Development of the Hereditary Angioedema Rapid Triage (HAE-RT) Tool
Publication date: Available online 22 June 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Stephen Betschel, Ernie Avilla, Amin Kanani, Monika Kastner, Paul Keith, Karen Binkley, Gina Lacuesta, Rozita Borici-Mazi, Jacquie Badiou, Anne Rowe, William H. Yang, Susan WasermanAbstractBackgroundHAE patients present to the emergency department (ED), where their symptoms are often incorrectly attributed to common allergic and gastrointestinal conditions resulting in major delays in diagnosis and treatment.ObjectiveThe goal of this study was to develop a rapid triage HAE tool for ED settings.MethodsA mixed methods approach was conducted in 3 phases: Phase 1: A literature review on the current management of HAE patients in the ED. Phase 2: A Delphi study with HAE specialists (N=9) and Patient Advocacy Group Members (N=3) to reach consensus on the predictor variables (PV) to be included in the HAE-RT tool. Phase 3: A retrospective chart review to assess the performance of the PV for HAE.ResultsThe literature review informed the final list of PVs included in the HAE-RT prototype. Nine experts participated in the Delphi study. Of 8 identified HAE-specific PVs identified, 3 reached consensus: (1) absence of urticaria; (2) recurrent abdominal pain/swelling; and (3) lack of response to allergic directed therapy. The retrospective study included 107 patients (N=66 with HAE; N=41 non-HAE). HAE patients were more likely to have a family history of HAE (71%; P
Allergy to galactose-alpha-1,3-galactose (alpha-gal) presents as an IgE-mediated, yet delayed-onset hypersensitivity reaction to non-primate mammalian meat.1 Alpha-gal sensitization develops after tick bite exposure.1-3 The lone-star tick (Amblyomma americanum) represents the North American vector, spanning a relatively vast southeast, mid-west, and northeast geographic distribution.4 Allergic manifestations include urticaria/angioedema, abdominal pain/diarrhea, or anaphylaxis, occurring approximately 3-6 hours after ingestion.
We present the first case of a delayed, protracted allergic reaction to oral viscous lidocaine with positive intradermal testing.
We describe the case of a 48-year-old woman suffering from EoE not responsive to the topical steroid administration and diagnosis of SNAS. The patient started nickel oral desensitization according to the literature protocol continuing nickel-free diet. After 1 year from the beginning of the treatment, during the maintenance dose (500 ng three times a week), she decreased gradually the dosage of immunotherapy and reintroduced all the culprit foods. After the immunotherapy interruption, during the free diet, she repeated the oesophagogastroscopy with a complete macroscopic and histological resolution. We showed...
The basis of venom immunotherapy (VIT) can be defined as protection against IgE-mediated immunologic mechanisms such as anaphylaxis.1,2 Most insect stings produce local reactions of swelling, pain, erythema and pruritus, typically peaking by 24-48 hours and resolving within 3-10 days.5 Unfortunately, some patients experience systemic reactions ranging from cutaneous reactions only (characterized by urticaria and/or angioedema, excluding throat, larynx and tongue) to life-threatening systemic anaphylactic reactions (SAR).
A 27-year-old female patient with a history of hereditary angioedema (HAE), diagnosed at the age of 15 years, is routinely followed-up in Immunology clinic. She initially presented with a 3-year history of recurrent angioedema of the extremities and episodic acute abdominal pain with nausea and vomiting. Although there was no clear family history of HAE, she noted that her father had experienced swelling of the hand years before but had not sought medical attention for this. Both parents were advised to have C1 esterase inhibitor level and function tested however, have not yet done so.
CONCLUSIONS: Incidence of eperisone-induced anaphylaxis calculated from the KIDS-KAERS database was 0.001%. Eperisone can cause hypersensitive reactions, including anaphylaxis, possibly by inducing non-immunoglobulin E-mediated immediate hypersensitivity. PMID: 30661315 [PubMed]
These days, it can seem like just about everybody has a food allergy. But according to a new study, about 11% of American adults actually do. Yet 19% of adults believe they have a food allergy, even though some don’t have the diagnosis or symptoms to back it up, according to findings published in JAMA Network Open. This discrepancy suggests that quite a few adults are conflating allergies with less-severe food intolerances, which typically come with minimal digestion-related symptoms, the researchers write. If someone is truly allergic to a food, eating it can trigger a potentially life-threatening immune response. (...
We describe the clinical case of a 9-year-olf-female with recurrent monthly episodes of fever, arthralgia, abdominal pain, and urticaria-angioedema who did not respond to steroids associated with antihistamines, however showed the complete resolution of the disease with omalizumab. PMID: 30426806 [PubMed - as supplied by publisher]
Conclusions: To our knowledge, this was the first study to assess the efficacy and tolerability of H-LDOFC in a pediatric population. Our study suggests that in children with HA, H-LDOFC is well accepted and safe because adverse reactions are mild and the majority are represented by localized symptoms (oral allergy syndrome) and efficient, especially in terms of improvement of quality of life. For these reasons it could be more extensively used in the treatment of HA.Int Arch Allergy Immunol
DISCUSSION: In the event of acute urticaria associated with systemic symptoms, in particular gastrointestinal signs, allergy to α-galactose should be considered. PMID: 30037744 [PubMed - as supplied by publisher]