Anaphylaxis and Hypersensitivity Reactions

Anaphylaxis and HypersensitivityReactions

Preface

Foreword

Contents

Contributors

Chapter 1: Definition and Criteria for the Diagnoses of Anaphylaxis

1.1 Introduction

1.2 History

1.3 Issues Surrounding the Definition Today

1.4 The Basis for the Definition of and Criteria for the Diagnosis of Anaphylaxis

1.5 Less Common Presentations of Anaphylaxis

1.6 Conditions with Similar Manifestations: The Differential Diagnosis of Anaphylaxis

1.7 The Need for a Biomarker

1.7.1 Tryptase

1.7.2 Plasma Histamine and Urinary Histamine

1.7.3 Carboxypeptidase A

1.7.4 Platelet-Activating Factor

1.8 Conclusions

References

Chapter 2: An Epidemiological Approach to Reducing the Risk of Fatal Anaphylaxis

2.1 Introduction

2.2 Prevalence and Incidence of Anaphylaxis

2.3 Epidemiological Studies of Nonfatal Anaphylaxis

2.4 Factors Determining the Severity of Acute Allergic Reactions

2.5 Epidemiology of Fatal Anaphylaxis

2.6 Fatal Anaphylaxis Around the World

2.7 The UK Fatal Anaphylaxis Register

2.7.1 What Has Triggered Fatal Reactions?

2.7.2 Who Died from Anaphylaxis?

2.7.3 When Did They Die?

2.7.4 How Did They Die?

2.8 Fatal First Reactions: Why Was Rescue Treatment Unsuccessful?

2.9 Fatal Recurrent Reactions

2.9.1 Reducing the Likelihood of a Severe Recurrence

2.9.2 Why Did Avoidance Fail?

2.10 Self-injectible Epinephrine

2.11 Conclusion

References

Chapter 3: Pathophysiology and Organ Damage in Anaphylaxis

3.1 Background

3.2 Proposed Immunopathologic Mechanisms

3.3 Non-immunologic Anaphylaxis

3.4 Chemical Mediators of Anaphylaxis

3.4.1 Histamine and Tryptase

3.4.2 Arachidonic Acid Metabolites

3.4.3 Nitric Oxide in Anaphylaxis

3.4.4 Other Inflammatory Pathways Are Probably Important

3.5 Shock Organs in Anaphylaxis

3.6 The Heart as Shock Organ in Anaphylaxis

3.6.1 Non-pharmacologic Myocardial Ischemia in Anaphylaxis

3.6.2 Bradycardia During Anaphylaxis

3.7 Respiratory Effects of Anaphylaxis

3.8 Autopsy Findings in Fatal Anaphylaxis

3.9 Anaerobic Metabolism Complicates Anaphylaxis

3.10 Conclusion

References

Chapter 4: Mast Cells: Effector Cells of Anaphylaxis

4.1 Introduction

4.2 The Basic Biology of Mast Cells

4.3 Approaches to Assess Mast-Cell Functions

4.4 Mouse Models of Anaphylaxis

4.5 IgE-Dependent Passive Systemic Anaphylaxis

4.6 IgE- or IgG1-Dependent Passive Local Anaphylaxis

4.7 Active Systemic or Local Anaphylaxis

4.8 Mast Cells in Peanut Allergy

4.9 Mast Cells in Intestinal Anaphylaxis

4.10 Roles of Mast Cells in Other Immune or Nonimmune Mechanisms of Anaphylaxis

4.11 Manipulation of Mast-Cell Effector Function

4.12 Conclusions

References

Chapter 5: Basophils in Anaphylaxis

5.1 Introduction

5.2 Review of Basophil Biology

5.2.1 Ontogeny

5.2.2 Morphology and Biochemistry

5.2.3 Life Span

5.2.4 Extravasation

5.2.5 Activation

5.2.6 Signal Transduction: Fce(epsilon)RI-Mediated Signal Transduction in Human Basophils

5.2.6.1 Lyn Kinase and Syk Kinase

5.2.6.2 Fyn Kinase

5.2.6.3 Phosphatidyl Inositol 3¢ Kinase (PI3K)

5.2.6.4 SH-2-Containing 5¢ Inositol Phosphatase-1 (SHIP-1)

5.2.6.5 MAP Kinase Pathway

5.2.6.6 Dynamics and Variability of Syk Expression

5.2.6.7 Regulation of Syk Expression

5.2.6.8 Variability of SHIP-1 Expression

5.2.6.9 Nuclear Factor of Activated T Cells (NFAT)

5.2.7 Effects of IL-3

5.2.7.1 Effects on Basophil Mediator Secretion

5.2.7.2 Effects on Basophil Survival

5.3 Evidence of Basophil Involvement in Anaphylaxis

5.3.1 Basophil Mediators

5.3.1.1 Histamine

5.3.1.2 Leukotriene C4

5.3.1.3 Platelet-Activating Factor

5.3.1.4 IL-4

5.3.2 Basophil Receptors

5.3.3 Location of Basophils

5.3.3.1 Circulation in Peripheral Blood

5.3.3.2 Migration into Tissues Involved in Allergic Reactions

5.4 Evidence for Basophil Activity in Human Anaphylaxis

5.5 Evidence for Basophil Activity in Murine Models of Anaphylaxis

5.6 Conclusion

References

Chapter 6: Protease Mediators of Anaphylaxis

6.1 Introduction

6.2 Chymase-like Peptidases

6.2.1 General Considerations

6.2.2 Rat Chymases

6.2.3 Mouse Chymases as Biomarkers

6.2.4 Human Chymase as a Biomarker

6.2.5 Chymases in Basophils

6.2.6 Cathepsin G

6.3 Tryptase-like Peptidases

6.3.1 Mast Cell Tryptases in Rats and Mice

6.3.2 Mast Cell Tryptases in Humans: Roles in Anaphylaxis

6.3.3 Human Mast Cell Tryptases: Variation of Form and Function

6.3.4 Human Soluble Tryptases: Significance of Genetic Variation and Disequilibrium

6.3.5 Tryptase Expression in Human Basophils

6.4 Carboxypeptidase A3

6.5 Dipeptidylpeptidase I (DPPI)/Cathepsin C

References

Chapter 7: Aspirin and NSAID Reactions: Diagnosis, Pathophysiology, and Management

7.1 Introduction

7.2 Aspirin-Exacerbated Respiratory Disease

7.3 Characteristics of AERD

7.3.1 Acetaminophen and AERD

7.3.2 COX-2 and AERD

7.4 AERD: An Aggressive Airway Disease

7.5 AERD in Children

7.6 Mediators Involved in AERD

7.7 AERD and Diagnostics

7.8 Routes of Challenge: Inhaled, Intranasal, and Intravenous

7.9 AERD and Desensitization

7.10 Side Effects

7.11 ASA Desensitization Specifics

7.12 Leukotriene-Modifying Drugs (LTMDs) in AERD and During Desensitization

7.13 Local Nasal Desensitization

7.14 Desensitization Events

7.15 Cutaneous Reactions

7.16 Desensitization

7.17 Isolated NSAID Reactions

7.18 Desensitization

7.19 COX-2 Isolated Reactions

References

Chapter 8: IgE-Dependent and Independent Effector Mechanisms in Human and Murine Anaphylaxis

8.1 Introduction

8.2 Definition of Anaphylaxis

8.3 Murine Models of Anaphylaxis

8.3.1 Advantages and Disadvantages

8.3.2 Murine IgE-Mediated Anaphylaxis

8.3.3 Murine IgG-Mediated Anaphylaxis

8.3.4 The Multiple Roles of Basophils in Anaphylaxis

8.3.5 Complement-Dependent Anaphylaxis

8.3.6 IgE–IgG Interactions in Murine Anaphylaxis

8.3.7 Fcg(gamma)RIIb-Dependent Inhibition of IgE-MediatedAnaphylaxis by IgG

8.3.8 Controversial and Confusing Issues in Murine Anaphylaxis

8.4 Human Anaphylaxis

8.4.1 Human IgE-Mediated Anaphylaxis

8.4.2 IgE-Independent Human Anaphylaxis

8.4.3 IgG-Dependent Human Anaphylaxis

8.4.4 Complement-Dependent Human Anaphylaxis

8.4.5 Other Mechanisms of Human Anaphylaxis

8.5 Conclusions and Clinical Implications

References

Chapter 9: Food-Induced Anaphylaxis

9.1 Introduction

9.2 Epidemiology

9.3 Food Allergens and Route of Exposure

9.4 Pathophysiology of Food-Induced Anaphylaxis

9.4.1 Murine Models

9.4.2 Intestinal Antigen Uptake

9.4.3 Allergenicity of Food Antigens

9.5 Clinical Presentation

9.5.1 Onset of Symptoms

9.5.2 Patterns of Anaphylaxis

9.5.3 Differential Diagnosis

9.6 Risk Factors for Food-Induced Anaphylaxis

9.7 Pediatric Considerations

9.7.1 Clinical Presentation

9.7.2 Risk Factors

9.7.3 Anaphylaxis in Infants

9.8 Biphasic Reactions

9.9 Fatal Food-Induced Anaphylaxis

9.10 Treatment of a Food-Induced Anaphylactic Reaction

9.11 Diagnosis of Food-Induced Anaphylaxis

9.12 Prevention, Education and Emergency Treatment Plan

9.13 Natural History

9.14 Future Therapies

9.14.1 Non-Allergen-Specific Therapy

9.14.1.1 Humanized Monoclonal Anti-IgE

9.14.1.2 Traditional Chinese Medicine (TCM)

9.14.2 Allergen-Specific Immunotherapy

9.14.2.1 Subcutaneous Peanut Immunotherapy

9.14.2.2 Oral Immunotherapy

Mechanism of OIT

Safety of OIT Home Dosing

9.14.2.3 Sublingual Immunotherapy

9.14.2.4 Immunotherapy with Recombinant Engineered Food Proteins

9.14.2.5 Other Approaches

9.15 Conclusion

References

Chapter 10: Antibiotic-Induced Anaphylaxis

10.1 Introduction

10.2 Drug Allergy Workup

10.2.1 Clinical History

10.2.2 Skin Tests

10.2.3 Provocation Tests

10.2.4 Biological Tests

10.2.5 Standard Operating Procedures and Preventive Measures

10.3 Antibiotic Anaphylaxis Diagnosis

10.3.1 ß(beta)-Lactams

10.3.2 Quinolones

10.3.3 Macrolides

10.3.4 Other Antibiotics

References

Chapter 11: Anaphylaxis During Radiological Procedures and in the Peri-operative Setting

11.1 Introduction

11.2 Definition

11.3 Epidemiology

11.3.1 Immediate Reactions Following Iodinated Contrast Agents

11.3.1.1 Hyperosmolar Ionic Iodinated Contrast Media

11.3.1.2 Comparison Between Ionic and Non-ionic Contrast Media

11.3.2 Immediate Reactions to Gadolinium-Containing Contrast Agents

11.3.3 Immediate Reactions in the Perioperative Setting

11.4 How to Diagnose Anaphylaxis

11.4.1 The Clinical History Should Always Be Known for an Appropriate Diagnosis

11.4.2 Predictive Criteria of Anaphylaxis Severity

11.4.3 Are There Any Clinical Differences Between Anaphylaxis Occurring During the Perioperative and the Radiological Setting

11.4.3.1 In the Perioperative Setting

11.4.3.2 In the Radiological Setting

11.4.4 Which Tools to Prove the Diagnosis?

11.4.4.1 Biological Assessment Is a Contributive Tool to the Appropriate Diagnosis

In vivo Biochemical Tests

In vitro Biochemical Tests

11.4.4.2 Skin Testing Is Essential to Prove the Diagnosis and Prevent Further Recurrences

General Considerations: How to Perform Skin Testing?

Skin Testing with Drugs or Agent Used During the Perioperative Setting?

Skin Testing with Contrast Agents

11.4.4.3 The Allergenic Determinant Is Not Iodine for Iodinated Contrast Agents

11.5 Management of Anaphylaxis

11.5.1 Epinephrine: When and How?

11.5.2 Fluid Therapy: When and How?

11.5.3 Bronchospasm

11.5.4 Additional Therapy

11.5.5 Anaphylaxis and Catecholamine Failure

11.6 Premedication

11.6.1 Anesthetic Drugs

11.6.2 Iodinated Contrast Agents

11.7 Conclusion

References

Chapter 12: Hymenoptera-Induced Hypersensitivity Reactions and Anaphylaxis

12.1 Introduction

12.2 Taxonomy of Hymenoptera Insects

12.3 Epidemiology of Hymenoptera Venom Allergy

12.4 Reactions to Hymenoptera Venom Stings

12.4.1 Fatalities from Anaphylaxis to Hymenoptera Stings

12.5 Diagnosis of Venom Hypersensitivity

12.5.1 Patients with Positive Allergy Tests to Both Honeybee and Wasp Venom

12.6 Anaphylaxis in Patients with Negative Allergy Tests

12.7 Treatment of Venom Hypersensitivity

12.7.1 Venom Immunotherapy

12.7.2 Selection of Patients Requiring Venom Immunotherapy

12.7.3 Contraindications for VIT

12.7.4 Selection of Venom To Be Used in Immunotherapy

12.7.5 Treatment Protocols

12.7.6 Duration of Venom Immunotherapy

12.7.7 Safety of Venom Immunotherapy

12.7.8 Efficacy of Venom Immunotherapy

12.8 Anaphylaxis After Hymenoptera Sting and Mastocytosis

References

Chapter 13: Idiopathic Anaphylaxis

13.1 Introduction

13.2 Pathogenesis

13.3 Differential Diagnosis

13.4 Classification of Idiopathic Anaphylaxis

13.5 Treatment

References

Chapter 14: Exercise-Induced Anaphylaxis and Food-Dependent Exercise-Induced Anaphylaxis

14.1 Introduction and Definition

14.2 Clinical Manifestations

14.2.1 Triggering Activities

14.2.2 Signs and Symptoms

14.2.3 Co-triggers

14.2.4 Causative Foods in FD-EIAn

14.3 Prevalence

14.4 Pathophysiology

14.5 Evaluation and Diagnosis

14.6 Differential Diagnosis

14.7 Management

14.8 Prognosis

14.9 Summary

References

Chapter 15: Mastocytosis and Mast Cell Activation Syndromes Presenting as Anaphylaxis*

15.1 Introduction

15.2 Mechanisms of Mast Cell Activation

15.3 Clinical Manifestations of Mast Cell Activation

15.3.1 Skin and Soft Tissues

15.3.2 Respiratory

15.3.3 Cardiovascular

15.3.4 Gastrointestinal

15.3.5 Musculoskeletal

15.3.6 Urinary

15.3.7 Hematopoietic and Immune Systems

15.3.8 Constitutional

15.4 Disorders of MC Activation

15.5 Systemic Mastocytosis

15.6 Monoclonal Mast Cell Activation Syndrome

15.7 Mast Cell Activation Syndrome

15.8 Diagnostic Approach to Mast Cell Activation Disorders

References

Chapter 16: Anaphylaxis in Mastocytosis*

16.1 Introduction

16.2 Mastocytosis

16.3 Allergy in Mastocytosis

16.4 Anaphylaxis in Mastocytosis

16.4.1 Idiopathic Anaphylaxis and Triggers for Anaphylaxis in Mastocytosis

16.4.2 Hymenoptera Venom Anaphylaxis in Mastocytosis

16.4.3 Anaphylaxis and Venom Immunotherapy in Mastocytosis

16.4.4 Anaphylaxis During Surgical Procedures and General Anesthesia

16.4.5 Treatment of Patients with Mastocytosis Associated to Anaphylaxis

16.4.5.1 General Considerations

16.4.5.2 Anesthesia

16.4.5.3 Systemic Therapy

16.4.6 Treatment of Refractory Cases

16.4.6.1 Interferon Alpha

16.4.6.2 Cladribine

16.4.6.3 Omalizumab

16.5 Concluding Remarks

References

Chapter 17: Flushing and Urticarial Syndromes Presenting as Anaphylaxis

17.1 Flushing and Urticaria

17.1.1 Introduction

17.1.2 Signs, Symptoms, and Pathophysiology of Flushing

17.1.3 Flushing in Anaphylaxis and Disorders with Non-IgE Anaphylaxis Features

17.1.4 Specific Flushing Syndromes with Anaphylaxis Features

17.1.4.1 Carcinoid Syndrome

17.1.4.2 Systemic Mastocytosis

17.1.4.3 Mast Cell Activation Disorder

17.1.4.4 Pheochromocytomas

17.1.4.5 Medullary Carcinoma of the Thyroid

17.1.4.6 Scombrotoxism

17.1.4.7 Medications

17.2 Urticarial Syndromes Presenting as Anaphylaxis

17.2.1 Introduction

17.2.2 Anaphylaxis Symptoms Associated with Specific Urticarial Syndromes

17.2.3 Physical Urticarias

17.2.3.1 Cholinergic Urticaria

17.2.4 Cold Urticaria Syndromes

17.2.5 Urticaria and Angioedema in Systemic Reactions to Allergens, Vaccines, and Drugs

17.2.5.1 Vespids

17.2.5.2 Vaccines

17.2.5.3 Drugs

17.3 Summary

References

Chapter 18: Pharmacologic Management of Acute Anaphylaxis

18.1 General Approach: Recognition of Anaphylaxis and Pharmacologic Management

18.2 Pharmacologic Management

18.2.1 Epinephrine

18.2.1.1 Indications and Toxicity

18.2.1.2 Route of Administration of Epinephrine

18.2.1.3 Epinephrine Dosing

18.2.2 Oxygen

18.2.3 Fluid Management

18.2.4 Antihistamines

18.2.5 Systemic Corticosteroids

18.3 Other Agents

18.3.1 Inhaled Albuterol

18.3.2 Glucagon

18.3.3 Other Vasopressors

18.4 Persistent Anaphylaxis Unresponsive to Epinephrine

18.5 Cardiac Arrest

18.6 Prevention of Anaphylaxis

References

Chapter 19: Drug Desensitizations in the Management of Allergy and Anaphylaxis to Chemotherapeutic Agents and Monoclonal Antibodies

19.1 Introduction

19.2 Mechanism of Drug Desensitization

19.3 Skin Testing for Drug Hypersensitivity

19.4 Drug Desensitization Procedures

19.5 Hypersensitivity and Drug Desensitization to Carboplatin and Cisplatin

19.6 Hypersensitivity and Drug Desensitization to Oxaliplatin

19.7 Hypersensitivity and Drug Desensitization to Taxanes

19.8 Hypersensitivity to Monoclonal Antibodies – General Considerations

19.9 Hypersensitivity to Monoclonal Antibodies – Clinical Observations

19.10 Desensitization to Monoclonal Antibodies

19.10.1 Cetuximab – An Unexpected Mechanism for Hypersensitivity

19.11 Summary

References

Chapter 20: Rapid Desensitizations for Antibiotic-Induced Hypersensitivity Reactions and Anaphylaxis

20.1 Introduction

20.2 Definition of Rapid Intravenous Desensitization

20.3 Indications for Desensitization

20.3.1 Inclusion Criteria for Desensitization

20.3.2 Type I HSRs (IgE-Mediated)

20.3.3 HSRs – Non-IgE-Mediated

20.3.4 Adverse Reactions Not Amenable to Desensitization

20.3.4.1 Cellular and Molecular Targets

20.3.4.2 Principles and Protocols of Rapid Desensitization

20.3.4.3 Symptoms During the Desensitization and Their Management

20.3.4.4 Safety Measures

20.3.4.5 Beta-Lactams

20.3.4.6 Glycopeptides

20.3.4.7 Quinolones

20.3.4.8 Aminoglycosides

20.3.4.9 Macrolides

20.3.4.10 Linezolid

20.3.4.11 Antivirals (Including Antiretroviral Agents)

20.3.4.12 Antitubercular Drugs

20.3.4.13 Sulfonamides

20.3.4.14 Antifungals

20.4 Conclusions

References

Chapter 21: Induction of Tolerance for Food-Induced Anaphylaxis

21.1 Introduction

21.2 Immunology and Oral Tolerance

21.3 Antigen Processing in the Gastrointestinal Tract

21.4 Mechanisms of Oral Tolerance

21.5 Factors Influencing Development of Tolerance

21.6 Potential Therapeutic Strategies

21.7 Conclusions

References

Chapter 22: Management of Anaphylaxis: Relevance of Causes and Future Trends in Treatment

22.1 Introduction

22.2 Relevance of Causes

22.2.1 Established Causes and Their Treatment

22.2.2 Novel Causes of Anaphylaxis

22.2.2.1 Overview of Cross Reactive Carbohydrate Determinants

22.2.2.2 Implications for Recombinant Therapeutics

22.3 Future Trends in Treatment: Anti-IgE

22.3.1 Mechanism of Action

22.3.2 Evidence for a (Broader) Role in Allergic Diseases

22.3.3 Safety and Efficacy

22.4 Conclusion

References

Index