk of anaphylaxis is increased with repeated exposure to rasburicase. Results None of the 97 patients who were reviewed experienced anaphylaxis during the first rasburicase course; however, six patients (6.2 %) experienced anaphylaxis during a subsequent rasburicase treatment course (p = 0.03). Conclusion Anaphylaxis after a second course of rasburicase appears to occur more frequently than described in the US Food and Drug Administration-approved package insert for initial treatment courses. Given the serious nature of anaphylactic events, caution is advised when administering repeated courses of rasburicase. PMID:25566825

  10. Anaphylaxis Imaging: Non-Invasive Measurement of Surface Body Temperature and Physical Activity in Small Animals.

    PubMed

    Manzano-Szalai, Krisztina; Pali-Schöll, Isabella; Krishnamurthy, Durga; Stremnitzer, Caroline; Flaschberger, Ingo; Jensen-Jarolim, Erika

    2016-01-01

    In highly sensitized patients, the encounter with a specific allergen from food, insect stings or medications may rapidly induce systemic anaphylaxis with potentially lethal symptoms. Countless animal models of anaphylaxis, most often in BALB/c mice, were established to understand the pathophysiology and to prove the safety of different treatments. The most common symptoms during anaphylactic shock are drop of body temperature and reduced physical activity. To refine, improve and objectify the currently applied manual monitoring methods, we developed an imaging method for the automated, non-invasive measurement of the whole-body surface temperature and, at the same time, of the horizontal and vertical movement activity of small animals. We tested the anaphylaxis imaging in three in vivo allergy mouse models for i) milk allergy, ii) peanut allergy and iii) egg allergy. These proof-of-principle experiments suggest that the imaging technology represents a reliable non-invasive method for the objective monitoring of small animals during anaphylaxis over time. We propose that the method will be useful for monitoring diseases associated with both, changes in body temperature and in physical behaviour. PMID:26963393

  11. Anaphylaxis Imaging: Non-Invasive Measurement of Surface Body Temperature and Physical Activity in Small Animals.

    PubMed

    Manzano-Szalai, Krisztina; Pali-Schöll, Isabella; Krishnamurthy, Durga; Stremnitzer, Caroline; Flaschberger, Ingo; Jensen-Jarolim, Erika

    2016-01-01

    In highly sensitized patients, the encounter with a specific allergen from food, insect stings or medications may rapidly induce systemic anaphylaxis with potentially lethal symptoms. Countless animal models of anaphylaxis, most often in BALB/c mice, were established to understand the pathophysiology and to prove the safety of different treatments. The most common symptoms during anaphylactic shock are drop of body temperature and reduced physical activity. To refine, improve and objectify the currently applied manual monitoring methods, we developed an imaging method for the automated, non-invasive measurement of the whole-body surface temperature and, at the same time, of the horizontal and vertical movement activity of small animals. We tested the anaphylaxis imaging in three in vivo allergy mouse models for i) milk allergy, ii) peanut allergy and iii) egg allergy. These proof-of-principle experiments suggest that the imaging technology represents a reliable non-invasive method for the objective monitoring of small animals during anaphylaxis over time. We propose that the method will be useful for monitoring diseases associated with both, changes in body temperature and in physical behaviour.

  12. Food-dependent exercise-induced anaphylaxis: a case related to chickpea ingestion and review.

    PubMed

    Wong, Chet G; Mace, Sean R

    2007-12-15

    : Food-dependent exercise-induced anaphylaxis (FDEIA) is recognized as a distinct category of exercise-induced anaphylaxis (EIA) but is very likely underdiagnosed. This report describes a 41-year-old Indian woman who experienced two separate episodes of anaphylaxis while dancing after she had eaten chickpea-containing foods. The chickpea, a small legume, is a staple ingredient in culinary traditions from around the world, especially in India, the Middle East, and North Africa. Chickpea-containing dishes are also becoming more widespread in the Western world with the growing popularity of South Asian, Middle Eastern, and African cuisines. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s). Furthermore, no reaction occurs if a sensitized individual eats the culprit food(s) without exercising afterward; therefore, triggering foods can easily be overlooked. Current ideas on the pathophysiology, predisposing factors, workup, and treatment of FDEIA are also summarized here.

  13. Comparison of School Food Allergy Emergency Plans to the Food Allergy and Anaphylaxis Network's Standard Plan

    ERIC Educational Resources Information Center

    Powers, Jill; Bergren, Martha Dewey; Finnegan, Lorna

    2007-01-01

    Eighty-four percent of children with food allergies have a reaction in school, and 25% of first food reactions occur in schools. An evaluation was conducted comparing food allergy emergency plans to the Food Allergy and Anaphylaxis Network's (FAAN) Food Allergy Action Plan. Of the 94 respondents, 60 provided food allergy emergency plans for…

  14. Allergy/Anaphylaxis Management in the School Setting. Position Statement. Revised

    ERIC Educational Resources Information Center

    Zacharski, Susan; DeSisto, Marie; Pontius, Deborah; Sheets, Jodi; Richesin, Cynthia

    2012-01-01

    It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse), is the leader in a comprehensive management approach…

  15. Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis

    PubMed Central

    Brusch, Anna M; Clarke, Russell C; Platt, Peter R; Phillips, Elizabeth J

    2014-01-01

    Neuromuscular blocking agents (NMBAs) are the most commonly implicated drugs in IgE-mediated anaphylaxis during anaesthesia that can lead to perioperative morbidity and mortality. The rate of NMBA anaphylaxis shows marked geographical variation in patients who have had no known prior exposure to NMBAs, suggesting that there may be external or environmental factors that contribute to the underlying aetiology and pathophysiology of reactions. Substituted ammonium ions are shared among NMBAs and are therefore thought to be the main allergenic determinant of this class of drugs. Substituted ammonium ions are found in a wide variety of chemical structures, including prescription medications, over-the-counter medications and common household chemicals, such as the quaternary ammonium disinfectants. Epidemiological studies have shown parallels in the consumption of pholcodine, a nonprescription antitussive drug which contains a tertiary ammonium ion, and the incidence of NMBA anaphylaxis. This link has prompted the withdrawal of pholcodine in some countries, with an ensuing fall in the observed rate of NMBA anaphylaxis. While such observations are compelling in their suggestion of a relationship between pholcodine exposure and NMBA hypersensitivity, important questions remain regarding the mechanisms by which pholcodine is able to sensitize against NMBAs and whether there are other, as yet unidentified, agents that can elicit similar hypersensitivity reactions. This review aims to explore the evidence linking pholcodine exposure to NMBA hypersensitivity and discuss the implications for our understanding of the pathophysiology of these reactions. PMID:24251966

  16. Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis.

    PubMed

    Brusch, Anna M; Clarke, Russell C; Platt, Peter R; Phillips, Elizabeth J

    2014-07-01

    Neuromuscular blocking agents (NMBAs) are the most commonly implicated drugs in IgE-mediated anaphylaxis during anaesthesia that can lead to perioperative morbidity and mortality. The rate of NMBA anaphylaxis shows marked geographical variation in patients who have had no known prior exposure to NMBAs, suggesting that there may be external or environmental factors that contribute to the underlying aetiology and pathophysiology of reactions. Substituted ammonium ions are shared among NMBAs and are therefore thought to be the main allergenic determinant of this class of drugs. Substituted ammonium ions are found in a wide variety of chemical structures, including prescription medications, over-the-counter medications and common household chemicals, such as the quaternary ammonium disinfectants. Epidemiological studies have shown parallels in the consumption of pholcodine, a nonprescription antitussive drug which contains a tertiary ammonium ion, and the incidence of NMBA anaphylaxis. This link has prompted the withdrawal of pholcodine in some countries, with an ensuing fall in the observed rate of NMBA anaphylaxis. While such observations are compelling in their suggestion of a relationship between pholcodine exposure and NMBA hypersensitivity, important questions remain regarding the mechanisms by which pholcodine is able to sensitize against NMBAs and whether there are other, as yet unidentified, agents that can elicit similar hypersensitivity reactions. This review aims to explore the evidence linking pholcodine exposure to NMBA hypersensitivity and discuss the implications for our understanding of the pathophysiology of these reactions. PMID:24251966

  17. Research to Practice: Developing an Integrated Anaphylaxis Education Curriculum for School Nurses

    ERIC Educational Resources Information Center

    Cavanaugh, Rebecca; Strickland, C. June

    2011-01-01

    The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for…

  18. Nursing advocacy for women veterans and suicide.

    PubMed

    Conard, Patricia L; Armstrong, Myrna L; Young, Cathy; Hogan, La Micha

    2015-03-01

    Little is known about suicide variables in women Veterans. The authors reviewed numerous applicable health care and military literary sources regarding suicide in this population. The current article describes the surrounding circumstances, military war/conflict culture, and potential effects on women Veterans, including major collection problems with current Veteran data. Women Veterans are increasingly reporting more behavioral health issues (e.g., posttraumatic stress disorder) and attempting suicide upon civilian reintegration. Outcomes from this literature review suggest the importance of nursing advocacy to create better rapport and communication with women Veterans from Vietnam, Gulf I, Iraq, and Afghanistan wars seeking care at civilian health facilities, as some may present with suicidal ideologies.

  19. Having a Voice: An Exploration of Children's Rights and Advocacy.

    ERIC Educational Resources Information Center

    Dalrymple, Jane, Ed.; Hough, Jan, Ed.

    This book explores the concept of advocacy in British society with regard to children and young people, examining advocacy from a number of different perspectives, and taking into account the UN Convention on the Rights of the Child and legislation that affects children and young people. The three parts of the book examine why young people need an…

  20. Social Justice Advocacy in Rural Communities: Practical Issues and Implications

    ERIC Educational Resources Information Center

    Bradley, Joshua M.; Werth, James L., Jr.; Hastings, Sarah L.

    2012-01-01

    The professional literature related to social justice has increased, but there has been little discussion of the practical issues and implications associated with social advocacy. However, adding new roles will result in new considerations for counseling psychologists. The need to be attuned to how the practical aspects of advocacy intersect with…

  1. Exploring Nonoffending Caregiver Satisfaction with a Children's Advocacy Center

    ERIC Educational Resources Information Center

    Bonach, Kathryn; Mabry, J. Beth; Potts-Henry, Candice

    2010-01-01

    This study is a case evaluation research report on one Children's Advocacy Center that provides a coordinated response to allegations of child maltreatment, particularly sexual abuse. The data come from a mailed survey of nonoffending caregivers measuring their satisfaction with services provided through the Children's Advocacy Center. The results…

  2. Promoting Systemic Change through the ACA Advocacy Competencies

    ERIC Educational Resources Information Center

    Toporek, Rebecca L.; Lewis, Judith A.; Crethar, Hugh C.

    2009-01-01

    In 2003, the American Counseling Association (ACA) adopted the ACA Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002) to provide guidance to counselors and acknowledge advocacy as an ethical aspect of service to clients. This article provides a foundation for this special section by sharing a historical perspective…

  3. What Is Self-Advocacy? NRC Fact Sheet

    ERIC Educational Resources Information Center

    Hall, Mair

    2010-01-01

    Self-advocacy is about independent groups of people with disabilities working together for justice by helping each other take charge of their lives and fight discrimination. The seeds of the self-advocacy movement go back to 1968 when a Swedish parent's organization held a meeting for people with developmental disabilities. Today, the…

  4. Participation, Decentralization, and Advocacy Planning, Resource Paper No. 25.

    ERIC Educational Resources Information Center

    Kasperson, Roger E.; Breitbart, Myrna

    This resource paper on the subject of citizen participation, decentralization, and advocacy planning is part of a series designed to supplement undergraduate geography courses. The approach of the paper de-emphasizes inventory or case study reviews of specific participation or advocacy planning projects for a more general conceptual discussion of…

  5. Advocacy for Child Wellness in High-Poverty Environments

    ERIC Educational Resources Information Center

    Mullen, Carol A.

    2014-01-01

    Child wellness needs to be understood holistically so that children and youth from high-poverty environments can succeed in schooling and life. Teachers who foster advocacy in themselves are well equipped to teach students to take ownership of their own well-being. Such advocacy can enrich the classroom curriculum and mitigate the negative effects…

  6. A Media Advocacy Intervention Linking Health Disparities and Food Insecurity

    ERIC Educational Resources Information Center

    Rock, Melanie J.; McIntyre, Lynn; Persaud, Steven A.; Thomas, Karen L.

    2011-01-01

    Media advocacy is a well-established strategy for transmitting health messages to the public. This paper discusses a media advocacy intervention that raised issues about how the public interprets messages about the negative effects of poverty on population health. In conjunction with the publication of a manuscript illustrating how income-related…

  7. The Big Picture of Advocacy: Counselor, Heal Society and Thyself

    ERIC Educational Resources Information Center

    Roysircar, Gargi

    2009-01-01

    This article, motivational in purpose, encourages counselors to be engaged in the growing movement for social justice advocacy in counseling. Analyses of a macrolevel framework of advocacy extend to microlevel operations of recruitment, sociopolitical education, diversity management, and self-care of counselor-advocates. Case studies and exemplars…

  8. Using Week of the Young Child as an Advocacy Event

    ERIC Educational Resources Information Center

    Young Children, 2009

    2009-01-01

    The Week of the Young Child 2009, April 19-25, presents a public policy advocacy opportunity for early childhood programs, faculty, and families. This article offers some ways one can use Week of the Young Child (WOYC) events specifically to further advocacy efforts.

  9. Using the Decision Case Method to Teach Legislative Policy Advocacy

    ERIC Educational Resources Information Center

    Wolfer, Terry A.; Gray, Karen A.

    2007-01-01

    Social work educators have long struggled with making policy practice real "more", especially to micro-oriented students (Sundet & Kelly, 2002). The decision case method can generate excitement about social policy advocacy while educating students about current advocacy work, particularly if the case involves state or local efforts to influence…

  10. Treatments for Neurodevelopmental Disorders: Evidence, Advocacy, and the Internet

    ERIC Educational Resources Information Center

    Di Pietro, Nina C.; Whiteley, Louise; Mizgalewicz, Ania; Illes, Judy

    2013-01-01

    The Internet is a major source of health-related information for parents of sick children despite concerns surrounding quality. For neurodevelopmental disorders, the websites of advocacy groups are a largely unexamined source of information. We evaluated treatment information posted on nine highly-trafficked advocacy websites for autism, cerebral…

  11. Kids Speaking Up for Kids: Advocacy by Children, for Children

    ERIC Educational Resources Information Center

    Zygmunt-Fillwalk, Eva; Staley, Lynn; Kumar, Rashmi; Lin, Cecilia Lingfen; Moore, Catherine; Salakaya, Manana; Szecsi, Tunde

    2007-01-01

    This article describes a project called "Kids Speaking Up for Kids: Advocacy by Children, for Children". The project was simple in scope. The authors sought to collect stories of child advocacy--ways in which children were working on behalf of other children. They also sought to collect and profile children's voices and vision and so they issued a…

  12. Speaking up about Advocacy: Findings from a Partnership Research Project

    ERIC Educational Resources Information Center

    Chapman, Melanie; Bannister, Susan; Davies, Julie; Fleming, Simon; Graham, Claire; Mcmaster, Andrea; Seddon, Angela; Wheldon, Anita; Whittell, Bridget

    2012-01-01

    This article describes a partnership research project carried out by a research team consisting of people with learning disabilities and people without learning disabilities. The research explored people's understandings of advocacy and identified gaps in advocacy provision for people with learning disabilities and their families. Four focus…

  13. Working for Change in Education: A Handbook for Planning Advocacy.

    ERIC Educational Resources Information Center

    Save the Children, London (England).

    This handbook is for those seeking to improve children's education, especially those organizations that work closely with children, parents, and teachers. It sets out a way of approaching advocacy work with the understanding that advocacy groups have a greater impact on the direction of educational change if they have a well-thought-out advocacy…

  14. Disability Identity of Leaders in the Self-Advocacy Movement

    ERIC Educational Resources Information Center

    Caldwell, Joe

    2011-01-01

    Life stories and perspectives of leaders in the self-advocacy movement were explored to enhance knowledge about disability identity formation. In-depth qualitative interviews were conducted with 13 leaders in the self-advocacy movement. Five major themes emerged: (a) resistance-claiming personhood and voice; (b) connection with disability…

  15. Protective Services and Citizen Advocacy. Monograph No. 3.

    ERIC Educational Resources Information Center

    Sigelman, Carol K., Ed.

    Presented are seven papers given at a conference on deinstitutionalization of the mentally handicapped which focus on protective services and citizen advocacy. Carol Sigelman stresses the following four concepts: follow-along (the monitoring of the developmentally disabled person in the community), advocacy, protection, and shelter, Alternatives…

  16. Social Justice Advocacy among Graduate Students: An Empirical Investigation

    ERIC Educational Resources Information Center

    Linnemeyer, Rachel McQuown

    2009-01-01

    Although social justice advocacy has increasingly been acknowledged as important in the field of psychology (e.g., Goodman et al., 2004; Toporek et al., 2006a, Vera & Speight, 2003), there is a dearth of empirical research examining social justice advocacy across graduate psychology students. This mixed-methods study examined demographic and…

  17. School Counselors United in Professional Advocacy: A Systems Model

    ERIC Educational Resources Information Center

    Cigrand, Dawnette L.; Havlik, Stacey Gaenzle; Malott, Krista M.; Jones, SaDohl Goldsmith

    2015-01-01

    Limited budgets may place educational positions in jeopardy and if school counseling positions become jeopardized, then school counselors must communicate their role and impact more effectively. However, school counselors may lack training and experience in professional self-advocacy practices, and advocacy efforts may be undermined by role…

  18. [Two cases of food-dependent exercise-induced anaphylaxis difficult to evoke symptoms by provocation test].

    PubMed

    Morimoto, Kenichi; Sanada, Seiko; Hara, Takeshi; Hide, Michihiro

    2006-11-01

    We report two cases of food-dependent exercise-induced anaphylaxis (FDEIA), which were hardly induced by provocation test in the hospital. Case 1: A 28-years-old Japanese female suffers repeated episodes of sternutation, nasal discharge and edema of eyelids after wheat ingestion of wheat followed by exercise. Case 2: A 14-years-old Japanese male suffers repeated episodes of wheal formation on whole body and dyspnea after lunch containing apple followed by exercise. Both of them had never developed symptoms by either ingestion or exercise alone. Provocation tests were performed on admission by combinations of the ingestion of suspected foods, exercise, and aspirin, but no symptoms were reproduced by any combination of them. After discharge, case 1 reproduced symptoms during exercise after the ingestion of wheat under prostration and cold climate. Case 2 reproduced symptoms during exercise after ingestion of apple when he suffered from common cold. Warm and comfortable condition in admission may make it harder to evoke symptoms by the provocation test. Frigidity, cold, prostration, and stress should be reckoned with in the provocation test to improve the accuracy of diagnosis for FDEIA. PMID:17159435

  19. Credibility and advocacy in conservation science

    PubMed Central

    Horton, Cristi C.; Peterson, Tarla Rai; Banerjee, Paulami

    2015-01-01

    Abstract Conservation policy sits at the nexus of natural science and politics. On the one hand, conservation scientists strive to maintain scientific credibility by emphasizing that their research findings are the result of disinterested observations of reality. On the other hand, conservation scientists are committed to conservation even if they do not advocate a particular policy. The professional conservation literature offers guidance on negotiating the relationship between scientific objectivity and political advocacy without damaging conservation science's credibility. The value of this guidance, however, may be restricted by limited recognition of credibility's multidimensionality and emergent nature: it emerges through perceptions of expertise, goodwill, and trustworthiness. We used content analysis of the literature to determine how credibility is framed in conservation science as it relates to apparent contradictions between science and advocacy. Credibility typically was framed as a static entity lacking dimensionality. Authors identified expertise or trustworthiness as important, but rarely mentioned goodwill. They usually did not identify expertise, goodwill, or trustworthiness as dimensions of credibility or recognize interactions among these 3 dimensions of credibility. This oversimplification may limit the ability of conservation scientists to contribute to biodiversity conservation. Accounting for the emergent quality and multidimensionality of credibility should enable conservation scientists to advance biodiversity conservation more effectively. PMID:26041036

  20. Reducing violent injuries: priorities for pediatrician advocacy.

    PubMed

    Dolins, J C; Christoffel, K K

    1994-10-01

    A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria. Developing strategies for educating the public and for approaching legislative/regulatory bodies. Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change. To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas. Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence. Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors. Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.

  1. Medical advocacy on behalf of detained immigrants.

    PubMed

    Venters, Homer D; Foote, Mary; Keller, Allen S

    2011-06-01

    Detention of immigrants by Immigration and Customs Enforcement (ICE) is a rapidly growing form of incarceration in the U.S. with almost 400,000 people detained in 2008 (Schriro in Immigration and Customs Enforcement, 2009, http://www.ice.gov/doclib/091005_ice_detention_report-final.pdf ). ICE detainees are predominantly from Mexico and Latin America and only a small minority of detainees are asylum seekers. Immigrant detainees lack a legal guarantee of medical care (unlike criminal arrestees and prisoners) and face challenges in receiving medical care, particularly those with chronic medical conditions (Venters and Keller in J Health Care Poor Underserved 20:951-957, 2009). Although we and others have long been involved in advocating for detained asylum seekers, few resources are dedicated to medical advocacy for the broader population of ICE detainees. At the NYU Center for Health and Human Rights (CHHR), a program of medical advocacy was initiated in 2007 on behalf of ICE detainees focused on improvement of care in detention and medical parole. Our preliminary efforts reveal a pressing need for more involvement by physicians and other health advocates in this area.

  2. Credibility and advocacy in conservation science.

    PubMed

    Horton, Cristi C; Peterson, Tarla Rai; Banerjee, Paulami; Peterson, Markus J

    2016-02-01

    Conservation policy sits at the nexus of natural science and politics. On the one hand, conservation scientists strive to maintain scientific credibility by emphasizing that their research findings are the result of disinterested observations of reality. On the other hand, conservation scientists are committed to conservation even if they do not advocate a particular policy. The professional conservation literature offers guidance on negotiating the relationship between scientific objectivity and political advocacy without damaging conservation science's credibility. The value of this guidance, however, may be restricted by limited recognition of credibility's multidimensionality and emergent nature: it emerges through perceptions of expertise, goodwill, and trustworthiness. We used content analysis of the literature to determine how credibility is framed in conservation science as it relates to apparent contradictions between science and advocacy. Credibility typically was framed as a static entity lacking dimensionality. Authors identified expertise or trustworthiness as important, but rarely mentioned goodwill. They usually did not identify expertise, goodwill, or trustworthiness as dimensions of credibility or recognize interactions among these 3 dimensions of credibility. This oversimplification may limit the ability of conservation scientists to contribute to biodiversity conservation. Accounting for the emergent quality and multidimensionality of credibility should enable conservation scientists to advance biodiversity conservation more effectively. PMID:26041036

  3. Credibility and advocacy in conservation science.

    PubMed

    Horton, Cristi C; Peterson, Tarla Rai; Banerjee, Paulami; Peterson, Markus J

    2016-02-01

    Conservation policy sits at the nexus of natural science and politics. On the one hand, conservation scientists strive to maintain scientific credibility by emphasizing that their research findings are the result of disinterested observations of reality. On the other hand, conservation scientists are committed to conservation even if they do not advocate a particular policy. The professional conservation literature offers guidance on negotiating the relationship between scientific objectivity and political advocacy without damaging conservation science's credibility. The value of this guidance, however, may be restricted by limited recognition of credibility's multidimensionality and emergent nature: it emerges through perceptions of expertise, goodwill, and trustworthiness. We used content analysis of the literature to determine how credibility is framed in conservation science as it relates to apparent contradictions between science and advocacy. Credibility typically was framed as a static entity lacking dimensionality. Authors identified expertise or trustworthiness as important, but rarely mentioned goodwill. They usually did not identify expertise, goodwill, or trustworthiness as dimensions of credibility or recognize interactions among these 3 dimensions of credibility. This oversimplification may limit the ability of conservation scientists to contribute to biodiversity conservation. Accounting for the emergent quality and multidimensionality of credibility should enable conservation scientists to advance biodiversity conservation more effectively.

  4. From Preservice Leaders to Advocacy Leaders: Exploring Intersections in Standards for Advocacy in Educational Leadership and School Counselling

    ERIC Educational Resources Information Center

    Crawford, Emily R.; Arnold, Noelle Witherspoon; Brown, Andre

    2014-01-01

    In this empirically based paper, we discuss educational leadership preparation as it relates to social justice, the concept of advocacy and the standards that guide leadership and counselling, respectively. To reveal how preservice leaders conceptualize advocacy as understood in professional standards, we draw on our research with 11 preservice…

  5. Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study

    PubMed Central

    Ye, Young-Min; Kim, Mi Kyeong; Kang, Hye-Ryun; Kim, Tae-Bum; Sohn, Seong-Wook; Koh, Young-Il; Park, Hye-Kyung; Jang, Gwang Cheon; Kim, Cheol-Woo; Hur, Gyu-Young; Kim, Joo-Hee; Kim, Sang-Heon; Choi, Gil-Soon; Lee, Soo-Keol

    2015-01-01

    Purpose Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. Methods To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. Results A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. Conclusions The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. PMID:25553259

  6. To What Question(s) Is Music Education Advocacy the Answer?

    ERIC Educational Resources Information Center

    Bowman, Wayne

    2005-01-01

    Advocacy can be a useful tool. But like all tools it has its limitations and potential dangers, its proper and improper uses. Understanding the difference is critical. Advocacy and philosophy are very different processes, serving very divergent ends. Philosophy is suited poorly to advocacy's political purposes, and advocacy arguments are seldom of…

  7. 75 FR 40033 - Proposed Collection; Comment Request for Taxpayer Advocacy Panel (TAP) Tax Check Waiver

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-13

    ... Internal Revenue Service Proposed Collection; Comment Request for Taxpayer Advocacy Panel (TAP) Tax Check...(c)(2)(A)). Currently, the IRS is soliciting comments concerning Taxpayer Advocacy Panel (TAP) Tax...: Taxpayer Advocacy Panel (TAP) Tax Check Waiver. OMB Number: 1545-2092. Abstract: Taxpayer Advocacy...

  8. 45 CFR 1386.23 - Periodic reports: Protection and Advocacy System.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Periodic reports: Protection and Advocacy System... Advocacy of the Rights of Individuals with Developmental Disabilities § 1386.23 Periodic reports: Protection and Advocacy System. (a) By January 1 of each year the Protection and Advocacy System shall...

  9. 42 CFR 476.110 - Use of immediate advocacy to resolve oral beneficiary complaints.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Use of immediate advocacy to resolve oral... § 476.110 Use of immediate advocacy to resolve oral beneficiary complaints. (a) Immediate advocacy. A QIO may offer the option of resolving an oral complaint through the use of immediate advocacy if:...

  10. 45 CFR 1386.23 - Periodic reports: Protection and Advocacy System.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Periodic reports: Protection and Advocacy System... Advocacy of the Rights of Individuals with Developmental Disabilities § 1386.23 Periodic reports: Protection and Advocacy System. (a) By January 1 of each year the Protection and Advocacy System shall...

  11. 75 FR 18957 - Open Meeting of Taxpayer Advocacy Panel Notice Improvement Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-13

    ... Internal Revenue Service Open Meeting of Taxpayer Advocacy Panel Notice Improvement Issue Committee AGENCY... Taxpayer Advocacy Panel Notice Improvement Issue Committee will be conducted. The Taxpayer Advocacy Panel....C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Notice Improvement...

  12. 45 CFR 1386.23 - Periodic reports: Protection and Advocacy System.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Periodic reports: Protection and Advocacy System... Advocacy of the Rights of Individuals with Developmental Disabilities § 1386.23 Periodic reports: Protection and Advocacy System. (a) By January 1 of each year the Protection and Advocacy System shall...

  13. Advocacy for Art Education: Beyond Tee-Shirts and Bumper Stickers

    ERIC Educational Resources Information Center

    Bobick, Bryna; DiCindio, Carissa

    2012-01-01

    Advocacy is not new to art education. Over the years, Goldfarb (1979), Hodsoll (1985), and Erickson and Young (1996) have written about the importance of arts advocacy, but the concept of advocacy has evolved with the times. For example, in the 1970s, arts advocacy was described as a "movement" and brought together art educators, administrators,…

  14. Self-Advocacy and Cancer: A Concept Analysis

    PubMed Central

    Hagan, Teresa L.; Donovan, Heidi S.

    2013-01-01

    Aim This paper is a report of an analysis of the concept of self-advocacy among individuals with cancer to clarify its meaning, to differentiate this meaning with related concepts and to unify understanding of the concept in cancer research and practice. Background Cancer survivors are increasingly required to assume an active role in their healthcare. A thorough analysis of how survivors advocate for themselves is a crucial aspect in supporting survivors’ ability to engage and manage their care throughout all stages of cancer survivorship. Design Walker and Avant’s eight-step process of conducting a concept analysis was used. Data Sources PubMed, PsycINFO and CINAHL databases were searched for articles, reviews, editorials and gray literature directly addressing self-advocacy. Review Methods A broad inquiry into the literature from 1960 – 2012 that produces a definition of self-advocacy. Model and contrary cases of self-advocacy demonstrate the concept’s application and intricacies. Results Antecedents to self-advocacy include particular personal characteristics, learned skills and attainable support. The essential element of self-advocacy and what differentiates it from related concepts, is the internalization of these antecedent resources into self-advocacy thoughts and actions while incorporating personal values and priorities in a way that upholds the survivors’ goals and beliefs. A full realization of self-advocacy facilitates a cancer survivor attaining a strong self-concept, sense of control and adaptation to a life with cancer. Conclusions Self-advocacy is a process of internalizing skills and resources to act in a way that supports survivors’ needs and goals. PMID:23347224

  15. Effective citizen advocacy of beneficial nuclear technologies

    SciTech Connect

    McKibben, J. Malvyn; Wood, Susan

    2007-07-01

    In 1991, a small group of citizens from communities near the Savannah River Site (SRS) formed a pro-nuclear education and advocacy group, Citizens for Nuclear Technology Awareness (CNTA). Their purpose was to: (1) counter nuclear misinformation that dominated the nation's news outlets, (2) provide education on nuclear subjects to area citizens, students, elected officials, and (3) provide informed citizen support for potential new missions for SRS when needed. To effectively accomplish these objectives it is also essential to establish and maintain good relations with community leaders and reporters that cover energy and nuclear subjects. The organization has grown considerably since its inception and has expanded its sphere of influence. We believe that our experiences over these fifteen years are a good model for effectively communicating nuclear subjects with the public. This paper describes the structure, operation and some of the results of CNTA. (authors)

  16. Nursing advocacy for women veterans and suicide.

    PubMed

    Conard, Patricia L; Armstrong, Myrna L; Young, Cathy; Hogan, La Micha

    2015-03-01

    Little is known about suicide variables in women Veterans. The authors reviewed numerous applicable health care and military literary sources regarding suicide in this population. The current article describes the surrounding circumstances, military war/conflict culture, and potential effects on women Veterans, including major collection problems with current Veteran data. Women Veterans are increasingly reporting more behavioral health issues (e.g., posttraumatic stress disorder) and attempting suicide upon civilian reintegration. Outcomes from this literature review suggest the importance of nursing advocacy to create better rapport and communication with women Veterans from Vietnam, Gulf I, Iraq, and Afghanistan wars seeking care at civilian health facilities, as some may present with suicidal ideologies. PMID:25751826

  17. Minority Women and Advocacy for Women's Health

    PubMed Central

    Kumanyika, Shiriki K.; Morssink, Christiaan B.; Nestle, Marion

    2001-01-01

    US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered. PMID:11527764

  18. Climate Change: On Scientists and Advocacy

    NASA Technical Reports Server (NTRS)

    Schmidt, Gavin A.

    2014-01-01

    Last year, I asked a crowd of a few hundred geoscientists from around the world what positions related to climate science and policy they would be comfortable publicly advocating. I presented a list of recommendations that included increased research funding, greater resources for education, and specific emission reduction technologies. In almost every case, a majority of the audience felt comfortable arguing for them. The only clear exceptions were related to geo-engineering research and nuclear power. I had queried the researchers because the relationship between science and advocacy is marked by many assumptions and little clarity. This despite the fact that the basic question of how scientists can be responsible advocates on issues related to their expertise has been discussed for decades most notably in the case of climate change by the late Stephen Schneider.

  19. Minority women and advocacy for women's health.

    PubMed

    Kumanyika, S K; Morssink, C B; Nestle, M

    2001-09-01

    US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered.

  20. Anaphylaxis caused by imported red fire ant stings in Málaga, Spain.

    PubMed

    Fernández-Meléndez, S; Miranda, A; García-González, J J; Barber, D; Lombardero, M

    2007-01-01

    A 27-year-old woman suffered from anaphylaxis after being stung by Solenopsis invicta ants while she was handling wood from South America. The patient reported no previous adverse reactions to stings by other hymenopteran species. Intradermal skin tests with hymenoptera venom (Vespula vulgaris, Polistes species, Apis melifera) were negative. Serum specific immunoglobulin (Ig) E yielded positive results for S invicta (5.28 kU/L) and negative results for A melifera, Ves v 5 and Pol a 5. Immunodetection assays showed the presence of serum IgE against the Sol i 2 allergen. The patient had probably been stung previously although inadvertently by red fire ants while she handled infested wood from South America, and precautionary measures are thus advisable when this material is to be handled. To our knowledge this is the first case of anaphylaxis from red fire ant stings reported in Europe.

  1. Anaphylaxis after eating Italian pizza containing buckwheat as the hidden food allergen.

    PubMed

    Heffler, E; Guida, G; Badiu, I; Nebiolo, F; Rolla, G

    2007-01-01

    A 20-year-old woman developed anaphylaxis after eating pizza on 4 different occasions in 2 restaurants. Both restaurants made their pizza dough with a mixture of wheat and buckwheat flours. A prick-to-prick test with buckwheat flour was positive. Skin prick tests and specific immunoglobulin E responses to soybean and peanut were weakly positive while the response to buckwheat was negative. We ruled out a pathogenic role for peanut and soybean because the patient usually eats both with no signs of allergic reaction. Double-blind, placebo-controlled food challenges with buckwheat flour were positive after the administration of a cumulative dose of 2.3 g of the culprit flour. To our knowledge, our report describes the first case of anaphylaxis after intake of buckwheat flour as the hidden allergen in pizza dough.

  2. Perceived history of anaphylaxis and parental overprotection, autonomy, anxiety, and depression in food allergic young adults.

    PubMed

    Herbert, Linda J; Dahlquist, Lynnda M

    2008-12-01

    This study examined autonomy, anxiety, depression, and perceptions of parental behavior in 86 food allergic young adults and 344 healthy young adults between the ages of 18 and 22. Participants completed an online survey measuring self-reported autonomy, anxiety, depression, and perceptions of parental behavior. Results indicated that, as a group, food allergic young adults did not differ from healthy peers. However, food allergic young adults who reported having experienced an anaphylactic reaction described their disease as more severe, reported more worry about their disease, and rated their parents as more overprotective than food allergic young adults who reported never having experienced anaphylaxis. The experience of anaphylaxis may be a reliable indicator of food allergic individuals who are at risk for psychological distress. PMID:19104982

  3. Successful treatment of acute systemic anaphylaxis in a western lowland gorilla (Gorilla gorilla gorilla).

    PubMed

    Hayman, David T S; King, Tony; Cameron, Kenneth

    2010-09-01

    This brief communication describes the successful treatment of acute systemic anaphylaxis in a wild-born but captive infant western lowland gorilla (Gorilla gorilla gorilla) in the Republic of Congo. The infant demonstrated signs of acute respiratory distress, lingual swelling, and reaction to intradermal tuberculin, given 55 hr earlier. Details of the treatment with steroids, anesthetic induction, and i.v. epinephrine are all reported, and potential antigens that may have initiated the anaphylactic shock are discussed.

  4. A Cases of Near-fatal Anaphylaxis: Parsley "Over-use" as an Herbal Remedy.

    PubMed

    Arslan, Sevket; Ucar, Ramazan; Caliskaner, Ahmet Zafer

    2014-12-01

    The use of herbal products in patients with allergic diseases is a special problem and still controversial. But, many people often use herbs to maintain good health. The patients use self-prescribed remedies as medications but do not inform their physicians about herbal use. Unfortunately, some herbal self-medications may have unexpected effects and interactions which may lead to fatal complications. In this report, we describe a female patient who suffered near-fatal anaphylaxis to parsley.

  5. Key components of anaphylaxis management plans: consensus findings from a national electronic Delphi study

    PubMed Central

    Worth, Allison; Nurmatov, Ulugbek; Sheikh, Aziz

    2010-01-01

    Objectives There is no international consensus on the components of anaphylaxis management plans and responsibility for their design and delivery is contested. We set out to establish consensus among relevant specialist and generalist clinicians on this issue to inform future randomized controlled trials. Design A two-round electronic Delphi study completed by a 25-person, multidisciplinary expert panel. Participants scored the importance of a range of statements on anaphylaxis management, identified from a systematic review of the literature, on a five-point scale ranging from ‘very important’ to ‘irrelevant’. Consensus was defined a priori as being achieved if 80% or more of panel members rated a statement as ‘important’ or ‘very important’ after Round 2. Setting Primary and secondary care and academic settings in the UK and Ireland. Participants Twenty-five medical, nursing and allied health professionals. Main outcome measures Consensus on the key components of anaphylaxis management plans. Results The response rate was 84% (n = 21) for Round 1 and 96% (n = 24) for Round 2. The key components of emergency care on which consensus was achieved included: awareness of trigger factors (100%); recognition and emergency management of reactions of different severity (100%); and clear information on adrenaline (epinephrine) use (100%). Consensus on longer-term management issues included: clear written guidelines on anaphylaxis management (96%); annual review of plans (87%); and plans that were tailored to individual needs (82%). Conclusions This national consensus-building exercise generated widespread agreement that emergency plans need to be simple, clear and generic, making them easy to implement in a crisis. In contrast, long-term plans need to be negotiated between patient/carers and professionals, and tailored to individual needs. The effectiveness of this expert-agreed long-term plan now needs to be evaluated rigorously. PMID:21103134

  6. Inhibitory effects of guarana seed extract on passive cutaneous anaphylaxis and mast cell degranulation.

    PubMed

    Jippo, Tomoko; Kobayashi, Yuko; Sato, Harumi; Hattori, Atsushi; Takeuchi, Hiroaki; Sugimoto, Keiichiro; Shigekawa, Munekazu

    2009-09-01

    This study investigated the effects of guarana seed extract (GSE) on an anti-allergic mechanism. GSE orally administered inhibited the anti-dinitrophenol IgE-induced passive cutaneous anaphylaxis reaction in mice. Furthermore, it inhibited the degranulation of rat basophilic leukemia RBL-2H3 cells. It had no cytotoxicity on RBL-2H3 cells. These results show that GSE is a candidate for effective therapeutic material for allergic diseases.

  7. IL-21 induces inhibitor of differentiation 2 and leads to complete abrogation of anaphylaxis in mice.

    PubMed

    Kishida, Tsunao; Hiromura, Yayoi; Shin-Ya, Masaharu; Asada, Hidetsugu; Kuriyama, Hiroko; Sugai, Manabu; Shimizu, Akira; Yokota, Yoshifumi; Hama, Takemitsu; Imanishi, Jiro; Hisa, Yasuo; Mazda, Osam

    2007-12-15

    IL-21 exerts pleiotrophic immunomodulatory activities on a variety of target cells including B cells that undergo class switch recombination (CSR) to IgE. In this study, we examined whether IgE-mediated systemic anaphylaxis was controlled by in vivo administration of IL-21 using the peanut allergy model in mice and investigated the molecular mechanisms underlying the IL-21-induced regulation of IgE. The anaphylactic reaction was completely abolished by the administration of recombinant mouse IL-21 or an IL-21 expression plasmid in terms of the change of body temperature and anaphylactic symptoms. The recombinant mouse IL-21 treatment remarkably suppressed IgE CSR in splenic B cells, resulting in significant decrease in serum concentrations of total as well as allergen-specific IgE. In the meanwhile, IL-21 provoked B cells in normal as well as allergic mice to express the inhibitor of differentiation 2 (Id2) gene that was shown to be crucially involved in the regulation of the activation-induced cytidine deaminase and IgE CSR. Moreover, mice genetically deficient for Id2 were completely unsusceptible to IL-21-induced prevention of IgE CSR and anaphylaxis. The present study strongly suggests that IL-21 is capable of regulating systemic allergic reactions by inducing the transcriptional regulator Id2, and the cytokine may be useful for clinical intervention for allergic diseases including anaphylaxis.

  8. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat

    PubMed Central

    Commins, Scott P.; Jerath, Maya R.; Cox, Kelly; Erickson, Loren D.; Platts-Mills, Thomas

    2016-01-01

    IgE-mediated hypersensitivity refers to immune reactions that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. To that end, identification of the associated allergen is important for facilitating both education and allergen avoidance that are essential to long-term risk reduction. As the number of known exposures associated with anaphylaxis is limited, discovery of novel causative agents is crucial to evaluation and management of patients with idiopathic anaphylaxis. Within the last 10 years several apparently separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins. Interestingly, the exposure differed from airborne allergens but was nevertheless capable of producing anaphylactic and hypersensitivity reactions. Our recent work has identified these responses as being due to a novel IgE antibody directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (“alpha-gal”). This review will present the historical summary of the identification of cetuximab hypersensitivity due to alpha-gal IgE and discuss the non-primate mammalian meat food allergy as well as current goals and directions of our research programs. PMID:26666477

  9. Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis.

    PubMed

    Simons, F Estelle R

    2004-01-01

    Epinephrine (adrenaline), the initial treatment of choice for systemic anaphylaxis, is an alpha- and beta-adrenergic agonist with bidirectional, cyclic adenosine monophosphate-mediated pharmacological effects on target organs, and a narrow therapeutic index. In a recent study, 0.95% of a geographically-defined population was found to have had epinephrine dispensed for out-of-hospital use; dispensing rates within this population varied from 1.44% for individuals under age 17 years to 0.32% for those older than 65 years. Although epinephrine is widely available in the community, it is not necessarily given in a timely manner when anaphylaxis occurs. Individuals with anaphylaxis may fail to respond to first-aid treatment with epinephrine for a variety of reasons. These include: (1) delay in treatment (in an animal model, epinephrine injection at the nadir of shock fails to provide sustained haemodynamic recovery); (2) administration of epinephrine by sub-optimal routes such as subcutaneous injection or inhalation from a pressurized metered-dose inhaler instead of intramuscular injection; (3) administration of an inappropriately low epinephrine dose due to the limitations currently imposed by the availability of only two fixed-dose auto-injectors: EpiPen Jr 0.15 mg or EpiPen 0.3 mg; and (4) injection of 'outdated' epinephrine, with inadvertent administration of an inadequate dose. Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes. PMID:15025402

  10. [Anaphylaxis Due to Ingestion of Ivy Syrup (Hedera hÈlix). Report of two Cases].

    PubMed

    Morfin-Maciel, Blanca María; Rosas-Alvarado, Alejandro; Velázquez-Sámano, Guillermo

    2012-01-01

    Common ivy is an ornamental plant, that is ubiquitous in Mexico. Its allergens can cause contact dermatitis, asthma and allergic rhinitis. We describe two cases of anaphylaxis related to common ivy syrup ingestion. We performed skin prick test with Hedera helix syrup, and using a dialized and ultrafiltered of common ivy syrup commercial presentation (dry common ivy extract: 7mg/ml), as well as using Hedera helix pollen extract. We describe two cases of anaphylaxis related to ingestion of Hedera helix syrup. Skin prick test with the commercial presentation and with the pollen extract were positive in both patients. In this study we confirmed the causal relationship of anaphylaxis due to the ingestion of ivy syrup in two patients through skin prick tests with ivy syrup and ivy pollen extract. Common ivy can cause contact dermatitis, asthma and allergic rhinitis, but we do not know the allergens that could be related to systemic and respiratory reactions, then, more studies in this topic are requiered. PMID:24007931

  11. Anaphylaxis to Polyethylene Glycol (Colyte®) in a Patient with Diverticulitis

    PubMed Central

    2016-01-01

    Polyethylene glycols (PEGs) are believed to be chemically inert agents, but larger PEG polymers could have immunogenicity. A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte®). In laboratory findings, the initial serum tryptase level was increased to 91.9 mg/L (normal range: 0.00-11.40 mg/L) without any other laboratory abnormalities. The intradermal test with 10 mg/mL Colyte® showed a 5 × 5 mm wheal, but basophil activation and histamine releasability tests were negative. PEG-3350 is widely used as an osmotic laxative due to its lack of absorption from the gastrointestinal tract. However, the loss of mucosal integrity at gastrointestinal membrane such as diverticulitis may be a predisposing factor for anaphylaxis to Colyte®. We report a case of anaphylaxis induced by the ingestion of PEG-3350 in a patient with diverticulitis which might be a risk factor of anaphylaxis. PMID:27550498

  12. Anaphylaxis to Polyethylene Glycol (Colyte®) in a Patient with Diverticulitis.

    PubMed

    Lee, So Hee; Hwang, Sun Hyuk; Park, Jin Soo; Park, Hae Sim; Shin, Yoo Seob

    2016-10-01

    Polyethylene glycols (PEGs) are believed to be chemically inert agents, but larger PEG polymers could have immunogenicity. A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte®). In laboratory findings, the initial serum tryptase level was increased to 91.9 mg/L (normal range: 0.00-11.40 mg/L) without any other laboratory abnormalities. The intradermal test with 10 mg/mL Colyte® showed a 5 × 5 mm wheal, but basophil activation and histamine releasability tests were negative. PEG-3350 is widely used as an osmotic laxative due to its lack of absorption from the gastrointestinal tract. However, the loss of mucosal integrity at gastrointestinal membrane such as diverticulitis may be a predisposing factor for anaphylaxis to Colyte®. We report a case of anaphylaxis induced by the ingestion of PEG-3350 in a patient with diverticulitis which might be a risk factor of anaphylaxis. PMID:27550498

  13. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community.

    PubMed

    Muraro, A; Agache, I; Clark, A; Sheikh, A; Roberts, G; Akdis, C A; Borrego, L M; Higgs, J; Hourihane, J O'B; Jorgensen, P; Mazon, A; Parmigiani, D; Said, M; Schnadt, S; van Os-Medendorp, H; Vlieg-Boerstra, B J; Wickman, M

    2014-08-01

    The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.

  14. A Case of Anaphylaxis Induced by Contact with Young Radish (Raphanus sativus L).

    PubMed

    Lee, Yung-Hee; Lee, Jae-Hyoung; Kang, Hye-Ran; Ha, Jung-Hoon; Lee, Byoung-Hoon; Kim, Sang-Hoon

    2015-01-01

    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.

  15. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2014.

    PubMed

    Sicherer, Scott H; Leung, Donald Y M

    2015-02-01

    This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2014. Studies on food allergy suggest worrisomely high rates of peanut allergy and food-induced anaphylaxis-related hospitalizations. Evidence is mounting to support the theory that environmental exposure to peanut, such as in house dust, especially with an impaired skin barrier attributed to atopic dermatitis (AD) and loss of function mutations in the filaggrin gene, is a risk factor for sensitization and allergy. Diagnostic tests are improving, with early studies suggesting the possibility of developing novel cellular tests with increased diagnostic utility. Treatment trials continue to show the promise and limitations of oral immunotherapy, and mechanistic studies are elucidating pathways that might define the degree of efficacy of this treatment. Studies have also provided insights into the prevalence and characteristics of anaphylaxis and insect venom allergy, such as suggesting that baseline platelet-activating factor acetylhydrolase activity levels are related to the severity of reactions. Advances in drug allergy include identification of HLA associations for penicillin allergy and a microRNA biomarker/mechanism for toxic epidermal necrolysis. Research identifying critical events leading to skin barrier dysfunction and the polarized immune pathways that drive AD have led to new therapeutic approaches in the prevention and management of AD.

  16. Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis.

    PubMed

    Simons, F Estelle R

    2004-01-01

    Epinephrine (adrenaline), the initial treatment of choice for systemic anaphylaxis, is an alpha- and beta-adrenergic agonist with bidirectional, cyclic adenosine monophosphate-mediated pharmacological effects on target organs, and a narrow therapeutic index. In a recent study, 0.95% of a geographically-defined population was found to have had epinephrine dispensed for out-of-hospital use; dispensing rates within this population varied from 1.44% for individuals under age 17 years to 0.32% for those older than 65 years. Although epinephrine is widely available in the community, it is not necessarily given in a timely manner when anaphylaxis occurs. Individuals with anaphylaxis may fail to respond to first-aid treatment with epinephrine for a variety of reasons. These include: (1) delay in treatment (in an animal model, epinephrine injection at the nadir of shock fails to provide sustained haemodynamic recovery); (2) administration of epinephrine by sub-optimal routes such as subcutaneous injection or inhalation from a pressurized metered-dose inhaler instead of intramuscular injection; (3) administration of an inappropriately low epinephrine dose due to the limitations currently imposed by the availability of only two fixed-dose auto-injectors: EpiPen Jr 0.15 mg or EpiPen 0.3 mg; and (4) injection of 'outdated' epinephrine, with inadvertent administration of an inadequate dose. Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes.

  17. The Basophil Activation Test Is Safe and Useful for Confirming Drug-Induced Anaphylaxis.

    PubMed

    Kim, Suk Yeon; Kim, Joo Hee; Jang, Young Sook; Choi, Jeong Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki Suck

    2016-11-01

    The basophil activation test (BAT) has been suggested as a complementary method for diagnosing drug allergies. The aim of this study was to evaluate the clinical utility of this test in patients with drug-induced anaphylaxis. In total, 19 patients, all of whom had a history of moderate to severe anaphylaxis, were enrolled. None of the causative drugs had available in vitro tests or reliable skin tests; these drugs included, among others, first and second-generation cephalosporins, H2 blockers, and muscle relaxants. The BAT yielded positive results in 57.9% of the cases, which was similar those results of skin prick and intradermal tests (42.1% and 57.9%, respectively). When basophils were double labelled with CD63 and CD203c, both of which are basophil activation markers, the positive rate was increased from 57.9% to 73.7%. Therefore, the results of this study confirm that the BAT is a quick, reliable, and safe diagnostic tool for patients with drug-induced anaphylaxis. PMID:27582406

  18. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community.

    PubMed

    Muraro, A; Agache, I; Clark, A; Sheikh, A; Roberts, G; Akdis, C A; Borrego, L M; Higgs, J; Hourihane, J O'B; Jorgensen, P; Mazon, A; Parmigiani, D; Said, M; Schnadt, S; van Os-Medendorp, H; Vlieg-Boerstra, B J; Wickman, M

    2014-08-01

    The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level. PMID:24905609

  19. Advocacy for strengthening civil registration and vital statistics.

    PubMed

    Upham, Susan; Mikkelsen, Lene

    2012-04-01

    This article has presented the key elements of the advocacy process and the steps to consider in developing an advocacy campaign. There are compelling reasons for engaging in advocacy, particularly as civil registration systems in many countries have progressed very little over the past 50 years. Lack of awareness of the benefits for individuals and governments has contributed to a vicious cycle of under development of civil registration and vital statistics systems. Advocates are needed across a range of sectors to persuade governments to make CRVS a priority and to work towards a greater political commitment and allocation of resources for establishing and improving systems. Advocating for better legal frameworks and policies that fully support a functioning and well-used CRVS system is needed. A selection of tools and resources has been included in this module to get you started in advocating for improvements in your CRVS system. Box 4 summarises some key considerations when developing your advocacy campaign.

  20. Advocacy communication, vaccines and the role of scientific societies.

    PubMed

    Signorelli, C; Odone, A

    2015-01-01

    In 1986 the Ottawa Charter underlined the importance of advocacy in health. This article analyzes the role of advocacy in Public Health making the case of immunization, whose coverage rates are decreasing in many countries. An effective advocacy action could counteract the growing phenomenon of the vaccine hesitancy within both the general population and an increasing share of healthcare providers as well as contrast antivax movements' action. We identify who are the advocates focusing on Italy and on the crucial role of scientific societies which share the responsibility of making the latest scientific evidence and most effective infectious diseases' control strategies available to health policy makers. The Italian Society of Hygiene (SItI) has been actively engaged for several years in a number of initiatives of advocacy communication and vaccines including research, training, media exposure and a dedicated website portal (vaccinarSì).

  1. Vocational Rehabilitation Counseling and Advocacy: An Analysis of Dissonant Concepts.

    ERIC Educational Resources Information Center

    Murphy, Stephen T.

    1980-01-01

    The article identifies and discusses the inherent differences that exist between vocational rehabilitation practice and client advocacy for the handicapped, and provides some recommendations as to how rehabilitation professionals may legitimately serve as advocates for handicapped persons. (DLS)

  2. Handicapped Infants and Euthanasia: A Challenge to Our Advocacy.

    ERIC Educational Resources Information Center

    Smith, J. David

    1985-01-01

    The issue of pediatric euthanasia for handicapped newborns is examined and contrasting viewpoints emphasizing the quality and the sanctity of life are considered. The author asserts that advocacy for handicapped children involves decisions regarding the euthanasia question. (CL)

  3. Bladder Cancer Patient Advocacy: A Global Perspective

    PubMed Central

    Quale, Diane Zipursky; Bangs, Rick; Smith, Monica; Guttman, David; Northam, Tammy; Winterbottom, Andrew; Necchi, Andrea; Fiorini, Edoardo; Demkiw, Stephanie

    2015-01-01

    Abstract Over the past 20 years, cancer patient advocacy groups have demonstrated that patient engagement in cancer care is essential to improving patient quality of life and outcomes. Bladder cancer patient advocacy only began 10 years ago in the United States, but is now expanding around the globe with non-profit organizations established in Canada, the United Kingdom and Italy, and efforts underway in Australia. These organizations, at different levels of maturity, are raising awareness of bladder cancer and providing essential information and resources to bladder cancer patients and their families. The patient advocacy organizations are also helping to advance research efforts by funding research proposals and facilitating research collaborations. Strong partnerships between these patient advocates and the bladder cancer medical community are essential to ensuringsustainability for these advocacy organizations, increasing funding to support advances in bladder cancer treatment, and improving patient outcomes. PMID:27398397

  4. What are the 'ideal' features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis?

    PubMed

    Frew, A J

    2011-01-01

    Anaphylaxis is a systemic allergic reaction that often involves respiratory symptoms and cardiovascular collapse, which are potentially life-threatening if not treated promptly with intramuscular adrenaline. Owing to the unpredictable nature of anaphylaxis and accidental exposure to allergens (such as peanuts and shellfish), patients should be prescribed intramuscular adrenaline auto-injectors and carry these with them at all times. Patients also need to be able to use their auto-injectors correctly while under high stress, when an anaphylactic attack occurs. Despite this, an alarming number of patients fail to carry their auto-injectors and many patients, carers of children with known anaphylaxis and healthcare professionals do not know how to use the device correctly, despite having had training. Currently available auto-injector devices have various limitations that may impede their use in the management of anaphylaxis. There is also a lack of validated assessment criteria and regulatory requirements for new devices. This review describes the different delivery systems used in currently available auto-injectors and discusses the key barriers to the use of adrenaline auto-injectors, with the goal of identifying the 'ideal' features/characteristics of such devices in the emergency treatment of anaphylaxis that will ensure ease of use, portability and accurate delivery of a life-saving drug.

  5. Social justice advocacy in nursing: what is it? How do we get there?

    PubMed

    Paquin, Siobhan O'Mahony

    2011-01-01

    Social justice advocacy is an expectation of all nurses as expressed in the professional codes that guide nursing practice. Nursing literature reflects this shift in the focus of nursing advocacy, providing insight into the potentials and challenges associated with nursing's evolution toward a broader social justice advocacy model. This article describes the concept of social justice advocacy as currently reflected in professional codes and nursing literature and contrasts this with the individual patient-nurse advocacy model, which continues to dominate in nursing practice today. Challenges associated with movement toward a social justice advocacy model and options for addressing these hurdles are also discussed.

  6. School Board Policies on Prevention and Management of Anaphylaxis in İstanbul: Where Do We Stand?

    PubMed Central

    Özen, Ahmet; Boran, Perran; Torlak, Fatih; Karakoç-Aydıner, Elif; Barış, Safa; Karavuş, Melda; Barlan, Işıl

    2016-01-01

    Background: Allergic diseases with a potential for anaphylaxis pose a critical public health issue in schools. Aims: This study was carried out to identify the current status of prevention and management of anaphylaxis in school children with the main goal of establishing such an action plan. Study Design: Cross-sectional study. Methods: Schools were randomly selected from 11 different regions of Istanbul. A questionnaire was filled out by 2596 teachers/school principals from 232 public schools. Results: A school safety committee was absent in 80% of elementary schools (ES) and 60.8% of preschools (PS). Although some form of health recording system was available in many schools, no such system was available in 24.5% of ESs and 10% of PSs. A specific inquiry for detecting children with food allergies was a routine practice in only 4% of ES and 10% of PS. Approximately 27% of teachers stated that monitoring children in school places was not possible at all times. Eighty four percent stated that no written anaphylaxis treatment protocol was available in their school and only around 2.3% in ES and 3.1% in PS stated that they would perform an epinephrine injection in the event of anaphylaxis. Conclusion: Our survey demonstrated critical gaps in the organization of schools for the management of children at risk of anaphylaxis. Data derived from this study would provide the initiative for legislators to review the current situation of school health policies along with the relevant authorities to establish school anaphylaxis guidelines. PMID:27761282

  7. The Severe Adverse Reaction to Vitamin K1 Injection Is Anaphylactoid Reaction but Not Anaphylaxis

    PubMed Central

    Mi, Yan-Ni; Ping, Na-Na; Xiao, Xue; Zhu, Yan-Bing; Liu, Jing; Cao, Yong-Xiao

    2014-01-01

    The severe adverse reaction to vitamin K1 injection is always remarkable and is thought to result from anaphylaxis. Paradoxically, however, some patients administered vitamin K1 injection for the first time have adverse reactions. Using beagle dogs, the present study tested the hypothesis that the response to vitamin K1 is an anaphylactoid reaction. The results showed that serious anaphylaxis-like symptoms appeared in beagle dogs after the administration of vitamin K1 injection for the first time. The plasma histamine concentration increased, and blood pressure decreased sharply. After sensitization, dogs were challenged with vitamin K1 injection and displayed the same degree of symptoms as prior to sensitization. However, when the vitamin K1 injection-sensitized dogs were challenged with a vitamin K1-fat emulsion without solubilizers such asTween-80, the abnormal reactions did not occur. Furthermore, there was no significant change in the plasma immunoglobulin E concentration after vitamin K1 challenge. Following treatment with vitamin K1 injection, the release of histamine and β-hexosaminidase by rat basophilic leukemia-2H3 cells as well as the rate of apoptosis increased. The Tween-80 group displayed results similar to those observed following vitamin K1 injection in vivo. However, the dogs in the vitamin K1-fat emulsion group did not display any abnormal behavior or significant change in plasma histamine. Additionally, degranulation and apoptosis did not occur in rat basophilic leukemia-2H3 cells. Our results indicate that the adverse reaction induced by vitamin K1 injection is an anaphylactoid reaction, not anaphylaxis. Vitamin K1 injection induces the release of inflammatory factors via a non-IgE-mediated immune pathway, for which the trigger may be the solubilizer. PMID:24594861

  8. Patient advocacy from the clinical nurses' viewpoint: a qualitative study.

    PubMed

    Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah

    2016-01-01

    One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy.

  9. Patient activation and advocacy: which literacy skills matter most?

    PubMed

    Martin, Laurie T; Schonlau, Matthias; Haas, Ann; Derose, Kathryn Pitkin; Rosenfeld, Lindsay; Buka, Stephen L; Rudd, Rima

    2011-01-01

    Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the United States increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy--a component of health literacy itself--when faced with a hypothetical barrier to scheduling a medical appointment. Although all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

  10. Patient advocacy from the clinical nurses' viewpoint: a qualitative study.

    PubMed

    Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah

    2016-01-01

    One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy. PMID:27471588

  11. Patient advocacy from the clinical nurses' viewpoint: a qualitative study

    PubMed Central

    Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah

    2016-01-01

    One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients’ health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy. PMID:27471588

  12. Pyrazolones metabolites are relevant for identifying selective anaphylaxis to metamizole.

    PubMed

    Ariza, Adriana; García-Martín, Elena; Salas, María; Montañez, María I; Mayorga, Cristobalina; Blanca-Lopez, Natalia; Andreu, Inmaculada; Perkins, James; Blanca, Miguel; Agúndez, José A G; Torres, María J

    2016-03-31

    Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common cause of hypersensitivity reactions, with pyrazolones the most frequent drugs inducing selective reactions. Immediate selective hypersensitivity to pyrazolones is thought to be mediated by specific-IgE. Sensitivity of in vitro diagnostic tests is low and this may be due to the incomplete characterization of the structures involved. Here we investigated whether main metabolites of metamizole (dipyrone) in human could be involved in the immune response using the basophil activation test (BAT). We studied subjects with confirmed selective immediate hypersensitivity to metamizole and performed BAT with metamizole and its metabolites: 4-methylamino-antipyrine (MAA), 4-aminoantipyrine (AA), 4-acetylamino-antipyrine (AAA) and 4-formylamino-antipyrine (FAA). BAT results showed an increase of positive results from 37.5% to 62.5% using metamizole plus metabolites as compared with the BAT carried out only with the parent drug, demonstrating that metamizole metabolites have a role in the reaction and can induce specific basophil activation in patients with immediate hypersensitivity to this drug. Our findings indicate that pyrazolone metabolites are useful for improving the in vitro diagnosis of allergic reactions to metamizole.

  13. A case of anaphylaxis: horse-fly or hymenoptera sting?

    PubMed

    Quercia, O; Emiliani, F; Foschi, F G; Stefanini, G F

    2009-10-01

    In literature it has been described a high risk of systemic reaction after blood-sucking Dyptera bites, like mosquitoes and horsefly, in people sensitive to hymenoptera. A 51 year old man, allergic to hymenoptera venom and with a history of i.v. reaction after Mueller, who has been treated with Vespula sp. ITS for the last 3 years, was stung by a yellow, black and green insect on the neck. Five minutes after the bite, he suffered generalized hitching and urticaria, oral cavity and lower limbs paresthesia, followed by lost of consciousness. At the Emergency Room he was successfully treated with adrenaline, intravenous antihistamines and corticosteroid. The description of the insect as well as the lack of the sting on the site suggested a wasp as the culprit. By studying one of these insect that has been captured by the patient, it turned out it wasn't a Vespula, but a horsefly, the Tabanus bovinus, which resembles Hymenoptera. Skin prick test and RAST for Tabanus confirmed the allergology diagnosis. In conclusion, also Tabanus bovines can cause systemic reaction up to anaphylactic shock.

  14. Signs and Symptoms of Food Allergy and Food-Induced Anaphylaxis.

    PubMed

    Sharma, Hemant P; Bansil, Shweta; Uygungil, Burcin

    2015-12-01

    Food allergies are increasing in prevalence. In order for pediatric clinicians to appropriately diagnose and manage food allergies, the characteristic signs and symptoms of these potentially severe reactions must be recognized. Unlike nonimmunologic adverse food reactions (such as lactose intolerance and food poisoning), food allergies by definition are immune-mediated responses that occur reproducibly on food ingestion. The varying clinical presentations of food allergy include IgE-mediated disorders, mixed IgE- and cell-mediated disorders, and cell-mediated food allergies. This review describes the clinical manifestations of each of these categories of food allergy, with special emphasis on recognition of food-induced anaphylaxis. PMID:26456438

  15. Anaphylaxis Triggered by Benzyl Benzoate in a Preparation of Depot Testosterone Undecanoate

    PubMed Central

    Ong, Gregory S. Y.; Somerville, Colin P.; Jones, Timothy W.; Walsh, John P.

    2012-01-01

    We report the first case of an anaphylactic reaction to Reandron 1000 (depot testosterone undecanoate with a castor oil and benzyl benzoate vehicle). While considered to have a favourable safety profile, serious complications such as oil embolism and anaphylaxis can occur. In our patient, skin testing identified benzyl benzoate to be the trigger, with no reaction to castor oil or testosterone undecanoate components. As benzyl benzoate exists in multiple pharmaceuticals, foods, and cosmetics, individual components of pharmaceuticals should be tested when investigating drug allergies. Doctors should be alert to the potential for serious reactions to any of the components of Reandron 1000. PMID:22272209

  16. The challenge of evaluating complex interventions: a framework for evaluating media advocacy.

    PubMed

    Stead, Martine; Hastings, Gerard; Eadie, Douglas

    2002-06-01

    New health promotion and public health approaches such as media advocacy pose particular evaluation challenges. Evaluation is important to provide feedback to media advocacy practitioners on how to enhance their efforts, and to funders and researchers seeking to assess media advocacy's effectiveness as a health promotion strategy. The media advocacy evaluation literature contains some examples of promising evaluation approaches but is still evolving. A comprehensive framework for the evaluation of media advocacy is presented. Building on existing approaches to evaluation in media advocacy and on current thinking regarding evaluation in health promotion, it proposes a series of indicators and research methods for evaluating media advocacy at the levels of formative, process and outcome evaluation. The framework can be used to encourage strategic reflection on the media advocacy process, to guide evaluation of specific interventions, and to demonstrate to funders the importance and complexity of evaluation in this promising field.

  17. 77 FR 55525 - Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-10

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project... meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee will be conducted....

  18. 77 FR 2611 - Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project... meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee will be conducted....

  19. 77 FR 37101 - Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project... meeting of the Taxpayer Advocacy Panel Bankruptcy Compliance Project Committee will be conducted....

  20. 78 FR 11277 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-15

    ...An open meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  1. 77 FR 21158 - Open Meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-09

    ...An open meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  2. 76 FR 77892 - Open Meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-14

    ...An open meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  3. 78 FR 69940 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-21

    ...An open meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  4. 77 FR 61053 - Open Meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-05

    ...An open meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  5. 77 FR 8327 - Open Meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ...An open meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  6. 78 FR 48230 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ...An open meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  7. 78 FR 15125 - Open Meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-08

    ...An open meeting of the Taxpayer Advocacy Panel Taxpayer Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  8. 77 FR 21157 - Internal Revenue Service; Open Meeting of the Taxpayer Advocacy Panel Refund Processing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-09

    ...An open meeting of the Taxpayer Advocacy Panel Refund Processing Communications Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer service at the Internal Revenue...

  9. A Novel Education and Training Program to Enhance Student Advocacy.

    PubMed

    Adams, Alex J; Matzke, Gary R; McCall, Kenneth L

    2015-09-25

    Objective. To develop and implement a unique student advocacy program to train student pharmacists to be effective advocates for the profession of pharmacy and the patients it serves. Design. The Academy is a 2-day program hosted annually in Washington, DC, that combines didactic presentations on the legislative process, communication with policymakers, current legislation, and active-learning exercises such as mock congressional visits. The Academy culminates with visits to Capitol Hill where students meet with legislators and their staff to discuss pending legislation. Assessment. Nearly 350 students from 43 schools and colleges of pharmacy completed the program in its 4 years. Students are assessed following the active-learning exercises and meetings with legislators. Conclusion. Advocacy has been listed as a competency that requires more attention in pharmacy education. The Academy provides a model that schools may replicate to enhance their advocacy offerings.

  10. International Dengue Vaccine Communication and Advocacy: Challenges and Way Forward.

    PubMed

    Carvalho, Ana; Van Roy, Rebecca; Andrus, Jon

    2016-01-01

    Dengue vaccine introduction will likely occur soon. However, little has been published on international dengue vaccine communication and advocacy. More effort at the international level is required to review, unify and strategically disseminate dengue vaccine knowledge to endemic countries' decision makers and potential donors. Waiting to plan for the introduction of new vaccines until licensure may delay access in developing countries. Concerted efforts to communicate and advocate for vaccines prior to licensure are likely challenged by unknowns of the use of dengue vaccines and the disease, including uncertainties of vaccine impact, vaccine access and dengue's complex pathogenesis and epidemiology. Nevertheless, the international community has the opportunity to apply previous best practices for vaccine communication and advocacy. The following key strategies will strengthen international dengue vaccine communication and advocacy: consolidating existing coalitions under one strategic umbrella, urgently convening stakeholders to formulate the roadmap for integrated dengue prevention and control, and improving the dissemination of dengue scientific knowledge.

  11. Evaluating Human Rights Advocacy on Criminal Justice and Sex Work.

    PubMed

    Amon, Joseph; Wurth, Margaret; McLemore, Megan

    2015-06-11

    Between October 2011 and September 2013, we conducted research on the use, by police and/or prosecutors, of condom possession as evidence of intent to engage in prostitution-related offenses. We studied the practice in five large, geographically diverse cities in the U.S. To facilitate our advocacy on this issue, conducted concurrent to and following our research, we developed an advocacy framework consisting of six dimensions: (1) raising awareness, (2) building and engaging coalitions, (3) framing debate, (4) securing rhetorical commitments, (5) reforming law and policy, and (6) changing practice. Using a case study approach, we describe how this framework also provided a basis for the evaluation of our work, and discuss additional considerations and values related to the measurement and evaluation of human rights advocacy.

  12. Breast cancer advocacy internships: student motivations, intentions, and perceptions.

    PubMed

    Trump, Tasha; Henderson, Jessica

    2011-03-01

    Currently, there are no published studies about the impact on students of a structured, breast-cancer-specific advocacy internship. Our goal was to provide the student perspective of participation in a national breast cancer advocacy conference in Washington, D.C. as part of an internship. Both qualitative and quantitative data were collected in three waves: 1 month before the training, during the training, and 1 month post-training. Four themes emerged: (1) empowerment, (2) connection with breast cancer patients and advocates, (3) learning outside the classroom, and (4) action through advocacy and civilian lobbying. This study found strong support for the internship model described here and is recommended for replication at other universities and institutions.

  13. Engaging health professionals in advocacy against gun violence.

    PubMed

    Pinto, Andrew D

    2008-01-01

    Health professionals have long been involved with advocacy around the social determinants of health, including protesting against war and mitigating the production, trade and use of specific weapon systems. Small arms and light weapons are a key area on which to focus, as they are responsible for the majority of injuries and deaths in war and their availability is related to increased levels of crime and suicide. Challenges for health professionals hoping to engage in such advocacy include a lack of adequate data, the need to confront political questions and the gun-lobby, and difficulty in measuring the effectiveness of campaigns. This article discusses some examples of successful advocacy and suggests future directions for health professionals in this area.

  14. A Novel Education and Training Program to Enhance Student Advocacy.

    PubMed

    Adams, Alex J; Matzke, Gary R; McCall, Kenneth L

    2015-09-25

    Objective. To develop and implement a unique student advocacy program to train student pharmacists to be effective advocates for the profession of pharmacy and the patients it serves. Design. The Academy is a 2-day program hosted annually in Washington, DC, that combines didactic presentations on the legislative process, communication with policymakers, current legislation, and active-learning exercises such as mock congressional visits. The Academy culminates with visits to Capitol Hill where students meet with legislators and their staff to discuss pending legislation. Assessment. Nearly 350 students from 43 schools and colleges of pharmacy completed the program in its 4 years. Students are assessed following the active-learning exercises and meetings with legislators. Conclusion. Advocacy has been listed as a competency that requires more attention in pharmacy education. The Academy provides a model that schools may replicate to enhance their advocacy offerings. PMID:27168608

  15. International Dengue Vaccine Communication and Advocacy: Challenges and Way Forward.

    PubMed

    Carvalho, Ana; Van Roy, Rebecca; Andrus, Jon

    2016-01-01

    Dengue vaccine introduction will likely occur soon. However, little has been published on international dengue vaccine communication and advocacy. More effort at the international level is required to review, unify and strategically disseminate dengue vaccine knowledge to endemic countries' decision makers and potential donors. Waiting to plan for the introduction of new vaccines until licensure may delay access in developing countries. Concerted efforts to communicate and advocate for vaccines prior to licensure are likely challenged by unknowns of the use of dengue vaccines and the disease, including uncertainties of vaccine impact, vaccine access and dengue's complex pathogenesis and epidemiology. Nevertheless, the international community has the opportunity to apply previous best practices for vaccine communication and advocacy. The following key strategies will strengthen international dengue vaccine communication and advocacy: consolidating existing coalitions under one strategic umbrella, urgently convening stakeholders to formulate the roadmap for integrated dengue prevention and control, and improving the dissemination of dengue scientific knowledge. PMID:26855170

  16. 76 FR 17995 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  17. 76 FR 56879 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The....C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit...

  18. 75 FR 10864 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The...) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be held...

  19. 75 FR 18955 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-13

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  20. 75 FR 33894 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-15

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  1. 76 FR 2196 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-12

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  2. 76 FR 63716 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The....C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit...

  3. 75 FR 7540 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-19

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer ] Income Tax Issue Committee will be conducted. The...) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be held...

  4. 76 FR 45006 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The.... (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project...

  5. 75 FR 7540 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-19

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  6. 76 FR 10942 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be conducted....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  7. 75 FR 25316 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  8. 75 FR 39332 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The.... (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be...

  9. 76 FR 17996 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be... Advocacy Panel Volunteer Income Tax Assistance Project Committee will be held Wednesday, May 18, 2011...

  10. 75 FR 11998 - Open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ... Internal Revenue Service Open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Issue Committee will be conducted. The... Act, 5 U.S.C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax...

  11. 75 FR 18955 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-13

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee will be... Act, 5 U.S.C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Volunteer Income...

  12. 75 FR 47348 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-05

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The.... (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be...

  13. 76 FR 32021 - Open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... Internal Revenue Service Open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  14. 76 FR 6189 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  15. 76 FR 22171 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-20

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  16. 76 FR 37199 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  17. 75 FR 33895 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-15

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The...) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be held...

  18. 76 FR 22171 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-20

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  19. 76 FR 63716 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  20. 75 FR 47349 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-05

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The.... (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project...

  1. 75 FR 4140 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-26

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned ] Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  2. 75 FR 39333 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-08

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  3. 75 FR 55406 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The.... (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be...

  4. 76 FR 32024 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  5. 76 FR 2197 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-12

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  6. 75 FR 62631 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The.... (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be...

  7. 75 FR 62632 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  8. 75 FR 4139 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-26

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The.... (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be...

  9. 76 FR 6188 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-03

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  10. 76 FR 56878 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  11. 76 FR 37197 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  12. 76 FR 45004 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance... open meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Project Committee will be....C. App. (1988) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance...

  13. 75 FR 55406 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The...) that an open meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will...

  14. 76 FR 10944 - Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project... meeting of the Taxpayer Advocacy Panel Earned Income Tax Credit Project Committee will be conducted. The... Committee Act, 5 U.S.C. App. (1988) that an open meeting of the Taxpayer Advocacy Panel Earned Income...

  15. 75 FR 25317 - Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Assistance Issue... meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be conducted. The...) that a meeting of the Taxpayer Advocacy Panel Volunteer Income Tax Issue Committee will be held...

  16. Advocacy and Accessibility Standards in the New "Code of Professional Ethics for Rehabilitation Counselors"

    ERIC Educational Resources Information Center

    Waldmann, Ashley K.; Blackwell, Terry L.

    2010-01-01

    This article addresses the changes in the Commission on Rehabilitation Counselor Certification's 2010 "Code of Professional Ethics for Rehabilitation Counselors" as they relate to Section C: Advocacy and Accessibility. Ethical issues are identified and discussed in relation to advocacy skills and to advocacy with, and on behalf of, the client; to…

  17. 7 CFR 2.94 - Director, Office of Advocacy and Outreach.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 1 2012-01-01 2012-01-01 false Director, Office of Advocacy and Outreach. 2.94... Secretary for Administration § 2.94 Director, Office of Advocacy and Outreach. (a) Delegations. Pursuant to..., Office of Advocacy and Outreach: (1) Ensure that small farms and ranches, beginning farmers or...

  18. 78 FR 78516 - Open Meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project... meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer...

  19. 45 CFR 1386.24 - Non-allowable costs for the Protection and Advocacy System.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Advocacy System. 1386.24 Section 1386.24 Public Welfare Regulations Relating to Public Welfare (Continued... Protection and Advocacy of the Rights of Individuals with Developmental Disabilities § 1386.24 Non-allowable costs for the Protection and Advocacy System. (a) Federal financial participation is not allowable...

  20. 78 FR 22948 - Open Meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-17

    ... Internal Revenue Service Open Meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project... meeting of the Taxpayer Advocacy Panel Notices and Correspondence Project Committee will be conducted. The Taxpayer Advocacy Panel is soliciting public comments, ideas, and suggestions on improving customer...