BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually i...BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually increasing.Anaphylactic shock due to camrelizumab has not been reported previously,until now.We report here,for the first time,a case of anaphylactic shock associated with camrelizumab in a patient with esophageal squamous cell carcinoma.CASE SUMMARY An 84-year-old male esophageal cancer patient received radiotherapy and chemotherapy 11 years ago.He was diagnosed with advanced esophageal squamous cell carcinoma with liver metastasis(Tx N1 M1)and received the first immunotherapy(camrelizumab 200 mg/each time,once every 3 wk)dose in December 2020,with no adverse reactions.Three weeks later,a generalized rash was noted on the chest and upper limbs;palpitations and breathing difficulties with a sense of dying occurred 10 min after the patient had been administered with the second camrelizumab therapy.Electrocardiograph monitoring revealed a 70 beats/min pulse rate,69/24 mm Hg(1 mm Hg=0.133 k Pa)blood pressure,28 breaths/min respiratory rate,and 86%pulse oximetry in room air.The patient was diagnosed with anaphylactic shock and was managed with intravenous fluid,adrenaline,dexamethasone sodium phosphate,calcium glucosate,and noradrenaline.Approximately 2 h after treatment,the patient’s anaphylactic shock symptoms had been completely relieved.CONCLUSION Due to the widespread use of camrelizumab,attention should be paid to anti-programmed cell death 1 antibody therapy-associated hypersensitivity or anaphylactic shock.展开更多
BACKGROUND Atezolizumab is a programmed death ligand 1(PD-L1)inhibitor,and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma(HCC).Treatment with immu...BACKGROUND Atezolizumab is a programmed death ligand 1(PD-L1)inhibitor,and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma(HCC).Treatment with immune checkpoint inhibitors(ICIs)can lead to hypersensitivity reactions;however,anaphylactic shock is rare.We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review.CASE SUMMARY A 75-year-old man was diagnosed with HCC recurrence after hepatectomy.He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1(PD-1)inhibitor.The patient showed a sudden onset of dizziness,numbness,and lack of consciousness with severe hypotension during atezolizumab infusion.The treatment was stopped immediately.The patient’s symptoms resolved after 5 mg dexamethasone was administered.Because of repeated hypersensitivity reactions to ICIs,treatment was changed to oral targeted regorafenib therapy.CONCLUSION Further research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.展开更多
AIM: To investigate oxaliplatin-induced severe anaphylactic reactions (SAR) in metastatic colorectal cancer in a retrospective case series analysis and to conduct a systemic literature review. METHODS: During a 6-year...AIM: To investigate oxaliplatin-induced severe anaphylactic reactions (SAR) in metastatic colorectal cancer in a retrospective case series analysis and to conduct a systemic literature review. METHODS: During a 6-year period from 2006 to 2011 at Kaohsiung Veterans General Hospital, a total of 412 patients exposed to oxaliplatin-related chemotherapy were retrospectively reviewed. Relevant Englishlanguage studies regarding life-threatening SAR following oxaliplatin were also reviewed in MEDLINE and PubMed search. RESULTS: Eight patients (1.9%, 8 of 412 cases) were identified. Seven patients were successful resuscitated without any sequelae and one patient expired. We changed the chemotherapy regimen in five patients and rechallenged oxaliplatin use in patient 3. Twenty-three relevant English-language studies with 66 patients were reported. Patients received a median of 10 cycles of oxaliplatin (range, 2 to 29). Most common symptoms were respiratory distress (60%), fever (55%), and hypotension (54%). Three fatal events were reported (4.5%). Eleven patients (16%) of the 66 cases were rechallenged by oxaliplatin. CONCLUSION: SAR must be considered in patients receiving oxaliplatin-related chemotherapy, especially in heavily pretreated patients. Further studies on the mechanism, predictors, preventive methods and management of oxaliplatin-related SAR are recommended.展开更多
The incidence of anaphylactic reaction after the long-term use of abatacept has not been reported until now. Herein, we present a case of rheumatoid arthritis (RA) in which the patient experienced an anaphylactic reac...The incidence of anaphylactic reaction after the long-term use of abatacept has not been reported until now. Herein, we present a case of rheumatoid arthritis (RA) in which the patient experienced an anaphylactic reaction one year after initiation of treatment with abatacept. A 75-year-old woman visited our hospital with symptoms of bilateral knee pain and swelling. She was initially treated with methotrexate (6 mg/week increased to 8 mg/week). Two months later, because of inadequate response, self-injections of abatacept (subcutaneous;125 mg every two weeks) were prescribed. However, 6 months later, because of frequent stomatitis, the methotrexate dose was decreased to 6 mg/week, which resulted in worsening of RA. We changed the route of abatacept administration from subcutaneous injection to intravenous infusion (500 mg/month as a drip). After 30 min of starting the drip, the patient experienced itchiness and drop in vital signs, which were managed using methylprednisolone (2 doses, 125 mg each), dopamine hydrochloride (8 mg/h), and oxygen therapy (flow decreased from 3 L/min to 1 L/min). Wheals and redness were treated with oral antihistamines. Six hours after the onset of the anaphylactic reaction, the vital signs were stabilized. On the subsequent day, the patient’s general state was confirmed to be normal. One month later, etanercept (25 mg) treatment was initiated. The patient is currently in remission. We recommend caution when changing the route of administration and dosage of abatacept in anti-cyclic citrullinated peptide antibody-positive patients or those with a history of mild infusion-related reaction.展开更多
Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forc-es and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as...Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forc-es and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as myocardial infarction with cardiovascular collapse that occurred in the dialysis room following an allergic reac-tion. The dialysis apparatus material of polyurethane, polyamide, polycarbonate, silicon rubber and polypro-pylene were incriminated causes. Physicians should be aware of the causality and existence of this disorder in order to achieve early and correct diagnosis and apply the appropriate therapeutic measures.展开更多
Background:Two health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces,and allergic reactions induced by triatomine bites.In the Southwestern United States,re...Background:Two health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces,and allergic reactions induced by triatomine bites.In the Southwestern United States,reduviid bugs bites commonly cause insect allergy.In South China,four cases of anaphylactic shock have been reported after this bite exposure.To further classify the species of these bugs and confirm the sensitization of the triatomine saliva,we caught triatomine bugs from the region where the bites occurred and performed phylogenetic and immunohistochemical(IHC)analysis.Methods:Triatomine bugs were collected in Donghai Island of Zhanjiang City in South China.The genomic DNA was extracted from three legs of the bugs.The fragments of mitochondrial 16S rRNA,cytochrome c oxidase subunit I(COI)gene and nuclear ribosomal 18S and 28S rRNA genes were obtained by PCR and sequenced.A phylogenetic tree was constructed based on the sequence of 16S rRNA gene using a maximum likelihood method with MEGA 7.0 software.Trypanosomal specific fragments and vertebrate COI genes were amplified from the fecal DNA to detect the infection of trypanosomes and analyze the blood feeding patterns,respectively.Paraffin-embedded sections were then prepared from adult triatomines and sent for IHC staining.Results:We collected two adult triatomine bugs in Donghai Island.Morphological and molecular analyses indicated that the triatomines were Triatoma rubrofasciata.No fragments of T.cruzi or other trypanosomes were detected from the fecal DNA.Mitochondrial gene segments of Homo sapiens and Mus musculus were successfully amplified.The allergens which induced specific IgE antibodies in human serum were localized in the triatomine saliva by IHC assay.Conclusions:The two triatomine bugs from Donghai Island were T.rubrofasciata.They had bitten humans and mice.Their saliva should contain the allergens related to the allergic symptoms and even anaphylactic shock of exposed residents.Great consideration should be given to this triatomine bugs due to their considerable distribution and potential threat to public health in South China.展开更多
Background Anaphylactic reactions during anesthesia and operation are common and life threatening.Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs.The purp...Background Anaphylactic reactions during anesthesia and operation are common and life threatening.Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs.The purpose of this study was to assess cellular allergen stimulation test （CAST） as a diagnostic instrument in immunoglobulin E （IgE）-and non-lgE-mediated anaphylactic reactions.Methods This study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital.We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.Results Of the 25 patients,17 had IgE-mediated anaphylactic reactions （causative agent identified by skin tests） and 8 had non-lgE-mediated anaphylactic reactions （negative skin tests）.CAST showed a sensitivity of 42.9％,specificity of 90％,and negative predictive value of 80.6％ for neuromuscular blocking agents.Conclusions CAST may be useful for the diagnosis of anaphylactic reactions during perioperative period.Our findings call for further investigation to increase the sensitivity of the test.展开更多
In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the ad...In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the adverse reactions induced by hemocoagulase for injection were collected in Chinese and foreign literatures. The clinical characteristics and influencing factors of anaphylactic shock induced by hemocoagulase for injection were evaluated by logistic regression analysis. In this study, 87 articles including 108 cases(68 cases of anaphylactic shock) were collected. Univariate logistic regression indicated that allergic constitution, daily dose, combined anesthesia, first drug delivery, post-dose time and course of treatment were positively associated with the incidence of anaphylactic shock caused by hemocoagulase for injection(P<0.05). The six above-mentioned factors were included in the multivariate logistic stepwise regression analysis to exclude the effects of confounding factors, and the results suggested that allergic constitution(P = 0.048, OR = 8.242), combined anesthesia(P = 0.024, OR = 22.675) and post-dose time(P = 0.006, OR = 20.255) were associated with the incidence of anaphylactic shock caused by hemocoagulase for injection. The clinicians should pay much more attention to risk factors that may cause anaphylactic shock, such as allergic constitution, combined anesthesia and post-dose time. The clinical pharmacists should strengthen pharmaceutical monitoring and improve the safety of medication.展开更多
BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of va...BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of vancomycin.VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use.A review of the literature showed that in the last 23 years,4 such cases have been reported.Here,we add another case of VFS developed after slow local absorption of vancomycin in cement beads.CASE SUMMARY A 44-year-old male with a known case of hypertension,no history of allergies to medications,and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg.The pus culture grew Staphylococcus aureus,which was sensitive to clindamycin and vancomycin.The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate.Three hours postoperatively,the patient developed a pruritic,erythematous,macular rash predominantly on his face,neck,chest,and lower extremities and to a lesser extent his upper extremities.A diagnosis of VFS was made and was successfully treated with cetirizine(10 mg,oral)and methylprednisolone sodium succinate(125 mg,intravenous).The patient continued to have itching with a facial rash for 12 h with gradual improvement.A decision was made to not remove the beads as the patient continued to improve.Gradually,the rash disappeared after 96 h with no further sequela.CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release,as in our case.As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty,they should be aware of such a complication occurring.展开更多
Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the per...Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.展开更多
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 sym...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.展开更多
BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications d...BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.展开更多
BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk o...BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk of cardiac arrest.CASE SUMMARY We present a case in which a patient with postoperative infection went into anaphylactic shock and cardiac arrest caused by povidone-iodine during secondary surgery.The patient was successfully resuscitated by 2 h of cardiopulmonary resuscitation.CONCLUSION This is the first known case of cardiac arrest caused by povidone-iodine allergy.展开更多
This is a case report of bleomycin induced drug allergy in a 34-year-old gentleman. He developed generalized maculopapular rashes with some vesicles over the shoulders, abdomen, both upper limbs and right thigh on the...This is a case report of bleomycin induced drug allergy in a 34-year-old gentleman. He developed generalized maculopapular rashes with some vesicles over the shoulders, abdomen, both upper limbs and right thigh on the second day after administration of bleomycin and that can be mistaken for herpes skin infections if we do not perform clinical examination thoroughly. In this case report, the importance of distinguishing between herpes virus skin infection and drug induced reaction is emphasized and the differences in management strategies are highlighted.展开更多
基金Supported by the National Natural Science Foundation of China,No.81873317the Natural Science Foundation of Zhejiang,No.LSY19H030002the Science and Technology Projects of Hangzhou City,No.20181228Y22。
文摘BACKGROUND Camrelizumab(SHR-1210),an immune checkpoint inhibitor,is clinically used as a therapeutic option for various types of tumors.However,reports of adverse reactions associated with camrelizumab are gradually increasing.Anaphylactic shock due to camrelizumab has not been reported previously,until now.We report here,for the first time,a case of anaphylactic shock associated with camrelizumab in a patient with esophageal squamous cell carcinoma.CASE SUMMARY An 84-year-old male esophageal cancer patient received radiotherapy and chemotherapy 11 years ago.He was diagnosed with advanced esophageal squamous cell carcinoma with liver metastasis(Tx N1 M1)and received the first immunotherapy(camrelizumab 200 mg/each time,once every 3 wk)dose in December 2020,with no adverse reactions.Three weeks later,a generalized rash was noted on the chest and upper limbs;palpitations and breathing difficulties with a sense of dying occurred 10 min after the patient had been administered with the second camrelizumab therapy.Electrocardiograph monitoring revealed a 70 beats/min pulse rate,69/24 mm Hg(1 mm Hg=0.133 k Pa)blood pressure,28 breaths/min respiratory rate,and 86%pulse oximetry in room air.The patient was diagnosed with anaphylactic shock and was managed with intravenous fluid,adrenaline,dexamethasone sodium phosphate,calcium glucosate,and noradrenaline.Approximately 2 h after treatment,the patient’s anaphylactic shock symptoms had been completely relieved.CONCLUSION Due to the widespread use of camrelizumab,attention should be paid to anti-programmed cell death 1 antibody therapy-associated hypersensitivity or anaphylactic shock.
基金Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,China,No.2020372769.
文摘BACKGROUND Atezolizumab is a programmed death ligand 1(PD-L1)inhibitor,and its combination with bevacizumab has been proven an effective immunotherapy for unresectable hepatocellular carcinoma(HCC).Treatment with immune checkpoint inhibitors(ICIs)can lead to hypersensitivity reactions;however,anaphylactic shock is rare.We present a case of life-threatening anaphylactic shock during atezolizumab infusion and performed a relevant literature review.CASE SUMMARY A 75-year-old man was diagnosed with HCC recurrence after hepatectomy.He was administered immunotherapy with atezolizumab plus bevacizumab after an allergy to a programmed death-1(PD-1)inhibitor.The patient showed a sudden onset of dizziness,numbness,and lack of consciousness with severe hypotension during atezolizumab infusion.The treatment was stopped immediately.The patient’s symptoms resolved after 5 mg dexamethasone was administered.Because of repeated hypersensitivity reactions to ICIs,treatment was changed to oral targeted regorafenib therapy.CONCLUSION Further research is necessary for elucidating the hypersensitivity mechanisms and establishing standardized skin test and desensitization protocols associated with PD-1 and PD-L1 to ensure effective treatment with ICIs.
文摘AIM: To investigate oxaliplatin-induced severe anaphylactic reactions (SAR) in metastatic colorectal cancer in a retrospective case series analysis and to conduct a systemic literature review. METHODS: During a 6-year period from 2006 to 2011 at Kaohsiung Veterans General Hospital, a total of 412 patients exposed to oxaliplatin-related chemotherapy were retrospectively reviewed. Relevant Englishlanguage studies regarding life-threatening SAR following oxaliplatin were also reviewed in MEDLINE and PubMed search. RESULTS: Eight patients (1.9%, 8 of 412 cases) were identified. Seven patients were successful resuscitated without any sequelae and one patient expired. We changed the chemotherapy regimen in five patients and rechallenged oxaliplatin use in patient 3. Twenty-three relevant English-language studies with 66 patients were reported. Patients received a median of 10 cycles of oxaliplatin (range, 2 to 29). Most common symptoms were respiratory distress (60%), fever (55%), and hypotension (54%). Three fatal events were reported (4.5%). Eleven patients (16%) of the 66 cases were rechallenged by oxaliplatin. CONCLUSION: SAR must be considered in patients receiving oxaliplatin-related chemotherapy, especially in heavily pretreated patients. Further studies on the mechanism, predictors, preventive methods and management of oxaliplatin-related SAR are recommended.
文摘The incidence of anaphylactic reaction after the long-term use of abatacept has not been reported until now. Herein, we present a case of rheumatoid arthritis (RA) in which the patient experienced an anaphylactic reaction one year after initiation of treatment with abatacept. A 75-year-old woman visited our hospital with symptoms of bilateral knee pain and swelling. She was initially treated with methotrexate (6 mg/week increased to 8 mg/week). Two months later, because of inadequate response, self-injections of abatacept (subcutaneous;125 mg every two weeks) were prescribed. However, 6 months later, because of frequent stomatitis, the methotrexate dose was decreased to 6 mg/week, which resulted in worsening of RA. We changed the route of abatacept administration from subcutaneous injection to intravenous infusion (500 mg/month as a drip). After 30 min of starting the drip, the patient experienced itchiness and drop in vital signs, which were managed using methylprednisolone (2 doses, 125 mg each), dopamine hydrochloride (8 mg/h), and oxygen therapy (flow decreased from 3 L/min to 1 L/min). Wheals and redness were treated with oral antihistamines. Six hours after the onset of the anaphylactic reaction, the vital signs were stabilized. On the subsequent day, the patient’s general state was confirmed to be normal. One month later, etanercept (25 mg) treatment was initiated. The patient is currently in remission. We recommend caution when changing the route of administration and dosage of abatacept in anti-cyclic citrullinated peptide antibody-positive patients or those with a history of mild infusion-related reaction.
文摘Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forc-es and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as myocardial infarction with cardiovascular collapse that occurred in the dialysis room following an allergic reac-tion. The dialysis apparatus material of polyurethane, polyamide, polycarbonate, silicon rubber and polypro-pylene were incriminated causes. Physicians should be aware of the causality and existence of this disorder in order to achieve early and correct diagnosis and apply the appropriate therapeutic measures.
基金This work was supported by National Key Research and Development Program of China(No.2016YFC1202000,2016YFC1202001,and 2016YFC1200500)Shenzhen San-Ming Project for prevention and research on vector-borne diseases(SZSM201611064).
文摘Background:Two health concerns primarily related to triatomine bugs are transmission of Trypanosoma cruzi through infective feces,and allergic reactions induced by triatomine bites.In the Southwestern United States,reduviid bugs bites commonly cause insect allergy.In South China,four cases of anaphylactic shock have been reported after this bite exposure.To further classify the species of these bugs and confirm the sensitization of the triatomine saliva,we caught triatomine bugs from the region where the bites occurred and performed phylogenetic and immunohistochemical(IHC)analysis.Methods:Triatomine bugs were collected in Donghai Island of Zhanjiang City in South China.The genomic DNA was extracted from three legs of the bugs.The fragments of mitochondrial 16S rRNA,cytochrome c oxidase subunit I(COI)gene and nuclear ribosomal 18S and 28S rRNA genes were obtained by PCR and sequenced.A phylogenetic tree was constructed based on the sequence of 16S rRNA gene using a maximum likelihood method with MEGA 7.0 software.Trypanosomal specific fragments and vertebrate COI genes were amplified from the fecal DNA to detect the infection of trypanosomes and analyze the blood feeding patterns,respectively.Paraffin-embedded sections were then prepared from adult triatomines and sent for IHC staining.Results:We collected two adult triatomine bugs in Donghai Island.Morphological and molecular analyses indicated that the triatomines were Triatoma rubrofasciata.No fragments of T.cruzi or other trypanosomes were detected from the fecal DNA.Mitochondrial gene segments of Homo sapiens and Mus musculus were successfully amplified.The allergens which induced specific IgE antibodies in human serum were localized in the triatomine saliva by IHC assay.Conclusions:The two triatomine bugs from Donghai Island were T.rubrofasciata.They had bitten humans and mice.Their saliva should contain the allergens related to the allergic symptoms and even anaphylactic shock of exposed residents.Great consideration should be given to this triatomine bugs due to their considerable distribution and potential threat to public health in South China.
文摘Background Anaphylactic reactions during anesthesia and operation are common and life threatening.Follow-up investigation is necessary for avoiding potential re-exposure of the patients to the offending drugs.The purpose of this study was to assess cellular allergen stimulation test （CAST） as a diagnostic instrument in immunoglobulin E （IgE）-and non-lgE-mediated anaphylactic reactions.Methods This study included 25 patients who developed perioperative anaphylactic reactions and 10 subjects that tolerated anesthetics and other drugs during perioperative period from September 2009 to October 2013 in Peking Union Medical College Hospital.We performed skin tests and flow cytometric analysis of basophil activation-based CAST in all subjects.Results Of the 25 patients,17 had IgE-mediated anaphylactic reactions （causative agent identified by skin tests） and 8 had non-lgE-mediated anaphylactic reactions （negative skin tests）.CAST showed a sensitivity of 42.9％,specificity of 90％,and negative predictive value of 80.6％ for neuromuscular blocking agents.Conclusions CAST may be useful for the diagnosis of anaphylactic reactions during perioperative period.Our findings call for further investigation to increase the sensitivity of the test.
文摘In the present study, we aimed to explore the influencing factors of anaphylactic shock caused by hemocoagulase for injection and to provide a scientific basis for clinical safe medication. The cases reports on the adverse reactions induced by hemocoagulase for injection were collected in Chinese and foreign literatures. The clinical characteristics and influencing factors of anaphylactic shock induced by hemocoagulase for injection were evaluated by logistic regression analysis. In this study, 87 articles including 108 cases(68 cases of anaphylactic shock) were collected. Univariate logistic regression indicated that allergic constitution, daily dose, combined anesthesia, first drug delivery, post-dose time and course of treatment were positively associated with the incidence of anaphylactic shock caused by hemocoagulase for injection(P<0.05). The six above-mentioned factors were included in the multivariate logistic stepwise regression analysis to exclude the effects of confounding factors, and the results suggested that allergic constitution(P = 0.048, OR = 8.242), combined anesthesia(P = 0.024, OR = 22.675) and post-dose time(P = 0.006, OR = 20.255) were associated with the incidence of anaphylactic shock caused by hemocoagulase for injection. The clinicians should pay much more attention to risk factors that may cause anaphylactic shock, such as allergic constitution, combined anesthesia and post-dose time. The clinical pharmacists should strengthen pharmaceutical monitoring and improve the safety of medication.
文摘BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of vancomycin.VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use.A review of the literature showed that in the last 23 years,4 such cases have been reported.Here,we add another case of VFS developed after slow local absorption of vancomycin in cement beads.CASE SUMMARY A 44-year-old male with a known case of hypertension,no history of allergies to medications,and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg.The pus culture grew Staphylococcus aureus,which was sensitive to clindamycin and vancomycin.The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate.Three hours postoperatively,the patient developed a pruritic,erythematous,macular rash predominantly on his face,neck,chest,and lower extremities and to a lesser extent his upper extremities.A diagnosis of VFS was made and was successfully treated with cetirizine(10 mg,oral)and methylprednisolone sodium succinate(125 mg,intravenous).The patient continued to have itching with a facial rash for 12 h with gradual improvement.A decision was made to not remove the beads as the patient continued to improve.Gradually,the rash disappeared after 96 h with no further sequela.CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release,as in our case.As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty,they should be aware of such a complication occurring.
文摘Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.
文摘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.
文摘BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.
文摘BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk of cardiac arrest.CASE SUMMARY We present a case in which a patient with postoperative infection went into anaphylactic shock and cardiac arrest caused by povidone-iodine during secondary surgery.The patient was successfully resuscitated by 2 h of cardiopulmonary resuscitation.CONCLUSION This is the first known case of cardiac arrest caused by povidone-iodine allergy.
文摘This is a case report of bleomycin induced drug allergy in a 34-year-old gentleman. He developed generalized maculopapular rashes with some vesicles over the shoulders, abdomen, both upper limbs and right thigh on the second day after administration of bleomycin and that can be mistaken for herpes skin infections if we do not perform clinical examination thoroughly. In this case report, the importance of distinguishing between herpes virus skin infection and drug induced reaction is emphasized and the differences in management strategies are highlighted.
