马齿苋治疗蜂毒过敏反应的实验研究

目的 以蜂针针刺动物足部使出现红肿热痛等局部过敏反应症状,建立峰针疗法所致局部过敏反应的动物模型,比较马齿苋不同给药方式对蜂毒过敏动物的抗炎作用、镇痛作用及解热作用大小,为马齿苋临床上用于治疗蜂针疗法引起的过敏反应提供依据.方法 以抗炎试验、镇痛试验、解热试验为主要试验方法,考察马齿苋水煎液口服给药、泡洗给药、口服兼泡洗给药对蜂毒引起的动物过敏反应的治疗作用.结果 与模型对照组比较,给药组、泡洗给药组及口服兼泡洗给药组对蜂针引起局部过敏反应均有显著抑制作用(P＜0.05或P＜0.01);与口服给药组、泡洗给药组比较,口服兼泡洗给药组抑制作用最强(P＜0.05).结论 提示中药马齿苋对蜂毒引起的局部过敏反应具有较强治疗作用,且给药方式不同其治疗作用强度不同.     

Markers of anaphylaxis – a systematic review

Anaphylaxis is defined as severe, life-threatening, systemic or general, immediate reaction of hypersensitivity, with repeatable symptoms caused by the dose of stimulus which is well tolerated by healthy persons. The proper diagnosis, immediate treatment and differential diagnosis are crucial for saving patient's life. However, anaphylaxis is relatively frequently misdiagnosed or confused with other clinical entities. Thus, there is a continuous need for identifying detectable markers improving the proper diagnosis of anaphylaxis. Here we presented currently known markers of anaphylaxis and discussed in more detail the most clinically valuable ones: tryptase, platelet activacting factor (PAF), PAF-acethylhydrolase, histamine and its metabolites.     

Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) – Parte I: tratamento e orientação pós‐crise

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.     

A case of piperacillin-induced occupational anaphylaxis: detection of serum IgE to piperacillin-HSA conjugate

This is the first reported detection of serum IgE antibody to piperacillin-human serum albumin (HSA) conjugate in a patient presenting with anaphylaxis that developed after occupational exposure. A 24-yr-old nurse, who had worked at a University Hospital for 2 yr, experienced chest tightness, dizziness, generalized urticaria, abdominal pain, and diarrhea 10 min after administering a piperacillin injection. She had previously suffered from atopic dermatitis. A skin prick test for common inhalant allergens was entirely negative; in contrast, her serum total IgE was elevated (283 IU/mL). A high level of piperacillin-specific serum IgE was detected by ELISA using piperacillin-HSA conjugate. Significant inhibition upon addition of both free piperacillin and piperacillin-HSA conjugate was detected by inhibition ELISA. These data suggest that piperacillin exposure in the workplace can induce occupational anaphylaxis and urticaria mediated by an interaction of IgE with the hapten of piperacillin.     

Adverse Reactions to Isosulfan Blue During Selective Sentinel Lymph Node Dissection in Melanoma

Background: Selective sentinel lymph node (SLN) dissection can spare about 80% of patients with primary melanoma from radical lymph node dissection. This procedure identifies the SLN either visually by injecting isosulfan blue dye around the primary melanoma site or by handheld gamma probe after radiocolloid injection.Methods: During selective SLN mapping, 1 to 5 ml of isosulfan blue was injected intradermally around the primary melanoma. From November 1993, to August 1998, 406 patients underwent intraoperative lymphatic mapping with the use of both isosulfan blue and radiocolloid injection. Three cases of selective SLN dissection, in which adverse reactions to isosulfan blue occurred, were reviewed.Results: We report three cases of anaphylaxis after intradermal injection with isosulfan blue of 406 patients who underwent intraoperative lymphatic mapping by using the procedure as described above. The three cases we report vary in severity from treatable hypotension with urticaria and erythema to severe cardiovascular collapse with or without bronchospasm or urticaria.Conclusions: In our series, the incidence of anaphylaxis to isosulfan blue was approximately 1%. Anaphylaxis can be fatal if not recognized and treated rapidly. Operating room personnel who participate in intraoperative lymphatic mapping where isosulfan blue is used must be aware of the potential consequences and be prepared to treat anaphylaxis.     

The β-adrenoceptors of the lung mediating inhibition of antigen-induced histamine release

The β-adrenoceptor stimulants, isoprenaline (IPR), orciprenaline (OPR), terbutaline (TRB), and ITP^** were studied for effects on antigen-induced release of histamine from guinea-pig lung tissue and for effects on guinea-pig isolated trachea and heart. The order of potency for the agents in the four functions studied were: (a) inhibition of histamine release, IPR > OPR ≈ TRB ITP = 0; (b) heart stimulation, chronotropic effect, IPR > OPR > ITP ≈ TRB; (c) heart stimulation, inotropic effect, IPR > OPR > ITP > TRB; (d) trachea relaxation: IPR > TRB > OPR ITP. These findings suggest that the β-adrenoceptors mediating inhibition of antigen-induced release of histamine are more related to those mediating trachea relaxation (β₂) than those mediating cardiac stimulation (β₁).