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Acute stroke during penicillin desensitization due to jarisch herxheimer
Jarisch Herxheimer reaction (JHR) is a transient episode seen within 24 hours of treatment with antibiotics in patients infected by spirochetes. Although seen in 95% of patients, it occurs rarely in late or latent syphilis. The severity depends on the spirochete load.
Source: Annals of Allergy, Asthma and Immunology - November 1, 2022 Category: Allergy & Immunology Authors: S. Bhatti, J. Deluca, J. McCracken Tags: M060 Source Type: research

Treatment of a 4-year-old boy with mepolizumab for Lymphocytic Hypereosinophilic Syndrome
A previously healthy 4-year-old boy presented to the emergency room with two days of headache, unsteady gait, and left hemiparesis. Emergent head CT revealed a right sided hypodensity concerning for ischemic stroke. Follow up MRI/MRA revealed multiple acute ischemic foci in the right MCA and PCA watershed territories, chronic appearing ischemic foci bilaterally, and bilateral carotid artery narrowing concerning for medium or large vessel vasculitis. Cardiac, hypercoagulability, and rheumatologic workup were unrevealing.
Source: Annals of Allergy, Asthma and Immunology - May 7, 2022 Category: Allergy & Immunology Authors: Jason A. Cascio, Madalyn Walsh, Kelly Hoenig, Benjamin Davis Tags: Letters Source Type: research

M054 biphasic vancomycin-induced anaphylaxis complicated by spinal cord stroke
We report a case of severe biphasic anaphylaxis secondary to vancomycin.
Source: Annals of Allergy, Asthma and Immunology - November 1, 2021 Category: Allergy & Immunology Authors: H. Joundi, I. Carrillo-Martin, A. Gonzalez-Estrada Source Type: research

Acute generalized exanthematous pustulosis to a novel oral anticoagulant (apixaban)
Non-vitamin K antagonist oral anticoagulants or novel oral anticoagulants (NOACs) are increasingly used in the prevention of stroke in atrial fibrillation and in the prevention and treatment of venous thromboembolism (VTE). NOACs include direct thrombin inhibitor dabigatran and factor Xa inhibitors apixaban, edoxaban and rivaroxaban. Severe cutaneous adverse reactions are rare with definite cases of drug reaction with eosinophilia and systemic symptoms (DRESS) attributed to both rivaroxaban and apixaban1,2.
Source: Annals of Allergy, Asthma and Immunology - August 2, 2021 Category: Allergy & Immunology Authors: Suran L Fernando, Jamma Li, Chris Toon, Chris Weir Source Type: research

M168 recurrent orolingual angioedema (oae) in the setting of stroke
OAE has been described in patients with stroke after tissue plasminogen activator (tPA) use. Here, we discuss a case that occurred without the use of tPA.
Source: Annals of Allergy, Asthma and Immunology - November 1, 2020 Category: Allergy & Immunology Authors: M. Kim, M. Perez, M. Chen, K. McGrath Source Type: research

M286 a rare heterozygous deficiency of adenosine deaminase 2 monogenic mutation with an autoinflammatory phenotype
Deficiency of Adenosine Deaminase 2 (DADA2) enzyme mutation is an autosomal recessive monogenic vasculitis syndrome resulting from loss of function biallelic hypomorphic mutation in the ADA2 gene. It is a syndrome with a broad severity spectrum of only cutaneous manifestation to a combination of that with fever, marrow aplasia, pure red cell aplasia, early-onset stroke, mild immunodeficiency, and other additional phenotypes. Here, we present the case of a heterozygous vasculitis syndrome with monogenic expression and borderline protein level with clinical phenotype consistent with auto-inflammatory state.
Source: Annals of Allergy, Asthma and Immunology - November 1, 2020 Category: Allergy & Immunology Authors: D. Imanirad, F. Tabatabaian Source Type: research

Delayed hypersensitivity reactions to edoxaban
Edoxaban is the fourth approved Direct Oral AntiCoagulant (DOAC) that has been introduced into the European market (2015), after dabigatran (2008), rivaroxaban (2008) and apixaban (2011). Dabigatran is the only direct thrombin inhibitor, whereas apixaban, edoxaban, and rivaroxaban are factor-Xa inhibitors. In a few years DOACs' use steadily increased in clinical practice for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF) [1], as well as for treatment and prevention of recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE)[2].
Source: Annals of Allergy, Asthma and Immunology - August 27, 2020 Category: Allergy & Immunology Authors: Laura Franceschini, Giulia Carli, Giancarlo Landini, Daniela Matarrese, Alessandro Farsi Tags: Letters Source Type: research

Prediction of acute asthma exacerbation severity and interrater reliability of manual pulsus paradoxus measurement
Pulsus paradoxus (PP) represents an exaggeration of the normal fluctuation of left ventricular stroke volume and systolic blood pressure during the respiratory cycle.1 This physiologic phenomenon was first described by Lower in 1669 and the term pulsus paradoxus first applied by Kussmaul in 1873.2 PP measurement is recommended to identify or assess the severity of acute asthma exacerbations, tension pneumothorax, cardiac tamponade and other potentially life-threatening disorders.3
Source: Annals of Allergy, Asthma and Immunology - March 26, 2019 Category: Allergy & Immunology Authors: Donald H. Arnold, Adam A. Vukovic, Cosby G. Arnold, Cody Penrod, Jonas A. Pologe Tags: Letters Source Type: research

Thromboembolic stroke: a sequela of Hymenoptera venom–induced anaphylaxis
The potential for anaphylaxis to Hymenoptera stings is well known. Anaphylaxis often occurs after a number of uneventful prior stings.1 In the United States, a Hymenoptera sting can lead to a systemic allergic reaction in 3% of adults and accounts for more deaths than any other envenomation.1 Thromboembolic stroke associated with Hymenoptera venom–induced anaphylaxis has not been documented in the literature.
Source: Annals of Allergy, Asthma and Immunology - March 1, 2016 Category: Allergy & Immunology Authors: John A. Johnson, John A. Frith, Jason Casselman, Ali Saad, Haig Tcheurekdjian, Robert Hostoffer Tags: Letter Source Type: research