Sample records for anaphylaxis ige-binding components

  1. Anaphylaxis (United States)

    ... to any allergen. Common causes include: Drug allergies Food allergies Insect bites/stings Pollen and other inhaled allergens ... reaction - anaphylaxis Images Shock Allergic reactions Anaphylaxis Hives Food allergies Insect stings and allergy Allergic reactions to medication ...

  2. Component Resolved Diagnosis in Hymenoptera Anaphylaxis. (United States)

    Tomsitz, D; Brockow, K


    Hymenoptera anaphylaxis is one of the leading causes of severe allergic reactions and can be fatal. Venom-specific immunotherapy (VIT) can prevent a life-threatening reaction; however, confirmation of an allergy to a Hymenoptera venom is a prerequisite before starting such a treatment. Component resolved diagnostics (CRD) have helped to better identify the responsible allergen. Many new insect venom allergens have been identified within the last few years. Commercially available recombinant allergens offer new diagnostic tools for detecting sensitivity to insect venoms. Additional added sensitivity to nearly 95% was introduced by spiking yellow jacket venom (YJV) extract with Ves v 5. The further value of CRD for sensitivity in YJV and honey bee venom (HBV) allergy is more controversially discussed. Recombinant allergens devoid of cross-reactive carbohydrate determinants often help to identify the culprit venom in patients with double sensitivity to YJV and HBV. CRD identified a group of patients with predominant Api m 10 sensitization, which may be less well protected by VIT, as some treatment extracts are lacking this allergen. The diagnostic gap of previously undetected Hymenoptera allergy has been decreased via production of recombinant allergens. Knowledge of analogies in interspecies proteins and cross-reactive carbohydrate determinants is necessary to distinguish relevant from irrelevant sensitizations.

  3. Anaphylaxis (United States)

    ... Find a Pediatrician Health Issues Conditions Injuries & Emergencies Sports Injuries Vaccine Preventable Diseases Healthy Children > Health Issues > Injuries & Emergencies > Anaphylaxis Health Issues Listen ...

  4. Anaphylaxis

    DEFF Research Database (Denmark)

    Muraro, A; Roberts, G; Worm, M


    features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized...... adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use...

  5. Purification of Recombinant Peanut Allergen Ara h 1 and Comparison of IgE Binding to the Natural Protein

    Directory of Open Access Journals (Sweden)

    Barry K. Hurlburt


    Full Text Available Allergic reactions to food are on the rise worldwide and there is a corresponding increase in interest to understand the molecular mechanisms responsible. Peanut allergies are the most problematic because the reaction often persists into adulthood and can be as severe as anaphylaxis and death. The purpose of the work presented here was to develop a reproducible method to produce large quantities of pure recombinant Ara h 1(rAra h 1 that will enable standardization of immunological tests for patients and allow structural and immunological studies on the wild type and mutagenized forms of the protein. Ara h 1 is initially a pre-pro-protein which, following two endoproteolytic cleavages, becomes the mature form found in peanut. The mature form however has flexible regions that make it refractory to some structural studies including crystallography. Therefore, independent purification of the mature and core regions was desirable. Expression constructs were synthesized cDNA clones for each in a pET plasmid vector without tags. Codons were optimized for expression in E. coli. High-level expression was achieved in BL21 strains. Purification to near homogeneity was achieved by a combination of ammonium sulfate precipitation and ion exchange chromatography. The purified rAra h 1 was then compared with natural Ara h 1 for IgE binding. All patients recognized both the folded natural and rAra h 1, but the IgE binding to the rArah1 was significantly reduced in comparison to the natural allergen, which could potentially make it useful for immunotherapeutic purposes.

  6. Polyphenol-Rich Pomegranate Juice Reduces IgE Binding to Cashew Nut Allergens (United States)

    Cashew nut allergy is mediated by IgE binding to seed-storage proteins including Ana o 1, 2, and 3. Cashew nuts commonly cause severe reactions and only small amounts are needed. Polyphenol rich juices and polyphenol compounds have been demonstrated to complex with peanut allergens. The interacti...

  7. In vitro assessment of allergenicity features and localization of probable IgE binding regions. (United States)

    Mishra, Ankita; Gaur, S N; Lavasa, Shakuntala; Arora, Naveen


    Rice is cultivated as a staple grain crop in many countries, especially in Asia. In the present study, recombinant rice chitinase was expressed, purified and characterized by in silico and immunobiochemical methods. Rice chitinase was affinity purified and it resolved at 24 kDa on SDS-PAGE. Purified protein was analyzed for pepsin resistance, heat stability, and IgE binding using atopic patients' sera. Chitinase was resistant to pepsin digestion and heat treatment at 90 °C for 1 h. It showed significant IgE binding with 7 of 110 patients' sera positive to different food allergens. Homology modeled 3D structure of rice chitinase was used for B cell epitope prediction. In silico predicted B cell peptides were assessed for IgE binding by ELISA using food allergic patients' sera, epitope RC2 showed IgE binding comparable to chitinase. In conclusion, chitinase was identified as a potential allergen and may share cross reactive epitopes with food allergens. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Heat-induced alterations in cashew allergen solubility and IgE binding (United States)

    Cashew nuts are included in a group of 8 foods that commonly cause food allergies. IgE binding to allergens within the nuts can cause allergic reactions that can be severe. Foods containing cashew nuts must be labeled to prevent accidental exposure to people who suffer from allergy to cashew nuts....

  9. Differential IgE binding to isoallergens from Asian seabass (Lates calcarifer) in children and adults. (United States)

    Sharp, Michael F; Kamath, Sandip D; Koeberl, Martina; Jerry, Dean R; O'Hehir, Robyn E; Campbell, Dianne E; Lopata, Andreas L


    Fish allergy is a common food allergy, with prevalence rates in the general population ranging between 0.2% and 2.3%. In both adults and children fish ranks in the top eight foods known to cause IgE mediated food allergy. Fish allergy is rarely outgrown and individuals with fish allergy may be allergic to some but not all species of fish. Whilst fish allergy occurs around the world, the characterization of allergenic components of individual species of fish has been largely confined to Northern hemisphere and European fish species. To date allergy to commonly consumed fish in the Asian-Pacific region including barramundi (Asian seabass; Lates calcarifer) have been less well investigated. The aim of this study was to identify and characterize allergenic proteins from barramundi in both fish allergic adult and pediatric patients. Serum from 17 fish allergic adults and children from Australia were characterized by immunoblotting and enzyme linked immunosorbent assays (ELISA) against raw and heated barramundi. Molecular analysis of identified allergens included genetic sequencing and generation of recombinant isoallergens. Two novel parvalbumin isoforms of the β-type were identified as the only allergens in barramundi and subsequently designated as Lat c 1.0101 and Lat c 1.0201 by the International Union of Immunological Societies. These two isoallergens do not differ in their ability to bind IgE antibodies, but are differentially expressed in barramundi tissue. This study characterized two novel heat stable parvalbumin allergens from barramundi, with differential IgE binding capacity between adults and pediatric patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Critical and direct involvement of the CD23 stalk region in IgE binding. (United States)

    Selb, Regina; Eckl-Dorna, Julia; Twaroch, Teresa E; Lupinek, Christian; Teufelberger, Andrea; Hofer, Gerhard; Focke-Tejkl, Margarete; Gepp, Barbara; Linhart, Birgit; Breiteneder, Heimo; Ellinger, Adolf; Keller, Walter; Roux, Kenneth H; Valenta, Rudolf; Niederberger, Verena


    The low-affinity receptor for IgE, FcεRII (CD23), contributes to allergic inflammation through allergen presentation to T cells, regulation of IgE responses, and enhancement of transepithelial allergen migration. We sought to investigate the interaction between CD23, chimeric monoclonal human IgE, and the corresponding birch pollen allergen Bet v 1 at a molecular level. We expressed 4 CD23 variants. One variant comprised the full extracellular portion of CD23, including the stalk and head domain; 1 variant was identical with the first, except for an amino acid exchange in the stalk region abolishing the N-linked glycosylation site; and 2 variants represented the head domain, 1 complete and 1 truncated. The 4 CD23 variants were purified as monomeric and structurally folded proteins, as demonstrated by gel filtration and circular dichroism. By using a human IgE mAb, the corresponding allergen Bet v 1, and a panel of antibodies specific for peptides spanning the CD23 surface, both binding and inhibition assays and negative stain electron microscopy were performed. A hitherto unknown IgE-binding site was mapped on the stalk region of CD23, and the non-N-glycosylated monomeric version of CD23 was superior in IgE binding compared with glycosylated CD23. Furthermore, we demonstrated that a therapeutic anti-IgE antibody, omalizumab, which inhibits IgE binding to FcεRI, also inhibited IgE binding to CD23. Our results provide a new model for the CD23-IgE interaction. We show that the stalk region of CD23 is crucially involved in IgE binding and that the interaction can be blocked by the therapeutic anti-IgE antibody omalizumab. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Identification of IgE binding to Api g 1-derived peptides. (United States)

    Ruppel, Elvira; Aÿ, Bernhard; Boisguerin, Prisca; Dölle, Sabine; Worm, Margitta; Volkmer, Rudolf


    Celery is a frequent cause of food allergy in pollen-sensitized patients and can induce severe allergic reactions. Clinical symptoms cannot be predicted by skin prick tests (SPTs) or by determining allergen-specific immunoglobulin E (IgE). Our aim was to identify specific IgE binding peptides by using an array technique. For our study, the sera of 21 patients with positive double-blind, placebo-controlled food challenge (DBPCFC) to celery, as well as the sera of 17 healthy patients were used. Additionally, all patients underwent skin tests along with determinations of specific IgE binding. The major allergen of celery Api g 1.0101 (Apium graveolens) was synthesized as an array of overlapping peptides and probed with the patients' sera. We developed an improved immunoassay protocol by investigating peptide lengths, peptide densities, incubation parameters, and readout systems, which could influence IgE binding. Sera of celery-allergic patients showed binding to three distinct regions of Api g 1.0101. The region including amino acids 100 to 126 of Api g 1.0101 is the most important region for IgE binding. This region caused a fivefold higher binding of IgE from the sera of celery-allergic patients compared to those of healthy individuals. In particular, one peptide (VLVPTADGGSIC) was recognized by all sera of celery-allergic patients. In contrast, no binding to this peptide was detected in sera of the healthy controls. Our improved assay strategy allows us to distinguish between celery-allergic and healthy individuals, but needs to be explored in a larger cohort of well-defined patients.

  12. Idiopathic anaphylaxis. (United States)

    Fenny, Nana; Grammer, Leslie C


    Idiopathic anaphylaxis is a diagnosis of exclusion after other causes have been thoroughly evaluated and excluded. The pathogenesis of idiopathic anaphylaxis remains uncertain, although increased numbers of activated lymphocytes and circulating histamine-releasing factors have been implicated. Signs and symptoms of patients diagnosed with idiopathic anaphylaxis are indistinguishable from the manifestations of other forms of anaphylaxis. Treatment regimens are implemented based on the frequency and severity of patient symptoms and generally include the use of epinephrine autoinjectors, antihistamines, and steroids. The prognosis of idiopathic anaphylaxis is generally favorable with well-established treatment regimens and effective patient education. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Perioperative anaphylaxis

    Directory of Open Access Journals (Sweden)

    Marta Inés Berrío Valencia


    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  14. Heat-induced alterations in cashew allergen solubility and IgE binding

    Directory of Open Access Journals (Sweden)

    Christopher P. Mattison

    Full Text Available Cashew nuts are an increasingly common cause of food allergy. We compare the soluble protein profile of cashew nuts following heating. SDS-PAGE indicate that heating can alter the solubility of cashew nut proteins. The 11S legumin, Ana o 2, dominates the soluble protein content in ready to eat and mildly heated cashew nuts. However, we found that in dark-roasted cashew nuts, the soluble protein profile shifts and the 2S albumin Ana o 3 composes up to 40% of the soluble protein. Analysis of trypsin-treated extracts by LC/MS/MS indicate changes in the relative number and intensity of peptides. The relative cumulative intensity of the 5 most commonly observed Ana o 1 and 2 peptides are altered by heating, while those of the 5 most commonly observed Ana o 3 peptides remaine relatively constant. ELISA experiments indicate that there is a decrease in rabbit IgG and human serum IgE binding to soluble cashew proteins following heating. Our findings indicate that heating can alter the solubility of cashew allergens, resulting in altered IgE binding. Our results support the use of both Ana o 2 and Ana o 3 as potential cashew allergen diagnostic targets. Keywords: Cashew nut, Food allergy, Immunoglobulin E, Mass-spectrometry, Peptide, Solubility

  15. Anaphylaxis Simulation

    Directory of Open Access Journals (Sweden)

    Christopher Eric McCoy


    Full Text Available Audience: This simulation-based scenario is appropriate for medical students and emergency medicine residents at any level of training. Introduction: Anaphylaxis is an acute, severe, systemic allergic reaction that is potentially life threatening. The epidemiological characteristics of anaphylaxis are not entirely accurate secondary to underreporting and misdiagnosis. Estimates of lifetime prevalence range from 0.05% to 2%, with rates up to 15% described in the literature, 2% of which have fatal episodes. The incidence is estimated at 0.03% to 0.95%, with 0.002% fatal episodes annually (~1500 annual deaths in the United States. Although described more than 100 years ago, only recently has a definition been described that provides the clinician with specific criteria for diagnosis in the clinical setting. The National Institute of Allergy and Infectious Disease (NIAID and Food Allergy and Anaphylaxis Network (FAAN convened a symposium that included representatives from 16 different organizations (including emergency medicine to establish clinical criteria that would accurately identify cases of anaphylaxis. Anaphylaxis is a true medical emergency. Rapid identification and management of this condition plays a major role in patient prognosis. Objectives: By the end of this simulation-based session, the learner will be able to: 1 Recognize and diagnose anaphylaxis according to the criteria set forth by the NIAID and FAAN symposium 2 discuss the appropriate dose, concentration, and delivery route of epinephrine for anaphylaxis 3 list and discuss the rationale for the second-line therapeutic options used to treat anaphylaxis, and 4 develop an appropriate disposition algorithm to be used when managing anaphylaxis in the clinical setting. Method: This educational session is a high-fidelity simulation.

  16. IgE binding to peanut allergens is inhibited by combined D-aspartic and D-glutamic acids. (United States)

    Chung, Si-Yin; Reed, Shawndrika


    The objective of this study was to determine if D-amino acids (D-aas) bind and inhibit immunoglobulin E (IgE) binding to peanut allergens. D-aas such as D-Asp (aspartic acid), D-Glu (glutamic acid), combined D-[Asp/Glu] and others were each prepared in a cocktail of 9 other D-aas, along with L-amino acids (L-aas) and controls. Each sample was mixed with a pooled plasma from peanut-allergic donors, and tested by ELISA (enzyme-linked immunosorbent assay) and Western blots for IgE binding to peanut allergens. Results showed that D-[Asp/Glu] (4 mg/ml) inhibited IgE binding (75%) while D-Glu, D-Asp and other D-aas had no inhibitory effect. A higher inhibition was seen with D-[Asp/Glu] than with L-[Asp/Glu]. We concluded that IgE was specific for D-[Asp/Glu], not D-Asp or D-Glu, and that D-[Asp/Glu] was more reactive than was L-[Asp/Glu] in IgE inhibition. The finding indicates that D-[Asp/Glu] may have the potential for removing IgE or reducing IgE binding to peanut allergens in vitro. Published by Elsevier Ltd.

  17. Perioperative anaphylaxis.

    LENUS (Irish Health Repository)

    Mertes, P M


    The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents are most frequently incriminated, followed by latex and antibiotics, although any drug or substance used may be a culprit. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests, specific immunoglobulin E, or basophil activation assays. Treatment consists of rapid volume expansion and epinephrine administration titrated to symptom severity.

  18. Polyphenol-rich pomegranate juice reduces IgE binding to cashew nut allergens. (United States)

    Li, Yichen; Mattison, Christopher P


    Food allergy negatively impacts quality of life and can be life-threatening. Cashew nuts can cause severe reactions in very small amounts, and they are included in a group of foods most commonly responsible for causing food allergy. Polyphenols and polyphenol-rich juices have been demonstrated to complex with peanut allergens. Here, the interaction between cashew nut allergens and polyphenol-rich juices is evaluated biochemically and immunologically. Various juices, including pomegranate (POM), blueberry (BB), and concord grape (CG) juices, were evaluated for polyphenol content and formation of polyphenol-cashew allergen complexes. Among the various juices studied, POM juice showed a greater capacity to form complexes with cashew proteins. Dynamic light scattering (DLS) demonstrated a sharp increase in cashew protein extract particle size to around 3580 nm, and fewer cashew proteins were resolved by electrophoresis after treatment with POM juice. Immunoassays demonstrated reduced IgG and IgE binding to cashew allergens due to allergen precipitation by POM juice. These observations support the formation of complexes between polyphenol and cashew proteins that can prevent antibody recognition of cashew allergens through allergen precipitation. POM juice treatment of cashew extract effectively reduces antibody binding through allergen precipitation, and these findings could be applied to the development of less allergenic cashew nut products and oral immunotherapy. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.


    Directory of Open Access Journals (Sweden)

    Zh. M. Zlobina


    Full Text Available Anaphylaxis is an acute potentially life-threatening syndrome; in children, it is usually triggered by food allergy. Virtually any food may serve as a provocative factor for an anaphylactic reaction, which is why timely detection of clinically significant allergens is important for prognosis and prevention of allergies. The article presents case record of a 4-years-old patient with polyvalent sensitization and predisposition to anaphylaxis. Demonstration of this case is aimed at justifying use of molecular allergological diagnostic methods for prognosis and selection of therapeutic tactics. Determination of sensitization profile helps to elaborate the optimal tactics of managing patients with severe allergic reactions. Use of biochips to determine the level of IgE-antibodies to various allergenic molecules helps to recognize and determine the true IgE-mediated sensitization and cross-reactivity in patients with polyvalent allergies, to assess the risk of systemic reactions in the event of a food allergy. 

  20. Prick by Prick Induced Anaphylaxis in a Patient with Peanuts and Lupine Allergy: Awareness of Risks and Role of Component Resolved Diagnosis

    Directory of Open Access Journals (Sweden)

    Anna Ciccarelli


    Full Text Available A case of anaphylaxis is reported in the course of a prick by prick with Lupinus albus and roasted peanut in a 20-year-old woman. We focused on some main topics. First of all it seems important to underscore the potential risks connected to the practice of the prick-by-prick with fresh foods in allergic patients, especially when testing cross-reactive substances, such as White Lupine, peanuts, or soy. It is important that clinicians who perform prick tests be aware of the risk related with in vivo tests in allergic patients. Second, we discuss the problem of the hidden allergens, such as White Lupine flour, or soy flour which are utilized to improve wheat flour because of their lower cost. Patients with a demonstrated allergy to peanuts should be assessed for lupine allergy and informed about the “hidden allergens” issue. Finally, we believe that component resolved diagnosis, the serum specific IgE against molecular components, that is normally considered a second-level diagnostic step has an important role even as a first line approach at least in some selected cases.

  1. Confirmation of a predicted lack of IgE binding to Cry3Bb1 from genetically modified (GM) crops. (United States)

    Nakajima, Osamu; Koyano, Satoru; Akiyama, Hiroshi; Sawada, Jun-Ichi; Teshima, Reiko


    Some GM crops including MON863 corn and stack varieties contain Cry3Bb1 protein. Cry3Bb1 is very important from the standpoint of assessing the safety of GM crops. In this study Cry3Bb1 was assessed from the standpoint of possible binding to IgE from allergy patients. First, an ELISA that was improved in our laboratory was used to test serum samples from 13 corn allergy patients in the United States with recombinant Cry3Bb1 expressed in Escherichia coli, and serum samples from 55 patients in Japan with various food allergies were also assayed. Two samples from the Japanese allergy patients were suspected of being positive, but Western blotting analysis with purified Cry3Bb1 indicated that the binding between IgE and Cry3Bb1 was nonspecific. Ultimately, no specific binding between IgE and recombinant Cry3Bb1 was detected. Next, all proteins extracted from MON863 corn and non-GM corn were probed with IgE antibodies in serum samples from the corn allergy patients by Western blotting, but the staining patterns of MON863 and non-GM corn were similar, meaning that unintended allergic reactions to MON863 are unlikely to occur. Our study provides additional information that confirms the predicted lack of IgE binding to Cry3Bb1 in people with existing food allergies. Copyright 2009 Elsevier Inc. All rights reserved.

  2. A comparative study of human IgE binding to proteins of a genetically modified (GM) soybean and six non-GM soybeans grown in multiple locations. (United States)

    Lu, Mei; Jin, Yuan; Ballmer-Weber, Barbara; Goodman, Richard E


    Prior to commercialization, genetically modified (GM) crops are evaluated to determine the allergenicity of the newly expressed protein. Some regulators require an evaluation of endogenous allergens in commonly allergenic crops including soybean to determine if genetic transformation increased endogenous allergen concentrations, even asking for IgE testing using sera from individual sensitized subjects. Little is known about the variability of the expression of endogenous allergens among non-GM varieties or under different environmental conditions. We tested IgE binding to endogenous allergenic proteins in an experimental non-commercial GM line, a non-GM near-isoline control, and five non-GM commercial soybean lines replicated at three geographically separated locations. One-dimensional (1D) and two-dimensional (2D) immunoblotting and ELISA were performed using serum or plasma from eleven soybean allergic patients. The results of immunoblots and ELISA showed no significant differences in IgE binding between the GM line and its non-GM near-isoline control. However, some distinct differences in IgE binding patterns were observed among the non-GM commercial soybean lines and between different locations, highlighting the inherent variability in endogenous allergenic proteins. Understanding the potential variability in the levels of endogenous allergens is necessary to establish a standard of acceptance for GM soybeans compared to non-GM soybean events and lines. Copyright © 2018. Published by Elsevier Ltd.

  3. Management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, S; Panesar, S S; Roberts, G


    , systemic glucocorticosteroids or methylxanthines to manage anaphylaxis. There was evidence regarding the optimum route, site and dose of administration of adrenaline from trials studying people with a history of anaphylaxis. This suggested that administration of intramuscular adrenaline into the middle...... of vastus lateralis muscle is the optimum treatment. Furthermore, fatality register studies have suggested that a failure or delay in administration of adrenaline may increase the risk of death. The main long-term management interventions studied were anaphylaxis management plans and allergen......To establish the effectiveness of interventions for the acute and long-term management of anaphylaxis, seven databases were searched for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted...

  4. Anesthetic-induced anaphylaxis. (United States)

    Norred, Carol L


    The purpose of this course is to update nurse anesthetists about anesthetic-induced anaphylaxis. This course discusses the pathophysiologic process of anaphylaxis with descriptions of the allergic immune response and the mediators and mechanisms of mast cell activation. The preoperative identification of patients at high risk and the assessment of potential anesthetic triggers of a hypersensitivity and/or allergic reaction are prudent strategies to minimize the risk of anaphylaxis. Other practices recommended for clinicians include suggestions for anesthetic management to decrease threat of an allergic response in high-risk patients. Furthermore, the identification of the severity grade of hypersensitivity reactions and the appropriate treatment of perioperative anaphylaxis is discussed. In addition, postoperative and follow-up interventions, including testing for patients who have had an anesthetic-induced hypersensitivity reaction, are considered.

  5. Epinephrine (adrenaline) in anaphylaxis. (United States)

    Simons, F Estelle R; Simons, Keith J


    Epinephrine (adrenaline) is universally recommended as the initial drug of choice for the treatment of anaphylaxis. No other medication has similar life-saving pharmacologic effects in multiple organ systems, including prevention and relief of both upper and lower airway obstruction, and of shock. Failure to inject epinephrine promptly contributes to anaphylaxis fatalities. It is most effective when given immediately after the onset of anaphylaxis symptoms. The initial recommended adult dose is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh. Injected by other routes, epinephrine appears to have a less satisfactory therapeutic window; for example, onset of action is potentially delayed when it is injected subcutaneously, and risk of adverse effects potentially increases when it is injected intravenously. The possibility of randomized, controlled trials of epinephrine in anaphylaxis should be considered. For ethical reasons, these trials will not be placebo-controlled. They might involve comparison of one epinephrine dose versus another, or one route of epinephrine administration versus another. For first-aid treatment of people with anaphylaxis in the community, novel epinephrine formulations are being developed. These include epinephrine autoinjectors that are safer and easier to use, and epinephrine formulations that can be administered through non-invasive routes. Copyright 2010 S. Karger AG, Basel.

  6. Protein-bound Vaccinium fruit polyphenols decrease IgE binding to peanut allergens and RBL-2H3 mast cell degranulation in vitro. (United States)

    Plundrich, Nathalie J; Bansode, Rishipal R; Foegeding, E Allen; Williams, Leonard L; Lila, Mary Ann


    Peanut allergy is a worldwide health concern. In this study, the natural binding properties of plant-derived polyphenols to proteins was leveraged to produce stable protein-polyphenol complexes comprised of peanut proteins and cranberry (Vaccinium macrocarpon Ait.) or lowbush blueberry (Vaccinium angustifolium Ait.) pomace polyphenols. Protein-bound and free polyphenols were characterized and quantified by multistep extraction of polyphenols from protein-polyphenol complexes. Immunoblotting was performed with peanut-allergic plasma to determine peanut protein-specific IgE binding to unmodified peanut protein, or to peanut protein-polyphenol complexes. In an allergen model system, RBL-2H3 mast cells were exposed to peanut protein-polyphenol complexes and evaluated for their inhibitory activity on ionomycin-induced degranulation (β-hexosaminidase and histamine). Among the evaluated polyphenolic compounds from protein-polyphenol complex eluates, quercetin, - in aglycone or glycosidic form - was the main phytochemical identified to be covalently bound to peanut proteins. Peanut protein-bound cranberry and blueberry polyphenols significantly decreased IgE binding to peanut proteins at p polyphenol complexes showed a significant (p polyphenols led to the formation of peanut protein-polyphenol complexes with significantly reduced allergenic potential. Future trials are warranted to investigate the immunomodulatory mechanisms of these protein-polyphenol complexes and the role of quercetin in their hypoallergenic potential.

  7. Structures of Two Major Allergens, Bla g 4 and Per a 4, From Cockroaches and Their IgE Binding Epitopes

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Y.; Chan, S; Ong, T; Yit, L; Tiong, Y; Chew, F; Sivaraman, J; Mok, Y


    Inhalant allergens from cockroaches are an important cause of asthma to millions of individuals worldwide. Here we report for the first time the structures of two major cockroach allergens, Bla g 4 and Per a 4, that adopt a typical lipocalin fold but with distinct structural features as compared with other known lipocalin allergens. Both Bla g 4 and Per a 4 contain two long-range disulfide bonds linking the N and C termini to a beta-barrel. The C-terminal helix of Bla g 4 is bent and greatly extended toward the N terminus. Bla g 4 is found to be a monomer, whereas Per a 4 exists as a dimer in solution with a novel dimeric interface involving residues from loops at the top and bottom of the beta-barrel. Putative ligand binding sites of both allergens are determined by docking of the juvenile hormone III inside the beta-barrel and found to interact with the ligand using non-conserved residues. Bla g 4 and Per a 4 are found to be cross-reactive in sera IgE binding, at least in the Singaporean Chinese population tested. A major IgE binding epitope unique to Per a 4 is found on the loops at the bottom of the beta-barrel that may aid the development of hypoallergens for immunotherapy.

  8. Anaphylaxis management in ER

    Directory of Open Access Journals (Sweden)

    Paolo Borrelli


    Full Text Available Anaphylaxis is a severe life threatening generalized or systemic hypersensitivity reaction that can affect all ages. The reaction originates from the discharge of chemical mediators released by either mast cells or by basophils activated after an allergic reaction or without any direct action of the immune system. Anaphylaxis usually develops gradually most often starting with skin manifestations and itching to a multiple organ reaction often dominated by severe asthma and culminating in hypotension and shock. In this work two clinical cases are presented. They are meant both to suggest the best therapy on the ground of evidence based medicine and to counsel the patient after his discharge.

  9. Anaphylaxis in children

    African Journals Online (AJOL)


    hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells. Anaphylaxis is defined by a number of signs and ..... Increased heart rate. • Abdominal cramps, nausea, vomiting, diarrhea. • Difficulty in breathing due to throat swelling, wheezing and asthma. • A sense of ...

  10. Anaphylaxis vulnerable groups

    African Journals Online (AJOL)


    Professor of Pediatric Allergy and Immunology, Ain Shams University, Cairo, Egypt. Age groups vulnerable to serious attacks of anaphylaxis include infants, teenagers, pregnant women, and the elderly. Concomitant diseases, such as severe or uncontrolled asthma, cardiovascular disease, mastocytosis or clonal mast cell ...

  11. Anaphylaxis in family practice

    African Journals Online (AJOL)

    Abstract. Manifestations of anaphylaxis may occur within seconds or minutes after exposure to a causative antigen. Almost any substance can be implicated as a potential precipitating agent. Reactions may be slow, progressive, or rapidly fatal within minutes. Any healthcare worker involved in the administration of ...

  12. Clinical observation of anaphylaxis after treated with Sweet BV

    Directory of Open Access Journals (Sweden)

    Ki Rok Kwon


    Full Text Available Objectives : Sweet bee venom(SBV is pure melittin, the main component of bee venom, made by removing another components through gel filtration chromatography and propionic acid/urea polyacrylamide gel electrophoresis. In the using SBV, 2 patients were experienced anaphylaxis by SBV. So, we reported the process of anaphylaxis and consider these situation. Methods : We observed 2 patients suffered from anaphylaxis after treated with SBV in the Korean Medical Hospital, Sangji University. Results : Though SBV was removed allergen from bee venom, it is not possible to complete prevention of anaphylactic shock in the clinics. So, Korean medical doctor using BV or SBV must be prepare the system consider a countermeasure by anaphylaxis.

  13. Anaphylaxis to gelatin-containing rectal suppositories. (United States)

    Sakaguchi, M; Inouye, S


    Some children--though the number is few-have been sensitized with gelatin. To investigate the relationship between the presence of antigelatin IgE and anaphylaxis to gelatin-containing rectal suppository, we measured antigelatin IgE in the sera of the children with anaphylaxis. Ten children showed systemic allergic reactions, including anaphylaxis, to a chloral hydrate rectal suppository containing gelatin (231 mg/dose) that had been used as a sedative. These children's clinical histories and serum samples were submitted from physicians to the National Institute of Infectious Diseases during a 2-year period from 1996 to 1997. Of the 10 children, 5 showed apparent anaphylaxis, including hypotension and/or cyanosis, along with urticaria or wheezing; 2 showed both urticaria and wheezing without hypotension or cyanosis; the other 3 showed only urticaria. All of the children had antigelatin IgE (mean value +/- SD, 7.9 +/- 8.4 Ua/mL). As a control, samples from 250 randomly selected children had no antigelatin IgE. These findings suggest that the 10 children's systemic allergic reactions to this suppository were caused by the gelatin component. Gelatin-containing suppositories must be used with the same caution as gelatin-containing vaccines and other medications.

  14. Anaphylaxis and sport. (United States)

    Bonini, Matteo; Palange, Paolo


    This article aims to review the most relevant studies on exercise-induced anaphylaxis, published in the last year, in order to provide comprehensive and updated evidence and hopefully contribute to a better definition of its pathophysiological mechanisms and treatment strategies. The search strategy was performed from 1/2/2013 to 31/1/2014 by scanning the principal electronic bibliographic database and by hand-searching the main scientific publications in Allergy and Clinical Immunology. Among the identified articles, 17 articles were selected to be part of the systematic review. Eligible studies included five experimental trials, eight case reports and four letters. The overall collected evidence was of very low quality. No randomized controlled trials were identified by the searching process. Most of the data derived from reports performed in small population samples or even in individual cases. Except for one article addressing issues related to the preventive management of exercise-induced anaphylaxis, all other articles focused on prevalence rates, causative triggers and pathogenetic mechanisms. More interesting findings were related to the influence of the IL-4-C590T polymorphism on the onset of wheat-dependent exercise-induced anaphylaxis and to the usefulness of the immuno solid-phase allergen chip technique in the allergic screening of polysensityzed athletes at risk of severe reactions.

  15. [Anaphylaxis to blue dyes]. (United States)

    Langner-Viviani, F; Chappuis, S; Bergmann, M M; Ribi, C


    In medicine, vital blue dyes are mainly used for the evaluation of sentinel lymph nodes in oncologic surgery. Perioperative anaphylaxis to blue dyes is a rare but significant complication. Allergic reactions to blue dyes are supposedly IgE-mediated and mainly caused by triarylmethanes (patent blue and isosulfane blue) and less frequently by methylene blue. These substances usually do not feature on the anesthesia record and should not be omitted from the list of suspects having caused the perioperative reaction, in the same manner as latex and chlorhexidine. The diagnosis of hypersensitivity to vital blue dyes can be established by skin test. We illustrate this topic with three clinical cases.

  16. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E


    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  17. Navigating the Updated Anaphylaxis Parameters

    Directory of Open Access Journals (Sweden)

    Kemp Stephen F


    Full Text Available Anaphylaxis, an acute and potentially lethal multi-system clinical syndrome resulting from the sudden, systemic degranulation of mast cells and basophils, occurs in a variety of clinical scenarios and is almost unavoidable inmedical practice. Healthcare professionalsmust be able to recognize its features, treat an episode promptly and appropriately, and be able to provide recommendations to prevent future episodes. Epinephrine, administered immediately, is the drug of choice for acute anaphylaxis. The discussion provides an overview of one set of evidence-based and consensus parameters for the diagnosis and management of anaphylaxis.

  18. Optimal treatment of anaphylaxis: antihistamines versus epinephrine. (United States)

    Fineman, Stanley M


    Anaphylaxis is a rapid, systemic, often unanticipated, and potentially life-threatening immune reaction occurring after exposure to certain foreign substances. The main immunologic triggers include food, insect venom, and medications. Multiple immunologic pathways underlie anaphylaxis, but most involve immune activation and release of immunomodulators. Anaphylaxis can be difficult to recognize clinically, making differential diagnosis key. The incidence of anaphylaxis has at least doubled during the past few decades, and in the United States alone, an estimated 1500 fatalities are attributed to anaphylaxis annually. The increasing incidence and potentially life-threatening nature of anaphylaxis coupled with diagnostic challenges make appropriate and timely treatment critical. Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome. Despite the evidence and guideline recommendations supporting its use for anaphylaxis, epinephrine remains underused. Data indicate that antihistamines are more commonly used to treat patients with anaphylaxis. Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock. Additionally, antihistamines do not act as rapidly as epinephrine; maximal plasma concentrations are reached between 1 and 3 hours for antihistamines compared with < 10 minutes for intramuscular epinephrine injection. This demonstrates the need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis.

  19. Delayed anaphylaxis to red meat masquerading as idiopathic anaphylaxis. (United States)

    Tripathi, Anubha; Commins, Scott P; Heymann, Peter W; Platts-Mills, Thomas A E


    Anaphylaxis is traditionally recognized as a rapidly developing combination of symptoms that often includes hives and hypotension or respiratory symptoms. Furthermore, when a specific cause is identified, exposure to this cause is usually noted to have occurred within minutes to 2 hours before the onset of symptoms. This case is of a 79-year-old woman who developed a severe episode of anaphylaxis 3 hours after eating pork. Before 2012, she had not experienced any symptoms after ingestion of meat products. Delayed anaphylaxis to mammalian meat has many contrasting features to immediate food-induced anaphylaxis. The relevant IgE antibody is specific for the oligosaccharide galactose-alpha-1,3-galactose, a blood group substance of nonprimate mammals. There is evidence from Australia, Sweden, and the United States that the primary cause of this IgE antibody response is tick bites. These bites characteristically itch for 10 days or more. Diagnosis can be made by the presence of specific IgE to beef, pork, lamb, and milk, and the lack of IgE to chicken, turkey, and fish. Skin prick tests (but not intradermal tests) generally are negative. Management of these cases, now common across the southeastern United States, consists of education combined with avoidance of both ingestion of red meat and further tick bites. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  20. Anaphylaxis to Insect Venom Allergens

    DEFF Research Database (Denmark)

    Ollert, Markus; Blank, Simon


    Anaphylaxis due to Hymenoptera stings is one of the most severe consequences of IgE-mediated hypersensitivity reactions. Although allergic reactions to Hymenoptera stings are often considered as a general model for the underlying principles of allergic disease, diagnostic tests are still hampered...

  1. The management of anaphylaxis in childhood

    DEFF Research Database (Denmark)

    Muraro, A; Roberts, G; Clark, A


    Anaphylaxis is a growing paediatric clinical emergency that is difficult to diagnose because a consensus definition was lacking until recently. Many European countries have no specific guidelines for anaphylaxis. This position paper prepared by the EAACI Taskforce on Anaphylaxis in Children aims...... to provide practical guidelines for managing anaphylaxis in childhood based on the limited evidence available. Intramuscular adrenaline is the acknowledged first-line therapy for anaphylaxis, in hospital and in the community, and should be given as soon as the condition is recognized. Additional therapies...... and avoid the allergen to prevent its recurrence. A tailored anaphylaxis management plan is needed, based on an individual risk assessment, which is influenced by the child's previous allergic reactions, other medical conditions and social circumstances. Collaborative partnerships should be established...

  2. Mechanisms of Anaphylaxis Beyond IgE. (United States)

    Muñoz-Cano, R; Picado, C; Valero, A; Bartra, J


    Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators derived from mast cells and basophils. Food allergens are the main triggers of anaphylaxis, accounting for 33%-56% of all cases and up to 81% of cases of anaphylaxis in children. Human anaphylaxis is generally thought to be mediated by IgE, with mast cells and basophils as key players, although alternative mechanisms have been proposed. Neutrophils and macrophages have also been implicated in anaphylactic reactions, as have IgG-dependent, complement, and contact system activation. Not all allergic reactions are anaphylactic, and the presence of the so-called accompanying factors (cofactors or augmenting factors) may explain why some conditions lead to anaphylaxis, while in other cases the allergen elicits a milder reaction or is even tolerated. In the presence of these factors, allergic reactions may be induced at lower doses of allergen or become more severe. Cofactors are reported to be relevant in up to 30% of anaphylactic episodes. Nonsteroidal anti-inflammatory drugs and exercise are the best-documented cofactors, although estrogens, angiotensin-converting enzyme inhibitors, β-blockers, lipid-lowering drugs, and alcohol have also been involved. The mechanisms underlying anaphylaxis are complex and involve several interrelated pathways. Some of these pathways may be key to the development of anaphylaxis, while others may only modulate the severity of the reaction. An understanding of predisposing and augmenting factors could lead to the development of new prophylactic and therapeutic approaches.

  3. Hospital admissions for anaphylaxis in Istanbul, Turkey. (United States)

    Cetinkaya, F; Incioglu, A; Birinci, S; Karaman, B E; Dokucu, A I; Sheikh, A


    There are very limited data characterizing the epidemiology of anaphylaxis from low- and middle-income country settings. We aimed to estimate the frequency of anaphylaxis admissions to hospitals in Istanbul. We obtained data from all 45 hospitals in Istanbul over a 12-month period and used ICD-10 codes to extract data on those admitted with a recorded primary diagnosis of anaphylaxis. Because of concerns about possible under-coding, we undertook an additional analysis to identify patients admitted with two or more clinical codes for symptoms and/or signs suggestive of, but not coded as having, anaphylaxis. A total of 114 cases (79 people with anaphylaxis codes and 35 with symptoms and signs suggestive of anaphylaxis) were identified, giving an overall estimate of 1.95 cases per 100 000 person-years. The novel two-stage identification approach employed suggests significant under-recording of anaphylaxis in those admitted to hospitals in Istanbul. © 2012 John Wiley & Sons A/S.

  4. Patterns of anaphylaxis after diagnostic workup

    DEFF Research Database (Denmark)

    Oropeza, Athamaica Ruiz; Bindslev-Jensen, Carsten; Broesby-Olsen, Sigurd


    BACKGROUND: Most published studies on anaphylaxis are retrospective or register based. Data on subsequent diagnostic work-up are sparse. We aimed to characterize patients seen with suspected anaphylaxis at the emergency care setting (ECS), after subsequent diagnostic work-up at our Allergy Center...... patient with clinical suspicion but not fulfilling the WAO/EAACI criteria at the ECS. The estimated incidence rate of anaphylaxis was 26 cases per 100,000 person years and the one year period prevalence was 0.04%. The most common elicitor was drugs (41.1%) followed by venom (27.4%) and food (20.6%). In 13...

  5. Anaphylaxis (United States)

    ... Categories: Family Health, Infants and Toddlers, Kids and Teens, Men, Seniors, WomenTags: allergy, Allergy and Immunologic, Anxiety, diarrhea, dizziness, emergency medicine, Facial Swelling, Mouth Problem, ...

  6. The epidemiology of anaphylaxis in Europe

    DEFF Research Database (Denmark)

    Panesar, S S; Javad, S; de Silva, D


    BACKGROUND: Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due...... for all-cause anaphylaxis ranged from 1.5 to 7.9 per 100,000 person-years. These data indicated that an estimated 0.3% (95% CI 0.1-0.5) of the population experience anaphylaxis at some point in their lives. Food, drugs, stinging insects, and latex were the most commonly identified triggers. CONCLUSIONS......: Anaphylaxis is a common problem, affecting an estimated 1 in 300 of the European population at some time in their lives. Future research needs to focus on better understanding of the trends across Europe and identifying those most likely to experience fatal reactions....

  7. Anaphylaxis in an emergency care setting

    DEFF Research Database (Denmark)

    Ruiz Oropeza, Athamaica; Lassen, Annmarie; Halken, Susanne


    BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS: Prospect......BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS......: Prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). To identify anaphylaxis cases, records from all patients with clinical suspicion on anaphylaxis or a related diagnosis according to the International Classification of Diseases 10 and from patients treated...... at the emergency care setting or at prehospital level with adrenaline, antihistamines or glucocorticoids were reviewed daily. The identified cases were referred to the Allergy Center, where a standardized interview regarding the anaphylactic reaction was conducted. International guidelines were applied...

  8. Chlorhexidine: an unrecognised cause of anaphylaxis. (United States)

    Odedra, Katy Mara; Farooque, Sophie


    Chlorhexidine is a highly effective antiseptic and disinfectant. In the past 20 years there has been a substantial increase in the number of chlorhexidine containing products used in healthcare. Anaphylaxis to chlorhexidine was first reported in 1984 and was almost always seen in men. However, in the last 4 years we have observed a surge in confirmed cases of anaphylaxis to chlorhexidine, with increasing numbers of female patients recently diagnosed. Yet, awareness of chlorhexidine as a cause of anaphylaxis is low because it is not a drug but a 'hidden' allergen, for example as a coating on medical devices such as central lines and urinary catheters. Patients will often have more than one allergic/anaphylactic reaction before the diagnosis is suspected. We have observed that there is poor recognition of an initial allergic reaction to chlorhexidine, which is well described. This, alongside poor labelling of chlorhexidine containing products, has resulted in further inadvertent exposure resulting in severe anaphylaxis. Prompt referral to a specialist allergy centre ensures appropriate investigations, diagnosis and management. Increasing awareness of the potential risk of life-threatening anaphylaxis associated with chlorhexidine use is vital, particularly in perioperative procedures. Healthcare workers are fundamental in avoiding and preventing further reactions to chlorhexidine containing products in patients diagnosed with anaphylaxis to chlorhexidine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  9. Vaccination and anaphylaxis: a forensic perspective. (United States)

    Palmiere, Cristian; Tettamanti, Camilla; Scarpelli, Maria Pia


    To review the available literature pertaining to fatalities following vaccine administration and, in particular, cases of vaccine-related fatal anaphylaxis. The MEDLINE database was systematically searched up to March 2016 to identify all relevant articles pertaining to fatal cases of anaphylaxis following vaccine administration. Six papers pertaining to fatal anaphylaxis following vaccination were found relevant. Mast cell tryptase and total IgE concentration was assessed exclusively in one case. Laryngeal edema was not detected in any of these cases, whereas eosinophil or mast cell infiltration was observed in lymphoid organs. In one case, immunohistochemical investigations using anti-tryptase antibodies allowed pulmonary mast cells and degranulating mast cells with tryptase-positive material outside to be identified. In any suspected IgE-mediated fatal anaphylactic cases, biochemical investigations should be systematically performed for forensic purposes. Splenic tissue should be routinely sampled for immunohistochemical investigations in all suspected anaphylaxis-related deaths and mast cell/eosinophil infiltrations should be systematically sought out in the spleen, myocardium, and coronary artery wall. The hypothesis of fatal anaphylaxis following vaccination should be formulated exclusively when circumstantial data, available medical records, laboratory investigations, and autopsy or histology findings converge in a consistent pattern. The reasonable exclusion of alternative causes of death after all postmortem investigations is also imperative in order to establish or rule out a cause-and-effect relationship between vaccine administration and any presumptive temporarily-related death.

  10. Anaphylaxis to black widow spider antivenom. (United States)

    Hoyte, Christopher O; Cushing, Tracy A; Heard, Kennon J


    Black widow spider envenomation is commonly reported to poison centers. Black widow spider envenomation produces a clinical syndrome, known as latrodectism, characterized by headache, nausea, vomiting, several muscle cramping and pain, joint stiffness, hypertension, and regional diaphoresis. Black widow spider antivenom (Merck & Co, Inc, West Point, PA USA) is an effective and relatively safe treatment option. There is 1 clear case of anaphylaxis secondary to black widow spider antivenom reported in the medical literature. Here, we report a case of anaphylaxis to antivenom. A 12-year-old boy presented to the emergency department (ED) with diffuse, severe pain 2 1/2 hours after being bitten by a black widow spider on the right lower extremity. In the ED, the patient failed analgesic therapy with fentanyl and was given black widow spider antivenom. Within 45 minutes, he exhibited signs and symptoms consistent with anaphylaxis, including wheezing, chest tightness, pruritus, and urticarial rash. The patient was given standard therapy for anaphylaxis, and all of his signs and symptoms (including the pain secondary to the black widow envenomation) resolved over 6 hours of observation. Leading experts agree that the use of antivenom is indicated in cases of severe envenomation not responsive to standard therapy. Despite concern that the antivenom is an equine-derived whole IgG and can precipitate early hypersensitivity reactions, there is only 1 other reported case of anaphylaxis to the antivenom in the medical literature.

  11. Endurance exercise after orange ingestion anaphylaxis

    Directory of Open Access Journals (Sweden)

    Manu Gupta


    Full Text Available Endurance exercise after orange ingestion cause anaphylaxis which is food-dependent exercise-induced anaphylaxis (FDEIA which is a form of exercise-induced anaphylaxis. In this article, an individual develops symptoms such as flushing, itching, urticaria, angioedema, and wheezing after eating a food allergen and proceeds to exercise. Neither the food alone nor exercise alone is sufficient to induce a reaction. This case report describes a 36-year-old asthmatic male athlete who experienced nausea, vomiting, flushing, urticaria, and facial swelling while exercising in a gymnasium after eating oranges. Neither oranges alone nor exercise alone induced the reaction. Total avoidance of suspected food allergens would be ideal. Persons with FDEIA should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids, and adrenaline.

  12. Jackfruit anaphylaxis in a latex allergic patient. (United States)

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat


    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

  13. Multifactorial Modulation of Food-Induced Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Sara Benedé


    Full Text Available Prevalence of food-induced anaphylaxis increases progressively and occurs in an unpredictable manner, seriously affecting the quality of life of patients. Intrinsic factors including age, physiological, and genetic features of the patient as well as extrinsic factors such as the intake of drugs and exposure to environmental agents modulate this disorder. It has been proven that diseases, such as mastocytosis, defects in HLA, or filaggrin genes, increase the risk of severe allergic episodes. Certain allergen families such as storage proteins, lipid transfer proteins, or parvalbumins have also been linked to anaphylaxis. Environmental factors such as inhaled allergens or sensitization through the skin can exacerbate or trigger acute anaphylaxis. Moreover, the effect of dietary habits such as the early introduction of certain foods in the diet, and the advantage of the breastfeeding remain as yet unresolved. Interaction of allergens with the intestinal cell barrier together with a set of effector cells represents the primary pathways of food-induced anaphylaxis. After an antigen cross-links the IgEs on the membrane of effector cells, a complex intracellular signaling cascade is initiated, which leads cells to release preformed mediators stored in their granules that are responsible for the acute symptoms of anaphylaxis. Afterward, they can also rapidly synthesize lipid compounds such as prostaglandins or leukotrienes. Cytokines or chemokines are also released, leading to the recruitment and activation of immune cells in the inflammatory microenvironment. Multiple factors that affect food-induced anaphylaxis are discussed in this review, paying special attention to dietary habits and environmental and genetic conditions.

  14. Anaphylaxis to Moringa oleifera: First description


    Lucinda J. Berglund


    We describe the first reported case of repeated anaphylaxis after ingestion of Moringa oleifera, causing significant hypotension, angioedema and elevation of serum tryptase. Moringa oleifera seedpod was confirmed as the causative allergen by skin testing with the fresh pod. Moringa oleifera is widely consumed, both as a vegetable and in herbal medicines.

  15. The modern aspects of anaphylaxis therapy

    Directory of Open Access Journals (Sweden)

    Puletić Neda M.


    Full Text Available Introduction: Anaphylactic reaction is a most serious allergy where the symptoms may occur shortly after contact with an allergen and can get worse quickly. Therefore, timely and appropriate treatment is of crucial importance. Methods: In this article, we draw on evidence from publications on the subject of anaphylaxis treatment that we got by searching Google Scholar and PubMed databases. Used articles included: systematic reviews, case reports and randomised controlled trials. We also used World Allergy Organization guidelines for the management and the assessment of anaphylaxis. A literature search with the keywords 'anaphylaxis treatment', 'anaphylactic shock', and 'allergy' identified a number of potentially eligible studies, of which 42 satisfied our eligibility criteria and were therefore included in this review. Topic: There was evidence regarding the optimum route, dose and site of adrenaline administration ,with the latest recommendations indicating the intramuscular route (i.m. in the mid-outer thigh as the optimum treatment. We found studies suggesting the purpose of applying H1 and H2 antihistamines, systemic glucocorticosteroids, calcium and methylxantines to manage anaphylactic shock, recommended doses and mode of administration. With regard to treatment, we focused on acute rather than on long-term management. Further, we have taken into consideration the mechanisms, common triggers and clinical manifestations of anaphylaxis. Conclusion: Adrenaline represents the first choice drug and it is necessary to be applied as soon as possible. However, there is a controversy regarding the application of the other specified medications in this life-threatening condition.

  16. Management of anaphylaxis : a systematic review

    NARCIS (Netherlands)

    Dhami, S.; Panesar, S. S.; Roberts, G.; Muraro, A.; Worm, M.; Bilo, M. B.; Cardona, V.; Dubois, A. E. J.; DunnGalvin, A.; Eigenmann, P.; Fernandez-Rivas, M.; Halken, S.; Lack, G.; Niggemann, B.; Rueff, F.; Santos, A. F.; Vlieg-Boerstra, B.; Zolkipli, Z. Q.; Sheikh, A.

    To establish the effectiveness of interventions for the acute and long-term management of anaphylaxis, seven databases were searched for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted

  17. Reducing or Eliminating Polysorbate Induced Anaphylaxis and Unwanted Immunogenicity in Biotherapeutics

    Directory of Open Access Journals (Sweden)

    Edward Maggio


    Full Text Available The increasing use of biotherapeutics across a growing spectrum of neoplastic, autoimmune, and inflammatory diseases has resulted in a corresponding increase in hypersensitivity reactions. The origins of anaphylaxis are often attributed to undefined intrinsic properties of the biotherapeutic protein itself, ignoring the broader potential negative contributions of functional excipients, in particular polyoxyethylene containing surfactants such as polysorbate 80 and polysorbate 20 (Tween 80 and Tween 20. These surfactants allow biotherapeutics to meet the stringent challenges of extended shelf-life, increased solubility, protein aggregation prevention, reduced administration volume, and satisfactory reconstitution properties in the case of lyophilized biotherapeutics. The potential negative impact of certain functional excipients on product performance characteristics such as anaphylaxis and immunogenicity is often overlooked. While regulatory authorities understandably focus heavily on comparable efficacy in evaluating biosimilars, similar efficacy does not necessarily imply a similar safety profile between the originator and biosimilar products. Both unwanted immunogenicity and anaphylaxis do comprise major components of safety assessment, however, few if any attempts are made to differentiate drug-related from excipient-related anaphylaxis. Replacement of anaphylactogenic and immunogenic functional excipients with equally effective but safer alternatives will allow biotherapeutic developers to differentiate their biotherapeutic, biosimilar, or biobetter from the large number of nearly identical competitor products, simultaneously providing a substantial commercial benefit as well as critical clinical benefits for all concerned – patients, physicians, and third party payers.

  18. Two cases of anaphylaxis after laminaria insertion. (United States)

    Kim, Sang-Hoon; Chang, Yun-Hae; Kim, Woo-Kyoung; Kim, Yoon-Keun; Cho, Sang-Heon; Kim, You-Young; Min, Kyung-Up


    Anaphylaxis following laminaria insertion rarely occurs but may be a life-threatening condition. Laminaria tents, prepared from natural sea kelp, are commonly used prior to elective termination of pregnancy to achieve cervical dilatation. We report herein two cases of anaphylaxis caused by IgE-mediated hypersensitivity to laminaria. Two women, each of whom had undergone at least one previous abortion where a laminaria had been utilized, developed anaphylactic reaction following laminaria insertion. The reaction included urticaria, nausea, breathing difficulty, and hypotension. The patients subsequently underwent skin testing and measurement of serum specific IgE level to laminaria extract, and were shown to elicit positive responses to laminaria. The implication and impact of laminaria allergy on gynecologic procedures are significant and this allergy should be included in the list of differential diagnoses for hypersensitive reaction in gynecologic procedures. PMID:14676449


    Directory of Open Access Journals (Sweden)

    Sami OZTURK


    Full Text Available Introduction: Exercise-induced anaphylaxis (EIA is a rare syndrome. We described two patients experienced anaphylaxis after exercise. Case 1: A 24 -year-old male patient, recruited to army as a private 6 months ago. The medical history was suggestive of an anaphylactic reaction which was developed about 30 minute after a vigorous exercise. Case 2: A 42-year old female, was referred to our clinic because of the recurrent episodes of generalized pruritus, nausea, vomiting, swelling on extremities and breathing difficultly. She was experienced with symptoms after moderate exercises which were performed to losing weight. Evaluation: The complete diagnostic procedures including skin tests with foods and inhalant allergens were performed. In Case 2, positive skin test results were detected in food allergens (apricot, tomato, vanilla and inhalant allergens (house-dust mites and cockroach. Management: In Case 1, he was first experienced EIA symptoms with the military training. For this reason, he exempted from vigorous exercises during his remaining compulsory military service and self-injectable epinephrine kit and antihistamine were prescribed him. In Case 2, she advised to avoid from vigorous exercises. Conclusion: EIA should be considered in cases of anaphylaxis with uncertain etiology. [TAF Prev Med Bull 2005; 4(1.000: 46-49

  20. Popsicle-induced anaphylaxis due to carmine dye allergy. (United States)

    Baldwin, J L; Chou, A H; Solomon, W R


    IgE-mediated hypersensitivity is a suggested mechanism to explain adverse reactions from carmine-containing products. To describe a patient who experienced anaphylaxis after ingestion of a popsicle colored with carmine and to provide additional evidence that the adverse reaction was IgE-mediated. The patient and her husband underwent skin prick tests to the popsicle and carmine. The patient also received skin prick tests and/or open oral challenge to each of the other components of the incriminated food. Topical application of cosmetics with and without carmine to the patient's forearm was also performed. To confirm carmine-specific IgE, a Prausnitz-Kustner (P-K) test was performed using the patient's husband as recipient. Twenty control subjects also were tested to carmine by skin prick test. The patient showed 4+ skin prick test responses to the popsicle and carmine. Skin prick tests and/or open oral challenge to each of the other components of the popsicle were negative. The patient's husband's and 20 control subjects' skin prick tests to carmine were negative as was the patient's husband's skin prick test to the popsicle. Skin prick test reactivity to the popsicle and carmine were successfully transferred to the patient's husband in P-K format. Cosmetics applied to the patient's forearm elicited no immediate response. The positive skin prick tests to the popsicle and carmine and the successful (P-K) transfer of skin prick test reactivity support a carmine-specific, IgE-mediated mechanism in explaining our patient's popsicle-induced anaphylaxis.

  1. Implementation of anaphylaxis management guidelines: a register-based study.

    Directory of Open Access Journals (Sweden)

    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  2. Guidelines for the management of anaphylaxis in children and adolescents

    Directory of Open Access Journals (Sweden)

    Tina Vesel


    Full Text Available Anaphylaxis is a severe life-threatening generalized or systemic hypersensitivity reaction. All doctors and other medical staff should be familiar with the treatment of anaphylaxis. Food, insect bites and drugs and are principal agents responsible for anaphylaxis in children and adolescents. In the absence of treatment, the reaction may rapidly progress with severe manifestations including fatal outcome. Intramuscular adrenaline is first-line therapy for anaphylaxis. Additional measures, such as removing the trigger, call for help, the correct position of the child or adolescent, high-flow oxygen, volume support, bronchodilator and adrenaline inhalations, systemic antihistamine and glucocorticoid, are supplementary to adrenaline. At discharge from hospital it is necessary to assess the risk of future anaphylaxis to determine the individualized management plan in case of anaphylaxis and to prescribe adrenaline auto-injector. Training of the child, parents and others who take care of the child, on when and how to use the self-injectable devices of adrenaline is necessary. Allergy assessment at an allergists office is obligatory in all children with a history of anaphylaxis in order to determine the cause of anaphylaxis, to provide detailed instructions on allergen avoidance and, if possible, to start with specific immunotherapy.

  3. A rare case of ceftriaxone induced anaphylaxis in anaethesia practice

    Directory of Open Access Journals (Sweden)

    Anita Kumari


    Full Text Available Medications are among the second most common cause of anaphylaxis and the primary cause of anaphylaxis in adults. The most common classes of drugs causing anaphylaxis are antibiotics especially β-lactam antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs. Diagnosis of anaphylaxis is clinically based and usually straight forward. However data on epidemiology of anaphylaxis, particularly the most profound and life threatening form such as anaphylactic shock is limited and thought to be under-reported. In spite of negative skin testing, our patient had severe reaction resulting in anaphylactic shock after antibiotic administration but was managed successfully without any residual compromise. This case reflects the limitations of screening test done preoperatively for the diagnosis of sensitization to the drugs.


    Landsteiner, K.


    From the experiments which have been reported, it follows that animals sensitized with one azoprotein react not only to the antigen used for the sensitization, but also to other azoproteins made up from the same simple azo-compounds and another protein. Although the specificity of the reaction has not yet been tested with various azo-components, its actual existence can reasonably be assumed on the basis of the phenomena observed in precipitation reactions. The sensitization is brought about with less facility than sensitization against the usual antigens and the effects are not uniform. Still, after sufficient treatment, 40 per cent of the animals succumbed with typical anaphylactic symptoms, mostly within a short time while 16 per cent showed severe symptoms. The experiments show that it is possible to make animals hypersensitive against a simple chemical group like para-arsanilic acid, and from this point of view connection would seem to be established with the phenomena of drug allergy in human beings. There is an essential difference, however, in that the sensitized animals did not react on injections of simple compounds such as para-amino-phenyl-arsanilic acid and phenyl-4-arsonic-acid-azo-tyrosine uncombined with protein. It remains to be determined whether under changed conditions positive results in this direction can be obtained. For this purpose it seems advisable to make experiments with isolated organs, according to the method of Schultz and Dale. While the simple substances failed to elicit direct reactions, they protected (as was foreseen by Doerr) against a subsequent injection of the active antigen. Similar compounds not containing the arsanilic acid group were considerably less active. The phenomenon is comparable to the inhibition of precipitin reactions already described. Considering the protection as a condition of antianaphylaxis, one would suppose that the simple substances mentioned are fixed by the cells in which the anaphylactic reaction

  5. Anaphylaxis Triggered by Benzyl Benzoate in a Preparation of Depot Testosterone Undecanoate

    Directory of Open Access Journals (Sweden)

    Gregory S. Y. Ong


    Full Text Available We report the first case of an anaphylactic reaction to Reandron 1000 (depot testosterone undecanoate with a castor oil and benzyl benzoate vehicle. While considered to have a favourable safety profile, serious complications such as oil embolism and anaphylaxis can occur. In our patient, skin testing identified benzyl benzoate to be the trigger, with no reaction to castor oil or testosterone undecanoate components. As benzyl benzoate exists in multiple pharmaceuticals, foods, and cosmetics, individual components of pharmaceuticals should be tested when investigating drug allergies. Doctors should be alert to the potential for serious reactions to any of the components of Reandron 1000.

  6. Adrenaline overdose in pediatric anaphylaxis: a case report. (United States)

    Liew, Pui Yi Lily; Craven, John Andrew


    Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pressure measurement, its use remains inconsistent in clinical practice. We report a case of adrenaline overdose in a 9-year-old white boy with anaphylaxis, where signs of adrenaline overdose were indistinguishable from progressive shock until blood pressure measurement was taken. The consequences of under-dosing adrenaline in anaphylaxis are well-recognized, but the converse is less so. Blood pressure measurement should be a routine part of pediatric assessment as it is key to differentiating adrenaline overdose from anaphylactic shock.

  7. Anaphylaxis management plans for the acute and long-term management of anaphylaxis: a systematic review. (United States)

    Nurmatov, Ulugbek; Worth, Allison; Sheikh, Aziz


    Anaphylaxis management plans (AMPs) are increasingly advocated to improve outcomes and reduce the risk of recurrence in persons with anaphylaxis. A recent systematic review investigating their effectiveness failed to identify any randomized controlled trial evidence to guide clinical decision making. We sought to identify and describe available AMPs, assess their acceptability and likely effectiveness, and understand potential facilitators and barriers to their use. We performed a systematic review of published, unpublished, and ongoing epidemiologic and qualitative studies, searching 13 international databases and contacting an international panel of anaphylaxis experts. Studies were critically appraised using established international criteria and thematically synthesized. Nineteen of 789 potentially eligible studies identified satisfied our inclusion criteria. A number of AMPs exist, and other than agreement on the central importance of early administration of self-administered epinephrine, there is a range of perspectives on what should be included. AMPs are acceptable to patients/caregivers and might considerably reduce the risk of recurrence. This latter finding needs to be interpreted with caution given the substantial risk of bias in the limited number of intervention studies conducted. Access to specialists, problems with follow-up, and indemnity considerations relating to emergency administration of epinephrine in schools are important structural barriers to their wider use. There are currently no universally accepted AMPs. The available evidence to support use of self-management plans is encouraging but is, in comparison with other long-term conditions, such as asthma, extremely weak. The effectiveness and cost-effectiveness of AMPs need to be formally evaluated.

  8. Anaphylaxis to annatto dye: a case report. (United States)

    Nish, W A; Whisman, B A; Goetz, D W; Ramirez, D A


    Annatto dye is an orange-yellow food coloring extracted from the seeds of the tree Bixa orellana. It is commonly used in cheeses, snack foods, beverages, and cereals. Previously reported adverse reactions associated with annatto dye have included urticaria and angioedema. We present a patient who developed urticaria, angioedema, and severe hypotension within 20 minutes following ingestion of milk and Fiber One cereal, which contained annatto dye. Subsequent skin tests to milk, wheat, and corn were negative. The patient had a strong positive skin test to annatto dye, while controls had no response. The nondialyzable fraction of annatto dye on SDS-PAGE demonstrated two protein staining bands in the range of 50 kD. Immunoblotting demonstrated patient IgE-specific for one of these bands, while controls showed no binding. Annatto dye may contain contaminating or residual seed proteins to which our patient developed IgE hypersensitivity. Annatto dye is a potential rare cause of anaphylaxis.

  9. EAACI Food Allergy and Anaphylaxis Guidelines

    DEFF Research Database (Denmark)

    Muraro, A; Werfel, T; Hoffmann-Sommergruber, K


    Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building...... on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists......, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management...

  10. Emergency treatment of anaphylaxis in infants and children


    Cheng, A


    Anaphylaxis is a severe, acute and potentially life-threatening condition, often in response to an allergen. Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. Epinephrine given intramuscularly remains the mainstay of treatment for this condition. Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs...

  11. Anaphylaxis in Poland: the epidemiology and direct costs

    Directory of Open Access Journals (Sweden)

    Karina Jahnz-Rozyk


    Full Text Available Introduction : Epidemiological data on anaphylaxis have been underestimated both in Poland and worldwide. Aim : To evaluate the prevalence of anaphylaxis in Poland, including a classification by gender, age and residential region. Material and methods : The data used in the analysis were derived from two sources, the National Health Fund records of healthcare services for 2008–2015 (official statistics and a questionnaire-based survey conducted in 2015 on a sample of 305 allergists practicing in different regions of Poland. Results : In 2015, 3144 people received treatment for anaphylactic shock (T78.0, T78.2, T80.5, T88.6 with an estimated prevalence rate of anaphylaxis of 8.2 per 100,000 (8.4 for females and 7.9 for males. The highest prevalence rate was found for women aged 50–54 years (14.5 per 100,000. There was a very large difference in the prevalence of anaphylaxis between rural and urban areas (13.1 vs. 0.8 per 100,000. In 2015, the Polish NHF spent PLN 3.5 million (EUR 835,000 on the management of anaphylaxis. Of the allergists surveyed, 73% had been currently managing patients who had experienced anaphylactic shock. The most common causes of anaphylaxis included insect venom (41.4%, food (29.8% and drugs (17.4%. Conclusions : A central anaphylaxis registry should be established in Poland. This is the only approach that would allow collecting a wide range of reliable information on the cases, management and consequences of anaphylaxis. Ongoing management of patients who have experienced anaphylactic shock should be improved.

  12. Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Maria Isabel Montañez


    Full Text Available Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.

  13. A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine


    Park, Kyung Hee; Yun, Il Seon; Choi, Soo-Young; Lee, Jae-Hyun; Hong, Chein-Soo; Park, Jung-Won


    We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test ...

  14. The Mast Cell, Contact, and Coagulation System Connection in Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Mar Guilarte


    Full Text Available Anaphylaxis is the most severe form of allergic reaction, resulting from the effect of mediators and chemotactic substances released by activated cells. Mast cells and basophils are considered key players in IgE-mediated human anaphylaxis. Beyond IgE-mediated activation of mast cells/basophils, further mechanisms are involved in the occurrence of anaphylaxis. New insights into the potential relevance of pathways other than mast cell and basophil degranulation have been unraveled, such as the activation of the contact and the coagulation systems. Mast cell heparin released upon activation provides negatively charged surfaces for factor XII (FXII binding and auto-activation. Activated FXII, the initiating serine protease in both the contact and the intrinsic coagulation system, activates factor XI and prekallikrein, respectively. FXII-mediated bradykinin (BK formation has been proven in the human plasma of anaphylactic patients as well as in experimental models of anaphylaxis. Moreover, the severity of anaphylaxis is correlated with the increase in plasma heparin, BK formation and the intensity of contact system activation. FXII also activates plasminogen in the fibrinolysis system. Mast cell tryptase has been shown to participate in fibrinolysis through plasmin activation and by facilitating the degradation of fibrinogen. Some usual clinical manifestations in anaphylaxis, such as angioedema or hypotension, or other less common, such as metrorrhagia, may be explained by the direct effect of the activation of the coagulation and contact system driven by mast cell mediators.

  15. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. (United States)

    Lieberman, Phil; Camargo, Carlos A; Bohlke, Kari; Jick, Hershel; Miller, Rachel L; Sheikh, Aziz; Simons, F Estelle R


    To improve understanding of the epidemiology of anaphylaxis. We performed a qualitative review by hand of the major epidemiology studies of anaphylaxis. This review was restricted to articles in the English language. Articles chosen were selected by the committee and dated back to 1968. There was no specific criterion used for selection except the determination of the members of the committee. Data on anaphylaxis incidence and prevalence are sparse and often imprecise. Findings are based on diverse study designs and are not entirely comparable. These factors have contributed to widely varying estimates of the frequency of this important condition. The roundtable discussion led to an improved estimation of the frequency of anaphylaxis: approximately 50 to 2,000 episodes per 100,000 persons or a lifetime prevalence of 0.05% to 2.0%. The largest number of incident cases is among children and adolescents. In addition to underdiagnosis, we noted undertreatment, especially for those at highest risk (ie, those without immediate access to treatment with epinephrine). Anaphylaxis is a relatively common problem, affecting up to 2% of the population. Further data on epinephrine dispensing could improve current estimates. Another way to improve current understanding would be through better population-based study designs in different geographic regions. A recurring theme was the importance of broader access to self-injectable epinephrine for high-risk populations. An improved epidemiologic understanding of this disorder would aid ongoing efforts to reduce morbidity and mortality from anaphylaxis and could provide important clues for primary prevention.

  16. Hepatic hydatid cyst presenting as anaphylaxis. (United States)

    Maqbool, Brig; Anwar, Major Syed Faraz


    A young soldier was brought to the emergency of Combined Military Hospital (CMH), Multan in a collapsed state with two day's history of chest pain. He was resuscitated and placed on ventilator. While the rest of examinations were normal, ultrasound examination of the abdomen revealed a cystic mass in liver most likely to be hydatid. The patient was fully conscious the next day and was put on tab albendazole (200 mg BID). CT scan of the abdomen revealed a large cystic mass having inner undulating wall with watery content diagnosed as hydatid cyst in right lobe of liver. Since anaphylaxis was considered consequent to hydatid cyst perforation, surgery was carried out. Approximately 100 ml of haemorrhagic fluid was aspirated and 10% hypertonic saline instilled. After re-aspiration, cyst cavity was opened and endocyst completely removed. Portion of ectocyst projecting away from the liver edge was also excised. He made an uneventful postoperative recovery and was discharged with the advice to continue tab albendazole 200mg BID for four weeks and weekly follow-up in surgical OPD. He is doing well now.

  17. Different clinical features of anaphylaxis according to cause and risk factors for severe reactions

    Directory of Open Access Journals (Sweden)

    Sang-Yoon Kim


    Conclusions: More severe anaphylaxis developed with drug treatment and in males. Low rate of epinephrine prescription was also observed. Male patients with drug induced anaphylaxis should be paid more attention.

  18. Anaphylaxis and allergic reactions during surgery and medical procedures

    Directory of Open Access Journals (Sweden)

    Blas J Larrauri


    Full Text Available Anaphylaxis during anesthesia is an unpredictable, severe, and rare reaction. It has an incidence of 1/10 000 to 1/20 000 surgeries. In most series, the responsible drugs include neuromuscular blocking agents, latex, or antibiotics. The frequency and etiology of systemic allergic reactions in other medical procedures are largely unknown. The identification of responsible drugs of anaphylaxis is a complex task, requiring testing of all medications and substances used during surgery. We describe our experience in a retrospective study of 15 patients. Ten subjects developed anaphylaxis during surgery, two in endoscopic studies and one in a trans-vaginal ultrasound. The remaining two subjects, one in a trans-vaginal ultrasound and another during a dental procedure had a systemic allergic reaction. We studied all patients with all medications administered during the procedures, including latex and detergents and disinfectants. Three surgeries had to be suspended at induction of anesthesia, five were stopped incomplete and two were completed. Both patients that presented a reaction during endoscopy required intensive care unit admission and the rest were observed in a Hospital. The responsible drugs during surgery anaphylaxis were neuromuscular blocking agents, latex, patent blue, and ranitidine. Ortho-phthalaldehyde (OPA was identified during endoscopic studies; latex was responsible in transvaginal ultrasounds; and amoxicillin in the dental procedure. The aim of the present article is to review our experience studying allergic systemic reactions and anaphylaxis during general anesthesia and medical procedures, emphasizing the severity of these reactions and the need for causative drug identification.

  19. [Anaphylaxis and allergic reactions during surgery and medical procedures]. (United States)

    Larrauri, Blas J; Torre, María Gabriela; Malbrán, Eloísa; Juri, María Cecilia; Fernández Romero, Diego S; Malbrán, Alejandro


    Anaphylaxis during anesthesia is an unpredictable, severe, and rare reaction. It has an incidence of 1/10 000 to 1/20 000 surgeries. In most series, the responsible drugs include neuromuscular blocking agents, latex, or antibiotics. The frequency and etiology of systemic allergic reactions in other medical procedures are largely unknown. The identification of responsible drugs of anaphylaxis is a complex task, requiring testing of all medications and substances used during surgery. We describe our experience in a retrospective study of 15 patients. Ten subjects developed anaphylaxis during surgery, two in endoscopic studies and one in a trans-vaginal ultrasound. The remaining two subjects, one in a trans-vaginal ultrasound and another during a dental procedure had a systemic allergic reaction. We studied all patients with all medications administered during the procedures, including latex and detergents and disinfectants. Three surgeries had to be suspended at induction of anesthesia, five were stopped incomplete and two were completed. Both patients that presented a reaction during endoscopy required intensive care unit admission and the rest were observed in a Hospital. The responsible drugs during surgery anaphylaxis were neuromuscular blocking agents, latex, patent blue, and ranitidine. Ortho-phthalaldehyde (OPA) was identified during endoscopic studies; latex was responsible in transvaginal ultrasounds; and amoxicillin in the dental procedure. The aim of the present article is to review our experience studying allergic systemic reactions and anaphylaxis during general anesthesia and medical procedures, emphasizing the severity of these reactions and the need for causative drug identification.

  20. Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register. (United States)

    Cardona, Victòria; Ferré-Ybarz, Laia; Guilarte, Mar; Moreno-Pérez, Nuria; Gómez-Galán, Catalina; Alcoceba-Borràs, Eva; Delavalle, Maria Belén; Garriga-Baraut, Teresa


    The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified. © 2017 S. Karger AG, Basel.

  1. Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. (United States)

    Kim, Sang-Yoon; Kim, Min-Hye; Cho, Young-Joo


    Anaphylaxis is a life-threatening allergic reaction. Several studies reported different anaphylactic reactions according to the causative substances. However, a comparison of anaphylaxis for each cause has not been done. This study was conducted to identify common causes of anaphylaxis, characteristics of anaphylactic reaction for each cause and to analyze the factors related to the severity of the reaction. Medical records of patients who visited the emergency room of Ewha Womans University Mokdong Hospital from March 2003 to April 2016 and diagnosed with anaphylactic shock were retrospectively reviewed. We compared the clinical features of anaphylaxis according to the cause. In addition, the severity of anaphylaxis was analyzed and contributing factors for severe anaphylaxis were reviewed. A total of 199 patients with anaphylaxis were analyzed. Food was the most common cause (49.7%), followed by drug reaction (36.2%), bee venom (10.1%), and unknown cause (4.0%). Cardiovascular symptoms of syncope and hypotension were more common in drug-induced anaphylaxis. The incidence of severe anaphylaxis was the highest in anaphylaxis due to drugs (54.2%). Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis. Risk factors for severe anaphylaxis included older age, male, and drug-induced one. Epinephrine treatment of anaphylaxis was done for 69.7% and 56.9% of patients with food-induced and drug-induced anaphylaxis, respectively. More severe anaphylaxis developed with drug treatment and in males. Low rate of epinephrine prescription was also observed. Male patients with drug induced anaphylaxis should be paid more attention. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  2. A case of immunoglobulin E mediated anaphylaxis to levodropropizine. (United States)

    Park, Kyung Hee; Yun, Il Seon; Choi, Soo-Young; Lee, Jae-Hyun; Hong, Chein-Soo; Park, Jung-Won


    We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA).

  3. Epinephrine auto-injector for anaphylaxis in food allergic patients

    NARCIS (Netherlands)

    Langenberg, Jacquelien


    Food allergy is one of leading causes of anaphylaxis. Currently there is no treatment for food allergy. It is therefore important that patients and health-care providers are capable of recognizing a severe food-allergic reaction and treating it adequately. The prevalence of food allergy in Dutch

  4. Omalizumab: Practical considerations regarding the risk of anaphylaxis

    Directory of Open Access Journals (Sweden)

    Kim Harold L


    Full Text Available Abstract Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis. In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.2%. Other researchers, including the American Omalizumab Joint Task Force (OJTF, have suggested a lower overall frequency of 0.09%. This paper provides a summary of the epidemiologic research carried out to date and presents a concise, practical set of recommendations for the prevention, monitoring and management of omalizumab-associated anaphylaxis. Prevention tips include advice on patient education measures, concomitant medications and optimal administration. For the first three injections, the recommendation is to monitor in clinic for two hours after the omalizumab injection; for subsequent injections, the monitoring period should be 30 minutes or an appropriate time agreed upon by the individual patient and healthcare professional. In the event that a patient does experience omalizumab-associated anaphylaxis, the paper provides recommendations for handling the situation in-clinic and recommendations on how to counsel patients to recognize the potential signs and symptoms in the community and react appropriately.

  5. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review. (United States)

    Song, Jae Won; Jang, Young Sook; Jung, Moon Chan; Kim, Joo Hee; Choi, Jeong Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki Suck


    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication. Copyright © 2017 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.

  6. Adrenaline in anaphylaxis treatment. Balancing benefits and harms. (United States)

    Cervellin, Gianfranco; Sanchis-Gomar, Fabian; Lippi, Giuseppe


    Although anaphylaxis is a relatively common disorder, clinicians and scientists have debated on how to best define and manage this condition. The current recommendations are focused on the central role of adrenaline, but evidence in support of this therapeutic approach is modest, mainly for the lack of well-designed trials. Conversely, serious adverse effects are commonly reported following adrenaline use, especially when given intravenously. These include hypertension, ventricular arrhythmias, myocardial infarction, pulmonary edema. Anaphylaxis treatment, with special focus on adrenaline utilization, both in pre-hospital and in-hospital settings. Aim is to examine in depth the balance between benefits and harms of this important drug. Due to the lack of solid evidence supporting the use of adrenaline in patients with anaphylaxis, except in severe cases, the strength of recommendations should be readdressed, limiting administration to selected categories of patients. Caregivers should promptly act in pre-hospital setting, given the shortness of time and lack of technology. In the hospital setting, and more specifically in the ED, clinicians should consider the prompt use of adrenaline in severe anaphylaxis cases, but they should also be able to judiciously wait in the vast majority of milder anaphylactic reactions, which may resolve spontaneously.

  7. Research to practice: developing an integrated anaphylaxis education curriculum for school nurses. (United States)

    Cavanaugh, Rebecca; Strickland, C June


    The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for anaphylaxis. School nurses require resources to assist them in providing health training for school staff on how to manage potentially life-threatening health conditions for children in their school, however, resources to address this training are limited. A search for and content analysis of currently available literature and resources about anaphylaxis and anaphylaxis training curricula revealed a lack of an integrated curriculum to train school staff. This article presents a discussion of the development of a train-the-trainer anaphylaxis education program providing school nurses with curriculum, lesson plans, teaching-learning activities, and resources for anaphylaxis education of all school staff.

  8. Anaphylaxis after administration of amikacin containing sodium metabisulfite in a premature newborn. (United States)

    Kendigelen, Pinar; BaktirClinic Of Anesthesiology And Reanimation Afşin State Hospital Afşin Kahramanmaraş Tureky, Mehmet; Sucu, Asena; Kaya, Guner


    Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction. Sociedad Argentina de Pediatría.

  9. Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis


    Jung, Hwa Sik; Park, Chan-Ho; Park, Young Tae; Bae, Mi Ae; Lee, Youn Im; Kang, Byung Ju; Jegal, Yangjin; Ahn, Jong Joon; Lee, Taehoon


    H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly ...

  10. Higher latitude and lower solar radiation influence on anaphylaxis in Chilean children. (United States)

    Hoyos-Bachiloglu, Rodrigo; Morales, Pamela S; Cerda, Jaime; Talesnik, Eduardo; González, Gilberto; Camargo, Carlos A; Borzutzky, Arturo


    Recent studies suggest an association between higher latitude, a proxy of vitamin D (VD) status, and allergic diseases. Chile provides an ideal setting to study this association due to its latitude span and high rates of VD deficiency in southern regions. The aim of this study is to explore the associations of latitude and solar radiation with anaphylaxis admission rates. We reviewed anaphylaxis admissions in Chile's hospital discharge database between 2001 and 2010 and investigated associations with latitude and solar radiation. 2316 anaphylaxis admissions were registered. Median age of patients was 41 yr; 53% were female. National anaphylaxis admission rate was 1.41 per 100,000 persons per year. We observed a strong north-south increasing gradient of anaphylaxis admissions (β 0.04, p = 0.01), with increasing rates south of latitude 34°S. A significant association was also observed between solar radiation and anaphylaxis admissions (β -0.11, p = 0.009). Latitude was associated with food-induced (β 0.05, p = 0.02), but not drug-induced (β -0.002, p = 0.27), anaphylaxis. The association between latitude and food-induced anaphylaxis was significant in children (β 0.01, p = 0.006), but not adults (β 0.003, p = 0.16). Anaphylaxis admissions were not associated with regional sociodemographic factors like poverty, rurality, educational level, ethnicity, or physician density. Anaphylaxis admission rates in Chile are highest at higher latitudes and lower solar radiation, used as proxies of VD status. The associations appear driven by food-induced anaphylaxis. Our data support a possible role of VD deficiency as an etiological factor in the high anaphylaxis admission rates found in southern Chile. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. A case of severe anaphylaxis following coronary angiography

    Directory of Open Access Journals (Sweden)

    Anil Kumar


    Full Text Available Anaphylaxis reactions are not uncommon in routine practice and involve multiple systems usually. Cardiovascular collapse is the severest form of reaction. We present a case of severe anaphylactic reaction with cardiovascular collapse without other systems involvement which had to treat with intravenous adrenaline for a prolonged duration (successfully. The case is presented because of the rarity of presentation (single system involvement and requirement of prolonged use of adrenaline for more than 24 h.

  12. Methylene blue for clinical anaphylaxis treatment: a case report

    Directory of Open Access Journals (Sweden)

    Janine Moreira Rodrigues

    Full Text Available CONTEXT AND OBJECTIVE: Nitric oxide has a pathophysiological role in modulating systemic changes associated with anaphylaxis. Nitric oxide synthase inhibitors may exacerbate bronchospasm in anaphylaxis and worsen clinical conditions, with limited roles in anaphylactic shock treatment. The aim here was to report an anaphylaxis case (not anaphylactic shock, reversed by methylene blue (MB, a guanylyl cyclase inhibitor. CASE REPORT: A 23-year-old female suddenly presented urticaria and pruritus, initially on her face and arms, then over her whole body. Oral antihistamine was administered initially, but without improvement in symptoms and signs until intravenous methylprednisolone 500 mg. Recurrence occurred after two hours, plus vomiting. Associated upper respiratory distress, pulmonary sibilance, laryngeal stridor and facial angioedema (including erythema and lip edema marked the evolution. At sites with severe pruritus, petechial lesions were observed. The clinical situation worsened, with dyspnea, tachypnea, peroral cyanosis, laryngeal edema with severe expiratory dyspnea and deepening unconsciousness. Conventional treatment was ineffective. Intubation and ventilatory support were then considered, because of severe hypoventilation. But, before doing that, based on our previous experience, 1.5 mg/kg (120 mg bolus of 4% MB was infused, followed by one hour of continuous infusion of another 120 mg diluted in dextrose 5% in water. Following the initial intravenous MB dose, the clinical situation reversed completely in less than 20 minutes, thereby avoiding tracheal intubation. CONCLUSION: Although the nitric oxide hypothesis for MB effectiveness discussed here remains unproven, our intention was to share our accumulated cohort experience, which strongly suggests MB is a lifesaving treatment for anaphylactic shock and/or anaphylaxis and other vasoplegic conditions.

  13. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review


    Song, Jae-Won; Jang, Young-Sook; Jung, Moon-Chan; Kim, Joo-Hee; Choi, Jeong-Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki-Suck


    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodroprop...

  14. Differences in hospital attendance for anaphylaxis between immigrants and non-immigrants

    DEFF Research Database (Denmark)

    Norredam, M.; Sheikh, Aziz; Svendsen, K. Dynnes


    Background: The impact of migration on the risk of anaphylaxis remains unknown. We hypothesized that non-Western immigrants have a lower incidence of anaphylaxis compared to Danish-born. We investigated variations in hospital attendance for anaphylaxis between immigrants and Danish-born including......-born individuals (n = 740 600). Personal identification numbers were cross-linked to the Danish National Patient Registry identifying all first-time hospital attendances for anaphylaxis from January 1, 1994 and December 31, 2010. Incidence rate ratios were estimated, stratified for sex and region of birth...

  15. Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA

    Directory of Open Access Journals (Sweden)

    Dirceu Sole


    Full Text Available OBJECTIVES: The aims of the Online Latin American Survey of Anaphylaxis (OLASA were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n =634. RESULTS: Of all patients, 68.5% were older than 18 years, 41.6% were male, and 65.4% experienced the allergic reaction at home. The etiologic agent was identified in 87.4% of cases and predominantly consisted of drugs (31.2%, foods (23.3%, and insect stings (14.9%. The main symptom categories observed during the acute episodes were cutaneous (94.0% and respiratory (79.0%. The majority of patients (71.6% were treated initially by a physician (office/emergency room within the first hour after the reaction occurred (60.2%, and 43.5% recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3% received parenteral epinephrine alone or associated with other medication. However, 80.5% and 70.2% were treated with corticosteroids or antihistamines (alone or in association, respectively. A total of 12.9% of the patients underwent reanimation maneuvers, and 15.2% were hospitalized. Only 5.8% of the patients returned to the emergency room after discharge, with 21.7% returning in the first 6 hours after initial treatment. CONCLUSION: The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2%, foods (23.3% and insect stings (14.9% in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency.

  16. Anaphylaxis Preparedness among Preschool Staff before and after an Educational Intervention

    Directory of Open Access Journals (Sweden)

    Ashley A. Foster


    Full Text Available Introduction. Children with severe food allergies may spend many hours in the preschool setting. Little is known about anaphylaxis recognition and management preparedness among preschool staff. The objective of this study was to assess anaphylaxis preparedness among preschool staff. Methods. Anonymous questionnaires were administered before and after a 40-minute educational seminar on anaphylaxis recognition and management. Results. In total, 181 individuals participated in the preintervention survey and 171 participated in the postintervention survey. The comfort level with recognizing anaphylaxis and administering an epinephrine autoinjector significantly increased after the intervention (P<.001 for both. Of the 5 steps needed to administer an epinephrine autoinjector, staff named a mean (SD of 3 (1.3 steps in the correct order compared with 4.2 (1.1 steps after the educational intervention (P<.001. Conclusion. This study shows that a brief education intervention can significantly increase caregiver comfort regarding identifying anaphylaxis and administering an epinephrine autoinjector.

  17. Anaphylaxis: lack of hospital doctors' knowledge of adrenaline (epinephrine) administration in adults could endanger patients' safety. (United States)

    Droste, J; Narayan, N


    Adrenaline (epinephrine) is the first line drug to be given in anaphylaxis and can save patients' lives. Conversely, incorrect administration of adrenaline in anaphylaxis has caused patients serious harm, including death. We compared the survey results of doctors' knowledge of adrenaline administration in adults of two District General Hospitals Trusts in England and found, that from 284 Hospital Doctors, 14.4% (n = 41) would administer adrenaline as recommended by published anaphylaxis guidelines. This survey comparison shows that a significant number of hospital doctors, regardless of seniority and specialty, have an educational deficit regarding correct administration of adrenaline (epinephrine) administration in adults with anaphylaxis. Multilevel strategies to educate doctors and prevent patient harm are needed. We propose a mnemonic for remembering the recommended treatment for anaphylaxis in the adult: "A Thigh 500" forAdrenaline into the antero-lateral thigh, 500 micrograms.

  18. Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis. (United States)

    Latimer, Andrew J; Husain, Sofia; Nolan, Jonathan; Doreswamy, Vinod; Rea, Thomas D; Sayre, Michael R; Eisenberg, Mickey S


    In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the "Check and Inject" program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms. We sought to determine if the "Check and Inject" program was safely implemented by EMTs treating presumed prehospital anaphylaxis or serious allergic reaction. We conducted a prospective investigation of all cases treated as part of the "Check and Inject" program from July 2014 through December 2016 in suburban King County, Washington, and January 2016 through December 2016 within the city of Seattle. All cases were prospectively collected using a custom quality improvement data form completed by the first responding EMTs. Two physicians completed a structured review of each EMS medical record to determine if the EMTs followed the Check and Inject protocol and determine if epinephrine was clinically-indicated based on physician review. Of the 411 cases eligible for analysis, EMTs followed the protocol appropriately in 367 (89.3%) cases. In the remaining 44 (10.7%) cases, the EMS incident report form failed to document either a clear inciting allergic trigger or an appropriate symptom from the protocol list. Physician review determined that epinephrine was clinically indicated in 36 of the 44 cases. Among the remaining 8 cases (1.9%) that did not meet protocol criteria and were not clinically-indicated based on physician review, none had a documented adverse reaction to the epinephrine. We observed that EMTs successfully implemented the manual "Check and Inject" program for severe

  19. Chloramine-induced anaphylaxis while showering: a case report

    Directory of Open Access Journals (Sweden)

    D’Alò Simona


    Full Text Available Abstract Introduction Sodium-N-chlorine-p-toluene sulfonamide, commonly known as chloramine-T, is a derivative of chlorine which is widely used as a disinfectant. For many years, chloramine-T has been described as a cause of immediate-type hypersensitivity, especially with regard to asthma and rhinitis, and as a cause of occupational dermatoses in cleaning personnel in hospitals, although no anaphylactic reaction has yet been reported. Hence, to the best of our knowledge we present the first case of anaphylaxis to chloramine-T with evidence of specific immunoglobulin E antibodies. Case presentation We describe the case of a 25-year-old Caucasian woman who was in good health and with a negative history for atopy, including no respiratory symptoms of rhinitis or asthma, and with no professional exposure to chloramine-T. She, while showering, applied a chloramine-T solution to a skin area with folliculitis on her leg, and within a few minutes developed generalized urticaria and angioedema, followed by vomiting and collapse with loss of consciousness. A skin prick test with a chloramine-T solution at 10mg/mL concentration was positive, and specific immunoglobulin E to chloramine-T was quantified at a value of 2.9 optical density as measured by the enzyme allergosorbent test technique. Conclusion The strict cause-effect relationship and the results of the skin test and the in vitro test make certain the causative role of chloramine-T in this case of anaphylaxis. This suggests that chloramine-T, based on its wide use as a disinfectant, should be considered a possible cause in anaphylaxis of unknown origin.

  20. Anaphylaxis after disinfection with 2% chlorhexidine wand applicator

    DEFF Research Database (Denmark)

    Bahal, Sameer; Sharma, Samriti; Garvey, Lene Heise


    A 54-year-old man with end-stage renal failure attended for dialysis. Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of his dialysis catheter (Tesio catheter), he developed pruritus, urticaria, shortness of breath......, hypotension and reduced responsiveness. Treatment for anaphylaxis was initiated with rapid improvement of his symptoms, and he made a full recovery. Allergy to chlorhexidine was confirmed with skin testing, and the patient was warned against all future exposure to chlorhexidine. Subsequent dialysis without...... chlorhexidine was uneventful....

  1. The Etiology and Clinical Features of Anaphylaxis in a developing country: A nationwide survey in Turkey. (United States)

    Civelek, Ersoy; Erkoçoğlu, Mustafa; Akan, Ayşegül; Özcan, Celal; Kaya, Ayşenur; Vezir, Emine; Giniş, Tayfur; Azkur, Dilek; Toyran, Müge; Tokaç, Mahmut; Kocabaş, Can Naci


    Despite the increasing frequency of anaphylaxis, there is inadequate information on the etiology and clinical features in various countries, regions and age groups, especially in developing countries. Our aim is to assess the etiology and clinical findings of anaphylaxis in Turkey. Gathering reliable data about the etiology and clinical findings of anaphylaxis in the general population will decrease the related morbidity and mortality. We obtained the names and phone numbers of individuals who had been prescribed an epinephrine auto-injector with a diagnosis of anaphylaxis from ministry of health. Demographic data, clinical history of the first episode of anaphylaxis including the triggering agent, clinical findings, course of hospitalization, and the management of anaphylaxis were obtained by phone survey. A total of 843 patients with a mean age of 21.4±17.3 years were evaluated. There was a significant male predominance among children younger than 10 years of age but a female predominance in older subjects. The most common causes of anaphylaxis were foods(40.1%) in children and bee venom(60.8%) in adults. The biphasic reaction rate was 4.3% and the median length of stay at an emergency department was 4.0 hours. Almost 60% of the patients had recurrent anaphylaxis episodes. Only 10.7% of the cases were prescribed an epinephrine auto-injector at their first anaphylaxis episode and only 59.2% of the patients were referred to an allergist during discharge from the emergency department. In Turkey, bee venom was the most common cause of anaphylaxis, followed by food and drug. While more than a half of patients reported recurrent attacks; only 10% had been prescribed epinephrine auto-injector kit after their first episode. Strategies to improve the anaphyalxis management are therefore urgently required.

  2. Managing nut-induced anaphylaxis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Lomas JM


    Full Text Available Jeanne M Lomas, Kirsi M Järvinen Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: The prevalence of peanut and tree nut allergy in the USA has increased, especially in the pediatric population. Nut allergy remains the leading cause of fatal anaphylactic reactions. Management of anaphylaxis includes not only treatment of symptoms during a reaction, but strict dietary avoidance and education on potential situations, which may place the patient at high risk for accidental exposure. Cross-reactivity between various nuts along with various cross-contamination sources should be discussed with all nut-allergic individuals. Exciting research continues to emerge on other potential treatments for patients allergic to nuts, including allergen immunotherapy. Results of such interventions have been encouraging, though further studies are needed regarding safety and long-term outcomes before these can be applied to clinical practice. Keywords: peanut, tree nut, anaphylaxis, cross-reactivity, avoidance, immunotherapy

  3. Clinical features and anaphylaxis in children with cold urticaria. (United States)

    Alangari, Abdullah A; Twarog, Frank J; Shih, Mei-Chiung; Schneider, Lynda C


    To characterize the features of cold urticaria in children, with particular focus on systemic reactions, because little pediatric data are available. Chart reviews of 30 children <18 years old who were evaluated in the past 3 years at the Children's Hospital Allergy Program (Boston, MA) and a private allergy practice. Demographic, diagnostic, and therapeutic data were collected. Telephone interviews of patients and/or their parents were performed to obtain follow-up data. Our data showed that the mean and median ages of onset were approximately 7 years. No secondary causes were found. One third of patients had anaphylactic reactions. These reactions could not be predicted based on available variables. Patients with negative cold-stimulation test (ice-cube challenge) at 10 minutes had similar symptoms and response to antihistamines as those patients with positive ice-cube-challenge test. In addition, our group of patients with cold urticaria had a strikingly high rate of asthma (46.7%) and allergic rhinitis (50%). The rate of family history of atopic diseases was even higher (89.3%). Cold urticaria occurs in children and may be associated with anaphylaxis. In our series, no secondary causes were found. All patients with cold urticaria and their parents should be cautioned regarding the risk of anaphylaxis and provided with an epinephrine autoinjector.

  4. Management and educational status of adult anaphylaxis patients at emergency department. (United States)

    Kim, Mi-Yeong; Park, Chan Sun; Jeong, Jae-Won


    We evaluated the management and educational status of adult anaphylaxis patients at emergency departments (EDs). Anaphylaxis patients who visited ED from 2011 to 2013 were enrolled from three hospitals. We analyzed clinical features, prior history of anaphylaxis, management and provided education for etiology and/or prevention. For analyzing associated factors with epinephrine injection, Pearson chi-square test was used by SPSS version 21 (IBM Co.). A total of 194 anaphylaxis patients were enrolled. Ninety-nine patients (51%) visited ED by themselves. Time interval from symptom onset to ED visit was 62 ± 70.5 minutes. Drug (56.2%) was the most frequent cause of anaphylaxis. Forty-seven patients (24.2%) had prior history of anaphylaxis and 33 patients had same suspicious cause with current anaphylaxis. Cutaneous (88.7%) and respiratory (72.7%) symptoms were frequent. Hypotension was presented in 114 patients (58.8%). Mean observation time in ED was 12 ± 25.7 hours and epinephrine was injected in 114 patients (62%). In 68 patients, epinephrine was injected intramuscularly with mean dose of 0.3 ± 0.10 mg. Associated factor with epinephrine injection was hypotension (p = 0.000). Twenty-three patients (13%) were educated about avoidance of suspicious agent. Epinephrine auto-injectors were prescribed only in five patients. Only 34 (19%) and 72 (40%) patients were consulted to allergist at ED and outpatient allergy department respectively. We suggested that management and education of anaphylaxis were not fully carried out in ED. An education and promotion program on anaphylaxis is needed for medical staff.

  5. Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest. (United States)

    Murphy, Christine M; Hong, Jeannie J; Beuhler, Michael C


    Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion.

  6. Medication errors in prehospital management of simulated pediatric anaphylaxis. (United States)

    Lammers, Richard; Willoughby-Byrwa, Maria; Fales, William


    Systematic evaluation of the performances of prehospital providers during actual pediatric anaphylaxis cases has never been reported. Epinephrine medication errors in pediatric resuscitation are common, but the root causes of these errors are not fully understood. The primary objective of this study was to identify underlying causes of prehospital medication errors that were observed during a simulated pediatric anaphylaxis reaction. Two- and 4-person emergency medical services crews from eight geographically diverse agencies participated in a 20-minute simulation of a 5-year old child with progressive respiratory distress and hypotension from an anaphylactic reaction. Crews used their own equipment and drugs. A checklist-based scoring protocol was developed to help identify errors. A trained facilitator conducted a structured debriefing, supplemented by playback of video recordings, immediately after the simulated event to elicit underlying causes of errors. Errors were analyzed with mixed quantitative and qualitative methods. One hundred forty-two subjects participated in 62 simulation sessions. Ninety-five percent of crews (59/62) gave epinephrine, but 27 of those crews (46%) delivered the correct dose of epinephrine in an appropriate concentration and route. Twelve crews (20%) gave a dose that was ≥5 times the correct dose; 8 crews (14%) bolused epinephrine intravenously. Among the 55 crews who gave diphenhydramine, 4 delivered the protocol-based dose. Three crews provided an intravenous steroid, and 1 used the protocol-based dose. Underlying causes of errors were categorized into eight themes: faulty reasoning, weight estimation errors, faulty recall of medication dosages, problematic references, calculation errors, dose estimation, communication errors, and medication delivery errors. Simulation, followed by a structured debriefing, identified multiple, underlying causes of medication errors in the prehospital management of pediatric anaphylactic reactions

  7. Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis. (United States)

    Jung, Hwa Sik; Park, Chan-Ho; Park, Young Tae; Bae, Mi Ae; Lee, Youn Im; Kang, Byung Ju; Jegal, Yangjin; Ahn, Jong Joon; Lee, Taehoon


    H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly developed gynecomastia. Because anaphylaxis recurred after the cessation of H1-antihistamine, the preventive medication was changed to omalizumab. A few months later, his gynecomastia had entirely disappeared. Physicians should be aware of this exceptional ADR of H1-antihistamine.

  8. Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

    DEFF Research Database (Denmark)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens


    BACKGROUND:: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment...... is important. METHODS:: A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock......, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). CONCLUSION:: Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence...

  9. Outcomes of allergy/immunology follow-up after an emergency department evaluation for anaphylaxis. (United States)

    Campbell, Ronna L; Park, Miguel A; Kueber, Michael A; Lee, Sangil; Hagan, John B


    Anaphylaxis guidelines currently recommend referring patients with anaphylaxis seen in the emergency department (ED) to an allergist for follow up. The objective of our study was to evaluate outcomes of allergy/immunology follow-up after an ED visit for anaphylaxis. A retrospective health records review was conducted from April 2008 to August 2012. Charts were reviewed independently by 2 allergists to determine outcomes. Descriptive statistics with corresponding 95% CIs were calculated. Among 573 patients seen in the ED who met anaphylaxis diagnostic criteria, 217 (38%) had a documented allergy/immunology follow-up. After allergy/immunology evaluation, 16 patients (7% [95% CI, 5%-12%]) had anaphylaxis ruled out. Among those with an unknown ED trigger (n = 74), 24 (32% [95% CI, 23%-44%]) had a trigger identified; and, among those who had a specific suspected ED trigger (n = 143), 9 (6% [95% CI, 3%-12%]) had a trigger identified in a category other than the one suspected in the ED, and 28 (20% [95% CI, 14%-27%]) had an unknown trigger. Thus, there were a total of 77 patients (35% [95% CI, 29%-42%]) who had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. Four patients (2% [95% CI, 0.7%-4.6%]) were diagnosed with a mast cell activation disorder, and 13 patients (6% [95% CI, 4%-10%]) underwent immunotherapy or desensitization. Overall, 35% of the patients with suspected anaphylaxis in the ED had an alteration in the diagnosis or suspected trigger after allergy/immunology evaluation. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  10. Anaphylaxis-related deaths in Ontario: a retrospective review of cases from 1986 to 2011 (United States)


    Background Examining deaths caused by anaphylaxis may help identify factors that may decrease the risk of these unfortunate events. However, information on fatal anaphylaxis is limited. The objectives of our study were to examine all cases of fatal anaphylaxis in Ontario to determine cause of death, associated features, co factors and trends in mortality. The identification of these factors is important for developing effective strategies to overcome gaps in monitoring and treatment of patients with food allergies and risk for anaphylaxis. Methods This was a retrospective case-series analysis of all causes of anaphylaxis-related deaths using data from the Ontario Coroner’s database between 1986 and 2011. Quantitative data (e.g. demographic) were analyzed using descriptive statistics and frequency analysis using SPSS. Qualitative data were analyzed using content analysis of grounded theory methodology. Results We found 92 deaths in the last 26 years related to anaphylaxis. Causes of death, in order of decreasing frequency, included food (40 cases), insect venom (30 cases), iatrogenic (16 cases), and idiopathic (6 cases). Overall, there appears to be a decline in the frequency of food related deaths, but an increase in iatrogenic causes of fatalities. We found factors associated with fatal anaphylaxis included: delayed epinephrine administration, asthma, allergy to peanut, food ingestion outside the home, and teenagers with food allergies. Conclusions Our findings indicate the need to improve epinephrine auto-injector use in acute reactions, particularly for teens and asthmatics with food allergies. In addition, education can be improved among food service workers and food industry in order to help food allergic patients avoid potentially fatal allergens. The increasing trend in iatrogenic related anaphylaxis is concerning, and requires monitoring and more investigation. PMID:25670935

  11. Contemporary issues in anaphylaxis and the evolution of epinephrine autoinjectors: What will the future bring? (United States)

    Greenberger, Paul A; Wallace, Dana V; Lieberman, Phillip L; Gregory, Sean M


    Food allergy and anaphylaxis appear to be increasing in the United States, especially in young children, and preparedness is paramount to successful emergency management in the community. Although the treatment of choice for anaphylaxis is epinephrine delivered by autoinjection, some devices are challenged by less user-friendly designs or pose the risk of injury, especially in young patients. Human factors engineering has played a larger role in the development of more recent epinephrine autoinjector technologies and will continue to play a role in the evolution and future design of epinephrine autoinjectors. To discuss contemporary issues related to the identification and management of anaphylaxis, current and future epinephrine autoinjector design, and unmet needs for the treatment of special populations, namely, young children weighing less than 15 kg. The literature was reviewed and select articles retrieved to support expert clinical opinions on the need for improved recognition of anaphylaxis, epinephrine autoinjector design, and unmet needs in special populations. Anaphylaxis may be underrecognized and poorly defined in infant- and toddler-aged children, current devices may not be adequate to safely treat these patients (ie, inappropriate needle length), and health care professionals may not be aware of these issues. As epinephrine autoinjector technology continues to evolve, device characteristics that promote safe, user-friendly experiences and give clinicians and their patients confidence to successfully treat anaphylaxis during an emergency, without injury, will be favored. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Anaphylaxis to iodinated contrast media: clinical characteristics related with development of anaphylactic shock.

    Directory of Open Access Journals (Sweden)

    Min-Hye Kim

    Full Text Available Anaphylaxis is the most severe form of radiocontrast media (RCM induced hypersensitivity and can be life-threatening if profound hypotension is combined. With increased use of iodine based RCM, related hypersensitivity is rapidly growing. However, the clinical characteristics and risk factors of RCM induced anaphylaxis accompanied by hypotension (anaphylactic shock are not clearly defined. This study was performed to investigate the risk factors of RCM induced anaphylactic shock and the clinical value of RCM skin testing to identify causative agents in affected patients.We analyzed the data of RCM induced anaphylaxis monitored by an inhospital pharmacovigilance center at a tertiary teaching hospital from January 2005 to December 2012 and compared the clinical features and skin test results according to the accompanying hypotension.Among total of 104 cases of RCM induced anaphylaxis, 34.6% of patients, developed anaphylaxis on their first exposure to RCM. Anaphylactic patients presenting with shock were older (57.4 vs. 50.1 years, p = 0.026 and had a history of more frequently exposure to RCM (5.1±7.8 vs. 1.9±3.3, p = 0.004 compared to those without hypotension. Among RCMs, hypotension was more frequent in anaphylaxis related to iopromide compared to other agents (85.0% vs. 61.4%, p = 0.011. Skin tests were performed in 51 patients after development of RCM induced anaphylaxis. Overall skin test positivity to RCM was 64.7% and 81.8% in patients with anaphylactic shock.RCM induced anaphylactic shock is related to multiple exposures to RCM and most patients showed skin test positivity to RCM.

  13. Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department. (United States)

    Mostmans, Y; Grosber, M; Blykers, M; Mols, P; Naeije, N; Gutermuth, J


    Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines. Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Anaphylaxis to pine nut: cross-reactivity to Artemisia vulgaris? (United States)

    Rodrigues-Alves, R; Pregal, A; Pereira-Santos, M C; Branco-Ferreira, M; Lundberg, M; Oman, H; Pereira-Barbosa, M


    The use of pine nuts, the seeds of Pinus pinea, is on the increasing in the modern Mediterranean diet. Little more than 20 cases of allergy to this tree nut have been published, and cross-reactivity with pine pollen, peanut and almond has already been reported. We describe the case of a young boy with several episodes of anaphylaxis after pine nut ingestion. Specific IgE to pine nut and Artemisia vulgaris was demonstrated by skin prick tests and in vitro determination of specific IgE, although no IgE to pine pollen or other nuts was detected. Immunoblotting of Artemisia vulgaris and pine nut revealed two matching diffuse bands, just below 14 kDa and 30 kDa. The ImmunoCAP inhibition assays showed complete inhibition of pine nut specific IgE after serum incubation with Artemisia vulgaris extract. As far as we know, this is the first reported case of documented cross-reactivity between pine nut and Artemisia vulgaris.

  15. Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. (United States)

    Sheikh, Aziz; Shehata, Yasser A; Brown, Simon Ga; Simons, F Estelle R


    Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline is recommended as the initial treatment of choice for anaphylaxis. To assess the benefits and harms of adrenaline (epinephrine) in the treatment of anaphylaxis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to March 2007), EMBASE (1966 to March 2007), CINAHL (1982 to March 2007), BIOSIS (to March 2007), ISI Web of Knowledge (to March 2007) and LILACS (to March 2007). We also searched websites listing ongoing trials:, and; and contacted pharmaceutical companies and international experts in anaphylaxis in an attempt to locate unpublished material. Randomized and quasi-randomized controlled trials comparing adrenaline with no intervention, placebo or other adrenergic agonists were eligible for inclusion. Two authors independently assessed articles for inclusion. We found no studies that satisfied the inclusion criteria. Based on this review, we are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis. Although there is a need for randomized, double-blind, placebo-controlled clinical trials of high methodological quality in order to define the true extent of benefits from the administration of adrenaline in anaphylaxis, such trials are unlikely to be performed in individuals with anaphylaxis. Indeed, they might be unethical because prompt treatment with adrenaline is deemed to be critically important for survival in anaphylaxis. Also, such studies would be difficult to conduct because anaphylactic episodes usually occur without warning, often in a non-medical setting, and differ in severity both among individuals and from one episode to another in the same individual. Consequently, obtaining baseline measurements and frequent timed measurements might be difficult

  16. Anaphylaxis with delayed appearance of skin manifestations during general anesthesia: two case reports. (United States)

    Hanamoto, Hiroshi; Kozu, Fumi; Oyamaguchi, Aiko; Inoue, Mika; Yokoe, Chizuko; Niwa, Hitoshi


    Anaphylaxis is difficult to diagnose in the absence of skin or mucosal signs and symptoms. We report two cases of anaphylaxis under general anesthesia, in which the initial presentation was in the form of respiratory signs, followed by skin manifestations 10-15 min later. Diagnosis of anaphylaxis was delayed because skin symptoms were absent early on in the presentation. In the first case, a 23-year-old male patient with jaw deformity was scheduled to undergo maxillary alveolar osteotomy. After intubation, auscultation indicated a sudden decrease in breath sounds, together with severe hypotension. Approximately 10 min later, flushing of the skin and urticaria on the thigh appeared and spread widely throughout the body. In the second case, a 21-year-old female patient with jaw deformity was scheduled to undergo maxillomandibular osteotomy. Twenty minutes after the start of dextran infusion, her lungs suddenly became difficult to ventilate, and oxygen saturation decreased to 90%. Approximately 15 min later, flushing of the skin and urticaria were observed. In both cases, there was a time lag between the appearance of respiratory and skin symptoms, which resulted in a delay in the diagnosis, and hence, treatment of anaphylaxis. Our experience highlights the fact that it is difficult to diagnose anaphylaxis under general anesthesia.

  17. [Physicians' knowledge with regard to the timing of adrenaline administration for anaphylaxis in Japan]. (United States)

    Imai, Takanori; Sugizaki, Chizuko; Ebisawa, Motohiro


    Adrenaline administration is a top priority treatment for severe anaphylaxis. A survey with regard to the timing of adrenaline administration for anaphylaxis was conducted among physicians in Japan. The survey was conducted using a questionnaire among physicians who had contributed to a nationwide survey for acute food allergy monitoring in 2011. The questionnaire comprised questions asking physicians whether they possessed registrations as an adrenaline self-injector (ASJ), and timing of adrenaline administration for anaphylaxis. Symptoms of anaphylaxis were categorized into shock or respiratory, gastrointestinal, cutaneous, or laryngeal symptoms. A total of 674 replies were obtained from physicians, and 547 physicians were reported to be registered as ASJs. With regard to time, when patients injected themselves with adrenaline, it resulted in laryngeal (78.4%) and circulatory symptoms (64.4%), whereas when physicians administered adrenaline in patients, it resulted in circulatory (74.8%) and laryngeal symptoms (70.0%). Japanese physicians did not necessarily understand the timing of adrenaline administration. Therefore, it is important to provide appropriate education to these physicians with regard to anaphylaxis and ASJ.

  18. Anaphylaxis after vaccination of children: review of literature and recommendations for vaccination in child and school health services in Belgium. (United States)

    Vanlander, Anouk; Hoppenbrouwers, Karel


    Concerns about the very small, but real risk of anaphylaxis after vaccination, has given rise to specific questions about the safe administration of vaccines to children and adolescents in the context of preventive settings (i.e. well baby clinics and school health services). As a support to preventive health professionals a guideline based on scientific evidence and supported by professional consensus was developed in Belgium. First, a draft of guideline was written based on a review of international literature. Second, through several rounds of consultation professional consensus about the document was obtained across the Belgian communities and professional groups, and in a final version endorsed by the Belgian Superior Health Council in July 2012. In a literature overview information is given about the definition of anaphylaxis, allergens in vaccines potentially causing anaphylaxis, published incidence rates of anaphylaxis after vaccination, and strategies for first-aid management of anaphylaxis. The Belgian guideline on the prevention of anaphylaxis after vaccination includes recommendations on prevaccination risk assessment, the content of the emergency kit, measures to be taken after vaccination, differential diagnosis and first-aid management of anaphylaxis. The guideline, summarized as a flowchart for the prevention and first-aid management of anaphylaxis, is considered as the actual state of the art in Belgium for vaccination of children and youngsters in preventive health services, and may inspire governmental bodies and/or professional groups in other countries to adopt similar recommendations. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Survival after anaphylaxis induced by a bumblebee sting in a dog. (United States)

    Thomas, Emily; Mandell, Deborah C; Waddell, Lori S


    A 3.5 yr old castrated male miniature schnauzer was referred with a history of collapse after a bee sting to the left hind limb. At the time of presentation, 14 hr after the sting, the dog was hypotensive, comatose, seizuring, and had a brief period of cardiac arrest. Over the following 48 hr, the dog developed azotemia, severely elevated liver enzyme levels, hypertension, hematochezia, hematemesis, and disseminated intravascular coagulation (DIC). The dog's neurologic status improved slowly, but significant behavioral abnormalities remained. The dog was discharged after 7 days with ongoing polyuria, polydipsia, and behavioral changes. The polydipsia and polyuria resolved within a few days, but the behavioral changes continued for 6 wk. Reports of anaphylaxis from any cause are sparse in the veterinary literature. This is the first report of suspected anaphylaxis following a bee sting. There are no previous reports of behavioral changes after physical recovery from anaphylaxis.

  20. Laboratory Animal Bite Anaphylaxis: A National Survey: Part 1: Case Series and Review of the Literature. (United States)

    Stave, Gregg M; Lee, Edward H; Darcey, Dennis J


    This study documents previously unreported cases of laboratory animal bite anaphylaxis in animal laboratory facilities in the United States. An online survey was e-mailed to designated institutional officials at laboratory animal facilities identified by the National Institutes of Health Office of Laboratory Animal Welfare. One hundred ninety eight organizations responded and 15 organizations indicated that workers had experienced anaphylaxis following an animal bite. Case report forms were completed by nine of these institutions for 14 cases, 13 for rodent bites, and one involving a needlestick from a horse. In half of the cases involving rodents, there was no prior history of animal allergy. All workers had uncomplicated recoveries. Treatment, testing, and work restrictions varied across cases. While uncommon, anaphylaxis from laboratory animal bites occurs more frequently than suggested by the literature.

  1. Serious shortcomings in the management of children with anaphylaxis in Scottish schools.

    Directory of Open Access Journals (Sweden)

    Kirsty E Rankin


    Full Text Available BACKGROUND: The United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis. METHODS AND FINDINGS: We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60% schools, 90 (61% of which reported having at least one at risk child. Most (80% schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001, with access to adrenaline being very poor (12%, p < 0.001. Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation. CONCLUSIONS: Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.

  2. Food-dependent exercise-induced anaphylaxis with a high level of plasma noradrenaline. (United States)

    Kato, Yukihiko; Nagai, Ayako; Saito, Masuyoshi; Ito, Tomonobu; Koga, Michiyuki; Tsuboi, Ryoji


    Ingesting certain foods sometimes triggers anaphylaxis when followed by exercise (food-dependent exercise-induced anaphylaxis, FDEIA). Specific food-induced mucocutaneous urticaria may also progress to anaphylaxis (oral allergy syndrome, OAS). A positive skin test and/or radioallergosorbent test (RAST) to the foods suggest involvement of immunoglobulin (Ig)E-anaphylaxis in both disorders. The triggering foods and initial target organs are usually different in each case. In the present study, a 32-year-old male reported dyspnea accompanied by wheals, and symptoms of low blood pressure while walking after eating Chinese noodles and donuts. He also reported uncomfortable sensations in his mouth and throat after ingesting melon. Exercise challenge tests were administered. Serum histamine, plasma adrenaline, noradrenaline and dopamine were measured pre- and post-test. No symptoms were induced by exercise or by the ingestion of any single food item before exercise. However, numerous wheals appeared when exercise followed the combined ingestion of foods. Likewise, the sequence of eating pancakes and then exercising resulted in numerous wheals and anaphylaxis. Olopatadine hydrochloride and ketotifen fumarate completely inhibited this anaphylaxis. The skin prick tests resulted in fruit-induced erythema and wheals. The results of these tests with wheat, butter and sugar were negative, and no symptoms were induced by the exercise test after ingestion of watermelon, melon or apple. The anaphylactoid symptoms were accompanied by a significant increase of plasma noradrenaline. In this case, not only wheat, but sugar and butter may induce the onset of FDEIA. There was no significant correlation between the intensity of the symptoms and the serum histamine levels in the present case. Noradrenaline may be involved in the onset of FDEIA, since noradrenaline may selectively inhibit T-helper (Th)1 functions while favoring Th2 responses. The tests showed no cross-reactivity between the

  3. Medication errors in the management of anaphylaxis in a pediatric emergency department. (United States)

    Benkelfat, Rislaine; Gouin, Serge; Larose, Guylaine; Bailey, Benoit


    Despite the publication of recent guidelines for anaphylaxis management, many studies show that physicians are still not at ease with the management of anaphylaxis. To evaluate the rate and severity of medication errors before and after implementation of a standard order form for anaphylaxis management. A before-and-after study was conducted. All children pediatric hospital Emergency Department with anaphylaxis between September 2007 and November 2010 were included. Patients were divided into two groups according to intervention (Pre and Post). Intervention consisted of the implementation of a standard order form (SOF) for anaphylaxis management. The post-intervention group was further sub-divided into SOF+ (when the SOF was used) and SOF- (when the SOF was not used). A total of 96 medical charts were reviewed. There were 31 patients in Pre and 65 in Post (29 in SOF+ and 36 in SOF-). A total of 243 drugs were ordered. Thirty-five percent (85/243) of these orders contained at least one medication error. Fifty-five percent (47/85) were dosage errors. The rate of medication errors was the same between Pre and Post (60% vs. 59%, p = 0.95). However, the rate of dosage errors was significantly reduced when the SOF was used (21% in SOF+ vs. 50% in Pre, p = 0.02 and 21% in SOF+ vs. 50% in SOF-, p = 0.02). Medication errors in the management of anaphylaxis were frequent. Use of an SOF significantly reduced the rate of dosage errors. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Tick bite anaphylaxis: incidence and management in an Australian emergency department. (United States)

    Rappo, Tristan B; Cottee, Alice M; Ratchford, Andrew M; Burns, Brian J


    Ticks are endemic to the eastern coastline of Australia. The aim of the present study is to describe the incidence of tick bites in such an area, the seasonal and geographical distribution, the incidence of anaphylaxis due to tick bite and its management. We retrospectively analysed emergency presentations of patients with tick bites to Mona Vale Hospital on Sydney's Northern Beaches over a 2 year period from 1 January 2007 to 1 January 2009. We recorded the geographical and seasonal distribution of tick bites as well as the symptoms from tick bite and its emergency management. We report over 500 cases of tick bites presenting to a single New South Wales hospital over a 2 year period, of which 34 resulted in anaphylaxis. Cutaneous symptoms were the most common feature associated with anaphylaxis (32/34, 94%). Forty per cent (13/34) of patients with tick bite anaphylaxis had a history of allergy or previous anaphylaxis. Seventy-six per cent (26/34) of patients were administered adrenaline either prior to presenting or in the ED, while 97% (33/34) were treated with steroids. Fifty-three per cent were referred to an immunologist and only one-quarter were discharged with an adrenaline auto-injector. We report 34 cases of tick bite anaphylaxis over a 2 year period at a single hospital in a tick endemic area. The variation in the presenting symptoms and signs, as well as in management highlights the need for increased awareness for tick bite management in tick endemic areas. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Regulatory CD4+Foxp3+ T cells control the severity of anaphylaxis.

    Directory of Open Access Journals (Sweden)

    Reem Kanjarawi

    Full Text Available OBJECTIVE: Anaphylaxis is a life-threatening outcome of immediate-type hypersensitivity to allergen, consecutive to mast cell degranulation by allergen-specific IgE. Regulatory T cells (Treg can control allergic sensitization and mast cell degranulation, yet their clinical benefit on anaphylactic symptoms is poorly documented. Here we investigated whether Treg action during the effector arm of the allergic response alleviates anaphylaxis. METHODS: We used a validated model of IgE-mediated passive systemic anaphylaxis, induced by intravenous challenge with DNP-HSA in mice passively sensitized with DNP-specific IgE. Anaphylaxis was monitored by the drop in body temperature as well as plasma histamine and serum mMCP1 levels. The role of Treg was analyzed using MHC class II-deficient (Aβ(°/° mice, treatment with anti-CD25 or anti-CD4 mAbs and conditional ablation of Foxp3(+ Treg in DEREG mice. Therapeutic efficacy of Treg was also evaluated by transfer experiments using FoxP3-eGFP knock-in mice. RESULTS: Anaphylaxis did not occur in mast cell-deficient W/W(v mutant mice and was only moderate and transient in mice deficient for histamine receptor-1. Defects in constitutive Treg, either genetic or induced by antibody or toxin treatment resulted in a more severe and/or sustained hypothermia, associated with a rise in serum mMCP1, but not histamine. Adoptive transfer of Foxp3(+ Treg from either naïve or DNP-sensitized donors similarly alleviated body temperature loss in Treg-deficient DEREG mice. CONCLUSION: Constitutive Foxp3(+ Treg can control the symptomatic phase of mast cell and IgE-dependent anaphylaxis in mice. This might open up new therapeutic avenues using constitutive rather than Ag-specific Treg for inducing tolerance in allergic patients.

  6. Management of anaphylaxis in child care centers: evaluation 6 and 12 months after an intervention program. (United States)

    Patel, Bina M; Bansal, Priya J; Tobin, Mary C


    Many young children with a history of allergic reactions or anaphylaxis spend considerable time in child care centers. We previously reported that a significant knowledge deficit exists in anaphylaxis recognition, evaluation, and treatment and that greater anaphylaxis education is needed among child care providers. To determine whether child care centers can recognize, evaluate, and treat anaphylactic episodes in children aged 1 to 6 years 6 months and 1 year after attending an allergy seminar. All 39 child care centers participating in the original study were selected to complete 6-month and 1-year follow-up surveys using a similar questionnaire. Those who did not attend the seminar or complete all the previous surveys were excluded. At 6 months and 1 year, 37 and 29 centers, respectively, completed surveys. There was a significant improvement regarding when to administer intramuscular epinephrine compared with before the allergy seminar. However, only 48% of the centers at 6 months (P = .02) and 31% at 1 year (P = .002) knew how to correctly administer intramuscular epinephrine compared with 77% four weeks after the seminar. With time, there was a significant decline in correctly recognizing typical anaphylaxis symptoms, including abdominal cramping, chest tightness, shortness of breath, low blood pressure, and diarrhea, whereas symptoms such as hives, swelling, and wheezing continued to be identified correctly. There is a need for renewed anaphylaxis education among child care providers. Initially, this intervention significantly increased the ability of child care center staff to recognize, evaluate, and treat anaphylaxis, but knowledge diminished gradually at 6-month and 1-year follow-up.

  7. Differences in hospital attendance for anaphylaxis between immigrants and non-immigrants: a cohort study. (United States)

    Norredam, M; Sheikh, A; Dynnes Svendsen, K; Holm Petersen, J; Garvey, L H; Kristiansen, M


    The impact of migration on the risk of anaphylaxis remains unknown. We hypothesized that non-Western immigrants have a lower incidence of anaphylaxis compared to Danish-born. We investigated variations in hospital attendance for anaphylaxis between immigrants and Danish-born including time- and age- trends. A register-based, historical prospective cohort design. Refugees or family reunified immigrants (n = 127 250) who, between January 1, 1994 and December 31, 2010, obtained residency permits in Denmark were included and matched in a 1 : 6 ratio on age and sex with Danish-born individuals (n = 740 600). Personal identification numbers were cross-linked to the Danish National Patient Registry identifying all first-time hospital attendances for anaphylaxis from January 1, 1994 and December 31, 2010. Incidence rate ratios were estimated, stratified for sex and region of birth, adjusting for age using a Cox regression model including the influence of duration of residence and age when residence was obtained. In total 1053 hospital attendances for anaphylaxis were identified: 89 among non-Western immigrants, 9 among Western immigrants and 955 among Danish-born patients. Both male (RR = 0.65; 95%CI: 0.46;0.90) and female (RR = 0.64; 95%CI: 0.48;0.85) non-Western immigrants had a significantly lower risk ratio of hospital attendance for anaphylaxis compared to Danish-born. Compared to Danish-born, non-Western immigrants living in Denmark during the entire follow-up period also showed a decreased risk (RR = 0.65; 95%CI: 0.34;1.25). Compared to Danish-born, non-Western immigrants who obtained residence permission as children had a decreased risk of hospital attendance for anaphylaxis (RR = 0.48; 95%CI: 0.25;0.91). This Danish register-based study using nationwide data revealed fewer hospital attendances for anaphylaxis among non-Western immigrants compared to Danish-born; however this protection was lost over time. © 2016 John Wiley & Sons Ltd.

  8. Drug Hypersensitivity and Anaphylaxis in Cancer and Chronic Inflammatory Diseases: The Role of Desensitizations

    Directory of Open Access Journals (Sweden)

    Mariana Castells


    Full Text Available Drug allergy is a rising problem in the twenty-first century which affects all populations and races, children, and adults, and for which the recognition, diagnosis, management, and treatment is still not well standardized. Classical and new chemotherapy drugs, monoclonal antibodies (MoAbs, and small molecules to treat cancer and chronic inflammatory diseases are aimed at improving quality of life and life expectancy of patients, but an increasing number of reactions including anaphylaxis precludes their use in targeted populations. Women are more affected by drug allergy and up to 27% of women with ovarian and breast cancer develop carboplatin allergy after multiple cycles of treatment. Carriers of BRCA genes develop drug allergy after fewer exposures and can present with severe reactions, including anaphylaxis. Atopic patients are at increased risk for chemotherapy and MoAbs drug allergy and the current patterns of treatment with recurrent and intermittent drug exposures may favor the development of drug allergies. To overcome drug allergy, desensitization has been developed, a novel approach which provides a unique opportunity to protect against anaphylaxis and to improve clinical outcomes. There is evidence that inhibitory mechanisms blocking IgE/antigen mast cell activation are active during desensitization, enhancing safety. Whether desensitization modulates drug allergic and anaphylactic responses facilitating tolerance is currently being investigated. This review provides insight into the current knowledge of drug allergy and anaphylaxis to cancer and chronic inflammatory diseases drugs, the mechanisms of drug desensitization and its applications to personalized medicine.

  9. Food-Dependent Exercise-Induced Anaphylaxis - Kasuistik med hydrolyseret valleprotein

    DEFF Research Database (Denmark)

    Junker Christensen, Morten


    Formål / Introduktion: Patienter med Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) eller løbershock kan udvikle livstruende allergiske reaktioner (anafylaksi), når de kombinere fysisk anstrengelse med samtidig indtagelse af et normalt tolereret fødeemne - oftest hvede. Hydrolysering af prot...

  10. Anaphylaxis Imaging: Non-Invasive Measurement of Surface Body Temperature and Physical Activity in Small Animals.

    Directory of Open Access Journals (Sweden)

    Krisztina Manzano-Szalai

    Full Text Available In highly sensitized patients, the encounter with a specific allergen from food, insect stings or medications may rapidly induce systemic anaphylaxis with potentially lethal symptoms. Countless animal models of anaphylaxis, most often in BALB/c mice, were established to understand the pathophysiology and to prove the safety of different treatments. The most common symptoms during anaphylactic shock are drop of body temperature and reduced physical activity. To refine, improve and objectify the currently applied manual monitoring methods, we developed an imaging method for the automated, non-invasive measurement of the whole-body surface temperature and, at the same time, of the horizontal and vertical movement activity of small animals. We tested the anaphylaxis imaging in three in vivo allergy mouse models for i milk allergy, ii peanut allergy and iii egg allergy. These proof-of-principle experiments suggest that the imaging technology represents a reliable non-invasive method for the objective monitoring of small animals during anaphylaxis over time. We propose that the method will be useful for monitoring diseases associated with both, changes in body temperature and in physical behaviour.

  11. [Diagnostic Significance of BAT in Anaphylaxis to Non-ionic Contrast Media]. (United States)

    Zhang, Hao-yue; Xu, Su-jun; Tang, Xiao-xian; Niu, Ji-jun; Guo, Xiang-jie; Gao, Cai-rong


    To investigate the diagnostic significance of basophil activation test (BAT) in anaphylaxis to non-ionic contrast media through testing the content of CD63, mast cell-carboxypeptidase A3 (MC-CPA3), and terminal complement complex SC5b-9 of the individuals by testing their levels in the normal immune group and the anaphylaxis groups to β-lactam drugs and non -ionic contrast media. The CD63 expression of basophilic granulocyte in blood was detected by flow cytometry. The levels of MC-CPA3 in blood serum and SC5b-9 in blood plasma were detected by ELISA. The CD63 expression of basophilic granulocyte in blood, the levels of MC-CPA3 and SC5b-9 of anaphylaxis to non-ionic contrast media and β-lactam drugs were significantly higher than that in normal immune group (P contrast media. BAT can be used to diagnose the anaphylaxis to non-ionic contrast media.

  12. Epidemiology of drug-induced anaphylaxis in a tertiary hospital in Korea

    Directory of Open Access Journals (Sweden)

    Han-Ki Park


    Conclusions: Platinum compounds are the most commonly reported causative agents of in-hospital drug-induced anaphylaxis. Older age ≥70 years and drugs such as iodinated contrast media and aminosteroid NMBA are related with high risk of anaphylactic shock.

  13. EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

    NARCIS (Netherlands)

    Muraro, A.; Agache, I.; Clark, A.; Sheikh, A.; Roberts, G.; Akdis, C. A.; Borrego, L. M.; Higgs, J.; Hourihane, J. O.'B.; Jorgensen, P.; Mazon, A.; Parmigiani, D.; Said, M.; Schnadt, S.; van Os-Medendorp, H.; Vlieg-Boerstra, B. J.; Wickman, M.


    The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to

  14. Nitric oxide decreases intestinal haemorrhagic lesions in rat anaphylaxis independently of mast cell activation

    Directory of Open Access Journals (Sweden)

    J. Carvalho Tavares


    Full Text Available The purpose of this study is to assess the role of nitric oxide (NO in the intestinal lesions of passive anaphylaxis, since this experimental model resembles necrotizing enterocolitis. Sprague-Dawley rats were sensitized with IgE anti-dinitrophenol monoclonal antibody. Extravasation of protein-rich plasma and haemorrhagia were measured in the small intestine. Plasma histamine was measured to assess mast cell activation. The effect of exogenous NO on the lesions was assessed by using two structurally unrelated NO-donors: sodium nitroprusside and S-nitroso-Nacetyl-penicillamine (SNAP. An increased basal production of NO was observed in cells taken after anaphylaxis, associated with a reduced response to platelet-activating factor, interleukin 1beta, and IgE/DNP-bovine serum albumin complexes. The response to bacterial lipopolysaccharide and dibutyryl cyclic adenosine monophosphate (AMP was enhanced 24 h after challenge, but at earlier times was not significantly different from that observed in controls. Treatment with either sodium nitroprusside or SNAP produced a significant reduction of the haemorrhagic lesions, which are a hallmark of rat anaphylaxis. The extravasation of protein-rich plasma was not influenced by NO-donors. The increase of plasma histamine elicited by the anaphylactic challenge was not influenced by SNAP treatment. NO-donors protect intestinal haemorrhagic lesions of rat anaphylaxis by a mechanism apparently independent of mast cell histamine release.

  15. Learning and Treatment of Anaphylaxis by Laypeople: A Simulation Study Using Pupilar Technology

    Directory of Open Access Journals (Sweden)

    Felipe Fernandez-Mendez


    Full Text Available An anaphylactic shock is a time-critical emergency situation. The decision-making during emergencies is an important responsibility but difficult to study. Eye-tracking technology allows us to identify visual patterns involved in the decision-making. The aim of this pilot study was to evaluate two training models for the recognition and treatment of anaphylaxis by laypeople, based on expert assessment and eye-tracking technology. A cross-sectional quasi-experimental simulation study was made to evaluate the identification and treatment of anaphylaxis. 50 subjects were randomly assigned to four groups: three groups watching different training videos with content supervised by sanitary personnel and one control group who received face-to-face training during paediatric practice. To evaluate the learning, a simulation scenario represented by an anaphylaxis’ victim was designed. A device capturing eye movement as well as expert valuation was used to evaluate the performance. The subjects that underwent paediatric face-to-face training achieved better and faster recognition of the anaphylaxis. They also used the adrenaline injector with better precision and less mistakes, and they needed a smaller number of visual fixations to recognise the anaphylaxis and to make the decision to inject epinephrine. Analysing the different video formats, mixed results were obtained. Therefore, they should be tested to evaluate their usability before implementation.

  16. Research to Practice: Developing an Integrated Anaphylaxis Education Curriculum for School Nurses (United States)

    Cavanaugh, Rebecca; Strickland, C. June


    The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for…

  17. Quality indicators for the acute and long-term management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella


    BACKGROUND: The quality of acute and long-term anaphylaxis management is variable and this contributes to the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but implementing guideline recommendations in routine practice is challeng...

  18. EAACI Food Allergy and Anaphylaxis Guidelines : Food allergy health-related quality of life measures

    NARCIS (Netherlands)

    Muraro, A.; Dubois, Anthony; DunnGalvin, A.; Hourihane, J. O'B.; de Jong, N. W.; Meyer, R.; Panesar, S. S.; Roberts, G.; Salvilla, S.; Sheikh, A.; Worth, A.; Flokstra-de Blok, B. M. J.

    Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a

  19. Allergy/Anaphylaxis Management in the School Setting. Position Statement. Revised (United States)

    Zacharski, Susan; DeSisto, Marie; Pontius, Deborah; Sheets, Jodi; Richesin, Cynthia


    It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse), is the leader in a comprehensive management approach…

  20. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy

    NARCIS (Netherlands)

    Muraro, A.; Werfel, T.; Hoffmann-Sommergruber, K.; Roberts, G.; Beyer, K.; Bindslev-Jensen, C.; Cardona, V.; Dubois, A.; duToit, G.; Eigenmann, P.; Fernandez Rivas, M.; Halken, S.; Hickstein, L.; Høst, A.; Knol, E.; Lack, G.; Marchisotto, M. J.; Niggemann, B.; Nwaru, B. I.; Papadopoulos, N. G.; Poulsen, L. K.; Santos, A. F.; Skypala, I.; Schoepfer, A.; van Ree, R.; Venter, C.; Worm, M.; Vlieg-Boerstra, B.; Panesar, S.; de Silva, D.; Soares-Weiser, K.; Sheikh, A.; Ballmer-Weber, B. K.; Nilsson, C.; de Jong, N. W.; Akdis, C. A.


    Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on

  1. Survey of the use of epinephrine (adrenaline) for anaphylaxis by junior hospital doctors. (United States)

    Jose, Ricardo; Clesham, Gerald J


    Anaphylaxis is a life threatening reaction where prompt and appropriate management can save lives. Epinephrine (adrenaline) is the treatment of choice; however, the recommended dose and route of administration of epinephrine used in the management of anaphylaxis is different from that used in the management of cardiac arrest. To investigate how junior doctors would administer epinephrine in a case of anaphylactic shock in an adult patient. Junior medical staff in two district general hospitals were assessed with a short questionnaire. 95 junior hospital doctors were assessed. The majority (94%) would administer epinephrine as the life saving drug of choice, but only 16.8% would administer it as recommended by the UK Resuscitation Council Guidelines. Junior doctors may be called to make immediate management decisions in patients with anaphylaxis; however, widespread confusion exists regarding the dose and route of administration of epinephrine. Strategies to improve education and access to appropriate drugs are needed. A labelled "anaphylaxis box" on every resuscitation trolley, containing the dose of epinephrine with clear labelling for intramuscular use, may be one solution.

  2. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. (United States)

    Decker, Wyatt W; Campbell, Ronna L; Manivannan, Veena; Luke, Anuradha; St Sauver, Jennifer L; Weaver, Amy; Bellolio, M Fernanda; Bergstralh, Eric J; Stead, Latha G; Li, James T C


    Reported incidences of anaphylaxis range from 3.2 to 20 per 100,000 population. The incidence and trend over time has meaningful public health implications but has not been well characterized because of a lack of a standard definition and deficiencies in reporting of events. We sought to determine the incidence and cause of anaphylaxis over a 10-year period. We performed a population-based incidence study that was conducted in Rochester, Minnesota, from 1990 through 2000. Anaphylaxis episodes were identified on the basis of symptoms and signs of mast cell and basophil mediator release plus mucocutaneous, gastrointestinal tract, respiratory tract, or cardiovascular system involvement. Two hundred eleven cases of anaphylaxis were identified (55.9% in female subjects). The mean age was 29.3 years (SD, 18.2 years; range, 0.8-78.2 years). The overall age- and sex-adjusted incidence rate was 49.8 (95% CI, 45.0-54.5) per 100,000 person-years. Age-specific rates were highest for ages 0 to 19 years (70 per 100,000 person-years). Ingested foods accounted for 33.2% (70 cases), insect stings accounted for 18.5% (39 cases), medication accounted for 13.7% (29 cases), radiologic contrast agent accounted for 0.5% (1 case), "other" causes accounted for 9% (19 cases), and "unknown" causes accounted for 25.1% (53 cases). The "other" group included cats, latex, cleaning agents, environmental allergens, and exercise. There was an increase in the annual incidence rate during the study period from 46.9 per 100,000 persons in 1990 to 58.9 per 100,000 persons in 2000 (P = .03). The overall incidence rate is 49.8 per 100,000 person-years, which is higher than previously reported. The annual incidence rate is also increasing. Food and insect stings continue to be major inciting agents for anaphylaxis.

  3. Treatment with epinephrine (adrenaline) in suspected anaphylaxis during anesthesia in Denmark. (United States)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens; Husum, Bent; Malling, Hans-Jørgen; Mosbech, Holger


    Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.

  4. Endothelial Regulator of Calcineurin 1 Promotes Barrier Integrity and Modulates Histamine-Induced Barrier Dysfunction in Anaphylaxis

    DEFF Research Database (Denmark)

    Ballesteros-Martinez, Constanza; Mendez-Barbero, Nerea; Montalvo-Yuste, Alma


    anaphylaxis. Functionalin vitroassays showed that overexpression of Rcan1 promotes barrier integrity, suggesting a role played by this molecule in vascular permeability. Consistent with these findings,in vivomodels of subcutaneous and intravenous histamine-mediated fluid extravasation showed increased...

  5. Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland. (United States)

    Worm, Margitta; Eckermann, Oliver; Dölle, Sabine; Aberer, Werner; Beyer, Kirsten; Hawranek, Thomas; Hompes, Stephanie; Koehli, Alice; Mahler, Vera; Nemat, Katja; Niggemann, Bodo; Pföhler, Claudia; Rabe, Uta; Reissig, Angelika; Rietschel, Ernst; Scherer, Kathrin; Treudler, Regina; Ruëff, Franziska


    Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year. We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis. The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols. Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was age-dependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above.

  6. Statewide prevalence of school children at risk of anaphylaxis and rate of adrenaline autoinjector activation in Victorian government schools, Australia. (United States)

    Loke, Paxton; Koplin, Jennifer; Beck, Cara; Field, Michael; Dharmage, Shyamali C; Tang, Mimi L K; Allen, Katrina J


    The prevalence of school students at risk of anaphylaxis in Victoria is unknown and has not been previously studied. Similarly, rates of adrenaline autoinjector usage in the school environment have yet to be determined given increasing prescription rates. We sought to determine time trends in prevalence of school children at risk of anaphylaxis across all year levels and the annual usage rate of adrenaline autoinjectors in the school setting relative to the number of students at risk of anaphylaxis. Statewide surveys from more than 1,500 government schools including more than 550,000 students were used and prevalence rates (%) with 95% CIs were calculated. The overall prevalence of students at risk of anaphylaxis has increased 41% from 0.98% (95% CI, 0.95-1.01) in 2009 to 1.38% (95% CI, 1.35-1.41) in 2014. There was a significant drop in reporting of anaphylaxis risk with transition from the final year of primary school to the first year of secondary school, suggesting a change in parental reporting of anaphylaxis risk among secondary school students. The number of adrenaline autoinjectors activated per 1000 students at risk of anaphylaxis ranged from 6 to 8 per year, with consistently higher activation use in secondary school students than in primary school students. Statewide prevalence of anaphylaxis risk has increased in children attending Victorian government schools. However, adrenaline autoinjector activation has remained fairly stable despite known increase in the rates of prescription. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Should adrenaline be used in patients with hemodynamically stable anaphylaxis? Incident case control study nested within a retrospective cohort study. (United States)

    Ko, Byuk Sung; Kim, Ji Yeon; Seo, Dong-Woo; Kim, Won Young; Lee, Jae Ho; Sheikh, Aziz; Bates, David W


    Although adrenaline (epinephrine) is a cornerstone of initial anaphylaxis treatment, it is not often used. We sought to assess whether use of adrenaline in hemodynamically stable patients with anaphylaxis could prevent the development of hypotension. We conducted a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care hospital over a 10-year period. We divided the patients into two groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Of the 340 patients with anaphylaxis who were normotensive at first presentation, 40 patients experienced hypotension during their ED stay. The ED stay of the hypotension group was significantly longer than that of patients who did not experience hypotension (496 min vs 253 min, P = 0.000). Adrenaline use in hemodynamically stable anaphylaxis patient was independently associated with a lower risk of developing in-hospital occurrence of hypotension: OR, 0.254 [95% CI, 0.091-0.706]. Adrenaline use in hemodynamically stable anaphylaxis patients was associated with a reduced risk of developing in-hospital occurrence of hypotension. Adverse events induced by adrenaline were rare when the intramuscular route was used.

  8. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia

    DEFF Research Database (Denmark)

    Kroigaard, M; Garvey, L H; Gillberg, L


    The present approach to the diagnosis, management and follow-up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists....... It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which, owing...... titration of adrenaline (epinephrine) and fluid therapy as first-line treatment. Recommendations for primary and secondary follow-up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek...

  9. Perceived history of anaphylaxis and parental overprotection, autonomy, anxiety, and depression in food allergic young adults. (United States)

    Herbert, Linda J; Dahlquist, Lynnda M


    This study examined autonomy, anxiety, depression, and perceptions of parental behavior in 86 food allergic young adults and 344 healthy young adults between the ages of 18 and 22. Participants completed an online survey measuring self-reported autonomy, anxiety, depression, and perceptions of parental behavior. Results indicated that, as a group, food allergic young adults did not differ from healthy peers. However, food allergic young adults who reported having experienced an anaphylactic reaction described their disease as more severe, reported more worry about their disease, and rated their parents as more overprotective than food allergic young adults who reported never having experienced anaphylaxis. The experience of anaphylaxis may be a reliable indicator of food allergic individuals who are at risk for psychological distress.

  10. Two episodes of anaphylaxis following exposure to hydroxypropyl methylcellulose during cataract surgery

    DEFF Research Database (Denmark)

    Munk, Sofie J; Heegaard, Steffen; Mosbech, Holger


    UNLABELLED: We report a case of immediate severe anaphylaxis to hydroxypropyl methylcellulose (HPMC) on 2 separate occasions during cataract surgery in a 71-year-old patient. Skin prick tests were positive for HPMC, a constituent of Ocucoat and Xylocaine gel, which were administered intraocularly...... during surgery. Skin prick tests were also positive for methylcellulose. Based on symptoms and clinical signs of anaphylaxis following 2 separate cataract operations together with positive prick tests to HPMC, HPMC is the most plausible cause of the reactions. The patient has since had uneventful surgery...... for a detached retina avoiding HPMC. This case stresses the importance of considering all medication given to patients as possible causes of an anaphylactic reaction. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned....

  11. Living with severe allergy: an Anaphylaxis Campaign national survey of young people. (United States)

    Worth, Allison; Regent, Lynne; Levy, Mark; Ledford, Carey; East, Mandy; Sheikh, Aziz


    The transition to adulthood can be particularly challenging for young people with severe allergies, who must learn to balance personal safety with independent living. Information and support for young people and their families are crucial to successfully managing this transition. We sought to: gather insights into the impact of severe allergies on the lives of young people; explore where young people go for information about anaphylaxis and what information they want and need; identify areas where further support is needed. An online questionnaire survey of young people aged 15-25 years with severe allergies in the United Kingdom (UK) was conducted on behalf of the Anaphylaxis Campaign, the main patient support organisation. Participants were recruited mainly from the Anaphylaxis Campaign membership database and also via allergy clinics and social media. The study was funded by the Anaphylaxis Campaign's In Memoriam Fund. A total of 520 young people responded to the survey. The majority had lived with severe allergies since they were young children; 59% reported having attended Accident and Emergency units as a consequence of their allergies. Only 66% of respondents reported always carrying their epinephrine auto-injectors; only 23% had ever used these. Few were currently receiving specialist allergy care; younger respondents were more likely to be under specialist care (34%) than those 18 years and above (23%). Respondents wanted more information about eating out (56%), travelling (54%) and food labelling (43%). Almost a quarter of respondents (23%) reported needing more information on managing their allergies independently without parental help. Managing allergies in the context of social relationships was a concern for 22% of respondents. This survey has identified the information and support needs and gaps in service provision for young people with severe allergies. Healthcare professionals and patient support organisations, with the support of the food

  12. School personnel's self-efficacy in managing food allergy and anaphylaxis. (United States)

    Polloni, Laura; Baldi, Ileana; Lazzarotto, Francesca; Bonaguro, Roberta; Toniolo, Alice; Celegato, Nicolò; Gregori, Dario; Muraro, Antonella


    Food allergy affects up to 4-7% European schoolchildren. Studies identified important shortcomings on food allergy and anaphylaxis management in schools. In social cognitive theory, personal beliefs in own capabilities influence choices, effort levels, perseverance and performance accomplishments. This study aimed to investigate school personnel's self-efficacy in managing food allergy and anaphylaxis, providing a valid instrument to deeply understand how to support schools to effectively manage students at risk of food reactions. A total of 440 schoolteachers and caretakers from north-east Italy completed a questionnaire assessing self-efficacy in managing food allergy and anaphylaxis at school. Exploratory factor analysis was performed. Factors' internal consistency was evaluated using Cronbach's alpha. Factors' scores were estimated using Bartlett approach, and kernel density estimate of distributions was provided. Descriptive statistics explored school personnel's self-efficacy. A regression model assessed the influence of gender, school, job and previous experience. Two factors emerged from exploratory factor analysis related to anaphylaxis management (AM) and food allergy management (FAM). The two subscales both showed good internal consistency. School personnel showed lower self-efficacy in recognizing symptoms, administering drugs and guaranteeing full participation to extra-curricular activities to food-allergic students. Participants who previously had food-allergic students showed a significantly increased self-efficacy in AM and a significantly decreased self-efficacy in FAM. The study supports the use of self-efficacy scale to identify specific areas where teachers' confidence in their ability to care for food-allergic students is especially weak. This would empower the development of training programs specifically tailored to the needs of teachers and caregivers. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Epinephrine Auto-Injector Versus Drawn Up Epinephrine for Anaphylaxis Management: A Scoping Review. (United States)

    Chime, Nnenna O; Riese, Victoria G; Scherzer, Daniel J; Perretta, Julianne S; McNamara, LeAnn; Rosen, Michael A; Hunt, Elizabeth A


    Anaphylaxis is a life-threatening event. Most clinical symptoms of anaphylaxis can be reversed by prompt intramuscular administration of epinephrine using an auto-injector or epinephrine drawn up in a syringe and delays and errors may be fatal. The aim of this scoping review is to identify and compare errors associated with use of epinephrine drawn up in a syringe versus epinephrine auto-injectors in order to assist hospitals as they choose which approach minimizes risk of adverse events for their patients. PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were searched using terms agreed to a priori. We reviewed human and simulation studies reporting errors associated with the use of epinephrine in anaphylaxis. There were multiple screening stages with evolving feedback. Each study was independently assessed by two reviewers for eligibility. Data were extracted using an instrument modeled from the Zaza et al instrument and grouped into themes. Three main themes were noted: 1) ergonomics, 2) dosing errors, and 3) errors due to route of administration. Significant knowledge gaps in the operation of epinephrine auto-injectors among healthcare providers, patients, and caregivers were identified. For epinephrine in a syringe, there were more frequent reports of incorrect dosing and erroneous IV administration with associated adverse cardiac events. For the epinephrine auto-injector, unintentional administration to the digit was an error reported on multiple occasions. This scoping review highlights knowledge gaps and a diverse set of errors regardless of the approach to epinephrine preparation during management of anaphylaxis. There are more potentially life-threatening errors reported for epinephrine drawn up in a syringe than with the auto-injectors. The impact of these knowledge gaps and potentially fatal errors on patient outcomes, cost, and quality of care is worthy of further investigation.

  14. Glucagon Effects on 3H-Histamine Uptake by the Isolated Guinea-Pig Heart during Anaphylaxis (United States)

    Rosic, Mirko; Parodi, Oberdan; Jokovic, Vuk; Pantovic, Suzana


    We estimated the influence of acute glucagon applications on 3H-histamine uptake by the isolated guinea-pig heart, during a single 3H-histamine passage through the coronary circulation, before and during anaphylaxis, and the influence of glucagon on level of histamine, NO, O2 −, and H2O2 in the venous effluent during anaphylaxis. Before anaphylaxis, glucagon pretreatment does not change 3H-histamine Umax and the level of endogenous histamine. At the same time, in the presence of glucagon, 3H-histamine Unet is increased and backflux is decreased when compared to the corresponding values in the absence of glucagon. During anaphylaxis, in the presence of glucagon, the values of 3H-histamine Umax and Unet are significantly higher and backflux is significantly lower in the presence of glucagon when compared to the corresponding values in the absence of glucagon. The level of endogenous histamine during anaphylaxis in the presence of glucagon (6.9–7.38 × 10−8  μM) is significantly lower than the histamine level in the absence of glucagon (10.35–10.45 × 10−8  μM). Glucagon pretreatment leads to a significant increase in NO release (5.69 nmol/mL) in comparison with the period before glucagon administration (2.49 nmol/mL). Then, in the presence of glucagon, O2 − level fails to increase during anaphylaxis. Also, our results show no significant differences in H2O2 levels before, during, and after anaphylaxis in the presence of glucagon, but these values are significantly lower than the corresponding values in the absence of glucagon. In conclusion, our results show that glucagon increases NO release and prevents the increased release of free radicals during anaphylaxis, and decreases histamine level in the venous effluent during cardiac anaphylaxis, which may be a consequence of decreased histamine release and/or intensified histamine capturing by the heart during anaphylaxis. PMID:24895609

  15. Anaphylaxis to Polyethylene Glycol (Colyte®) in a Patient with Diverticulitis. (United States)

    Lee, So Hee; Hwang, Sun Hyuk; Park, Jin Soo; Park, Hae Sim; Shin, Yoo Seob


    Polyethylene glycols (PEGs) are believed to be chemically inert agents, but larger PEG polymers could have immunogenicity. A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte®). In laboratory findings, the initial serum tryptase level was increased to 91.9 mg/L (normal range: 0.00-11.40 mg/L) without any other laboratory abnormalities. The intradermal test with 10 mg/mL Colyte® showed a 5 × 5 mm wheal, but basophil activation and histamine releasability tests were negative. PEG-3350 is widely used as an osmotic laxative due to its lack of absorption from the gastrointestinal tract. However, the loss of mucosal integrity at gastrointestinal membrane such as diverticulitis may be a predisposing factor for anaphylaxis to Colyte®. We report a case of anaphylaxis induced by the ingestion of PEG-3350 in a patient with diverticulitis which might be a risk factor of anaphylaxis.

  16. [Anaphylaxis needing adrenaline administration during anesthesia: a 7-year single-institution study]. (United States)

    Kayashima, Kenji; Sozen, Reiko


    Adrenaline is the key treatment for acute anaphylaxis; however, it is difficult to use it appropriately in terms of dosage and timing. If used incorrectly, adrenaline can cause cardiac infarction, stroke, recurrence and other problems. We collected data of suspected anaphylaxis from records in our anesthesia department between April 2005 and March 2012. All cases where the skin of patients turned red and blood pressure decreased continuously were included. We analyzed the usage of adrenaline in these cases. Six (0.034%) suspected anaphylaxis cases were analyzed from a total of 27,597 anesthesia cases. Adrenaline was administered subcutaneously in 2 cases, intravenously in 3 cases, and with and infused in 1 case. In the 4 cases with intravenous administration, the median dose was 0.52 (range : 0.02-1.6) mg. Following decreased and unstable blood pressure, adrenaline was initiated after a median of 12.5 (5-25) min, and blood pressure returned to normal after 20 (5-95) min. Patients were extubated 19 (4-24) hours after observation of anomalous blood pressure. No aftereffects or recurrences were observed. Adrenaline was administered appropriately in terms of dosage, but timing should have been earlies in 3 of 6 cases.

  17. Prescriptions for self-injectable epinephrine and follow-up referral in emergency department patients presenting with anaphylaxis. (United States)

    Campbell, Ronna L; Luke, Anuradha; Weaver, Amy L; St Sauver, Jennifer L; Bergstralh, Eric J; Li, James T; Manivannan, Veena; Decker, Wyatt W


    Anaphylaxis guidelines recommend that patients with a history of anaphylactic reaction should carry self-injectable epinephrine and should be referred to an allergist. To evaluate how frequently patients dismissed from the emergency department after treatment for anaphylaxis received a prescription for self-injectable epinephrine or allergist referral. A retrospective medical record review identified patients with anaphylaxis in a community-based study from 1990 through 2000. Records of patients with Hospital Adaptation of the International Classification of Diseases, Second Edition or International Classification of Diseases, Ninth Revision codes representing anaphylaxis were reviewed, and a random sample of patients with associated diagnoses was also reviewed. Patients who met the criteria for diagnosis of anaphylaxis were included in the study. Among 208 patients identified with anaphylaxis, 134 (64.4%) were seen in the emergency department and discharged home. On dismissal, 49 patients (36.6%; 95% confidence interval [CI], 28.4%-44.7%) were prescribed self-injectable epinephrine, and 42 patients (31.3%; 95% CI, 23.5%-39.2%) were referred to an allergist. Treatment with epinephrine in the emergency department (odds ratio, 3.6; 95% CI, 1.6-7.9; P = .001) and insect sting as the inciting allergen (odds ratio, 4.0; 95% CI, 1.6-10.5; P = .004) were significantly associated with receiving a prescription for self-injectable epinephrine. Patient age younger than 18 years was the only factor associated with referral to an allergist (P = .007). Most patients dismissed after treatment for anaphylaxis did not receive a self-injectable epinephrine prescription or allergist referral. Emergency physicians may be missing an important opportunity to ensure prompt treatment of future anaphylactic reactions and specialized follow-up care.

  18. Predictors of epinephrine dispensing and allergy follow-up after emergency department visit for anaphylaxis. (United States)

    Motosue, Megan; Bellolio, M Fernanda; Van Houten, Holly K; Shah, Nilay D; Campbell, Ronna L


    National guidelines recommend that patients with anaphylaxis be prescribed an epinephrine auto-injector (EAI) and referred to an allergy/immunology (A/I) specialist. To evaluate guideline concordance and identify predictors of EAI dispensing and A/I follow-up in patients with anaphylaxis treated in the emergency department (ED). We identified patients seen in the ED for anaphylaxis from 2010 through 2014 from an administrative claims database using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Of 7,790 patients identified, 46.5% had an EAI dispensed and 28.8% had A/I follow-up within 1 year after discharge. On multivariable analysis, those 65 years or older (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.30-0.41) and with a medication trigger (OR 0.24, 95% CI 0.21-0.28) had a lower likelihood of EAI dispensing. Those younger than 5 years (OR 2.67, 95% CI 2.15-3.32) and with food (OR 1.40, 95% CI 1.24-1.59) or venom (OR 4.48, 95% CI 3.51-5.72) triggers had a higher likelihood of EAI dispensing. Similarly, for A/I follow-up, the likelihood was lower for age 65 years or older (OR 0.46, 95% CI 0.39-0.54) and medication trigger (OR 0.66, 95% CI 0.56-0.78) and higher for age younger than 5 years (OR 3.15, 95% CI 2.63-3.77) and food trigger (OR 1.39, 95% CI 1.22-1.58). Overall, 46.5% of patients with anaphylaxis in the ED had EAI dispensing and 28.8% had A/I follow-up. Patient age and triggers were associated with likelihood of EAI dispensing and A/I follow-up. Post-ED visit anaphylaxis management can be improved, with the potential to decrease future morbidity and mortality risk. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. Influence of glucocorticoids on time-of-day-dependent variations in IgE-, histamine-, and platelet-activating factor-mediated systemic anaphylaxis in different mouse strains. (United States)

    Hasegawa, Ayana; Watanabe, Miwa; Osada, Hironari; Ogawa, Misato; Ohno, Hikaru; Yanuma, Nanako; Sasaki, Kazuaki; Shimoda, Minoru; Shirai, Junsuke; Ohmori, Keitaro


    A time-of-day-dependent variation in IgE-mediated passive systemic anaphylaxis was previously reported in ICR mice. In the present study, we investigated time-of-day-dependent variations in IgE-, histamine-, and platelet-activating factor (PAF)-mediated systemic anaphylaxis in C57BL/6, BALB/c, and NC/Nga mice at 9:00 h and 21:00 h, and evaluated the potential influence of glucocorticoids (GCs) on these variations. We found significant time-of-day-dependent variations in IgE-mediated systemic anaphylaxis in C57BL/6 mice, and in histamine- and PAF-mediated systemic anaphylaxis in BALB/c mice. Significant daily variations in IgE-, histamine-, and PAF-mediated systemic anaphylaxis were not observed in NC/Nga mice. Pretreatment with dexamethasone and adrenalectomy abolished the daily variations in IgE-mediated systemic anaphylaxis in C57BL/6 mice and in PAF-mediated systemic anaphylaxis in BALB/c mice, suggesting that GCs from adrenal glands are pivotal in regulating these variations. In contrast, pretreatment with dexamethasone and adrenalectomy did not abolish the daily variation in histamine-mediated systemic anaphylaxis in BALB/c mice, suggesting that GC-independent and adrenal gland-independent mechanisms are important for the variation. The present study demonstrated that time-of-day-dependent variations in systemic anaphylaxis differed among inbred mouse strains and with anaphylaxis-inducing substances. Thus, mouse strains, time of experiment, and anaphylaxis-inducing substances used must be considered to obtain appropriate experimental results. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. What are the 'ideal' features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis? (United States)

    Frew, A J


    Anaphylaxis is a systemic allergic reaction that often involves respiratory symptoms and cardiovascular collapse, which are potentially life-threatening if not treated promptly with intramuscular adrenaline. Owing to the unpredictable nature of anaphylaxis and accidental exposure to allergens (such as peanuts and shellfish), patients should be prescribed intramuscular adrenaline auto-injectors and carry these with them at all times. Patients also need to be able to use their auto-injectors correctly while under high stress, when an anaphylactic attack occurs. Despite this, an alarming number of patients fail to carry their auto-injectors and many patients, carers of children with known anaphylaxis and healthcare professionals do not know how to use the device correctly, despite having had training. Currently available auto-injector devices have various limitations that may impede their use in the management of anaphylaxis. There is also a lack of validated assessment criteria and regulatory requirements for new devices. This review describes the different delivery systems used in currently available auto-injectors and discusses the key barriers to the use of adrenaline auto-injectors, with the goal of identifying the 'ideal' features/characteristics of such devices in the emergency treatment of anaphylaxis that will ensure ease of use, portability and accurate delivery of a life-saving drug. © 2010 John Wiley & Sons A/S.

  1. We're Not Doctors and Nurses: The Teacher's Role in the Management of Anaphylaxis in Primary School Settings (United States)

    Eastwood, Kate; Cutter-Mackenzie, Amy


    Worldwide the prevalence of severe and life threatening allergies is rising. In 2007 35% of Victorian schools had students at-risk for anaphylaxis (Office of the Premier), and three children have allegedly died from anaphylaxis in Australian school and early childhood education settings during the last six years alone. Teaching personnel are…

  2. Anti-FcγRIIB mAb suppresses murine IgG-dependent anaphylaxis by Fc domain targeting of FcγRIII. (United States)

    Clay, Corey D; Strait, Richard T; Mahler, Ashley; Khodoun, Marat V; Finkelman, Fred D


    The inhibitory receptor FcγRIIB is expressed on human and murine bone marrow-derived cells and limits inflammation by suppressing signaling through stimulatory receptors. We sought to evaluate the effects of K9.361, a mouse IgG 2a alloantibody to mouse FcγRIIB, on murine anaphylaxis. Wild-type and FcγR-deficient mice were used to study anaphylaxis, which was induced by injection of 2.4G2 (rat IgG 2b mAb that binds both FcγRIIB and the stimulatory receptor FcγRIII), by actively immunizing IgE-deficient mice and then challenging with the immunizing antigen, and by passive immunization with IgG or IgE anti-2,4,6-trinitrophenyl mAb, followed by injection of 2,4,6-trinitrophenyl-ovalbumin. Pretreatment with K9.361 was assessed for its ability to influence anaphylaxis. Unexpectedly, K9.361 injection induced mild anaphylaxis, which was both FcγRIIB and FcγRIII dependent and greatly enhanced by β-adrenergic blockade. K9.361 injection also decreased expression of stimulatory Fcγ receptors, especially FcγRIII, and strongly suppressed IgG-mediated anaphylaxis without strongly affecting IgE-mediated anaphylaxis. The F(ab') 2 fragment of K9.361 did not induce anaphylaxis, even after β-adrenergic blockade, and did not deplete FcγRIII or suppress IgG-mediated anaphylaxis but prevented intact K9.361-induced anaphylaxis without diminishing intact K9.36 suppression of IgG-mediated anaphylaxis. Cross-linking FcγRIIB to stimulatory FcγRs through the Fc domains of an anti-FcγRIIB mAb induces and then suppresses IgG-mediated anaphylaxis without affecting IgE-mediated anaphylaxis. Because IgG- and IgE-mediated anaphylaxis can be mediated by the same cell types, this suggests that desensitization acts at the receptor rather than cellular level. Sequential treatment with the F(ab') 2 fragment of anti-FcγRIIB mAb followed by intact anti-FcγRIIB safely prevents IgG-mediated anaphylaxis. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier

  3. Successful administration of measles-rubella-mumps vaccine by graded challenge in a case with anaphylaxis after prior vaccination. (United States)

    Tuncel, Tuba; Sancakli, Ozlem; Ozdogru, Ece


    Egg allergy is one of the most common food allergies during childhood along with cow's milk allergy. The measles-mumpsrubella (MMR) vaccine is included in the pediatric immunization schedule and contains egg protein. The currently accepted opinion is that the MMR vaccination should be done in a single dose under medical observation in patients with egg allergy. Although it is reported that the MMR vaccine is safe for that patients, there are some patients who developed anaphylaxis. Generally, the development of anaphylaxis after the previous vaccination is reported as a contraindication. We present a successful administration of MMR vaccine by gradually increased doses for a patient who developed anaphylaxis after the previous vaccination. Sociedad Argentina de Pediatría.

  4. Effect of a cocoa-enriched diet on immune response and anaphylaxis in a food allergy model in Brown Norway rats. (United States)

    Abril-Gil, Mar; Pérez-Cano, Francisco J; Franch, Àngels; Castell, Margarida


    Previous studies have demonstrated that cocoa intake decreased Th2 immune-related antibodies in rats. In consequence, we aimed to study in depth this cocoa action, particularly assessing its effect on a rat model of food allergy (FA) and also on an anaphylactic response. The involvement of the intestinal immune system was analyzed to allow the action mechanisms to be investigated. The role of cocoa flavonoids in the antiallergic properties of cocoa was also established. Brown Norway rats were fed either a reference diet or diets containing conventional cocoa (CC) or nonfermented cocoa (NFC). FA to ovalbumin (OVA) was induced and, later, an anaphylactic response was provoked. As expected, the synthesis of anti-OVA IgE and other Th2-related antibodies was inhibited by CC diet. In addition, the release of mast cell protease II after anaphylaxis was partially prevented by CC, although other variables were not modified. The CC diet also attenuated the increase of some Th2-related cytokines released from mesenteric lymph node and spleen cells, and modulated the intestinal gene expression of molecules involved in allergic response. These results demonstrated the local and systemic influence of CC diet. The effects of the NFC diet were weaker than those of CC, suggesting that cocoa components other than flavonoids play a role in cocoa's action. In conclusion, by acting on intestinal and systemic immune functions, a cocoa-enriched diet in rats exhibited a protective effect against FA and partially against anaphylaxis, making this a food of high interest to the fields of health and immunonutrition. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Value of a Second Dose of Epinephrine During Anaphylaxis: A Patient/Caregiver Survey. (United States)

    Song, T Ted; Brown, Duncan; Karjalainen, Martin; Lehnigk, Ulrike; Lieberman, Phil


    Anaphylaxis guidelines recommend prescription of more than 1 epinephrine autoinjector (EAI) for patients at risk. A second epinephrine dose is required in 16% to 36% of patients. To evaluate real-world use of EAIs and understand the patients'/caregivers' adherence to guidelines. We collected survey responses from US patients and caregivers with an EAI prescription in November 2015. The survey covered several domains relevant to anaphylaxis and EAI use. The survey was completed by 953 respondents (505 patients and 448 caregivers). Most respondents were women (71%). Most of the respondents had previously administered an EAI (75%). The mean age of the respondents was 28 ± 14.0 years. A total of 786 (82%) respondents did not carry 2 EAIs all the time, and the main reason given was to have 1 EAI in another location. Most respondents kept at least 1 EAI at home (84%). The percentages of respondents with more than 1 EAI available at locations surveyed were low (patients: 22% at home, 2% at work; caregivers: 27% at home, 10% at school). During training, most respondents (64%) were instructed to always carry 1 EAI and keep the other in another location. Half of the respondents reported the use of a second epinephrine dose in a previous event. Forty-five percent of the 73 respondents who sought emergency care did so because of the unavailability of a second dose. Our study suggests poor adherence in patients and caregivers to anaphylaxis guidelines recommending more than 1 EAI available at all times and implies that this can result in adverse outcomes. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines. (United States)

    Fiedler, Claudia; Miehe, Ulrich; Treudler, Regina; Kiess, Wieland; Prenzel, Freerk


    Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial. © 2017 S. Karger AG, Basel.

  7. The tripeptide feG ameliorates systemic inflammatory responses to rat intestinal anaphylaxis

    Directory of Open Access Journals (Sweden)

    Davison Joseph S


    Full Text Available Abstract Background Food allergies are generally associated with gastrointestinal upset, but in many patients systemic reactions occur. However, the systemic effects of food allergies are poorly understood in experimental animals, which also offer the opportunity to explore the actions of anti-allergic drugs. The tripeptide D-phenylalanine-D-glutamate-Glycine (feG, which potentially alleviates the symptoms of systemic anaphylactic reactions, was tested to determine if it also reduced systemic inflammatory responses provoked by a gastric allergic reaction. Results Optimal inhibition of intestinal anaphylaxis was obtained when 100 μg/kg of feG was given 20 min before the rats were challenged with antigen. The increase in total circulating neutrophils and accumulation of neutrophils in the heart, developing 3 h and 24 h, respectively, after antigen challenge were reduced by both feG and dexamethasone. Both anti-inflammatory agents reduced the increase in vascular permeability induced by antigen in the intestine and the peripheral skin (pinna, albeit with different time courses. Dexamethasone prevented increases in vascular permeability when given 12 h before antigen challenge, whereas feG was effective when given 20 min before ingestion of antigen. The tripeptide prevented the anaphylaxis induced up regulation of specific antibody binding of a cell adhesion molecule related to neutrophil activation, namely CD49d (α4 integrin. Conclusions Aside from showing that intestinal anaphylaxis produces significant systemic inflammatory responses in non-intestinal tissues, our results indicate that the tripeptide feG is a potent inhibitor of extra-gastrointestinal allergic reactions preventing both acute (30 min and chronic (3 h or greater inflammatory responses.

  8. Component-resolved diagnosis of baker's allergy based on specific IgE to recombinant wheat flour proteins. (United States)

    Sander, Ingrid; Rihs, Hans-Peter; Doekes, Gert; Quirce, Santiago; Krop, Esmeralda; Rozynek, Peter; van Kampen, Vera; Merget, Rolf; Meurer, Ursula; Brüning, Thomas; Raulf, Monika


    Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma. We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen. Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses. Eighty percent of bakers had specific IgE levels of 0.35 kUA/L or greater and 91% had specific IgE levels of 0.1 kUA/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric α-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric α-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor-like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour-specific IgE (AUC = 0.89 or 0.88, respectively). Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however

  9. Factors that determine parents' perception of their child's risk of life-threatening food-induced anaphylaxis. (United States)

    Ogg, Jennifer; Wong, Jayne; Wan, Ming Wai; Davis, Naomi; Arkwright, Peter D


    Although food allergy is known to be associated with increased disease burden, factors that shape parents' perception of their child's risk of future severe or fatal anaphylaxis are poorly understood. This study aimed to evaluate factors associated with parents' perceived risk of food-induced anaphylaxis. A questionnaire-based survey of 202 parents was conducted in a single specialist center outpatient clinic that treats children with food allergies. Parents' perceived risk of their child experiencing further food-induced anaphylaxis was assessed by using a validated food allergy independent measure. Demographic data as well as parents' anxiety and depression scores were assessed by using the Hospital Anxiety and Depression score. Nineteen percent of parents believed that their child had a moderate-to-high chance of dying from food-induced anaphylaxis. A lack of a university education, higher anxiety score, and, particularly, possession of an epinephrine autoinjector (relative risk 9.9 [95% confidence interval, 3.3-30]) were key factors associated with heightened risk perception. Caring for a child with multiple food allergies was the main factor associated with parents feeling less able to manage future reactions (relative risk 9.5 [95% confidence interval, 1.7-53]). Parents' risk perception of fatal anaphylaxis correlated with anxiety and mood scores. Parents' education, affect, and possession of an epinephrine autoinjector were associated with a heightened perceived risk of future anaphylaxis. Clinicians should consider not only the child's needs but should also provide counseling for parents, particularly those who possess autoinjectors. Parents of children with multiple food allergies may need additional education and training to help them cope with future reactions.

  10. Sudden cardiovascular collapse caused by severe anaphylaxis after cisatracurium use: a case report. (United States)

    Yoon, Syn-Hae; Bang, Ji-Yeon; Seo, Hyungseok; Song, Jun-Gol


    Kounis syndrome is an acute coronary syndrome concurrently occurs with allergic or hypersensitivity reactions. In patient with this syndrome, inflammatory mediators released due to an allergic reaction implicate to induce coronary artery spasm and atheromatous plaque rupture. We describe a patient with coronary artery disease who developed acute perioperative myocardial infarction leading to cardiac arrest after the anaphylactic reaction to cisatracurium, which led to a suspicion of Kounis syndrome. Anesthesiologists should be aware that anaphylaxis or allergic reactions can progress to acute coronary syndrome, thereby significantly change the course of the disease.

  11. Contrast Media–Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report

    Directory of Open Access Journals (Sweden)

    Rajeev Seecheran


    Full Text Available Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies.

  12. Contrast Media–Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report (United States)

    Seecheran, Rajeev; Seecheran, Valmiki; Persad, Sangeeta; Lalla, Sasha; Seecheran, Naveen Anand


    Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs) have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies. PMID:28607937

  13. Contrast Media-Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report. (United States)

    Seecheran, Rajeev; Seecheran, Valmiki; Persad, Sangeeta; Lalla, Sasha; Seecheran, Naveen Anand


    Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs) have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies.

  14. Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France. (United States)

    Picaud, J; Beaudouin, E; Renaudin, J M; Pirson, F; Metz-Favre, C; Dron-Gonzalvez, M; Moneret-Vautrin, D A


    Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Farkas, Dóra Körmendiné; Vestergaard, Hanne


    , venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9-2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4-16.3). Specifically, we found a HR of 7.......9-3.2); and for stroke a HR of 1.6 (95% CI 1.1-2.3) with a 10-year AR of 4.6% (95% CI 2.8-6.9). The HR for anaphylaxis was 7.2 (95% CI 5.3-9.9), and the 10-year AR was 3.1% (95% CI 1.9-4.9). For osteoporosis the HR was 3.6 (95% CI 2.7-4.6) with a 10-year AR of 7.2% (95% CI 5.2-9.8). For fractures the HR was 1.2 (95% CI...


    Nagakura, Toshikazu; Tanaka, Katsuichirou; Horikawa, Satoshi


    We here report a 34-years old male who had nattou-(fermented-soybean) induced late-onset anaphylaxis following SCUBA diving to about 20 m in the ocean off a small remote Japanese island (Kuroshima, Okinawa). He had eaten nattou for breakfast at 7:30 am. He traveled by boat to the dive site, dove twice and then ate lunch at 12:30 on the diving boat (no nattou at lunch). After lunch at 14:30 he dove again (third dive of the day) during which time itchiness started. Back on the diving boat, urticarial was noticed. At 15:30, while washing his diving gear at the diving shop near the harbor, he fainted. A physician arrived on the scene at 15:45. Chest sound was clear and SpO2 was 98%, and blood pressure was 60/- mmHg. Intra-venous hydrocortisone was given, however, his recovery was not satisfactory. Then he was transferred to the Yaeyama Hospital by helicopter at 17:45. The examination of diving computer analysis reveals no sign of increased residual nitrogen, denying the possibility of decompression syndrome. Prick to prick test shows a strongly positive response to nattou. Nattou-induced late-onset anaphylaxis following SCUBA diving was suspected.

  17. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

    Directory of Open Access Journals (Sweden)

    Arunangshu Ghoshal


    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  18. Wheat-Dependent Exercise-Induced Anaphylaxis Sensitized with Hydrolyzed Wheat Protein in Soap

    Directory of Open Access Journals (Sweden)

    Yuko Chinuki


    Full Text Available Wheat-dependent exercise-induced anaphylaxis (WDEIA is a specific form of wheat allergy typically induced by exercise after ingestion of wheat products. Wheat ω-5 gliadin is a major allergen associated with conventional WDEIA, and detection of serum immunoglobulin E (IgE specific to recombinant ω-5 gliadin is a reliable method for its diagnosis. Recently, an increased incidence of a new subtype of WDEIA, which is likely to be sensitized via a percutaneous and/or rhinoconjunctival route to hydrolyzed wheat protein (HWP, has been observed. All of the patients with this new subtype had used the same brand of soap, which contained HWP. Approximately half of these patients developed contact allergy several months later and subsequently developed WDEIA. In each of these patients, contact allergy with soap exposure preceded food ingestion-induced reactions. Other patients directly developed generalized symptoms upon ingestion of wheat products. The predominant observed symptom of the new WDEIA subtype was angioedema of the eyelids; a number of patients developed anaphylaxis. This new subtype of WDEIA has little serum ω-5 gliadin-specific serum IgE.

  19. Chronic Atherosclerotic Mesenteric Ischemia That Started to Develop Symptoms Just after Anaphylaxis

    Directory of Open Access Journals (Sweden)

    M. Goto


    Full Text Available An 83-year-old woman was referred to our emergency department with acute urticaria and sudden shortness of breath approximately 30 min after taking rectal diclofenac potassium for lumbago. After treatment with adrenaline and corticosteroids, the patient became hemodynamically stable and left the hospital on the next day. She attended our hospital 1 week after the onset of anaphylaxis because of repeated postprandial epigastric pain. No abnormal lesions were found in endoscopy. Radiographic selective catheter angiography revealed chronic mesenteric ischemia caused by atherosclerosis and abundant collateral arteries between the celiac trunk, the superior mesenteric artery and the inferior mesenteric artery. Patients with chronic mesenteric ischemia usually present with a clinical syndrome characterized by painful abdominal cramps and colic occurring typically during the postprandial phase. Fear of eating resulted in malnutrition. She was prescribed proton pump inhibitor, digestants, anticholinergic agents, serine protease inhibitors, prokinetics, antiplatelet agents and transdermal nitroglycerin intermittently, but these had no beneficial effects. It was most probable that this patient with chronic atherosclerotic mesenteric ischemia was suffering from functional abdominal pain syndrome induced by anaphylaxis. Since psychiatric disorders were associated with alterations in the processing of visceral sensation, we facilitated the patient’s understanding of functional abdominal pain syndrome with the psychologist. Postprandial abdominal pain gradually faded after administration of these drugs and the patient left the hospital. Developing a satisfactory patient-physician relationship was considered more effective for the management of persistent abdominal pain caused by complicated mechanisms.

  20. Fullerene carbon-70 derivatives dampen anaphylaxis and allergic asthma pathogenesis in mice (United States)

    Norton, Sarah Brooke

    Fullerenes are carbon nanospheres that can be solublized by the addition of polar chemical groups to the carbon cage, forming fullerene derivatives. One specifically derivatized fullerene compound, termed C 70-Tetragylocolate (C70-TGA), has been shown to stabilize mast cell responses in vitro thus we hypothesized it may have an effect on mast cell-driven diseases such as asthma and systemic anaphylaxis. To observe the effects of C70-TGA on systemic anaphylaxis, mice were subjected to a model of passive systemic anaphylaxis. In this model, mice were injected with DNP-specific IgE 16 hours prior to challenge, then treated with C 70-TGA. Immediately prior to DNP challenge, mice were subjected to a second injection of C70-TGA. Following DNP challenge, body temperature was recorded and blood was collected for quantitation of histamine levels. Treatment with C70-TGA significantly reduced body temperature drop associated with systemic anaphylaxis and serum histamine levels. To observe the effects of C70-TGA on chronic features of asthma in vivo, we utilized a heavily MC influenced model of asthma pathogenesis. Mice were sensitized by intraperitoneal (i.p.) injection of ovalbumin (OVA) in saline, challenged intranasally (i.n.) with OVA, and one of two treatment strategies was pursued. In one, C70-TGA was given i.n. throughout disease development. In the other, C70-TGA was given following an initial set of challenges to allow disease to develop prior to treatment; mice were then re-challenged with OVA to assess the effect on established disease. We found that C70-TGA treatment significantly reduced airway inflammation and eosinophilia and dramatically reduced bronchoconstriction in either model. Cytokines IL-4 and IL-5 and serum IgE levels are significantly reduced in C70-TGA treated animals. Interestingly, we also saw an increase in the anti-inflammatory eicosanoid 11, 12-epoxyeicosatreinoic acid (11,12-EET) in the BAL fluid, suggesting the involvement of this mediator in

  1. Beyond IgE—When Do IgE-Crosslinking and Effector Cell Activation Lead to Clinical Anaphylaxis?

    Directory of Open Access Journals (Sweden)

    Lars K. Poulsen


    Full Text Available Anaphylaxis in humans is inherently difficult to study due to the acuteness of symptoms and the lack of biomarkers serving as risk predictors. Most cases are related to IgE sensitizations to foods, insect venoms, and drugs with mastocytosis patients forming a smaller risk group. However, identifying the relatively small fraction of persons at risk has been exceedingly difficult. In this review, we propose to describe anaphylaxis in a broader context than defined by IgE sensitization alone. Exposure to a trigger, such as an allergen, may lead to anaphylaxis, but in particular, the internal dose sensed by the immune system needs to be established. Moreover, intrinsic patient factors as well as the specific circumstances of the exposure, i.e., the extrinsic factors, need to be thoroughly accounted for. More controversially, other triggers of anaphylaxis, such as increased sensitivity to or reduced catabolism of histamine (“histamine intolerance” or mast cell activation syndrome also named mast cell activation disorder have been suggested, but still with very limited epidemiological evidence that a significant proportion of the observed reactions are caused by these alleged conditions. Thus, when all conditions are considered, it seems as if IgE-mediated reactions are responsible for the vast majority of anaphylactic conditions.

  2. Evaluation of IgE Antibodies to Omalizumab (Xolair®) and Their Potential Correlation to Anaphylaxis. (United States)

    Baker, Dana L; Nakamura, Gerald R; Lowman, Henry B; Fischer, Saloumeh Kadkhodayan


    Omalizumab (Xolair®) is a recombinant humanized monoclonal antibody that selectively binds to human immunoglobulin E (IgE). Omalizumab is used to treat IgE-mediated diseases such as chronic idiopathic urticaria (CIU) and moderate to severe allergic asthma. In pre-marketing clinical trials in patients with asthma, anaphylaxis was reported in 3 of 3,507 (0.1%) patients. In post-marketing spontaneous reports, the frequency of anaphylaxis attributed to omalizumab use was estimated to be at least 0.2% of patients based on an estimated exposure of about 57,300 patients from June 2003 through December 2006. To better understand the risk of anaphylaxis in patients with allergic asthma receiving omalizumab, a post-marketing pharmacosurveillance study was initiated in 2009. As part of this study, an assay was developed to detect antibodies of IgE isotype to omalizumab. Serum samples from patients in the study were evaluated using this assay. Our results indicated that there was no observable correlation between either anaphylaxis or skin test reactivity and the presence of antibodies of IgE isotype to omalizumab. Here, we discuss the development of this assay as well as the results of the immunogenicity assessment.

  3. Tick-host conflict: immunoglobulin E antibodies to tick proteins in patients with anaphylaxis to tick bite

    Czech Academy of Sciences Publication Activity Database

    Mateos-Hernández, L.; Villar, M.; Moral, A.; Garcia Rodriguez, C.; Alfaya Arias, T.; de la Osa, V.; Feo Brito, F.; Fernández de Mera, I.G.; Alberdi, P.; Ruiz-Fons, F.; Cabezas Cruz, Alejandro; Estrada-Peňa, A.; de la Fuente, J.


    Roč. 8, č. 13 (2017), s. 20630-20644 ISSN 1949-2553 EU Projects: European Commission(XE) 278976 - ANTIGONE Institutional support: RVO:60077344 Keywords : immunology * allergy * alpha-Gal * anaphylaxis * proteomics * immunology and microbiology section * immune response * immunity Subject RIV: EC - Immunology OBOR OECD: Immunology Impact factor: 5.168, year: 2016

  4. Detection of an activating c-kit mutation by real-time PCR in patients with anaphylaxis. (United States)

    Lawley, Wendy; Hird, Heather; Mallinder, Philip; McKenna, Sue; Hargadon, Beverley; Murray, Alistair; Bradding, Peter


    A well-characterised gain-of-function point mutation within exon 17 of the c-kit proto-oncogene known as Asp816Val is present in patients with mastocytosis. Activation of mast cells through this receptor primes them for IgE-dependent activation, and patients with mastocytosis are at increased risk of anaphylaxis. We hypothesised that the Asp816Val mutation is associated with a history of anaphylaxis in the general population. A mismatch amplification real-time PCR assay was developed and validated to test for the Asp816Val mutation. Subjects were recruited to four subject groups: normal non-atopics, atopics without anaphylaxis, food-induced anaphylactics and non-food anaphylactics. Blood samples collected from forty subjects were tested for the presence of Asp816Val. Thirteen subjects were found to carry the mutation; normals (2/9), atopics (2/10), food anaphylactics (5/11) and non-food anaphylactics (4/10). Statistical analysis of the data determined that there was no significant difference between the numbers of subjects found to carry the Asp816Val mutation in each of the groups although a trend towards an increased occurrence in anaphylactics was observed. In summary, the hypothesis that the presence of the Asp816Val mutation is linked to the occurrence of anaphylaxis was not supported, but interestingly, we have shown for the first time Asp816Val may occur more frequently than previously reported within the general population.

  5. Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community. (United States)

    Sheikh, Aziz; Simons, F Estelle R; Barbour, Victoria; Worth, Allison


    Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline (epinephrine) auto-injectors are recommended as the initial, potentially life-saving treatment of choice for anaphylaxis in the community, but they are not universally available and have limitations in their use. To assess the effectiveness of adrenaline (epinephrine) auto-injectors in relieving respiratory, cardiovascular, and other symptoms during episodes of anaphylaxis that occur in the community. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE (Ovid SP) (1950 to January 2012), EMBASE (Ovid SP) (1980 to January 2012 ), CINAHL (EBSCO host) (1982 to January 2012 ), AMED (EBSCO host) (1985 to January 2012 ), LILACS, (BIREME) (1980 to January 2012 ), ISI Web of Science (1950 to January 2012 ). We adapted our search terms for other databases. We also searched websites listing on-going trials: the World Health Organization International Clinical Trials Registry Platform, the UK Clinical Research Network Study Portfolio, and the meta Register of Controlled Trials; and contacted pharmaceutical companies who manufacture adrenaline auto-injectors in an attempt to locate unpublished material. Randomized and quasi-randomized controlled trials comparing auto-injector administration of adrenaline with any control including no intervention, placebo, or other adrenergic agonists were eligible for inclusion. Two authors independently assessed articles for inclusion. None of the 1328 studies that were identified satisfied the inclusion criteria. Based on this review, we cannot make any new recommendations on the effectiveness of adrenaline auto-injectors for the treatment of anaphylaxis. Although randomized, double-blind, placebo-controlled clinical trials of high methodological quality are necessary to define the true extent of benefits from the administration of adrenaline in anaphylaxis via an auto

  6. Diagnostic utility of two case definitions for anaphylaxis: a comparison using a retrospective case notes analysis in the UK. (United States)

    Erlewyn-Lajeunesse, Michel; Dymond, Sandra; Slade, Ingrid; Mansfield, Helen L; Fish, Rosie; Jones, Owen; Benger, Jonathan R


    Anaphylaxis is a clinical diagnosis with no gold-standard test. Recent case definitions have attempted to provide objective criteria for diagnosis. The aim of this study was to compare the diagnostic concordance of the Brighton Collaboration case definition (the 'Brighton' case definition) to the consensus case definition from the Second Symposium on the Definition and Management of Anaphylaxis (the 'Symposium' definition). The study setting was a hospital-based emergency department in the UK. We identified cases of anaphylaxis by physicians' discharge diagnoses over a 2-year period from 2005 to 2006, and used randomly selected cases of allergic reaction, asthma and urticaria as a control group. Data was extracted by clinicians (who were unaware of the content of either case definition), and the two case definitions were applied by Boolean operators in a Microsoft Excel spreadsheet. Concordance between the case definitions was measured using Cohen's kappa (kappa) statistic. We reviewed 128 sets of notes, with 47 cases of anaphylaxis. Brighton and Symposium definitions had sensitivities of 0.681 and 0.671, respectively, and specificities of 0.790 and 0.704, respectively. A discordant result was found in 36/128 cases (28.1%; kappa = 0.414 [95% CI 0.253, 0.574]), which represents a moderate level of agreement between case definitions. The Brighton case definition has a similar diagnostic concordance to the Symposium case definition. It does not seem to over- or underestimate cases and is sufficiently unique that the identification of an allergic trigger does not have to form part of the case definition. This will be important in the recognition of anaphylaxis resulting from the administration of drug and vaccines, where causality should be examined separately from case ascertainment.

  7. Fatal anaphylaxis with neuromuscular blocking agents: a risk factor and management analysis. (United States)

    Reitter, M; Petitpain, N; Latarche, C; Cottin, J; Massy, N; Demoly, P; Gillet, P; Mertes, P M


    Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was to evaluate mortality rate in France from anaphylactic reactions to NMBAs, to identify risk factors for a fatal outcome, and to describe management of the cases that proved fatal. The French National Pharmacovigilance Database was queried for reports of NMBA anaphylaxis that occurred between January 2000 and December 2011. A questionnaire was sent to regional pharmacovigilance centers to obtain further information on the management of cases with a fatal outcome. Two thousand and twenty-two cases of NMBA hypersensitivity were retrieved, of which 84 were fatal (4.1%). Among the 1247 cases of severe NMBA anaphylaxis (grades 3 and 4), independent risk factors associated with a fatal outcome in a multivariate analysis were male gender (female gender: OR = 0.4; 95% CI 0.2-0.7; P = 0.0004), an emergency setting (OR = 2.6; 95% CI 1.5-4.6; P = 0.0007), a history of hypertension (OR = 2.5; 95% CI 1.5-4.4; P = 0.0010) or of other cardiovascular disease (OR = 4.4; 95% CI 2.4-8.1; P < 0.0001), obesity (OR = 2.4; 95% CI 1.1-5.3; P = 0.0376), and ongoing beta-blocker treatment (OR = 4.2; 95% CI 1.8-9.8; P = 0.0011). All 31 patients with a fatal outcome received epinephrine in a titrated manner according to international guidelines. Obese males with a history of cardiovascular disease receiving ongoing beta-blocker treatment and undergoing surgery in an emergency setting were at high risk of a fatal outcome after NMBA-induced anaphylaxis. Some epinephrine-resistant cases may play a role in our high mortality rate. New therapeutic approaches need to be developed to treat these cases. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Ferulic acid enhances IgE binding to peanut allergens in western blots. (United States)

    Phenolic compounds at high concentrations are known to form insoluble complexes with proteins. We hypothesized that this complex formation could interfere with Western blot and ELISA assays for peanut allergens. To verify this, three simple phenolic compounds (ferulic, caffeic, and chlorogenic acids...

  9. Decreased immunoglobulin E (IgE) binding to cashew allergens following sodium sulfite treatment and heating (United States)

    Cashew nut and other nut allergies can result in serious and sometimes life threatening reactions. Linear and conformational epitopes within food allergens are important for immunoglobulin E binding. Methods that disrupt allergen structure can reduce immunoglobulin E binding and lessen the likelih...

  10. Structure, Stability, and IgE Binding of the Peach Allergen Peamaclein (Pru p 7)

    NARCIS (Netherlands)

    Tuppo, Lisa; Spadaccini, Roberta; Alessandri, Claudia; Wienk, Hans; Boelens, Rolf; Giangrieco, Ivana; Tamburrini, Maurizio; Mari, Adriano; Picone, Delia; Ciardiello, Maria Antonietta

    Knowledge of the structural properties of allergenic proteins is a necessary prerequisite to better understand the molecular bases of their action, and also to design targeted structural/functional modifications. Peamaclein is a recently identified 7 kDa peach allergen that has been associated with

  11. Psyllium anaphylaxis. (United States)

    Sussman, G L; Dorian, W


    Allergic reactions from handling psyllium have been reported since 1970. Health professionals and workers in laxative-manufacturing plants are at greatest risk. Sensitized people are at risk of life-threatening anaphylactic reactions. Two illustrative cases are presented. The first is A 39-year-old female dialysis nurse with a 3-year history of nasal and eye symptoms from exposure to psyllium. She obtained an over-the-counter psyllium bulk laxative, took it for constipation and developed flushing, tachycardia, urticaria, angioedema, laryngeal edema, and lightheadedness. An epicutaneous skin test and radioallergosorbent test for psyllium were both strongly positive. The second is a 42-year-old female nurse with a history of asthma who had allergic nasal and eye symptoms while dispensing psyllium. She received a prescription for crystallized psyllium, took it by mouth, and developed immediate flushing, tachycardia, urticaria, and angioedema. With subsequent ingestion of psyllium she had, in addition, severe wheezing, lightheadedness, and loss of consciousness. A psyllium epicutaneous skin test was strongly positive. These patient reports illustrate the risk of severe allergic reactions in sensitized people. Ingestion by sensitized people, such as from a routine postoperative and postpartum order, is potentially dangerous.

  12. Transfusion-associated anaphylaxis during anaesthesia and surgery--a retrospective study

    DEFF Research Database (Denmark)

    Lindsted, G; Larsen, R; Krøigaard, M


    at the Danish Anaesthesia Allergy Centre (DAAC). Based on the outcome of this investigation, the patients were classified as DAAC positive (confirmed hypersensitivity to identified agent, n = 112), or DAAC negative (no confirmed hypersensitivity, n = 133). Data on case history, details of blood transfusion...... and results of laboratory and clinical investigations were collected. TAA cases were identified according to the recommendations of the International Society of Blood Transfusion (ISBT). RESULTS: Ten possible TAA cases (30% of all transfused patients) were identified, all DAAC negative. The frequency......BACKGROUND AND OBJECTIVES: Transfusion-associated anaphylaxis (TAA) is a severe adverse reaction reported to occur in 1:9000-90 000 transfusions. According to the Danish Registration of Transfusion Risks (DART), the frequency is 1:300 000 transfusions, which suggests insufficient reporting of TAA...

  13. The risk and management of anaphylaxis in the setting of immunotherapy. (United States)

    Lieberman, Phil


    Anaphylactic events due to immunotherapy are probably not completely preventable. There is always an inherent risk surrounding the administration of an allergen to an individual who is sensitized to the substance administered. There are, however, effective measures to reduce the risk of these events, and to optimize the assurance of a good outcome in the face of such an event. Of prime importance in preventing these episodes is the regular assessment of the patient's health status, especially in regard to asthma, and the careful attention to the prevention of dosing errors. Of equal importance, in regard to assuring a good outcome should such an event occur, are the rapid recognition of symptoms and the immediate injection of epinephrine, the drug of choice for the treatment of any episode of anaphylaxis.

  14. EAACI Food Allergy and Anaphylaxis Guidelines. Food allergy health-related quality of life measures. (United States)

    Muraro, A; Dubois, A E J; DunnGalvin, A; Hourihane, J O'B; de Jong, N W; Meyer, R; Panesar, S S; Roberts, G; Salvilla, S; Sheikh, A; Worth, A; Flokstra-de Blok, B M J


    Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a systematic review of the literature on quality of life instruments for food allergy and the Appraisal of Guidelines for Research & Evaluation (AGREE II) guideline development process. Guidance is provided on the use of such instruments in research, and the current limitations of their use in clinical practice are described. Gaps in current knowledge as well as areas of future interest are also discussed. This document is relevant to healthcare workers dealing with food-allergic patients, scientists engaging in food allergy research and policy makers involved in regulatory aspects concerning food allergy and safety. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy

    DEFF Research Database (Denmark)

    Muraro, A; Halken, S; Arshad, S H


    Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared...... by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood...... strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers...

  16. BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia. (United States)

    Ewan, P W; Dugué, P; Mirakian, R; Dixon, T A; Harper, J N; Nasser, S M


    Investigation of anaphylaxis during general anaesthesia requires an accurate record of events including information on timing of drug administration provided by the anaesthetist, as well as timed acute tryptase measurements. Referrals should be made to a centre with the experience and ability to investigate reactions to a range of drug classes/substances including neuromuscular blocking agents (NMBAs) intravenous (i.v.) anaesthetics, antibiotics, opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), local anaesthetics, colloids, latex and other agents. About a third of cases are due to allergy to NMBAs. Therefore, investigation should be carried out in a dedicated drug allergy clinic to allow seamless investigation of all suspected drug classes as a single day-case. This will often require skin prick tests, intra-dermal testing and/or drug challenge. Investigation must cover the agents administered, but should also include most other commonly used NMBAs and i.v. anaesthetics. The outcome should be to identify the cause and a range of drugs/agents likely to be safe for future use. The allergist is responsible for a detailed report to the referring anaesthetist and to the patient's GP as well as the surgeon/obstetrician. A shorter report should be provided to the patient, adding an allergy alert to the case notes and providing an application form for an alert-bracelet indicating the wording to be inscribed. The MHRA should be notified. Investigation of anaphylaxis during general anaesthesia should be focussed in major allergy centres with a high throughput of cases and with experience and ability as described above. We suggest this focus since there is a distinct lack of validated data for testing, thus requiring experience in interpreting tests and because of the serious consequences of diagnostic error.

  17. A Mouse Model of Anaphylaxis and Atopic Dermatitis to Salt-Soluble Wheat Protein Extract. (United States)

    Jin, Yining; Ebaugh, Sarah; Martens, Anna; Gao, Haoran; Olson, Eric; Ng, Perry K W; Gangur, Venu


    Wheat allergy and other immune-mediated disorders triggered by wheat proteins are growing at an alarming rate for reasons not well understood. A mouse model to study hypersensitivity responses to salt-soluble wheat protein (SSWP) extract is currently unavailable. Here we tested the hypothesis that SSWP extract from wheat will induce sensitization as well as allergic disease in mice. Female BALB/cJ mice were weaned onto a plant protein-free diet. The mice were injected a total of 4 times with an SSWP (0.01 mg/mouse) fraction extracted from durum wheat along with alum as an adjuvant. Blood was collected biweekly and SSWP-specific IgE (SIgE) and total IgE (TIgE) levels were measured using ELISA. Systemic anaphylaxis upon intraperitoneal injection with SSWP was quantified by hypothermia shock response (HSR). Mucosal mast cell degranulation was measured by the elevation of mMCP-1 in the blood. The mice were monitored for dermatitis. Skin tissues were used in histopathology and for measuring cytokine/chemokine/adhesion molecule levels using a protein microarray system. Injection with SSWP resulted in time-dependent SIgE antibody responses associated with the elevation of TIgE concentration. Challenge with SSWP elicited severe HSR that correlated with a significant elevation of plasma mMCP-1 levels. Sensitized mice developed facial dermatitis associated with mast cell degranulation. Lesions expressed significant elevation of Th2/Th17/Th1 cytokines and chemokines and E-selectin adhesion molecule. Here we report a mouse model of anaphylaxis and atopic dermatitis to SSWP extract that may be used for further basic and applied research on wheat allergy. © 2017 S. Karger AG, Basel.

  18. Amelioration of anaphylaxis, mast cell degranulation and bronchospasm by Euphorbia hirta L. extracts in experimental animals

    Directory of Open Access Journals (Sweden)

    Ghanshyam Parmar


    Full Text Available The current investigation was aimed to assess anti-anaphylactic, mast cell stabilizing and anti-asthmatic activity of methanol and aqueous extract of Euphorbia hirta L. (Euphorbiaceae on experimental animals. Anaphylaxis was induced by administration of horse serum and triple antigen vaccine subcutaneously in albino Wistar rats. Extracts of E. hirta (EH were administered to the rats in dose of 250 and 500 mg/kg b.w. orally for 14 days. At the end of treatment, asthma score was measured and various blood parameters like differential count (DC, total WBC count and IgE were estimated. Interleukin (IL-4, IL-5 and tumour necrosis factor (TNF-α were measured by ELISA commercial kit from Broncho alveolar lavage fluid (BALF. Histopathological changes of lungs were observed. Anti-asthmatic activity of extracts of EH was also studied on histamine-induced bronchospasm in guinea pigs. In vitro mast cell stabilizing activity of extracts was evaluated on compound 48/80 challenged rat intestinal mesenteric mast cells. The treatment with extracts of EH produced significant decrease in asthma score and they also brought to normalcy the increased total WBC, DC counts, serum IgE, TNF-α, IL-4 and IL-5 in BALF. The histopathological study further supported the protective effect of EH extracts. The pre-treatment with extracts of EH displayed significant reduction in degranulation of mesenteric mast cell numbers. The treatment with extracts of EH significantly increased in time of pre-convulsive dyspnoea (PCD. Thus, these findings concluded that E. hirta could be effectively used in the treatment of anaphylaxis and asthma.

  19. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2008. (United States)

    Sicherer, Scott H; Leung, Donald Y M


    This review highlights some of the research advances in anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in anaphylaxis in a population-based study and lower rates of peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in food allergy diagnosis include IgE epitope mapping that discloses the likelihood and severity of allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline angiotensin-converting enzyme level may be associated with having pharyngeal edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and egg allergy tolerate these proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral immunotherapy to treat milk allergy and sublingual immunotherapy for honey bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and bacterial infection. New therapeutic approaches to AD, urticaria, and angioedema have been reported including use of probiotics, biologics, vitamin D, and skin barrier creams.

  20. Anaphylaxis to the 23-valent pneumococcal vaccine: a second explored case by means of immediate-reading skin tests with pneumococcal vaccines. (United States)

    Ponvert, C; Scheinmann, P; de Blic, J


    Anaphylaxis to pneumococcal vaccines is rare. In the only one child with anaphylaxis to a first injection of the 23-valent pneumococcal vaccine that has been explored, skin tests and specific IgE determination diagnosed immediate-type hypersensitivity to pneumococcal antigens. We report the case of a child who tolerated three injections of the 7-valent pneumococcal vaccine, but experienced anaphylaxis to a fourth injection of the 23-valent vaccine. Immediate responses in skin tests diagnosed immediate-type hypersensitivity to the two vaccines. Immunizations with the 7-valent pneumococcal vaccine may induce IgE-dependent sensitization to pneumococcal antigens, responsible for anaphylaxis to subsequent injections of pneumococcal vaccines. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit? (United States)

    Jayamali, W D; Herath, H M M T B; Kulathunga, Aruna


    Anaphylaxis is an acute, potentially fatal medical emergency. Myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis syndrome or it can also be due to the effect of epinephrine treatment. Epinephrine is considered as the cornerstone in management of anaphylaxis. Myocardial infarction secondary to therapeutic doses of adrenaline is a rare occurrence and only a few cases have been reported in literature. The mechanism of myocardial injury was considered to be due to coronary vasospasm secondary to epinephrine as the coronary angiograms were normal on these occasions. A 21-year- old previously healthy male got admitted to the local hospital with an urticarial rash and difficulty in breathing, one hour after ingestion of prawns for which he was known to be allergic. He was treated with 0.5 ml of intramuscular adrenaline (1:1000) which was administered to the lateral side of the thigh, following which he developed palpitations and tightening type central chest pain. Electrocardiogram showed ST segment depressions in leads III, aVF and V1 to V5 and he was transferred to a tertiary care hospital. The second electrocardiogram, done 2 h later, showed resolution of ST segment depressions but new T inversions in leads I and aVL. Troponin I was elevated with a titer of 2.15 ng/ml. He was treated with sublingual GTN in the emergency treatment unit and the symptoms resolved. Transthoracic 2D echocardiogram and stress testing with treadmill was normal and CT coronary angiogram revealed normal coronary arteries. Here we present a case of a young healthy adult with no significant risk factors for coronary artery disease who developed myocardial infarction following intramuscular administration of therapeutic dose of adrenalin for an anaphylactic reaction. The postulated mechanism is most likely an alpha receptor mediated coronary vascular spasm. However the use of adrenaline in the setting of life

  2. Anti-histamine effect of Rubia tibetica, used to treat anaphylaxis caused by tick bites in the Pamir Mountains, Afghanistan

    DEFF Research Database (Denmark)

    Jeppesen, Anne S.; Kristiansen, Uffe; Soelberg, Jens


    Ethnopharmacological relevance: The roots of Rubia tibetica are chewed as an antidote to anaphylaxis caused by bites of the tick Ornithodoros lahorensis by the Wakhi people in Afghanistan. Aims of the study: To test whether Rubia tibetica possess anti-histamine effect. Materials and methods: Water...... and ethanol extracts of roots of Rubia tibetica were tested for anti-histamine effect on the H 1-receptor in the guinea pig ileum assay. Fixed concentrations of plant extract with increasing concentrations of histamine were examined. Mepyramine was used as control. Results and conclusion: The ethanol extract...... of Rubia tibetica showed dose-dependent anti-histamine effect, whereas the water extract had little activity. The chewing of Rubia tibetica roots may alleviate the fatal swelling of the tongue during anaphylaxis....

  3. Beyond IgE-When Do IgE-Crosslinking and Effector Cell Activation Lead to Clinical Anaphylaxis?

    DEFF Research Database (Denmark)

    Poulsen, Lars K; Jensen, Bettina M; Esteban, Vanesa


    Anaphylaxis in humans is inherently difficult to study due to the acuteness of symptoms and the lack of biomarkers serving as risk predictors. Most cases are related to IgE sensitizations to foods, insect venoms, and drugs with mastocytosis patients forming a smaller risk group. However, identify......Anaphylaxis in humans is inherently difficult to study due to the acuteness of symptoms and the lack of biomarkers serving as risk predictors. Most cases are related to IgE sensitizations to foods, insect venoms, and drugs with mastocytosis patients forming a smaller risk group. However...... to or reduced catabolism of histamine ("histamine intolerance") or mast cell activation syndrome also named mast cell activation disorder have been suggested, but still with very limited epidemiological evidence that a significant proportion of the observed reactions are caused by these alleged conditions. Thus...

  4. Mesenchymal stromal stem cell therapy in advanced interstitial lung disease - Anaphylaxis and short-term follow-up

    Directory of Open Access Journals (Sweden)

    Balamugesh Thangakunam


    Full Text Available There are limited treatment options for advanced interstitial lung disease (ILD. We describe a patient of ILD treated with mesenchymal stromal stem cell infusion. The index patient had end-stage ILD due to a combination of insults including treatment with radiotherapy and a tyrosine kinase inhibitor Erlotinib. He was oxygen-dependent and this was hampering his quality of life. He tolerated the first infusion stem cells without any problem. During the second infusion he developed anaphylactic shock, which was appropriately managed. At 6-months follow-up he had no improvement in oxygenation, pulmonary function or CT scan parameters. In view of anaphylaxis, further infusions of MSC were withheld. A longer follow-up may reveal long-term benefits or side effects, if any. However the occurrence of anaphylaxis is of concern suggesting that further trials should be conducted with intensive monitoring.

  5. Anti-histamine effect of Rubia tibetica, used to treat anaphylaxis caused by tick bites in the Pamir Mountains, Afghanistan. (United States)

    Jeppesen, Anne S; Kristiansen, Uffe; Soelberg, Jens; Jäger, Anna K


    The roots of Rubia tibetica are chewed as an antidote to anaphylaxis caused by bites of the tick Ornithodoros lahorensis by the Wakhi people in Afghanistan. To test whether Rubia tibetica possess anti-histamine effect. Water and ethanol extracts of roots of Rubia tibetica were tested for anti-histamine effect on the H1-receptor in the guinea pig ileum assay. Fixed concentrations of plant extract with increasing concentrations of histamine were examined. Mepyramine was used as control. The ethanol extract of Rubia tibetica showed dose-dependent anti-histamine effect, whereas the water extract had little activity. The chewing of Rubia tibetica roots may alleviate the fatal swelling of the tongue during anaphylaxis.

  6. Endothelial Regulator of Calcineurin 1 Promotes Barrier Integrity and Modulates Histamine-Induced Barrier Dysfunction in Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Constanza Ballesteros-Martinez


    Full Text Available Anaphylaxis, the most serious and life-threatening allergic reaction, produces the release of inflammatory mediators by mast cells and basophils. Regulator of calcineurin 1 (Rcan1 is a negative regulator of mast-cell degranulation. The action of mediators leads to vasodilation and an increase in vascular permeability, causing great loss of intravascular volume in a short time. Nevertheless, the molecular basis remains unexplored on the vascular level. We investigated Rcan1 expression induced by histamine, platelet-activating factor (PAF, and epinephrine in primary human vein (HV-/artery (HA-derived endothelial cells (ECs and human dermal microvascular ECs (HMVEC-D. Vascular permeability was analyzed in vitro in human ECs with forced Rcan1 expression using Transwell migration assays and in vivo using Rcan1 knockout mice. Histamine, but neither PAF nor epinephrine, induced Rcan1-4 mRNA and protein expression in primary HV-ECs, HA-ECs, and HMVEC-D through histamine receptor 1 (H1R. These effects were prevented by pharmacological inhibition of calcineurin with cyclosporine A. Moreover, intravenous histamine administration increased Rcan1 expression in lung tissues of mice undergoing experimental anaphylaxis. Functional in vitro assays showed that overexpression of Rcan1 promotes barrier integrity, suggesting a role played by this molecule in vascular permeability. Consistent with these findings, in vivo models of subcutaneous and intravenous histamine-mediated fluid extravasation showed increased response in skin, aorta, and lungs of Rcan1-deficient mice compared with wild-type animals. These findings reveal that endothelial Rcan1 is synthesized in response to histamine through a calcineurin-sensitive pathway and may reduce barrier breakdown, thus contributing to the strengthening of the endothelium and resistance to anaphylaxis. These new insights underscore its potential role as a regulator of sensitivity to anaphylaxis in humans.

  7. Fluoroquinolone-associated anaphylaxis in spontaneous adverse drug reaction reports in Germany: differences in reporting rates between individual fluoroquinolones and occurrence after first-ever use. (United States)

    Sachs, Bernhardt; Riegel, Stefan; Seebeck, Jörg; Beier, Rainer; Schichler, Dagmar; Barger, Antina; Merk, Hans F; Erdmann, Stephan


    The frequency of fluoroquinolone-associated anaphylaxis has been estimated to be 1.8-23 per 10 million days of treatment based on spontaneous reports. It is unknown whether there are differences between the reporting rates of anaphylaxis with individual fluoroquinolones. According to pathophysiology, anaphylaxis may be immune mediated (anaphylactic) or not (anaphylactoid). The latter may occur after first-ever intake since no sensitisation phase is necessary. To analyse spontaneous reports of fluoroquinolone-associated anaphylaxis contained in the spontaneous adverse drug reaction database of the Federal Institute for Drugs and Medical Devices in Germany with regard to differences in reporting rates between various fluoroquinolones, the previous intake and the time to onset of the reaction. All fluoroquinolone-associated cases of anaphylaxis, anaphylactic shock, and anaphylactic/anaphylactoid reaction spontaneously reported to the Federal Institute for Drugs and Medical Devices between 1 January 1993 and 31 December 2004 were identified and assessed with regard to the correctness of the diagnosis of anaphylaxis, the causal relationship with the drug, the previous intake of fluoroquinolones and the time to onset of the reaction. In 166 of 204 cases identified, the diagnosis of anaphylaxis and a causal relationship with the drug were considered at least possible. Moxifloxacin, levofloxacin, ciprofloxacin and ofloxacin accounted for 90 (54%), 25 (15%), 21 (13%) and 16 (10%) of the 166 cases, respectively. The corresponding reporting rates per 1 million defined daily doses based on crude estimates of exposure were 3.3, 0.6, 0.2 and 0.2 for moxifloxacin, levofloxacin, ciprofloxacin and ofloxacin, respectively. The occurrence of anaphylaxis after the first dose or within the first three days was reported in 71 of 166 (43%) cases, but no information on prior exposure with this or any other fluoroquinolone was provided with these reports. In 21 of 166 (13%) cases, the

  8. 422 A Rare Case of Food-induced Anaphylaxis to Pink Peppercorns (United States)

    Kim, John; Minikes, Neil


    Background The incidence and prevalence of food allergies appear to be on the rise over the past 20 years. The most common foods to produce an IgE mediated hypersensitivity reaction in adults include peanut, tree nuts, and seafood. The increased use of spices in the U.S. has resulted in a growing number of patients presenting with hypersensitivity reactions. Methods We report a case of a 26 year-old-female who developed anaphylaxis after ingesting pink peppercorn seasoning. The patient was diagnosed with a tree nut allergy at 18 years of age when she developed hives, vomiting and throat closure after ingesting cashews. More recently, she had 3 similar anaphylactic episodes requiring epinephrine and emergency room care when she unknowingly consumed tree nuts contained in foods while dining out (veggie burger, pesto sauce, almonds in Indian food). She again had similar symptoms while eating a home prepared meal in which tree nuts were not included. Intramuscular epinephrine was administered and she was subsequently treated with oral steroids and antihistamines. It was later determined that a new peppercorn medley with pink peppercorns was used for seasoning. The reaction did not occur when she ate the same meal without pink peppercorn seasoning. Food specific IgE testing revealed an elevated IgE for cashews (2.52 kUA/L) and pistachios (2.85 kUA/L). Results Pink peppercorn is not a true pepper, but dried roasted berries derived from Schinus terebinthifolius, a flowering plant in the family Anacardiaceae, native to South America. Common names include Brazilian Pepper, Rose Pepper and Christmasberry. Pink peppercorns are used as a spice to add a mild pepper-like taste to foods. It may potentially cause an irritating skin effect and has been associated with atopic dermatitis in canines. Interestingly, S. terebinthifolius is a member of the family Anacardiaceae, which include plants in the genus Anacardium (cashew nut) and Pistacia (pistachio). No allergens from this

  9. Allergists' self-reported adherence to anaphylaxis practice parameters and perceived barriers to care: an American College of Allergy, Asthma, and Immunology member survey. (United States)

    Fineman, Stanley; Dowling, Paul; O'Rourke, Dianne


    Anaphylaxis is life-threatening and requires rapid medical intervention. Knowledge of treatment guidelines and addressing barriers to care are essential for appropriate management. To investigate allergists' self-reported practices in managing patients at risk for anaphylaxis, specifically in following practice parameters for diagnosis, treatment, and appropriate use of epinephrine, and to identify perceived barriers to care. Online questionnaires were distributed to members of the American College of Allergy, Asthma, and Immunology. The US physicians who self-identified as "allergist/immunologist" were eligible to participate. The first 500 completed questionnaires were analyzed. Nearly all (≥95%) reported adherence to practice parameters in prescribing an epinephrine auto-injector and instructing patients on its use, taking a detailed allergy history, counseling patients on avoidance measures, and educating patients on the signs and symptoms of anaphylaxis. More than 90% stated they determined the best diagnostic procedures to identify triggers and coordinated laboratory and allergy testing. Adherence to practice parameters was less robust for providing patients with written action plans and in-office anaphylaxis preparedness. Perceived barriers to care included a significant proportion of patients who were uncomfortable using epinephrine auto-injectors and inadequate knowledge of anaphylaxis among referral physicians. Allergists overwhelmingly adhere to practice parameter recommendations for the treatment and management of anaphylaxis, including appropriate use of epinephrine as first-line treatment, educating patients, and testing to diagnose anaphylaxis and identify its triggers. Opportunities for improvement include preparing staff and patients for anaphylactic events, providing written action plans, and improving knowledge of referring physicians. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights

  10. [A case of food-dependent exercise-induced anaphylaxis caused by ingestion of orange]. (United States)

    Ono, Rintaro; Motomura, Chikako; Takamatsu, Nobue; Kondo, Yasuto; Akamine, Yuko; Matsuzaki, Hiroshi; Murakami, Yoko; Amimoto, Yuko; Taba, Naohiko; Honjyo, Satoshi; Shibata, Rumiko; Odajima, Hiroshi


    The patient was a 10-year-old girl who presented with a history of anaphylactic episodes on three occasions, that developed in association with exercise after she ate citrus fruit. She underwent tolerance tests, as food-dependent exercise-induced anaphylaxis (FDEIA) induced by citrus fruit was suspected. The result of the test for the combination of intake of oranges and exercise was negative. The patient presented with swollen eyelid and wheezing following combined intake of orange and aspirin, based on which she was diagnosed as having FDEIA. Many patients developing an allergic reaction to fruit are diagnosed as having oral allergy syndrome (OAS), and only few cases of FDEIA are reported. Immunoblot tests revealed antigens of 9 kDa, 39 kDa and 53 kDa in this patient, and an inhibition study with oranges revealed that the 39 kDa and 53 kDa antigens were probably antigen-specific allergens. Although the studied patient showed a strongly positive result for IgE antibodies specifically directed at cedar pollen, no common antigenicity with cedar pollen could be recognized. The final diagnosis was a type of FDEIA caused by 39 kDa and 53 kDa proteins, which are different from antigens previously identified in patients with citrus fruits allergy. It should be the first report of such a case.

  11. Anaphylaxis to Spirulina confirmed by skin prick test with ingredients of Spirulina tablets. (United States)

    Le, Thuy-My; Knulst, André C; Röckmann, Heike


    Spirulina (Arthrospira platensis), blue-green microalgae, has high content in proteins, γ-linoleic acid and vitamins and therefore gained popularity as food supplement. According to the Food and Agriculture Organization of the United Nations Spirulina is also an interesting alternative and sustainable protein source with the growing world population. We present a case of a 17-year-old male, who developed anaphylaxis the first time he ingested a Spirulina tablet. Skin prick test with diluted Spirulina tablet was positive. Further skin prick testing with separated ingredients (Spirulina platensis algae, silicon dioxide, inulin and magnesium stearate) was only positive for Spirulina platensis algae and negative in controls, confirming the allergy was caused by Spirulina and not by one of the additives. This case report shows that diagnosis of Spirulina allergy can safely be made by skin prick test with dilutions of the A. platensis or even more simple by skin prick test with the diluted tablet. Since Spirulina has gained popularity as food and nutritional supplement, it is important to realize the potential risk of this dietary supplement. Before Spirulina is produced and consumed on a wider scale, allergenicity risk assessment should be performed, including investigation of potential crossreactivity with well-known inhalant allergens and foods.

  12. Exercise-Induced Anaphylaxis: A Case Report and Review of the Diagnosis and Treatment of a Rare but Potentially Life-Threatening Syndrome

    Directory of Open Access Journals (Sweden)

    Nathan T. Jaqua


    Full Text Available A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

  13. Proposed use of adrenaline (epinephrine) in anaphylaxis and related conditions: a study of senior house officers starting accident and emergency posts (United States)

    Gompels, L; Bethune, C; Johnston, S; Gompels, M


    Senior house officers (SHOs) (n=78) at the start of their accident and emergency (A&E) post were given an anonymous five case history questionnaire, containing one case of true anaphylaxis, and asked to complete the medication they would prescribe. In the case of anaphylaxis, 100% would administer adrenaline (epinephrine) but 55% would do so by the incorrect route. In the remaining cases, 10%–56% would be prepared to administer adrenaline inappropriately. Only 5% were able to indicate the correct route and dose of adrenaline according to Resuscitation Council guidelines (UK). This has implications for training as the survey took place before the start of the A&E posting. Anaphylaxis is over-diagnosed and poorly treated despite Resuscitation Council guidelines. PMID:12151658

  14. Lifelong memory responses perpetuate humoral TH2 immunity and anaphylaxis in food allergy. (United States)

    Jiménez-Saiz, Rodrigo; Chu, Derek K; Mandur, Talveer S; Walker, Tina D; Gordon, Melissa E; Chaudhary, Roopali; Koenig, Joshua; Saliba, Sarah; Galipeau, Heather J; Utley, Adam; King, Irah L; Lee, Kelvin; Ettinger, Rachel; Waserman, Susan; Kolbeck, Roland; Jordana, Manel


    A number of food allergies (eg, fish, shellfish, and nuts) are lifelong, without any disease-transforming therapies, and unclear in their underlying immunology. Clinical manifestations of food allergy are largely mediated by IgE. Although persistent IgE titers have been attributed conventionally to long-lived IgE + plasma cells (PCs), this has not been directly and comprehensively tested. We sought to evaluate mechanisms underlying persistent IgE and allergic responses to food allergens. We used a model of peanut allergy and anaphylaxis, various knockout mice, adoptive transfer experiments, and in vitro assays to identify mechanisms underlying persistent IgE humoral immunity over almost the entire lifespan of the mouse (18-20 months). Contrary to conventional paradigms, our data show that clinically relevant lifelong IgE titers are not sustained by long-lived IgE + PCs. Instead, lifelong reactivity is conferred by allergen-specific long-lived memory B cells that replenish the IgE + PC compartment. B-cell reactivation requires allergen re-exposure and IL-4 production by CD4 T cells. We define the half-lives of antigen-specific germinal centers (23.3 days), IgE + and IgG 1 + PCs (60 and 234.4 days, respectively), and clinically relevant cell-bound IgE (67.3 days). These findings can explain lifelong food allergies observed in human subjects as the consequence of allergen exposures that recurrently activate memory B cells and identify these as a therapeutic target with disease-transforming potential. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Resveratrol inhibits IgE-mediated basophilic mast cell degranulation and passive cutaneous anaphylaxis in mice. (United States)

    Han, Seon-Young; Bae, Ji-Young; Park, Sin-Hye; Kim, Yun-Ho; Park, Jung Han Yoon; Kang, Young-Hee


    Resveratrol is a phytoalexin abundantly found in red grape skin and is effective in antitumor and antiinflammation associated with immune responses. This study investigated whether resveratrol suppressed immunoglobulin (Ig)E-mediated allergic responses and passive cutaneous anaphylaxis (PCA) in rat RBL-2H3 mast cells and in BALB/c mice. The release of β-hexosaminidase and histamine was enhanced in mast cells sensitized with anti-dinitrophenyl (DNP)-IgE and subsequently stimulated by DNP-human serum albumin (HSA), indicative of mast cell degranulation. When mast cells were pretreated with nontoxic resveratrol at 1-25 μmol/L, such induction was dose dependently diminished. Spleen tyrosine kinase (Syk) and phospholipase Cγ (PLCγ) of sensitized mast cells were activated by stimulation with DNP-HSA antigen, which was dampened by ≥5 μmol/L resveratrol. The phosphorylation of protein kinase C (PKC)μ and PKCθ was attenuated by administering resveratrol to DNP-HSA-exposed mast cells, whereas quiescent PKCζ/λ in sensitized cells was dose-dependently activated by resveratrol. Male BALB/c mice were sensitized for 24 h with DNP-IgE and orally administered with resveratrol 1 h before the DNP-HSA challenge. The histamine concentration was enhanced in sensitized mice challenged to DNP-HSA, which was reversed by administration of 10 mg/kg resveratrol. Additionally, it encumbered the tissue activation of Syk, PLCγ, and PKCμ in antigen-exposed mice. Resveratrol decreased IgE-mediated PCA and alleviated allergic edema of mouse ear and dorsal skin. Mast cell degranulation and allergic inflammation, accompanying the induction of monocyte chemotactic protein-1 and macrophage inflammatory protein-2, were inhibited by supplementing resveratrol to antigen-challenged mice. Resveratrol inhibited mast cell-derived, immediate-type allergic reactions, and these responses of resveratrol suggest possible therapeutic strategies in preventing allergic inflammatory diseases.

  16. Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. (United States)

    Umasunthar, T; Procktor, A; Hodes, M; Smith, J G; Gore, C; Cox, H E; Marrs, T; Hanna, H; Phillips, K; Pinto, C; Turner, P J; Warner, J O; Boyle, R J


    Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices. We allocated mothers of food-allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer-generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi-Q), without device-specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events. We randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful - RR 1.00 (95% CI 0.68-1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi-Q (26/28, 93%) than other devices (39/80, 49%; P adrenaline administration. Success rates were low with several devices, but were high using the audio-prompt device Auvi-Q. © 2015 The Authors Allergy Published by John Wiley & Sons Ltd.

  17. Allergen immunotherapy with heat-killed Listeria monocytogenes alleviates peanut and food-induced anaphylaxis in dogs. (United States)

    Frick, O L; Teuber, S S; Buchanan, B B; Morigasaki, S; Umetsu, D T


    Heat-killed Listeria monocytogenes (HKL) potently stimulates interferon (IFN)-gamma production in CD4 T-lymphocytes, and when used as adjuvant for immunotherapy, reduces immunoglobulin (Ig)E production and reverses established allergen-induced airway hyperreactivity (AHR) in a murine model of asthma. We asked if such treatment could decrease established peanut-induced anaphylaxis or cow's milk-induced food allergy in highly food-allergic dogs. We therefore studied four 4-year-old atopic colony dogs extremely allergic to peanut (Group I), as well as five 7-year-old dogs very allergic to wheat, milk and other foods (Group II). All dogs experienced marked allergic symptoms, including vomiting and diarrhea on oral challenge with the relevant foods. The dogs were then vaccinated once subcutaneously with peanut or milk and wheat with HKL emulsified in incomplete Freund's adjuvant. Following vaccination of the allergic dogs with HKL and allergen, oral challenges with peanut (Group I) or milk (Group II) elicited only minor or no symptoms. In addition, skin test end-point titrations showed marked reductions for >10 weeks after treatment, and levels of Ara h 1-specific IgE in serum of peanut sensitive dogs, as demonstrated by immunoblotting, were greatly reduced by treatment with HKL plus peanut allergen. Thus, HKL plus allergen treatment markedly improved established food allergic responses in dogs, suggesting that such an immunotherapy strategy in humans might greatly improve individuals with food allergy and anaphylaxis.


    Alshaeri, Taghreed; Gupta, Deepak; Nagabhushana, Ananthamurthy


    Anaphylaxis during anesthesia is uncommon. Diagnosis of peri-anesthesia anaphylaxis (PAA) requires anesthesia providers' vigilance for prompt diagnosis and treatment. In this case report, we present a challenging case with suspected PAA including its perioperative management, intensive care unit (ICU) course, and post-discharge follow-up. A 44-year-old female (body mass index = 26) presented for elective abdominal panniculectomy. Post-intubation, severe bronchospasm occurred that was non-responsive to nebulized albuterol and intravenous epinephrine. Continuous infusion of epinephrine was initiated. After aborting surgical procedure, the patient was transferred to ICU on continuous intravenous infusion of epinephrine. Venous blood sampling showed elevated troponin level. Echocardiography revealed ejection fraction of 25% suspicious of Takotsubo cardiomyopathy (mid cavitary variant). Tracheal extubation was only possible after three days. Subsequently, patient was discharged home with a cardiology follow-up appointment and a referral to an allergy specialist. Unfortunately at our institution (an academic university hospital in United States) along with neighboring institutions in near-by areas, the only allergy skin tests available are for local anesthetics and antibiotics, while neuromuscular blocking agents (NMBAs) cannot be tested (the suspected anaphylactic agent in our case was presumably rocuronium). In summary, PAA requires and responds to emergent diagnosis and immediate treatment; however there is still a long way to go to ensure post-PAA testing for inciting anesthesia-related allergens.

  19. Testing of gastric contents for peanut proteins in a 13-year old anaphylaxis victim. (United States)

    Beavers, Charles; Stauble, M Elaine; Jortani, Saeed A


    We report the case of a 13-y female who went into anaphylactic shock following the ingestion of a meal suspected to be contaminated by peanuts. The teenager had a known sensitivity to peanuts, however, the restaurant claimed that no peanut products were used in the preparation of her meal. The gastric contents of the decedent were retained and tested for peanut proteins due to the possible legal liability of the proprietor. Using antibodies against peanut proteins (roasted and unroasted), we optimized a method to detect total soluble peanut proteins by Western-blot analysis in gastric contents. In addition, we validated two commercially available tests which were originally intended for detection of peanut proteins in food matrices to examine the same gastric sample. One was an enzyme-linked immunosorbent assay (ELISA) that utilized polyclonal antibodies against Ara h 1 (Tepnel Life Sciences). The other was a laminar-flow assay directed against Ara h 1, Ara h 2 and Ara h 3 (R-Biopharm). A positive food-based control was created by reducing bread and peanuts (1:1, w/w) with water (1:1, w/v) using a mortar and pestle. A food-based negative food control was created similar to the positive control, except the peanuts were omitted and the amount of bread was doubled. The Western-blot assay was sensitive down to 2.5ng/ml of total peanut protein. The laminar flow was the most rapid and least complex. The ELISA was the most analytically sensitive with a cut-off of 1ng/ml of Ara h 1 protein compared to the laminar flow which had a cut-off of 4ng/ml Ara h 1 equivalent. Both ELISA and laminar flow assays were able to detect peanut proteins in the food matrices and positive controls, and not in negative controls. No peanut related proteins were detected in the decedent's gastric sample. The gastric sample spiked with peanuts was reliably detectable. The anaphylaxis patient had no peanut allergens detected in her gastric contents by any of the three methods employed. Both

  20. Three cases of anaphylaxis following injection of a depot corticosteroid with evidence of IgE sensitization to macrogols rather than the active steroid

    DEFF Research Database (Denmark)

    Brandt, Nicolaj; Garvey, Lene H; Bindslev-Jensen, Ulla


    We present three cases with anaphylaxis after injection of a depot corticosteroid. First, the steroid was suspected as the elicitor, but after evaluation the excipient macrogol was found to be the elicitor. One of the patients had reactions to several unrelated drugs. Increased awareness of anaph...

  1. Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive lgE to vicilin (Ara h 1)

    NARCIS (Netherlands)

    Wensing, M.; Knulst, A.C.; Piersma, S.; O'Kane, F.; Knol, E.F.; Koppelman, S.J.


    Background: Serologic cross-reactivity among legumes has been described; however, it is rarely clinically significant. In this study 3 patients with a history of anaphylaxis to pea are described who subsequently had symptoms after ingestion of peanut. Objective: We investigated whether the

  2. Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive IgE to vicilin (Ara h 1)

    NARCIS (Netherlands)

    Wensing, M.; Knulst, A.C.; Piersma, S.R.; O'Kane, F.E.; Knol, E.F.; Koppelman, S.J.


    Background: Serologic cross-reactivity among legumes has been described; however, it is rarely clinically significant. In this study 3 patients with a history of anaphylaxis to pea are described who subsequently had symptoms after ingestion of peanut. Objective: We investigated whether the

  3. Eighteen cases of wheat allergy and wheat-dependent exercise-induced urticaria/anaphylaxis sensitized by hydrolyzed wheat protein in soap. (United States)

    Kobayashi, Tomoko; Ito, Tomonobu; Kawakami, Hiroshi; Fuzishiro, Kanzan; Hirano, Hirofumi; Okubo, Yukari; Tsuboi, Ryoji


    Glupearl 19S, an acid-hydrolyzed wheat protein (HWP), is used widely in Japan as a moisturizing ingredient in facial soaps. Since 2010, there has been an increasing number of reports of contact urticaria and wheat allergy resulting from the use of products containing this substance. Sixty-one patients who had used HWP-containing facial soap visited our hospital. Thirty-five of these experienced urticaria or anaphylaxis after consuming wheat-containing food. Eighteen of the 35 patients tested positive to 0.01% Glupearl 19S solution. Wheat-specific IgE and serum gluten-specific IgE were higher in the patients with HWP allergy than in non-HWP allergy patients. Among the patients who tested positive to Glupearl 19S on the skin prick test, nine experienced HWP-wheat-dependent exercise-induced anaphylaxis, and four experienced food-dependent anaphylaxis. Moreover, four of these patients not only experienced food-dependent anaphylaxis but also a worsening of the symptoms during exercise. The clinical symptomology was so variable that the patients were classified into six groups. We found that patients with HWP allergy tended to manifest symptoms of both HWP-wheat-dependent exercise-induced anaphylaxis and contact urticaria. The etiology of hydrolyzed wheat protein allergy is unknown. Patients with a history of these symptoms need to be informed about the risk of consuming wheat-containing foods and the importance of excluding such items from their diet. © 2015 The International Society of Dermatology.

  4. Delayed Anaphylaxis to Mammalian Meat Following Tick Exposure and Its Impact on Anesthetic Management for Cardiac Surgery: A Case Report. (United States)

    Kleiman, Amanda M; Littlewood, Keith E; Groves, Danja S


    Hypersensitivity reactions to mammalian meat following tick exposure are increasing in prevalence and provide a unique challenge to anesthesiologists. The reactions, including anaphylaxis, are delayed and therefore may not be easily recognized and treated. The risk is especially high in cardiac surgery, where several potential triggers, including biological valves as well as heparin, are used frequently. In the presence of such hypersensitivity, prophylactic measures including preoperative testing and pharmacologic prophylaxis may be useful in modulating the immune response such that triggering agents may be used relatively safely. We present 3 patients with previous sensitization to meat protein following a tick bite with known allergic reactions to mammalian meat who presented for cardiac surgery involving exposure to potential allergens and discuss the perioperative management including possible prevention.

  5. Endothelial Regulator of Calcineurin 1 Promotes Barrier Integrity and Modulates Histamine-Induced Barrier Dysfunction in Anaphylaxis

    DEFF Research Database (Denmark)

    Ballesteros-Martinez, Constanza; Mendez-Barbero, Nerea; Montalvo-Yuste, Alma


    Anaphylaxis, the most serious and life-threatening allergic reaction, produces the release of inflammatory mediators by mast cells and basophils. Regulator of calcineurin 1 (Rcan1) is a negative regulator of mast-cell degranulation. The action of mediators leads to vasodilation and an increase...... in vascular permeability, causing great loss of intravascular volume in a short time. Nevertheless, the molecular basis remains unexplored on the vascular level. We investigated Rcan1 expression induced by histamine, platelet-activating factor (PAF), and epinephrine in primary human vein (HV)-/artery (HA......)-derived endothelial cells (ECs) and human dermal microvascular ECs (HMVEC-D). Vascular permeability was analyzed in vitro in human ECs with forced Rcan1 expression using Transwell migration assays and in vivo using Rcan1 knockout mice. Histamine, but neither PAF nor epinephrine, induced Rcan1-4 mRNA and protein...

  6. Drug-specific cyclodextrins with emphasis on sugammadex, the neuromuscular blocker rocuronium and perioperative anaphylaxis: implications for drug allergy. (United States)

    Baldo, B A; McDonnell, N J; Pham, N H


    Cyclodextrins, oligosaccharides linked in a circular arrangement around a central cavity, are used extensively in the pharmaceutical industry to improve drug delivery. Their usefulness depends on their capacity to form a drug inclusion, or host-guest, complex within the cavity. In an attempt to improve the delivery of the widely used neuromuscular blocking drug (NMBD) rocuronium, a rocuronium inclusion complex was formed with a chemically modified γ-cyclodextrin. The high binding affinity and specificity of the modified carrier (named sugammadex) for rocuronium (and other aminosteroid NMBDs) led to its use in anaesthesia as an innovative and useful agent for rapid reversal of rocuronium-induced neuromuscular block by sequestering the drug as an inclusion complex. This, in turn, led to the suggestion that sugammadex might be useful to remove the NMBD from the circulation of patients experiencing rocuronium-induced anaphylaxis, a suggestion subsequently supported in case reports where traditional treatment had failed. Successful resuscitations suggested that sugammadex might be a valuable new treatment for such intractable cases but, given the inappropriateness of clinical trials, confirmation or refutation will have to await the slow accumulation of results of individual case reports. Important questions related to antibody accessibility of drug allergenic structures on the rocuronium-sugammadex inclusion complex, and the competition between sugammadex and IgE antibodies (both free and cell bound) for rocuronium, also remain and can be investigated in vitro. The sugammadex findings indicate that the use of carrier molecules such as the cyclodextrins to improve drug delivery will sometimes give rise to changed immunologic and allergenic behaviour of some drugs and this will have to be taken into account in preclinical drug safety assessments of drug-carrier complexes. The possibility of encapsulating and removing other allergenic drugs, e.g., penicillins and

  7. IgE antibodies, FcεRIα, and IgE-mediated local anaphylaxis can limit snake venom toxicity. (United States)

    Starkl, Philipp; Marichal, Thomas; Gaudenzio, Nicolas; Reber, Laurent Lionel; Sibilano, Riccardo; Tsai, Mindy; Galli, Stephen Joseph


    Type 2 cytokine-related immune responses associated with development of antigen-specific IgE antibodies can contribute to pathology in patients with allergic diseases and to fatal anaphylaxis. However, recent findings in mice indicate that IgE also can enhance defense against honeybee venom. We tested whether IgE antibodies, IgE-dependent effector mechanisms, and a local anaphylactic reaction to an unrelated antigen can enhance defense against Russell viper venom (RVV) and determined whether such responses can be influenced by immunization protocol or mouse strain. We compared the resistance of RVV-immunized wild-type, IgE-deficient, and Fcer1a-deficient mice after injection of a potentially lethal dose of RVV. A single prior exposure to RVV enhanced the ability of wild-type mice, but not mice lacking IgE or functional FcεRI, to survive challenge with a potentially lethal amount of RVV. Moreover, IgE-dependent local passive cutaneous anaphylaxis in response to challenge with an antigen not naturally present in RVV significantly enhanced resistance to the venom. Finally, we observed different effects on resistance to RVV or honeybee venom in BALB/c versus C57BL/6 mice that had received a second exposure to that venom before challenge with a high dose of that venom. These observations illustrate the potential benefit of IgE-dependent effector mechanisms in acquired host defense against venoms. The extent to which type 2 immune responses against venoms can decrease pathology associated with envenomation seems to be influenced by the type of venom, the frequency of venom exposure, and the genetic background of the host. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. Oral delivery of bioencapsulated coagulation factor IX prevents inhibitor formation and fatal anaphylaxis in hemophilia B mice. (United States)

    Verma, Dheeraj; Moghimi, Babak; LoDuca, Paul A; Singh, Harminder D; Hoffman, Brad E; Herzog, Roland W; Daniell, Henry


    To address complications of pathogenic antibody or life-threatening anaphylactic reactions in protein replacement therapy for patients with hemophilia or other inherited protein deficiencies, we have developed a prophylactic protocol using a murine hemophilia B model. Oral delivery of coagulation factor IX fused with cholera toxin beta-subunit (with or without a furin cleavage site; CTB-FFIX or CTB-FIX), expressed in chloroplasts (up to 3.8% soluble protein or 0.4 mg/g leaf tissue), bioencapsulated in plant cells, effectively blocked formation of inhibitory antibodies (undetectable or up to 100-fold less than controls). Moreover, this treatment eliminated fatal anaphylactic reactions that occurred after four to six exposures to intravenous F.IX. Whereas only 20-25% of control animals survived after six to eight F.IX doses, 90-93% of F.IX-fed mice survived 12 injections without signs of allergy or anaphylaxis. Immunostaining confirmed delivery of F.IX to Peyer's patches in the ileum. Within 2-5 h, feeding of CTB-FFIX additionally resulted in systemic delivery of F.IX antigen. This high-responder strain of hemophilia B mice represents a new animal model to study anaphylactic reactions. The protocol was effective over a range of oral antigen doses (equivalent to 5-80 microg recombinant F.IX/kg), and controlled inhibitor formation and anaphylaxis long-term, up to 7 months (approximately 40% life span of this mouse strain). Oral antigen administration caused a deviant immune response that suppressed formation of IgE and inhibitory antibodies. This cost-effective and efficient approach of antigen delivery to the gut should be applicable to several genetic diseases that are prone to pathogenic antibody responses during treatment.

  9. Other components

    International Nuclear Information System (INIS)



    This chapter includes descriptions of electronic and mechanical components which do not merit a chapter to themselves. Other hardware requires mention because of particularly high tolerance or intolerance of exposure to radiation. A more systematic analysis of radiation responses of structures which are definable by material was given in section 3.8. The components discussed here are field effect transistors, transducers, temperature sensors, magnetic components, superconductors, mechanical sensors, and miscellaneous electronic components

  10. Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. (United States)

    Bury, Danielle; Langlois, Neil; Byard, Roger W


    In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids. © 2011 American Academy of Forensic Sciences.

  11. Reclassifying Anaphylaxis to Neuromuscular Blocking Agents Based on the Presumed Patho-Mechanism: IgE-Mediated, Pharmacological Adverse Reaction or “Innate Hypersensitivity”?

    Directory of Open Access Journals (Sweden)

    David Spoerl


    Full Text Available Approximately 60% of perioperative anaphylactic reactions are thought to be immunoglobulin IgE mediated, whereas 40% are thought to be non-IgE mediated hypersensitivity reactions (both considered non-dose-related type B adverse drug reactions. In both cases, symptoms are elicited by mast cell degranulation. Also, pharmacological reactions to drugs (type A, dose-related may sometimes mimic symptoms triggered by mast cell degranulation. In case of hypotension, bronchospasm, or urticarial rash due to mast cell degranulation, identification of the responsible mechanism is complicated. However, determination of the type of the underlying adverse drug reaction is of paramount interest for the decision of whether the culprit drug may be re-administered. Neuromuscular blocking agents (NMBA are among the most frequent cause of perioperative anaphylaxis. Recently, it has been shown that NMBA may activate mast cells independently from IgE antibodies via the human Mas-related G-protein-coupled receptor member X2 (MRGPRX2. In light of this new insight into the patho-mechanism of pseudo-allergic adverse drug reactions, in which as drug-receptor interaction results in anaphylaxis like symptoms, we critically reviewed the literature on NMBA-induced perioperative anaphylaxis. We challenge the dogma that NMBA mainly cause IgE-mediated anaphylaxis via an IgE-mediated mechanism, which is based on studies that consider positive skin test to be specific for IgE-mediated hypersensitivity. Finally, we discuss the question whether MRGPRX2 mediated pseudo-allergic reactions should be re-classified as type A adverse reactions.

  12. Reclassifying Anaphylaxis to Neuromuscular Blocking Agents Based on the Presumed Patho-Mechanism: IgE-Mediated, Pharmacological Adverse Reaction or "Innate Hypersensitivity"? (United States)

    Spoerl, David; Nigolian, Haig; Czarnetzki, Christoph; Harr, Thomas


    Approximately 60% of perioperative anaphylactic reactions are thought to be immunoglobulin IgE mediated, whereas 40% are thought to be non-IgE mediated hypersensitivity reactions (both considered non-dose-related type B adverse drug reactions). In both cases, symptoms are elicited by mast cell degranulation. Also, pharmacological reactions to drugs (type A, dose-related) may sometimes mimic symptoms triggered by mast cell degranulation. In case of hypotension, bronchospasm, or urticarial rash due to mast cell degranulation, identification of the responsible mechanism is complicated. However, determination of the type of the underlying adverse drug reaction is of paramount interest for the decision of whether the culprit drug may be re-administered. Neuromuscular blocking agents (NMBA) are among the most frequent cause of perioperative anaphylaxis. Recently, it has been shown that NMBA may activate mast cells independently from IgE antibodies via the human Mas-related G-protein-coupled receptor member X2 (MRGPRX2). In light of this new insight into the patho-mechanism of pseudo-allergic adverse drug reactions, in which as drug-receptor interaction results in anaphylaxis like symptoms, we critically reviewed the literature on NMBA-induced perioperative anaphylaxis. We challenge the dogma that NMBA mainly cause IgE-mediated anaphylaxis via an IgE-mediated mechanism, which is based on studies that consider positive skin test to be specific for IgE-mediated hypersensitivity. Finally, we discuss the question whether MRGPRX2 mediated pseudo-allergic reactions should be re-classified as type A adverse reactions.

  13. Electronic components

    CERN Document Server

    Colwell, Morris A


    Electronic Components provides a basic grounding in the practical aspects of using and selecting electronics components. The book describes the basic requirements needed to start practical work on electronic equipment, resistors and potentiometers, capacitance, and inductors and transformers. The text discusses semiconductor devices such as diodes, thyristors and triacs, transistors and heat sinks, logic and linear integrated circuits (I.C.s) and electromechanical devices. Common abbreviations applied to components are provided. Constructors and electronics engineers will find the book useful

  14. Component testing

    International Nuclear Information System (INIS)

    Hutchings, M.T.; Schofield, Peter; Seymour, W.A.J.


    A method for non-destructive testing of an industrial component to ascertain if it is a single crystal, and to find the crystal orientations of those parts of the component which are single crystals, involves irradiating the component with a monochromatic collimated neutron beam. Diffracted neutron beams are observed live by means of LiF/ZnS composite screen, an image intensifier and a television camera and screen. (author)

  15. Antiallergic effect of fisetin on IgE-mediated mast cell activation in vitro and on passive cutaneous anaphylaxis (PCA). (United States)

    Jo, Woo-Ri; Park, Hye-Jin


    Fisetin (3,7,3',4'-tetrahydroxyflavone), a naturally occurring bioactive flavonoid, has been shown to inhibit inflammation. However, little is known about the effect of fisetin on immunoglobulin E (IgE)-mediated allergic responses. In this study, the effect of fisetin on rat basophilic leukemia (RBL-2H3) cell-mediated allergic reactions was investigated. Fisetin inhibited β-hexosaminidase release and decreased the level of interleukin-4 and tumor necrosis factor-α mRNA in IgE/antigen (IgE/Ag)-stimulated RBL-2H3 cells. To elucidate the antiallergic mechanism, we examined the levels of signaling molecules responsible for degranulation and release of inflammatory cytokines. Fisetin decreased the levels of activated spleen tyrosine kinase, Gab2 proteins, linker of activated T cells, extracellular signal-related kinase 1/2 in the IgE/Ag-stimulated RBL2H3 cells, and NFκB and STAT3 proteins activated in the ear tissue of mice with passive cutaneous anaphylaxis (PCA). In addition, fisetin significantly lowered of FcɛRI α-subunit mRNA expression. Consistent with the cellular data, fisetin markedly suppressed RBL-2H3 cell-dependent PCA in IgE/Ag-sensitized mice. These results suggest that fisetin may have potential as a therapeutic agent for the treatment of allergic diseases. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. IgA attenuates anaphylaxis and subsequent immune responses in mice: possible application of IgA to vaccines. (United States)

    Yamaki, Kouya; Nakashima, Takayuki; Miyatake, Kenji; Ishibashi, Yuki; Ito, Ayaka; Kuranishi, Ayu; Taguchi, Akihito; Morioka, Ayumi; Yamamoto, Midori; Yoshino, Shin


    Administration of the influenza vaccination to patients with an egg allergy is major health concern. Contaminating egg antigens occasionally induce severe anaphylactic shock in these patients following administration of the vaccination; therefore, the development of a safer vaccination is needed. In the present study, we investigated whether a mixture of four newly and previously generated anti-ovalbumin (OVA) IgA monoclonal antibodies (mAbs) could inhibit both anaphylactic shock upon a subcutaneous OVA challenge and subsequent further sensitization against OVA in passively anti-OVA IgE-sensitized mice and actively sensitized mice with an injection of OVA. The prevention of anaphylaxis by anti-OVA IgA mAbs was suggested to be mediated through the inhibition of OVA binding to allergenic antibodies such as anti-OVA IgE on mast cells and deceleration of the rate of OVA penetration from the injected site into the systemic circulation. Anti-OVA IgA mAbs inhibited further sensitization against OVA in mice actively sensitized with OVA, but did not affect sensitization against the unrelated antigen, phosphorylcholine-keyhole limpet hemocyanin co-injected with OVA. Our findings indicate that adding the anti-egg antigen IgA to the influenza vaccine should reduce not only the risk of inducing anaphylactic shock, but also undesired further sensitization against egg antigens following the vaccination without affecting the intended beneficial effect of the vaccine, namely the upregulation of immune responses to influenza viruses.

  17. Boletus edulis: a digestion-resistant allergen may be relevant for food allergy. (United States)

    Helbling, A; Bonadies, N; Brander, K A; Pichler, W J


    Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Whereas respiratory allergy is thought to be induced by spores, allergic reactions following ingestion are attributed to other parts of the mushroom. Reports of food-related allergic reactions due to the edible mushroom Boletus edulis have occasionally been reported. The aim of the study was to investigate whether separate allergens may be detected in alimentary allergy to Boletus edulis. Sera of two subjects, one with recurrent anaphylaxis and the other with a predominantly oral allergy syndrome following ingestion of Boletus edulis, have been analysed by a time-course digestion assay using simulated gastric fluid and by SDS-PAGE immunoblotting. Sera of four Boletus edulis skin prick test-negative subjects and all without clinical symptoms to ingested Boletus edulis served as controls. In lyophilized Boletus edulis extract, at least four water-soluble proteins were detected, the most reactive at 55 kDa and at 80 kDa. Following the time-course digestion assay, IgE binding was found to a 75-kDa protein, but only if the sera of the subject with recurrent anaphylaxis was used. The data indicate that Boletus edulis can cause an IgE-mediated food allergy due to a digestion-stabile protein at 75 kDa. No IgE immune response to this protein was detected in the serum of a subject with respiratory allergy and oral allergy syndrome to Boletus edulis nor in control sera.

  18. Polydatin (PD) inhibits IgE-mediated passive cutaneous anaphylaxis in mice by stabilizing mast cells through modulating Ca{sup 2+} mobilization

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Meichun [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China); Department of Physiology, Hubei University of Medicine, Shiyan (China); Li, Jianjie [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Lv, Jingzhang [Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen 518045 (China); Mo, Xucheng; Yang, Chengbin [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Chen, Xiangdong [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China); Liu, Zhigang [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Liu, Jie, E-mail: [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China)


    Mast cells play a key role in the pathogenesis of asthma and are a promising target for therapeutic intervention in asthma. This study investigated the effects of polydatin (PD), a resveratrol glucoside, on mast cell degranulation upon cross-linking of the high-affinity IgE receptors (FcεRI), as well as the anti-allergic activity of PD in vivo. Herein, we demonstrated that PD treatment for 30 min suppressed FcεRI-mediated mast cell degranulation in a dose-dependent manner. Concomitantly, PD significantly decreased FcεRI-mediated Ca{sup 2+} increase in mast cells. The suppressive effects of PD on FcεRI-mediated Ca{sup 2+} increase were largely inhibited by using LaCl{sub 3} to block the Ca{sup 2+} release-activated Ca{sup 2+} channels (CRACs). Furthermore, PD significantly inhibited Ca{sup 2+} entry through CRACs evoked by thapsigargin (TG). Knocking down protein expression of Orai1, the pore-forming subunit of CRACs, significantly decreased PD suppression of FcεRI-induced intracellular Ca{sup 2+} influx and mast cell degranulation. In a mouse model of mast cell-dependent passive cutaneous anaphylaxis (PCA), in vivo PD administration suppressed mast cell degranulation and inhibited anaphylaxis. Taken together, our data indicate that PD stabilizes mast cells by suppressing FcεRI-induced Ca{sup 2+} mobilization mainly through inhibiting Ca{sup 2+} entry via CRACs, thus exerting a protective effect against PCA. -- Highlights: ► Polydatin can prevent the pathogenesis of passive cutaneous anaphylaxis in mice. ► Polydatin stabilizes mast cells by decreasing FcεRI-mediated degranulation. ► Polydatin suppresses Ca{sup 2+} entry through CRAC channels in mast cells.

  19. IL-7Rα and L-selectin, but not CD103 or CD34, are required for murine peanut-induced anaphylaxis

    Directory of Open Access Journals (Sweden)

    Maltby Steven


    Full Text Available Abstract Background Allergy to peanuts results in severe anaphylactic responses in affected individuals, and has dramatic effects on society and public policy. Despite the health impacts of peanut-induced anaphylaxis (PIA, relatively little is known about immune mechanisms underlying the disease. Using a mouse model of PIA, we evaluated mice with deletions in four distinct immune molecules (IL7Rα, L-selectin, CD34, CD103, for perturbed responses. Methods PIA was induced by intragastric sensitization with peanut antigen and cholera toxin adjuvant, followed by intraperitoneal challenge with crude peanut extract (CPE. Disease outcome was assessed by monitoring body temperature, clinical symptoms, and serum histamine levels. Resistant mice were evaluated for total and antigen specific serum IgE, as well as susceptibility to passive systemic anaphylaxis. Results PIA responses were dramatically reduced in IL7Rα−/− and L-selectin−/− mice, despite normal peanut-specific IgE production and susceptibility to passive systemic anaphylaxis. In contrast, CD34−/− and CD103−/− mice exhibited robust PIA responses, indistinguishable from wild type controls. Conclusions Loss of L-selectin or IL7Rα function is sufficient to impair PIA, while CD34 or CD103 ablation has no effect on disease severity. More broadly, our findings suggest that future food allergy interventions should focus on disrupting sensitization to food allergens and limiting antigen-specific late-phase responses. Conversely, therapies targeting immune cell migration following antigen challenge are unlikely to have significant benefits, particularly considering the rapid kinetics of PIA.

  20. Management of anaphylaxis in schools: Evaluation of an epinephrine auto-injector (EpiPen® use by school personnel and comparison of two approaches of soliciting participation

    Directory of Open Access Journals (Sweden)

    Nguyen Luu Nha


    Full Text Available Abstract Background There has been no large study characterizing selection bias in allergy and evaluating school personnel’s ability to use an epinephrine auto-injector (EpiPen®. Our objective was to determine if the consent process introduces selection bias by comparing 2 methods of soliciting participation of school personnel in a study evaluating their ability to demonstrate the EpiPen®. Methods School personnel from randomly selected schools in Quebec were approached using a 1 partial or 2 full disclosure approach and were assessed on their ability to use the EpiPen® and identify anaphylaxis. Results 343 school personnel participated. In the full disclosure group, the participation rate was lower: 21.9% (95%CI, 19.0%-25.2% versus 40.7% (95%CI, 36.1%-45.3%, but more participants achieved a perfect score: 26.3% (95%CI, 19.6%-33.9% versus 15.8% (95%CI, 10.8%-21.8%, and identified 3 signs of anaphylaxis: 71.8% (95%CI, 64.0%-78.7% versus 55.6% (95%CI, 48.2%-62.9%. Conclusions Selection bias is suspected as school personnel who were fully informed of the purpose of the assessment were less likely to participate; those who participated among the fully informed were more likely to earn perfect scores and identify anaphylaxis. As the process of consent can influence participation and bias outcomes, researchers and Ethics Boards need to consider conditions under which studies can proceed without full consent. Despite training, school personnel perform poorly when asked to demonstrate the EpiPen®.

  1. Evaluation of physiological parameters of dogs submitted to uterine lymphatic mapping using patent blue V dye for anaphylaxis detection

    Directory of Open Access Journals (Sweden)

    Rebeca C. Justino

    Full Text Available ABSTRACT: Lymphatic mapping has been performed in humans and dogs. Although several cases of anaphylaxis have been reported in humans, there are no such reports in dogs. The objective of this study was to identify the occurrence of adverse reactions to patent blue V dye in bitches undergoing uterine lymphatic mapping procedures using cardiovascular and hematological evaluations. The experiment was performed in 14 mongrel bitches without any reproductive disease, randomly assigned into two equal groups (PBV- uterine lynphatic mapping and OHE; Control - OHE only. The animals were submitted to pre- and postoperative hematological and serum biochemistry exams (7 days. The anesthetic protocol was: sedation (morphine and acepromazine, induction (propofol, maintenance (isoflurane, transoperative analgesia (fentanyl. Systolic blood pressure was monitored throughout the procedure and arterial blood gas analysis was performed immediate pre and postoperatively. For lymphatic mapping was injected patent blue V in the uterine wall, 10 minutes before OEH. Comparisons between the pre- and postoperative parameters within the same animal were performed using the Wilcoxon-Mann-Whitney test. To compare the values between control and PBV group was obtaining the difference between the pre and post of each group, subjected to the Mann-Whitney test (significance of 5%. Differences were observed (P<0.05 between the pre- and postoperative evaluations in the PBV (total protein and the albumin serum, in both groups (arterial partial pressure of oxygen and in the Control (arterial oxygen saturation. There were no signs of adverse reactions to the patent blue V dye in the healthy bitches submitted to lymphatic uterine mapping.

  2. Epinephrine in Anaphylaxis: Preclinical Study of Pharmacokinetics after Sublingual Administration of Taste-Masked Tablets for Potential Pediatric Use. (United States)

    Rachid, Ousama; Rawas-Qalaji, Mutasem; Simons, Keith J


    Epinephrine is a life-saving treatment in anaphylaxis. In community settings, a first-aid dose of epinephrine is injected from an auto-injector (EAI). Needle phobia highly contributes to EAI underuse, leading to fatalities-especially in children. A novel rapidly-disintegrating sublingual tablet (RDST) of epinephrine was developed in our laboratory as a potential alternative dosage form. The aim of this study was to evaluate the sublingual bioavailability of epinephrine 30 mg as a potential pediatric dose incorporated in our novel taste-masked RDST in comparison with intramuscular (IM) epinephrine 0.15 mg from EAI, the recommended and only available dosage form for children in community settings. We studied the rate and extent of epinephrine absorption in our validated rabbit model ( n = 5) using a cross-over design. The positive control was IM epinephrine 0.15 mg from an EpiPen Jr ® . The negative control was a placebo RDST. Tablets were placed under the tongue for 2 min. Blood samples were collected at frequent intervals and epinephrine concentrations were measured using HPLC with electrochemical detection. The mean ± SEM maximum plasma concentration ( C max ) of 16.7 ± 1.9 ng/mL at peak time ( T max ) of 21 min after sublingual epinephrine 30 mg did not differ significantly ( p > 0.05) from the C max of 18.8 ± 1.9 ng/mL at a T max of 36 min after IM epinephrine 0.15 mg. The C max of both doses was significantly higher than the C max of 7.5 ± 1.7 ng/mL of endogenous epinephrine after placebo. These taste-masked RDSTs containing a 30 mg dose of epinephrine have the potential to be used as an easy-to-carry, palatable, non-invasive treatment for anaphylactic episodes for children in community settings.

  3. Using a gluten oral food challenge protocol to improve diagnosis of wheat-dependent exercise-induced anaphylaxis. (United States)

    Brockow, Knut; Kneissl, Daniel; Valentini, Luzia; Zelger, Otto; Grosber, Martine; Kugler, Claudia; Werich, Martina; Darsow, Ulf; Matsuo, Hiroaki; Morita, Eishin; Ring, Johannes


    Oral wheat plus cofactors challenge tests in patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) produce unreliable results. We sought to confirm WDEIA diagnosis by using oral gluten flour plus cofactors challenge, to determine the amount of gluten required to elicit symptoms, and to correlate these results with plasma gliadin levels, gastrointestinal permeability, and allergologic parameters. Sixteen of 34 patients with a history of WDEIA and ω5-gliadin IgE underwent prospective oral challenge tests with gluten with or without cofactors until objective symptoms developed. Gluten reaction threshold levels, plasma gliadin concentrations, gastrointestinal permeability, sensitivities and specificities for skin prick tests, and specific IgE levels were ascertained in patients and 38 control subjects. In 16 of 16 patients (8 female and 8 male patients; age, 23-76 years), WDEIA was confirmed by challenges with gluten alone (n = 4) or gluten plus cofactors (n = 12), including 4 patients with previous negative wheat challenge results. Higher gluten doses or acetylsalicylic acid (ASA) plus alcohol instead of physical exercise were cofactors in 2 retested patients. The cofactors ASA plus alcohol and exercise increased plasma gliadin levels (P gluten skin prick tests was 100% and 96%, respectively. Oral challenge with gluten alone or along with ASA and alcohol is a sensitive and specific test for the diagnosis of WDEIA. Exercise is not an essential trigger for the onset of symptoms in patients with WDEIA. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Characterization of causative allergens for wheat-dependent exercise-induced anaphylaxis sensitized with hydrolyzed wheat proteins in facial soap. (United States)

    Yokooji, Tomoharu; Kurihara, Saki; Murakami, Tomoko; Chinuki, Yuko; Takahashi, Hitoshi; Morita, Eishin; Harada, Susumu; Ishii, Kaori; Hiragun, Makiko; Hide, Michihiro; Matsuo, Hiroaki


    In Japan, hydrolyzed wheat proteins (HWP) have been reported to cause wheat-dependent exercise-induced anaphylaxis (WDEIA) by transcutaneous sensitization using HWP-containing soap. Patients develop allergic reactions not only with soap use, but also with exercise after the intake of wheat protein (WP). ω5-Gliadin and HMW-glutenin were identified as major allergens in conventional WP-WDEIA patients. However, the allergens in HWP-WDEIA have yet to be elucidated. Sera were obtained from 22 patients with HWP-sensitized WDEIA. The allergenic activities of HWP and six recombinant wheat gluten proteins, including α/β-, γ-, ω1,2- and ω5-gliadin and low- and high molecular weight (HMW)-glutenins, were characterized by immunoblot analysis and histamine releasing test. IgE-binding epitopes were identified using arrays of overlapping peptides synthesized on SPOTs membrane. Immunoblot analysis showed that IgE antibodies (Abs) from HWP-WDEIA bound to α/β-, γ- and ω1,2-gliadin. Recombinant γ-gliadin induced significant histamine release from basophils in eight of 11 patients with HWP-WDEIA. An IgE-binding epitope "QPQQPFPQ" was identified within the primary sequence of γ-gliadin, and the deamidated peptide containing the "PEEPFP" sequence bound with IgE Abs more strongly compared to the native epitope-peptide. The epitope-peptide inhibited IgE-binding to HWP, indicating that the specific IgE to HWP cross-reacts with γ-gliadin. HWP-WDEIA patients could be sensitized to HWP containing a PEEPFP sequence, and WDEIA symptoms after WP ingestion could partly be induced by γ-gliadin. These findings could be useful to help develop tools for diagnosis and desensitization therapy for HWP-WDEIA.

  5. The Bee Sting That Was Not: An Unusual Case of Hymenoptera Anaphylaxis Averted in a Patient Treated with Omalizumab for Asthma

    Directory of Open Access Journals (Sweden)

    Evelyn M. Slaughter


    Full Text Available This paper presents a case of hymenoptera venom anaphylaxis averted by omalizumab, a monoclonal antibody to IgE antibody. This case suggests a novel and unintentional effect of this therapy. Currently omalizumab is only FDA approved for the treatment of moderate-persistent allergic asthma. However case reports, such as ours have illustrated omalizumab’s efficacy in the treatment of a myriad immunologic and allergic diseases. These outcomes have broadened the understanding of omalizumab’s complex mechanism of action.

  6. Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis: A nationwide population-based study. (United States)

    Broesby-Olsen, Sigurd; Farkas, Dóra Körmendiné; Vestergaard, Hanne; Hermann, Anne Pernille; Møller, Michael Boe; Mortz, Charlotte Gotthard; Kristensen, Thomas Kielsgaard; Bindslev-Jensen, Carsten; Sørensen, Henrik Toft; Frederiksen, Henrik


    In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997-2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer, venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9-2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4-16.3). Specifically, we found a HR of 7.5 (95% CI 4.4-13.0) for melanoma and a HR of 2.5 (95% CI 1.7-3.5) for non-melanoma skin cancers (NMSCs). For VTE we found a HR of 1.9 (95% CI 1.2-3.0), with a 10-year AR of 3.9% (95% CI 2.3-6.1); for MI a nonsignificant increased HR of 1.4 (95% CI 0.9-2.3), with a 10-year AR of 1.8% (95% CI 0.9-3.2); and for stroke a HR of 1.6 (95% CI 1.1-2.3) with a 10-year AR of 4.6% (95% CI 2.8-6.9). The HR for anaphylaxis was 7.2 (95% CI 5.3-9.9), and the 10-year AR was 3.1% (95% CI 1.9-4.9). For osteoporosis the HR was 3.6 (95% CI 2.7-4.6) with a 10-year AR of 7.2% (95% CI 5.2-9.8). For fractures the HR was 1.2 (95% CI 0.9-1.6) and the 10-year AR was 5.9% (95% CI 3.9-8.4). SM patients are at increased risk of solid cancers - especially melanoma and NMSC-and cardiovascular disease. The risk of anaphylaxis and osteoporosis is clearly increased in SM, though absolute risk was low in this population-based study. The fracture-risk was only slightly increased. Am. J. Hematol. 91:1069-1075, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  7. Component Rhinoplasty


    Mohmand, Muhammad Humayun; Ahmad, Muhammad


    BACKGROUND According to statistics of American Society of Plastic Surgeons, cosmetic rhinoplasty was the second most frequently performed cosmetic surgery. This study shares the experiences with component rhinoplasty. METHODS From 2004 to 2010, all patients underwent aesthetic nasal surgery were enrolled. The patients requiring only correction of septal deviation and those presenting with cleft lip nasal deformity were excluded. All procedures were performed under general anaesthesia with ope...

  8. Hyperfrequency components (United States)


    The document has a collection of 19 papers (11 on technologies, 8 on applications) by 26 authors and coauthors. Technological topics include: evolution from conventional HEMT's double heterojunction and planar types of pseudomorphic HEMT's; MMIC R&D and production aspects for very-low-noise, low-power, and very-low-noise, high-power applications; hyperfrequency CAD tools; parametric measurements of hyperfrequency components on plug-in cards for design and in-process testing uses; design of Class B power amplifiers and millimetric-wave, bigrid-transistor mixers, exemplifying combined use of three major types of physical simulation in electrical modeling of microwave components; FET's for power amplification at up to 110 GHz; production, characterization, and nonlinear applications of resonant tunnel diodes. Applications topics include: development of active modules for major European programs; tubes versus solid-state components in hyperfrequency applications; status and potentialities of national and international cooperative R&D on MMIC's and CAD of hyperfrequency circuitry; attainable performance levels in multifunction MMIC applications; state of the art relative of MESFET power amplifiers (Bands S, C, X, Ku); creating a hyperfrequency functions library, of parametrizable reference cells or macrocells; and design of a single-stage, low-noise, band-W amplifier toward development of a three-stage amplifier.

  9. Variance Components

    CERN Document Server

    Searle, Shayle R; McCulloch, Charles E


    WILEY-INTERSCIENCE PAPERBACK SERIES. The Wiley-Interscience Paperback Series consists of selected books that have been made more accessible to consumers in an effort to increase global appeal and general circulation. With these new unabridged softcover volumes, Wiley hopes to extend the lives of these works by making them available to future generations of statisticians, mathematicians, and scientists. ". . .Variance Components is an excellent book. It is organized and well written, and provides many references to a variety of topics. I recommend it to anyone with interest in linear models.".

  10. Severe IgE-mediated anaphylaxis following consumption of fried frog legs: definition of alpha-parvalbumin as the allergen in cause. (United States)

    Hilger, C; Grigioni, F; Thill, L; Mertens, L; Hentges, F


    IgE-mediated allergic reactions to bullfrog and edible frog have been reported. The implicated allergens have not been defined so far. The frog material and the patient's serum from a case of severe food-induced anaphylaxis were used to define the implicated allergen at the protein and DNA level. Immunoblotting techniques and N-terminal protein microsequencing were used to define the allergen recognized by the patient's serum. Back translation from the identified protein sequence was used to design degenerated primers to amplify the allergen's cDNA by polymerase chain reaction (PCR). We defined the nucleotide sequence of the allergen from the frog of Indonesian origin that was consumed by the patient, and the homologous cDNA from Rana esculenta. Protein microsequencing revealed that the implicated frog allergen belonged to the parvalbumin family. cDNAs coding for alpha- and beta-parvalbumin of R. esculenta and Rana species were cloned. Recombinant proteins were expressed in Escherichia coli. The patient's serum IgE antibodies recognized parvalbumin prepared from frog muscle and recombinant alpha-parvalbumin from R. species but not from R. esculenta. Recombinant beta-parvalbumin was not recognized by the IgE antibodies. This work defines at the protein and DNA levels alpha-parvalbumin as the allergen implicated in a case of IgE-mediated anaphylaxis to frog muscle. It also shows that a protein belonging to the parvalbumin family is implicated in type I allergies outside the fish species.

  11. [Food additives as a cause of medical symptoms: relationship shown between sulfites and asthma and anaphylaxis; results of a literature review]. (United States)

    Reus, K E; Houben, G F; Stam, M; Dubois, A E


    To determine if a causal connection exists between food additives and various medical complaints. Literature study. Medline over the period January 1966-January 1999 was searched for articles on the following substances not containing protein and lactose: monosodium glutamate (MSG), sulfites, azo-dyes (tartrazine, sunset yellow, azorubin, amarant, cochineal red), benzoates, sorbates, butylated hydroxyanisole/butylated hydroxytoluene (BHA/BHT), parabens, cinnamon and vanilla, in combination with key words regarding food and side effects. Of those studies purporting to demonstrate an effect, only double-blind randomized placebo-controlled studies with oral challenge were assessed further, unless the complaint was anaphylaxis. Of studies not demonstrating an effect the design was assessed. Only for sulfites as causative agents of asthma and anaphylaxis, methodologically adequate studies demonstrating a causal connection could be found. For azo-dyes, benzoates, MSG, sorbates and BHA/BHT, no link with medical symptoms was demonstrable. For parabens, cinnamon and vanilla there were insufficient or inadequate data to justify a conclusion.

  12. IgE antibodies of fish allergic patients cross-react with frog parvalbumin. (United States)

    Hilger, C; Thill, L; Grigioni, F; Lehners, C; Falagiani, P; Ferrara, A; Romano, C; Stevens, W; Hentges, F


    The major allergens in fish are parvalbumins. Important immunoglobulin (Ig)E cross-recognition of parvalbumins from different fish species has been shown. Recently frog parvalbumin alpha has been found to be responsible for a case of IgE-mediated anaphylaxis triggered by the ingestion of frog meat. The aim of this study was to investigate whether IgE antibodies of fish allergic persons cross-react with frog parvalbumin and to appreciate its clinical relevance. The sera of 15 fish allergic patients and one fish and frog allergic patient were tested by IgE-immunoblotting against frog muscle extract. Sera were tested against recombinant parvalbumin alpha and beta from Rana esculenta. Skin prick tests were performed in selected patients with recombinant frog parvalbumin. Ca(2+) depletion experiments and inhibition studies with purified cod and frog recombinant parvalbumin were done to characterize the cross-reactive pattern. Fourteen of the sera tested had IgE antibodies recognizing low molecular weight components in frog muscle extract. Calcium depletion experiments or inhibition of patient sera with purified cod parvalbumin led to a significant or complete decrease in IgE binding. When tested against recombinant parvalbumins, three of 13 sera reacted with alpha parvalbumin and 11 of 12 reacted with beta parvalbumin from R. esculenta. Skin prick tests performed with recombinant frog parvalbumin were positive in fish allergic patients. Inhibition studies showed that a fish and frog allergic patient was primarily sensitized to fish parvalbumin. Cod parvalbumin, a major cross-reactive allergen among different fish species, shares IgE binding epitopes with frog parvalbumin. This in vitro cross-reactivity seems to be also clinically relevant. Parvalbumins probably represent a new family of cross-reactive allergens.

  13. Self-reported adverse food reactions and anaphylaxis in the SchoolNuts study: A population-based study of adolescents. (United States)

    McWilliam, Vicki L; Koplin, Jennifer J; Field, Michael J; Sasaki, Mari; Dharmage, Shyamali C; Tang, Mimi L K; Sawyer, Susan M; Peters, Rachel L; Allen, Katrina J


    Adolescents are at the highest risk of death from anaphylaxis, yet few population-based studies have described the frequencies and risk factors for allergic reactions caused by accidental allergen ingestion in this group. We describe the prevalence, frequency, and associated risk factors for recent adverse food reactions in 10- to 14-year-olds in Melbourne, Australia, recruited from a stratified, random, population-based sample of schools (SchoolNuts, n = 9663; 48% response rate). Self-reported food allergy and adverse reaction details, including anaphylaxis, were identified by using a student questionnaire over the past year. Of 547 students with possible IgE-mediated food allergy, 243 (44.4%; 95% CI, 40.3% to 48.7%) reported a reaction to a food. Fifty-three (9.7%; 95% CI, 7.2% to 12.2%) students reported 93 anaphylaxis episodes. Peanut and tree nuts were the most common food triggers. Among students with current IgE-mediated food allergy, those with resolved or current asthma (adjusted odds ratio [aOR], 1.9 [95% CI, 1.1-1.3] and 1.7 [95% CI, 1.1-2.6]) and those with more than 2 food allergies (aOR, 1.9 [95% CI, 1.1-3.1]) were at greatest risk of any adverse food reaction, and those with nut allergy were most at risk of severe reactions (aOR, 2.9 [95% CI, 1.1-4.4]). Resolved or current asthma was not associated with increased risk of severe reactions (aOR, 0.8 [95% CI, 0.3-2.2] and 1.6 [95% CI, 0.7-3.7]). Adolescents with food allergy are frequently exposed to food allergens. Those with asthma and more than 2 food allergies were at the greatest risk for adverse food reactions. Those with nut allergies were most at risk of severe reactions. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  14. Anaphylaxis: Tips to Remember (United States)

    ... yellow jackets, honeybees, paper wasps, hornets and fire ants can cause severe and even deadly reactions in ... have had an anaphylactic reaction, inform family, healthcare workers, employers and school staff about your allergy. Healthy ...

  15. Serious Allergic Reactions (Anaphylaxis) (United States)

    ... anafilaxia) Someone with certain types of allergies (like food allergies) can be at risk for a sudden, potentially ... epinephrine injector! That's especially true if you have food allergies and also have asthma. After using an epinephrine ...

  16. Precision Medicine in Allergic Disease - Food Allergy, Drug Allergy, and Anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology

    DEFF Research Database (Denmark)

    Muraro, Antonella; Lemanske, Robert F; Castells, Mariana


    This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology (EAACI...... underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug......) and the American Academy of Allergy, Asthma and Immunology (AAAAI), which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms...

  17. Evaluation of the sensitization rates and identification of IgE-binding components in wild and genetically modified potatoes in patients with allergic disorders

    Directory of Open Access Journals (Sweden)

    Kim Seung-Hyun


    Full Text Available Abstract Background The potato is one of the most common types of genetically modified (GM food. However, there are no published data evaluating the impact of genetic manipulations on the allergenicity of GM potatoes. To compare the allergenicity of GM potatoes with that of wild-type potatoes using in vivo and in vitro methods in adult allergy patients sensitized to potatoes. Methods A total of 1886 patients with various allergic diseases and 38 healthy controls participated in the study. Skin-prick testing and IgE-ELISA were carried out with extracts prepared from wild-type and GM potatoes. An ELISA inhibition test was used to confirm the binding specificity. IgE-binding components in extracts from the two types of potato were identified by SDS-PAGE and IgE-immunoblotting. The effects of digestive enzymes and heat on the allergenicity of the extracts was evaluated by preincubating the potatoes with or without simulated gastric and intestinal fluids in the absence or presence of heat. Results Positive responses (ratio of the wheal size induced by the allergen to that induced by histamine (A/H ≥ 2+ to wild-type or GM potato extracts, as demonstrated by the skin-prick test, were observed in 108 patients (5.7%. Serum-specific IgE was detected in 0–88% of subjects who tested positively. ELISA inhibition tests indicated significant inhibition when extract from each type of potato was added. IgE-immunoblot analysis demonstrated the presence of 14 IgE-binding components within the wild-type potato and 9 within the GM potato. Furthermore, a common 45-kDa binding component that yielded similar IgE-binding patterns was noted in more than 80% of the reactions using sera from patients sensitized to wild-type or GM potato. Exposure to simulated gastric fluid and heat treatment similarly inhibited IgE binding by extracts from wild-type and GM potatoes, whereas minimal changes were obtained following exposure of the extracts to simulated intestinal fluid

  18. Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission (United States)

    Chough, Natacha G.; Watkins, Sharmi; Menon, Anil S.


    As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.

  19. The sensitivity and clinical course of patients with wheat-dependent exercise-induced anaphylaxis sensitized to hydrolyzed wheat protein in facial soap - secondary publication. (United States)

    Hiragun, Makiko; Ishii, Kaori; Hiragun, Takaaki; Shindo, Hajime; Mihara, Shoji; Matsuo, Hiroaki; Hide, Michihiro


    Recently, an increasing number of patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) have been reported in Japan. Most of them had developed this condition during or after using hydrolyzed wheat protein (HWP)-containing soap (HWP-WDEIA). To clarify the relation between WDEIA and HWP-containing soap and their prognosis, we retrospectively studied the patients who visited Hiroshima University Hospital and were diagnosed as WDEIA from January 2010 to June 2011. We took detailed clinical histories, performed skin prick tests, serum immunoassays for antigen-specific IgE and basophil histamine release test, and followed up their clinical courses after the diagnosis. Among 36 patients with WDEIA, 30 patients had used only one type of HWP-soap. The patients with HWP-WDEIA were mainly women and had developed facial symptoms and angioedema. They suffered from blood pressure reductions less frequently than patients with conventional WDEIA. The levels of gluten-specific IgE were higher than those of omega-5 gliadin in patients with HWP-WDEIA (P soap. The development of HWP-WDEIA is associated with the use of HWP-soap. The sensitivity to HWP that cross reacts with non-processed wheat may be reduced or possibly cured after the discontinuation of HWP-soap.

  20. [The sensitivity and clinical course of patients with wheat-dependent exercise-induced anaphylaxis sensitized to hydrolyzed wheat protein in facial soap]. (United States)

    Hiragun, Makiko; Ishii, Kaori; Hiragun, Takaaki; Shindo, Hajime; Mihara, Shoji; Matsuo, Hiroaki; Hide, Michihiro


    Recently an increasing number of patients with wheat-dependent exercise-induced anaphylaxis (WDEIA), developed during or after using hydrolyzed wheat protein (HWP)-containing soap (HWP-WDEIA), were reported in Japan. To clarify the relation between WDEIA and HWP-containing soap and their prognosis, we investigated the patients who visited Hiroshima University Hospital and were diagnosed as WDEIA from January 2010 to June 2011. We took detailed clinical histories, performed skin prick tests, serum immunoassays for antigen-specific IgE and basophil histamine release test, and followed up their clinical courses after the diagnosis. Among 36 patients with WDEIA, 30 patients had used only one type of HWP-soap. The patients with HWP-WDEIA were mainly women and had developed facial symptoms and angioedema. They suffered from blood pressure reductions less frequently than patients with conventional WDEIA. The levels of glutens-specific IgE were higher than those of ω-5 gliadin in patients with HWP-WDEIA (psoap. The development of HWP-WDEIA is associated with the use of HWP-soap. The sensitivities to HWP that cross reacts with non-processed wheat may be reduced or possibly cured after the discontinuation of HWP-soap.

  1. Beta(1,2)-xylose and alpha(1,3)-fucose residues have a strong contribution in IgE binding to plant glycoallergens

    NARCIS (Netherlands)

    van Ree, R.; Cabanes-Macheteau, M.; Akkerdaas, J.; Milazzo, J. P.; Loutelier-Bourhis, C.; Rayon, C.; Villalba, M.; Koppelman, S.; Aalberse, R.; Rodriguez, R.; Faye, L.; Lerouge, P.


    Primary structures of the N-glycans of two major pollen allergens (Lol p 11 and Ole e 1) and a major peanut allergen (Ara h 1) were determined. Ole e 1 and Ara h 1 carried high mannose and complex N-glycans, whereas Lol p 11 carried only the complex. The complex structures all had a beta(1,2)-xylose

  2. Reduction of IgE binding and nonpromotion of Aspergillus flavus fungal growth by simultaneously silencing Ara h 2 and Ara h 6 in peanut. (United States)

    The most potent peanut allergens, Ara h 2 and 6, were silenced in transgenic plants by RNA interference. Three independent transgenic lines were recovered after microprojectile bombardment, of which two contained single, integrated copies of the transgene. The third line contained multiple copies ...

  3. Mitigating component performance variation (United States)

    Gara, Alan G.; Sylvester, Steve S.; Eastep, Jonathan M.; Nagappan, Ramkumar; Cantalupo, Christopher M.


    Apparatus and methods may provide for characterizing a plurality of similar components of a distributed computing system based on a maximum safe operation level associated with each component and storing characterization data in a database and allocating non-uniform power to each similar component based at least in part on the characterization data in the database to substantially equalize performance of the components.

  4. Variability and component composition

    NARCIS (Netherlands)

    T. van der Storm (Tijs)


    textabstractIn component-based product populations, feature models have to be described at the component level to be able to benefit from a product family approach. As a consequence, composition of components becomes very complex. We describe how component-level variability can be managed in the

  5. Combined Blockade of the Histamine H1 and H4 Receptor Suppresses Peanut-Induced Intestinal Anaphylaxis by Regulating Dendritic Cell Function (United States)

    Wang, Meiqin; Han, Junyan; Domenico, Joanne; Shin, Yoo Seob; Jia, Yi; Gelfand, Erwin W.


    Background Signaling through histamine receptors on dendritic cells (DCs) may be involved in the effector phase of peanut-induced intestinal anaphylaxis. Objectives To determine the role of histamine H1 (H1R) and H4 receptors (H4R) in intestinal allergic responses in a model of peanut allergy. Methods Balb/c mice were sensitized and challenged to peanut. During the challenge phase, mice were treated orally with the H1R antagonist, loratadine, and/or the H4R antagonist, JNJ7777120. Bone marrow-derived DCs (BMDCs) were adoptively transferred to non-sensitized WT mice. Symptoms, intestinal inflammation, mesenteric lymph node and intestine mucosal DCs were assessed. Effects of the drugs on DC chemotaxis, calcium mobilization, and antigen-presenting cell function were measured. Results Treatment with loratadine or JNJ7777120 individually partially suppressed development of diarrhea and intestinal inflammation and decreased the numbers of DCs in the mesenteric lymph nodes and lamina propria. Combined treatment with both drugs prevented development of diarrhea and intestinal inflammation. In vitro, the combination suppressed DC antigen presenting cell function to T helper cells and DC calcium mobilization and chemotaxis to histamine. Conclusion Blockade of both H1R and H4R in the challenge phase had additive effects in preventing the intestinal consequences of peanut sensitization and challenge. These effects were mediated through limitation of mesenteric lymph node and intestinal DC accumulation and function. Identification of this histamine-H1R/H4R-DC-CD4+ T cell axis provides new insights into the development of peanut-induced intestinal allergic responses and for prevention and treatment of peanut allergy. PMID:27059534

  6. Anafilaxia associada à vacina contra sarampo, caxumba e rubéola Anafilaxia asociada a la vacuna contra sarampión, varicela y rubéola Anaphylaxis associated with the vaccine against measles, mumps and rubella

    Directory of Open Access Journals (Sweden)

    Iolanda Maria Novadzki


    sensibilización por algún componente residual de la vacuna y posible reacción cruzada con el dextrano.A case-control study was carried out aiming to describe the cases and causes of anaphylaxis associated with the vaccine against measles, mumps and rubella. A total of 22 reported cases in children who showed mucocutaneous manifestations, during the Campanha Nacional de Vacinação (Brazilian Vaccination Campaign, conducted in the city of Curitiba, Southern Brazil, in 2004, were studied. In addition, 66 children, who were next to these cases and did not show a symptomatology after the vaccine was applied, were selected. Serum measurements of antibodies for vaccine antigens and total IgE, specific IgE antibody measurements for several allergens, and skin tests were performed. Vaccine response was adequate, specific IgE measurement and skin tests showed that potential allergens in vaccines and atopy were not associated with anaphylactic reactions. Skin tests with the vaccine and dextran were positive in the cases exclusively, suggesting sensitization to certain residual components of the vaccine and possible cross-reaction with dextran.

  7. Added sensitivity of component-resolved diagnosis in hymenoptera venom-allergic patients with elevated serum tryptase and/or mastocytosis

    DEFF Research Database (Denmark)

    Michel, J B; Brockow, K; Darsow, U


    BACKGROUND: Anaphylaxis caused by hymenoptera venom allergy is associated with elevation of baseline serum tryptase (sBT) and/or mastocytosis in about 5% of patients. Up to now, no information has become available on single venom allergen sIgE reactivity and the usefulness of component......-resolved approaches to diagnose this high-risk patient group. To address the component-resolved sIgE sensitization pattern and diagnostic sensitivity in hymenoptera venom-allergic patients with elevated sBT levels and/or mastocytosis, a panel of yellow jacket and honeybee venom allergens was applied on a widely used...... IgE immunoassay platform. METHODS: Fifty-three patients with mastocytosis and/or elevated sBT tryptase level and systemic reactions to hymenoptera venoms were analyzed for their IgE reactivity to recombinant yellow jacket and honeybee venom allergens by Immulite3 g. RESULTS: sIgE reactivity to Ves v...

  8. Exercise Lowers Threshold and Increases Severity, but Wheat-Dependent, Exercise-Induced Anaphylaxis Can Be Elicited at Rest

    DEFF Research Database (Denmark)

    Christensen, Morten J.; Eller, Esben; Mortz, Charlotte G.


    ) and in combination with exercise 24 g (4-80 g). Severity was significantly higher with exercise (2.3) than at rest (1.1) using Sampson severity score. In the challenge, SPT was positive to wheat in 93.6% (44 of 47) and to gluten in 95.7% (45 of 47). sIgE to wheat, gliadin, and omega-5 gliadin was present in 78.7...... for the diagnosis of WDEIA and to investigate whether exercise is an essential trigger factor or alternatively an augmentation factor able to lower threshold and increase severity. Methods: We investigated 71 patients (age, 18.6-73.7 years) with a case history of WDEIA. Skin prick test (SPT) and measurement......% (37 of 47), 76.5% (36 of 47), and 91.4% (43 of 47) of the patients. Receiver operating characteristic–curve analysis for sIgE to omega-5 gliadin, a component of the gluten fraction and the major allergen in WDEIA, showed best sensitivity (91%) and specificity (92%) when gluten was combined...

  9. Reusable Component Services (United States)

    U.S. Environmental Protection Agency — The Reusable Component Services (RCS) is a super-catalog of components, services, solutions and technologies that facilitates search, discovery and collaboration in...

  10. Software component quality evaluation (United States)

    Clough, A. J.


    The paper describes a software inspection process that can be used to evaluate the quality of software components. Quality criteria, process application, independent testing of the process and proposed associated tool support are covered. Early results indicate that this technique is well suited for assessing software component quality in a standardized fashion. With automated machine assistance to facilitate both the evaluation and selection of software components, such a technique should promote effective reuse of software components.

  11. Reactor component automatic grapple

    International Nuclear Information System (INIS)

    Greenaway, P.R.


    A grapple for handling nuclear reactor components in a medium such as liquid sodium which, upon proper seating and alignment of the grapple with the component as sensed by a mechanical logic integral to the grapple, automatically seizes the component. The mechanical logic system also precludes seizure in the absence of proper seating and alignment. (author)

  12. Principal component analysis

    NARCIS (Netherlands)

    Bro, R.; Smilde, A.K.


    Principal component analysis is one of the most important and powerful methods in chemometrics as well as in a wealth of other areas. This paper provides a description of how to understand, use, and interpret principal component analysis. The paper focuses on the use of principal component analysis

  13. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. (United States)

    Muraro, A; Lemanske, R F; Castells, M; Torres, M J; Khan, D; Simon, H-U; Bindslev-Jensen, C; Burks, W; Poulsen, L K; Sampson, H A; Worm, M; Nadeau, K C


    This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Twenty four-hour helpline access to expert management advice for food-allergy-triggered anaphylaxis in infants, children and young people: a pragmatic, randomized controlled trial. (United States)

    Kelleher, M M; Dunngalvin, A; Sheikh, A; Cullinane, C; Fitzsimons, J; Hourihane, J O'B


    Anaphylaxis is a life-threatening emergency. If promptly administered, adrenaline is potentially life-saving. Many food-allergic-children/carers are unsure when to use their adrenaline autoinjectors, contributing to a low quality of life and worse outcomes in the setting of an acute allergic reaction. The aim of this study was to assess the effectiveness of 24-hour telephone access to specialist clinical advice on disease-specific quality of life. A pragmatic two-arm, parallel-group randomized control trial was conducted. Children/carers (<16 years) with food allergy, trained in adrenaline auto-injector use, were recruited from a hospital-based paediatric allergy clinic. Baseline disease-specific quality of life was ascertained using the validated Food-Allergy-Related Quality-of-Life Questionnaire (FAQLQ), either Parent Form, Child Form or Teenager Form depending on child's age. Participants were then centrally randomized for a 6-month period to 24-hour telephone specialist support line or to usual care. The primary outcome measure was a change in FAQL scores, at one and 6 months postrandomization, compared with baseline. The minimum clinically important difference (MCID) in score is 0.5. Fifty two children/carers were recruited. FAQL scores remained static in the control group across the three time points. Scores gradually improved in the intervention group, with a significant difference seen at 6 months (T1-T3 Mean difference = -1.5, (CI 0.87-2.25) P < 0.005] Follow-up questionnaires, 6 months after the intervention was removed, T4, showed sustained significant difference between the groups (control M = 3.0; intervention M = 1.1[t = -4.113, P < 0.05]). The 24-hour helpline improved food-allergy-specific quality of life in children. Six-month intervention support resulted in sustained benefits for at least a further 6 months. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Supply chain components

    Directory of Open Access Journals (Sweden)

    Vieraşu, T.


    Full Text Available In this article I will go through three main logistics components, which are represented by: transportation, inventory and facilities, and the three secondary logistical components: information, production location, price and how they determine performance of any supply chain. I will discuss then how these components are used in the design, planning and operation of a supply chain. I will also talk about some obstacles a supply chain manager may encounter.

  16. Supply chain components


    Vieraşu, T.; Bălăşescu, M.


    In this article I will go through three main logistics components, which are represented by: transportation, inventory and facilities, and the three secondary logistical components: information, production location, price and how they determine performance of any supply chain. I will discuss then how these components are used in the design, planning and operation of a supply chain. I will also talk about some obstacles a supply chain manager may encounter.

  17. Hot gas path component (United States)

    Lacy, Benjamin Paul; Kottilingam, Srikanth Chandrudu; Porter, Christopher Donald; Schick, David Edward


    Various embodiments of the disclosure include a turbomachine component. and methods of forming such a component. Some embodiments include a turbomachine component including: a first portion including at least one of a stainless steel or an alloy steel; and a second portion joined with the first portion, the second portion including a nickel alloy including an arced cooling feature extending therethrough, the second portion having a thermal expansion coefficient substantially similar to a thermal expansion coefficient of the first portion, wherein the arced cooling feature is located within the second portion to direct a portion of a coolant to a leakage area of the turbomachine component.


    Energy Technology Data Exchange (ETDEWEB)



    The core component pot is an open top vessel used to hold both new and irradiated core components for storage in the IDS and for holding the components submerged in sodium while being trasported inside CLEM. The top of the CCP is equipped with a grapple lip which is engaged by the hoisting grapples. Heat for maintaining the preheat of new components and dissipation of decay heat of irradiated fuel assemblies is conducted between the wall of the pot and the surrounding environment by thermal radiation and convection.

  19. Towards Cognitive Component Analysis

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Ahrendt, Peter; Larsen, Jan


    Cognitive component analysis (COCA) is here defined as the process of unsupervised grouping of data such that the ensuing group structure is well-aligned with that resulting from human cognitive activity. We have earlier demonstrated that independent components analysis is relevant for representi...

  20. [Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases]. (United States)

    Maeda, Nobuko; Inomata, Naoko; Morita, Akiko; Kirino, Mio; Moriyama, Tatsuya; Ikezawa, Zenro


    We report two cases of anaphylactic reactions to peach with negative result of ImmunoCAP to peach. Case 1 is a 35-year-old man, who felt an itch in his oral cavity immediately after ingesting a whole fresh peach. He rapidly developed generalized urticaria, dyspnea, vomiting, and loss of consciousness. He recovered after treatment at a local hospital, thereafter he was referred to our hospital because ImmunoCAP conducted for screening allergens revealed a negative test result to peach and the cause of anaphylaxis remained unclear. He had a history of pollinosis. He reported that he previously felt an itch on his oral cavity after ingesting melon, watermelon, apple, and strawberry. Serum total IgE was 436 IU/ml. CAP-RAST revealed negative results to peach, strawberry and kiwi. Skin prick tests (SPTs) with raw peach pulp, canned peach pulp, strawberry and kiwi were positive. Case 2 is a 30-year-old woman who felt an itch on her oral cavity accompanied by blepharedema, rhinorrhea, generalized urticaria, nausea, abdominal pain and diarrhea after eating peach. She had a history of pollinosis. She reported that she previously developed urticaria after ingesting an apple. Serum total IgE was 85 IU/ml. ImmunoCAP revealed negative results to peach and apple. SPTs with canned yellow peach, strawberry and apple were positive. Consequently, the two patients were diagnosed with anaphylaxis due to peach, and allergic symptoms have never recurred since they avoided ingesting peach. Furthermore, in two patients ImmunoCAP to rPru p 1, rPru p 3, and rPru p 4 were negative. However, in IgE-immunoblotting of peach, serum IgE antibodies of two patients were bound to approximately 10 kDa proteins. Meanwhile, the cross-reactivity between Rosaceae fruits, such as peach, apple, apricot, and plum, has been reported. These results suggest that in patients, who are suspected of having peach anaphylaxis and show a negative ImmunoCAP result to peach, the additional testing, such as SPT with

  1. allergy, asthma airway and anaphylaxis

    African Journals Online (AJOL)

    The perioperative preparation of children presenting for surgery aims to identify medical problems that might influence the outcome and to institute management strategies to reduce those risks. Respiratory and airway complications remain the most significant cause of morbidity and mortality in modern paediatric ...

  2. Local Anaesthetic Neurotoxicity Mimicking Anaphylaxis


    Deniz Özçeker; Zeynep Tamay; Nermin Güler


    Lidocaine and articaine are commonly used in infiltration anesthesia, extremity blockage, topical anesthesia and intravenous regional anesthesia due to high activity and rapid onset effect. Although commonly administered, the allergic drug reactions of local anesthetics are rarely reported. However, reactions related to systemic toxicity can be seen Hereby, we reported two cases related to drug allergy and convulsion after administering of lidocaine and articaine.

  3. Explosive Components Facility (United States)

    Federal Laboratory Consortium — The 98,000 square foot Explosive Components Facility (ECF) is a state-of-the-art facility that provides a full-range of chemical, material, and performance analysis...

  4. Space laser components reliability


    Riede, Wolfgang; Schroeder, Helmut


    Space environment presents unique challenges for operation of optics and optical coatings as part of laser systems. Besides testing components and sub-systems on the component qualification level, the extended testing of complete laser systems like flight modules under acceptance level conditions is an effective way to determine the reliability and long term stability, mitigating the mission risk. Hence, optics as part of high power space laser systems have to be extensively tested in view...

  5. Refractory alloy component fabrication

    International Nuclear Information System (INIS)

    Young, W.R.


    Purpose of this report is to describe joining procedures, primarily welding techniques, which were developed to construct reliable refractory alloy components and systems for advanced space power systems. Two systems, the Nb-1Zr Brayton Cycle Heat Receiver and the T-111 Alloy Potassium Boiler Development Program, are used to illustrate typical systems and components. Particular emphasis is given to specific problems which were eliminated during the development efforts. Finally, some thoughts on application of more recent joining technology are presented. 78 figures

  6. Component fragility research program

    International Nuclear Information System (INIS)

    Tsai, N.C.; Mochizuki, G.L.; Holman, G.S.


    To demonstrate how ''high-level'' qualification test data can be used to estimate the ultimate seismic capacity of nuclear power plant equipment, we assessed in detail various electrical components tested by the Pacific Gas ampersand Electric Company for its Diablo Canyon plant. As part of our Phase I Component Fragility Research Program, we evaluated seismic fragility for five Diablo Canyon components: medium-voltage (4kV) switchgear; safeguard relay board; emergency light battery pack; potential transformer; and station battery and racks. This report discusses our Phase II fragility evaluation of a single Westinghouse Type W motor control center column, a fan cooler motor controller, and three local starters at the Diablo Canyon nuclear power plant. These components were seismically qualified by means of biaxial random motion tests on a shaker table, and the test response spectra formed the basis for the estimate of the seismic capacity of the components. The seismic capacity of each component is referenced to the zero period acceleration (ZPA) and, in our Phase II study only, to the average spectral acceleration (ASA) of the motion at its base. For the motor control center, the seismic capacity was compared to the capacity of a Westinghouse Five-Star MCC subjected to actual fragility tests by LLNL during the Phase I Component Fragility Research Program, and to generic capacities developed by the Brookhaven National Laboratory for motor control center. Except for the medium-voltage switchgear, all of the components considered in both our Phase I and Phase II evaluations were qualified in their standard commercial configurations or with only relatively minor modifications such as top bracing of cabinets. 8 refs., 67 figs., 7 tabs

  7. Impact test of components

    International Nuclear Information System (INIS)

    Borsoi, L.; Buland, P.; Labbe, P.


    Stops with gaps are currently used to support components and piping: it is simple, low cost, efficient and permits free thermal expansion. In order to keep the nonlinear nature of stops, such design is often modeled by beam elements (for the component) and nonlinear springs (for the stops). This paper deals with the validity and the limits of these models through the comparison of computational and experimental results. The experimental results come from impact laboratory tests on a simplified mockup. (orig.)

  8. Anti-allergic activity of 2,4,6-trihydroxy-3-geranylacetophenone (tHGA) via attenuation of IgE-mediated mast cell activation and inhibition of passive systemic anaphylaxis. (United States)

    Tan, Ji Wei; Israf, Daud Ahmad; Harith, Hanis Hazeera; Md Hashim, Nur Fariesha; Ng, Chean Hui; Shaari, Khozirah; Tham, Chau Ling


    tHGA, a geranyl acetophenone compound originally isolated from a local shrub called Melicope ptelefolia, has been previously reported to prevent ovalbumin-induced allergic airway inflammation in a murine model of allergic asthma by targeting cysteinyl leukotriene synthesis. Mast cells are immune effector cells involved in the pathogenesis of allergic diseases including asthma by releasing cysteinyl leukotrienes. The anti-asthmatic properties of tHGA could be attributed to its inhibitory effect on mast cell degranulation. As mast cell degranulation is an important event in allergic responses, this study aimed to investigate the anti-allergic effects of tHGA in cellular and animal models of IgE-mediated mast cell degranulation. For in vitro model of IgE-mediated mast cell degranulation, DNP-IgE-sensitized RBL-2H3 cells were pre-treated with tHGA before challenged with DNP-BSA to induce degranulation. For IgE-mediated passive systemic anaphylaxis, Sprague Dawley rats were sensitized by intraperitoneal injection of DNP-IgE before challenged with DNP-BSA. Both in vitro and in vivo models showed that tHGA significantly inhibited the release of preformed mediators (β-hexosaminidase and histamine) as well as de novo mediators (interleukin-4, tumour necrosis factor-α, prostaglandin D 2 and leukotriene C 4 ). Pre-treatment of tHGA also prevented IgE-challenged RBL-2H3 cells and peritoneal mast cells from undergoing morphological changes associated with mast cell degranulation. These findings indicate that tHGA possesses potent anti-allergic activity via attenuation of IgE-mediated mast cell degranulation and inhibition of IgE-mediated passive systemic anaphylaxis. Thus, tHGA may have the potential to be developed as a mast cell stabilizer for the treatment of allergic diseases in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Intravenous IgA complexed with antigen reduces primary antibody response to the antigen and anaphylaxis upon antigen re-exposure by inhibiting Th1 and Th2 activation in mice. (United States)

    Yamaki, Kouya; Miyatake, Kenji; Nakashima, Takayuki; Morioka, Ayumi; Yamamoto, Midori; Ishibashi, Yuki; Ito, Ayaka; Kuranishi, Ayu; Yoshino, Shin


    Serum IgG, IgE and IgM have been shown to enhance the primary antibody responses upon exposure to the soluble antigens recognized by those antibodies. However, how IgA affects these responses remains unknown. We investigated the effects of intravenously administered monoclonal IgA on the immune responses in mice. DBA/1J mice were immunized with ovalbumin in the presence or absence of anti-ovalbumin monoclonal IgA. The Th1 and Th2 immune responses to ovalbumin and the anaphylaxis induced by re-exposure to ovalbumin were measured. IgA complexed with antigen attenuated the primary antibody responses to the antigen in mice, in contrast to IgG2b and IgE. The primary antibody responses, i.e. the de novo synthesis of anti-ovalbumin IgG2a, IgG1 and IgE in the serum, and the subsequent anaphylaxis induced with re-exposure to ovalbumin were reduced by the co-injection of anti-ovalbumin monoclonal IgA at ovalbumin immunization. The Th1, Th2 and Tr1 cytokines interferon-γ, interleukin-4 and interleukin-10, respectively, released from ovalbumin-restimulated cultured splenocytes collected from allergic mice were also reduced by the treatment. The induction of interferon-γ and interleukin-4 secretion by splenocytes from ovalbumin-immunized mice stimulated in vitro with ovalbumin was also significantly reduced by the antigen complexed with anti-ovalbumin IgA. These data suggest that the direct inhibition of Th1 and Th2 activation by anti-ovalbumin monoclonal IgA participates in the inhibition of the primary antibody responses. IgA plays important immunosuppressive roles under physiological and pathological conditions and is a promising candidate drug for the treatment of immune disorders.

  10. Workgroup Report by the Joint Task Force Involving American Academy of Allergy, Asthma & Immunology (AAAAI); Food Allergy, Anaphylaxis, Dermatology and Drug Allergy (FADDA) (Adverse Reactions to Foods Committee and Adverse Reactions to Drugs, Biologicals, and Latex Committee); and the Centers for Disease Control and Prevention Botulism Clinical Treatment Guidelines Workgroup-Allergic Reactions to Botulinum Antitoxin: A Systematic Review. (United States)

    Schussler, Edith; Sobel, Jeremy; Hsu, Joy; Yu, Patricia; Meaney-Delman, Dana; Grammer, Leslie C; Nowak-Wegrzyn, Anna


    Naturally occurring botulism is rare, but a large number of cases could result from unintentional or intentional contamination of a commercial food. Despeciated, equine-derived, heptavalent botulinum antitoxin (HBAT) is licensed in the United States. Timely treatment reduces morbidity and mortality, but concerns that botulinum antitoxin can induce anaphylaxis exist. We sought to quantify the allergy risk of botulinum antitoxin treatment and the usefulness of skin testing to assess this risk. We conducted a systematic review of (1) allergic reactions to botulinum antitoxin and (2) the predictive value of skin testing (ST) before botulinum antitoxin administration. We searched 5 scientific literature databases, reviewed articles' references, and obtained data from the HBAT manufacturer and from the Centers for Disease Control and Prevention. Anaphylaxis incidence was determined for HBAT and previously employed botulinum antitoxins. We calculated the positive predictive value (PPV) and negative predictive value (NPV) of ST for anaphylaxis related to HBAT and other botulinum antitoxins. Seven articles were included. Anaphylaxis incidence was 1.64% (5/305 patients) for HBAT and 1.16% (8/687 patients) for all other botulinum antitoxins (relative risk, 1.41 [95% confidence interval, .47-4.27]; P = .5). Observed values for both PPV and NPV for HBAT-ST (33 patients) were 100%. Observed PPVs and NPVs of ST for other botulinum antitoxins (302 patients) were 0-56% and 50%-100%, respectively. There were no reports of fatal anaphylaxis. Considering the <2 % rate of anaphylaxis, fatal outcomes, modest predictive value of ST, resource requirements for ST, and the benefits of early treatment, data do not support delaying HBAT administration to perform ST in a mass botulinum toxin exposure. Anaphylactic reactions may occur among 1%-2% of botulinum antitoxin recipients and will require epinephrine and antihistamine treatment and, possibly, intensive care. Published by Oxford

  11. Encyclopedia of Software Components (United States)

    Warren, Lloyd V. (Inventor); Beckman, Brian C. (Inventor)


    Intelligent browsing through a collection of reusable software components is facilitated with a computer having a video monitor and a user input interface such as a keyboard or a mouse for transmitting user selections, by presenting a picture of encyclopedia volumes with respective visible labels referring to types of software, in accordance with a metaphor in which each volume includes a page having a list of general topics under the software type of the volume and pages having lists of software components for each one of the generic topics, altering the picture to open one of the volumes in response to an initial user selection specifying the one volume to display on the monitor a picture of the page thereof having the list of general topics and altering the picture to display the page thereof having a list of software components under one of the general topics in response to a next user selection specifying the one general topic, and then presenting a picture of a set of different informative plates depicting different types of information about one of the software components in response to a further user selection specifying the one component.

  12. Multiscale principal component analysis

    International Nuclear Information System (INIS)

    Akinduko, A A; Gorban, A N


    Principal component analysis (PCA) is an important tool in exploring data. The conventional approach to PCA leads to a solution which favours the structures with large variances. This is sensitive to outliers and could obfuscate interesting underlying structures. One of the equivalent definitions of PCA is that it seeks the subspaces that maximize the sum of squared pairwise distances between data projections. This definition opens up more flexibility in the analysis of principal components which is useful in enhancing PCA. In this paper we introduce scales into PCA by maximizing only the sum of pairwise distances between projections for pairs of datapoints with distances within a chosen interval of values [l,u]. The resulting principal component decompositions in Multiscale PCA depend on point (l,u) on the plane and for each point we define projectors onto principal components. Cluster analysis of these projectors reveals the structures in the data at various scales. Each structure is described by the eigenvectors at the medoid point of the cluster which represent the structure. We also use the distortion of projections as a criterion for choosing an appropriate scale especially for data with outliers. This method was tested on both artificial distribution of data and real data. For data with multiscale structures, the method was able to reveal the different structures of the data and also to reduce the effect of outliers in the principal component analysis

  13. Cognitive Component Analysis

    DEFF Research Database (Denmark)

    Feng, Ling


    of audio contexts along with pattern recognition methods to map components to known contexts. It also involves looking for the right representations for auditory inputs, i.e. the data analytic processing pipelines invoked by human brains. The main ideas refer to Cognitive Component Analysis, defined......This dissertation concerns the investigation of the consistency of statistical regularities in a signaling ecology and human cognition, while inferring appropriate actions for a speech-based perceptual task. It is based on unsupervised Independent Component Analysis providing a rich spectrum...... as the process of unsupervised grouping of generic data such that the ensuing group structure is well-aligned with that resulting from human cognitive activity. Its hypothesis runs ecologically: features which are essentially independent in a context defined ensemble, can be efficiently coded as sparse...

  14. Solid state lighting component

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Thomas; Keller, Bernd; Tarsa, Eric; Ibbetson, James; Morgan, Frederick; Dowling, Kevin; Lys, Ihor


    An LED component according to the present invention comprising an array of LED chips mounted on a submount with the LED chips capable of emitting light in response to an electrical signal. The array can comprise LED chips emitting at two colors of light wherein the LED component emits light comprising the combination of the two colors of light. A single lens is included over the array of LED chips. The LED chip array can emit light of greater than 800 lumens with a drive current of less than 150 milli-Amps. The LED chip component can also operate at temperatures less than 3000 degrees K. In one embodiment, the LED array is in a substantially circular pattern on the submount.

  15. Electronic components and systems

    CERN Document Server

    Dennis, W H


    Electronic Components and Systems focuses on the principles and processes in the field of electronics and the integrated circuit. Covered in the book are basic aspects and physical fundamentals; different types of materials involved in the field; and passive and active electronic components such as capacitors, inductors, diodes, and transistors. Also covered in the book are topics such as the fabrication of semiconductors and integrated circuits; analog circuitry; digital logic technology; and microprocessors. The monograph is recommended for beginning electrical engineers who would like to kn

  16. Component Reengineering Workshops

    DEFF Research Database (Denmark)

    Hansen, Klaus Marius; Christensen, Henrik Bærbak


    In mature domains, a number of competing product lines may emerge, and from the point of view of customers of such product lines, reengineering and reuse of assets across product lines from different vendors becomes important. To address this issue we present a low-cost approach, component...... reengineering workshops, for assessing reengineering costs of reusing components between different product lines. The approach works on the level of software architectures, and relies critically on input from various (technical) stakeholders. It has been validated through case studies that are also presented...

  17. Spain's nuclear components industry

    International Nuclear Information System (INIS)

    Kaibel, E.


    Spanish industrial participation in supply of components for nuclear power plants has grown steadily over the last fifteen years. The share of Spanish companies in work for the five second generation nuclear power plants increased to 50% of total capital investments. The necessity to maintain Spanish technology and production in the nuclear field is emphasized

  18. Component-oriented programming

    NARCIS (Netherlands)

    Bosch, J; Szyperski, C; Weck, W; Buschmann, F; Buchmann, AP; Cilia, MA


    This report covers the eighth Workshop on Component-Oriented Programming (WCOP). WCOP has been affiliated with ECOOP since its inception in 1996. The report summarizes the contributions made by authors of accepted position papers as well as those made by all attendees of the workshop sessions.

  19. Grey component analysis

    NARCIS (Netherlands)

    Westerhuis, J.A.; Derks, E.P.P.A.; Hoefsloot, H.C.J.; Smilde, A.K.


    The interpretation of principal component analysis (PCA) models of complex biological or chemical data can be cumbersome because in PCA the decomposition is performed without any knowledge of the system at hand. Prior information of the system is not used to improve the interpretation. In this paper

  20. Molecular Models Candy Components (United States)

    Coleman, William F.


    An explanation of various principles of chemistry in a paper by Fanny Ennever by the use of candy is described. The paper explains components of sucrose and the invert sugar that results from the hydrolysis of sucrose and will help students in determining whether the products are indeed hydrates of carbon.

  1. Component lifetime modelling

    NARCIS (Netherlands)

    Verweij, J.F.; Verweij, J.F.; Brombacher, A.C.; Brombacher, A.C.; Lunenborg, M.M.; Lunenborg, M.M.


    There are two approaches to component lifetime modelling. The first one uses a reliability prediction method as described in the (military) handbooks with the appropriate models and parameters. The advantages are: (a) It takes into account all possible failure mechanisms. (b) It is easy to use. The

  2. Euler principal component analysis

    NARCIS (Netherlands)

    Liwicki, Stephan; Tzimiropoulos, Georgios; Zafeiriou, Stefanos; Pantic, Maja

    Principal Component Analysis (PCA) is perhaps the most prominent learning tool for dimensionality reduction in pattern recognition and computer vision. However, the ℓ 2-norm employed by standard PCA is not robust to outliers. In this paper, we propose a kernel PCA method for fast and robust PCA,

  3. Validating Timed Component Contracts

    DEFF Research Database (Denmark)

    Le Guilly, Thibaut; Liu, Shaoying; Olsen, Petur


    This paper presents a technique for testing software components with contracts that specify functional behavior, synchronization, as well as timing behavior. The approach combines elements from unit testing with model-based testing techniques for timed automata. The technique is implemented...... in an online testing tool, and we demonstrate its use on a concrete use case....

  4. ITER plasma facing components

    International Nuclear Information System (INIS)

    Kuroda, T.; Vieider, G.; Akiba, M.


    This document summarizes results of the Conceptual Design Activities (1988-1990) for the International Thermonuclear Experimental Reactor (ITER) project, namely those that pertain to the plasma facing components of the reactor vessel, of which the main components are the first wall and the divertor plates. After an introduction and an executive summary, the principal functions of the plasma-facing components are delineated, i.e., (i) define the low-impurity region within which the plasma is produced, (ii) absorb the electromagnetic radiation and charged-particle flux from the plasma, and (iii) protect the blanket/shield components from the plasma. A list of critical design issues for the divertor plates and the first wall is given, followed by discussions of the divertor plate design (including the issues of material selection, erosion lifetime, design concepts, thermal and mechanical analysis, operating limits and overall lifetime, tritium inventory, baking and conditioning, safety analysis, manufacture and testing, and advanced divertor concepts) and the first wall design (armor material and design, erosion lifetime, overall design concepts, thermal and mechanical analysis, lifetime and operating limits, tritium inventory, baking and conditioning, safety analysis, manufacture and testing, an alternative first wall design, and the limiters used instead of the divertor plates during start-up). Refs, figs and tabs

  5. Developing a Model Component (United States)

    Fields, Christina M.


    The Spaceport Command and Control System (SCCS) Simulation Computer Software Configuration Item (CSCI) is responsible for providing simulations to support test and verification of SCCS hardware and software. The Universal Coolant Transporter System (UCTS) was a Space Shuttle Orbiter support piece of the Ground Servicing Equipment (GSE). The initial purpose of the UCTS was to provide two support services to the Space Shuttle Orbiter immediately after landing at the Shuttle Landing Facility. The UCTS is designed with the capability of servicing future space vehicles; including all Space Station Requirements necessary for the MPLM Modules. The Simulation uses GSE Models to stand in for the actual systems to support testing of SCCS systems during their development. As an intern at Kennedy Space Center (KSC), my assignment was to develop a model component for the UCTS. I was given a fluid component (dryer) to model in Simulink. I completed training for UNIX and Simulink. The dryer is a Catch All replaceable core type filter-dryer. The filter-dryer provides maximum protection for the thermostatic expansion valve and solenoid valve from dirt that may be in the system. The filter-dryer also protects the valves from freezing up. I researched fluid dynamics to understand the function of my component. The filter-dryer was modeled by determining affects it has on the pressure and velocity of the system. I used Bernoulli's Equation to calculate the pressure and velocity differential through the dryer. I created my filter-dryer model in Simulink and wrote the test script to test the component. I completed component testing and captured test data. The finalized model was sent for peer review for any improvements. I participated in Simulation meetings and was involved in the subsystem design process and team collaborations. I gained valuable work experience and insight into a career path as an engineer.

  6. Bayesian Independent Component Analysis

    DEFF Research Database (Denmark)

    Winther, Ole; Petersen, Kaare Brandt


    In this paper we present an empirical Bayesian framework for independent component analysis. The framework provides estimates of the sources, the mixing matrix and the noise parameters, and is flexible with respect to choice of source prior and the number of sources and sensors. Inside the engine...... in a Matlab toolbox, is demonstrated for non-negative decompositions and compared with non-negative matrix factorization.......In this paper we present an empirical Bayesian framework for independent component analysis. The framework provides estimates of the sources, the mixing matrix and the noise parameters, and is flexible with respect to choice of source prior and the number of sources and sensors. Inside the engine...

  7. Adaptable component frameworks

    DEFF Research Database (Denmark)

    Katajainen, Jyrki; Simonsen, Bo


    for vector, which is undoubtedly the most used container of the C++ standard library. In particular, we specify the details of a vector implementation that is safe with respect to referential integrity and strong exception safety. Additionally, we report the experiences and lessons learnt from......The CPH STL is a special edition of the STL, the containers and algorithms part of the C++ standard library. The specification of the generic components of the STL is given in the C++ standard. Any implementation of the STL, e.g. the one that ships with your standard-compliant C++ compiler, should...... the development of component frameworks which we hope to be of benefit to persons engaged in the design and implementation of generic software libraries....

  8. Bacterial Cell Wall Components (United States)

    Ginsberg, Cynthia; Brown, Stephanie; Walker, Suzanne

    Bacterial cell-surface polysaccharides cells are surrounded by a variety of cell-surface structures that allow them to thrive in extreme environments. Components of the cell envelope and extracellular matrix are responsible for providing the cells with structural support, mediating intercellular communication, allowing the cells to move or to adhere to surfaces, protecting the cells from attack by antibiotics or the immune system, and facilitating the uptake of nutrients. Some of the most important cell wall components are polysaccharide structures. This review discusses the occurrence, structure, function, and biosynthesis of the most prevalent bacterial cell surface polysaccharides: peptidoglycan, lipopolysaccharide, arabinogalactan, and lipoarabinomannan, and capsular and extracellular polysaccharides. The roles of these polysaccharides in medicine, both as drug targets and as therapeutic agents, are also described.

  9. Components of the environment

    International Nuclear Information System (INIS)

    Klinda, J.; Lieskovska, Z.


    This report of the Ministry of the Environment of the Slovak Republic deals with the components of the environment. The results of monitoring of air (emission situation), ambient air quality, atmospheric precipitation, tropospheric ozone, water (surface water, groundwater resources, waste water and drinking water), geological factors (geothermal energy, fuel deposits, ore deposits, non-metallic ore deposits), soil (area statistics, soil contamination. soil reaction and active extractable aluminium, soil erosion), flora and fauna (national strategy of biodiversity protection) are presented

  10. Fabricating nuclear components

    International Nuclear Information System (INIS)



    Activities of the Nuclear Engineering Division of Vickers Ltd., particularly fabrication of long slim tubular components for power reactors and the construction of irradiation loops and rigs, are outlined. The processes include hydraulic forming for fabrication of various types of tubes and outer cases of fuel transfer buckets, various specialised welding operations including some applications of the TIG process, and induction brazing of specialised assemblies. (U.K.)

  11. Surface mount component jig (United States)

    Kronberg, James W.


    A device for bending and trimming the pins of a dual-inline-package component and the like for surface mounting rather than through mounting to a circuit board comprises, in a first part, in pin cutter astride a holder having a recess for holding the component, a first spring therebetween, and, in a second part, two flat members pivotally interconnected by a hinge and urged to an upward peaked position from a downward peaked position by a second spring. As a downward force is applied to the pin cutter it urges the holder downward, assisted by the first spring and a pair of ridges riding on shoulders of the holder, to carry the component against the upward peaked flat members which guide the pins outwardly. As the holder continues downwardly, the flat members pivot to the downward peaked position bending the pins upwardly against the sides of the holder. When the downward movement is met with sufficient resistance, the ridges of the pin cutter ride over the holder's shoulders to continue downward to cut any excess length of pin.

  12. Inkjet deposited circuit components (United States)

    Bidoki, S. M.; Nouri, J.; Heidari, A. A.


    All-printed electronics as a means of achieving ultra-low-cost electronic circuits has attracted great interest in recent years. Inkjet printing is one of the most promising techniques by which the circuit components can be ultimately drawn (i.e. printed) onto the substrate in one step. Here, the inkjet printing technique was used to chemically deposit silver nanoparticles (10-200 nm) simply by ejection of silver nitrate and reducing solutions onto different substrates such as paper, PET plastic film and textile fabrics. The silver patterns were tested for their functionality to work as circuit components like conductor, resistor, capacitor and inductor. Different levels of conductivity were achieved simply by changing the printing sequence, inks ratio and concentration. The highest level of conductivity achieved by an office thermal inkjet printer (300 dpi) was 5.54 × 105 S m-1 on paper. Inkjet deposited capacitors could exhibit a capacitance of more than 1.5 nF (parallel plate 45 × 45 mm2) and induction coils displayed an inductance of around 400 µH (planar coil 10 cm in diameter). Comparison of electronic performance of inkjet deposited components to the performance of conventionally etched items makes the technique highly promising for fabricating different printed electronic devices.

  13. Analysis Components Investigation Report (United States)


    ssification a the marg ford and h ures such ge of this l s integratio PREVIOUS WRI ities. For in annotating ame meanin ck by valid rest. These ansion...ent to rder. order. rder el has d to the val, and learning , which ibrary is oo! and feature ovides a Analys 4 4 1 is Component THIS DOCU... learn m tor Machin sed to give to re-rank be execut he model w s the follow ed by any the trainin ciated with ation of the the docume all terms

  14. Impedance of accelerator components

    International Nuclear Information System (INIS)

    Corlett, J.N.


    As demands for high luminosity and low emittance particle beams increase, an understanding of the electromagnetic interaction of these beams with their vacuum chamber environment becomes more important in order to maintain the quality of the beam. This interaction is described in terms of the wake field in time domain, and the beam impedance in frequency domain. These concepts are introduced, and related quantities such as the loss factor are presented. The broadband Q = 1 resonator impedance model is discussed. Perturbation and coaxial wire methods of measurement of real components are reviewed

  15. Automotive component failures

    CSIR Research Space (South Africa)

    Heyes, AM


    Full Text Available [ However\\ in the presence of a stress concentration the ultimate tensile stress can be exceeded before the ultimate shear stress is reached\\ resulting in a tensile failure 0 [ 2[6[ Metallo`raphy and Ener`y Dispersive Spectroscopy "EDS# A microspecimen...\\ Vol[ 4\\ No[ 1\\ pp[ 018 030\\ 0887 0887 Elsevier Science Ltd[ All rights reserved\\ Pergamon Printed in Great Britain 0249 5296:87 ,08[99 9[99 PII] S0249 5296"87#99909 6 AUTOMOTIVE COMPONENT FAILURES A[ M[ HEYES Advanced Engineering and Testing...

  16. Food Components and Supplements

    DEFF Research Database (Denmark)

    Parlesak, Alexandr


    .g., secondary plant metabolites such as flavonoids), or as contaminants that enter the food chain at different stages or during the food production process. For these components, a wide spectrum of biological effects was observed that ranges from health-threatening impacts (e.g., polycyclic aromatic amines...... acting as carcinogens) to health-protective effects (e.g., flavonoids ameliorating detrimental effects of mitochondrial oxidative stress). In particular, secondary plant metabolites along with vitamins, specific types of macronutrients and live bacteria (probiotics) as well as substances promoting...

  17. Mesh Retrieval by Components (United States)

    Tal, Ayellet; Zuckerberger, Emanuel

    This paper examines the application of the human vision theories of Marr and Biederman to the retrieval of three-dimensional objects. The key idea is to represent an object by an attributed graph that consists of the object's meaningful components as nodes, where each node is fit to a basic shape. A system that realizes this approach was built and tested on a database of about 400 objects and achieves promising results. It is shown that this representation of 3D objects is very compact. Moreover, it gives rise to a retrieval algorithm that is invariant to non-rigid transformations and does not require normalization.

  18. Prognostics for Microgrid Components (United States)

    Saxena, Abhinav


    Prognostics is the science of predicting future performance and potential failures based on targeted condition monitoring. Moving away from the traditional reliability centric view, prognostics aims at detecting and quantifying the time to impending failures. This advance warning provides the opportunity to take actions that can preserve uptime, reduce cost of damage, or extend the life of the component. The talk will focus on the concepts and basics of prognostics from the viewpoint of condition-based systems health management. Differences with other techniques used in systems health management and philosophies of prognostics used in other domains will be shown. Examples relevant to micro grid systems and subsystems will be used to illustrate various types of prediction scenarios and the resources it take to set up a desired prognostic system. Specifically, the implementation results for power storage and power semiconductor components will demonstrate specific solution approaches of prognostics. The role of constituent elements of prognostics, such as model, prediction algorithms, failure threshold, run-to-failure data, requirements and specifications, and post-prognostic reasoning will be explained. A discussion on performance evaluation and performance metrics will conclude the technical discussion followed by general comments on open research problems and challenges in prognostics.

  19. Interactions between photodegradation components

    Directory of Open Access Journals (Sweden)

    Abdollahi Yadollah


    Full Text Available Abstract Background The interactions of p-cresol photocatalytic degradation components were studied by response surface methodology. The study was designed by central composite design using the irradiation time, pH, the amount of photocatalyst and the p-cresol concentration as variables. The design was performed to obtain photodegradation % as actual responses. The actual responses were fitted with linear, two factor interactions, cubic and quadratic model to select an appropriate model. The selected model was validated by analysis of variance which provided evidences such as high F-value (845.09, very low P-value (2 = 0.999, adjusted R-squared (Radj2 = 0.998, predicted R-squared (Rpred2 = 0.994 and the adequate precision (95.94. Results From the validated model demonstrated that the component had interaction with irradiation time under 180 min of the time while the interaction with pH was above pH 9. Moreover, photocatalyst and p-cresol had interaction at minimal amount of photocatalyst (p-cresol. Conclusion These variables are interdependent and should be simultaneously considered during the photodegradation process, which is one of the advantages of the response surface methodology over the traditional laboratory method.

  20. Chondrites and their Components (United States)

    Scott, E. R. D.; Krot, A. N.


    What are Chondrites?Chondrites are meteorites that provide the best% clues to the origin of the solar system. They are the oldest known rocks - their components formed during the birth of the solar system ca. 4,567 Ma - and their abundances of nonvolatile elements are close to those in the solar photosphere. Chondrites are broadly ultramafic in composition, consisting largely of iron, magnesium, silicon, and oxygen. The most abundant constituents of chondrites are chondrules, which are igneous particles that crystallized rapidly in minutes to hours. They are composed largely of olivine and pyroxene, commonly contain metallic Fe,Ni and are 0.01-10 mm in size. Some chondrules are rounded as they were once entirely molten but many are irregular in shape because they were only partly melted or because they accreted other particles as they solidified. Chondrites themselves were never molten. The definition of a chondrite has expanded recently with the discovery in Antarctica and the Sahara Desert of extraordinary meteorites with chondrules 10-100 μm in size, and chondrites so rich in metallic Fe,Ni that they were initially classified as iron meteorites with silicate inclusions. Thus, in meteoritics, as in other fields of planetary science, new discoveries sometimes require definitions to be modified.Chondrites are so diverse in their mineralogical and textural characteristics that it is not possible to describe a typical chondrite. We show one with diversely textured chondrules including prominent, aesthetically pleasing, rounded chondrules (Figure 1(a)), and another with more uniformly textured chondrules (Figure 1(b)). Owing to the high abundance of rounded or droplet chondrules in the abundant, so-called "ordinary" chondrites ( Figure 1(a)), studies of the origin of chondrules have commonly been based on these chondrites. (7K)Figure 1. Maps showing magnesium concentrations in two chondrites: (a) PCA91082, a CR2 carbonaceous chondrite, and (b) Tieschitz, an H/L3

  1. Component Based Testing with ioco

    NARCIS (Netherlands)

    van der Bijl, H.M.; Rensink, Arend; Tretmans, G.J.

    Component based testing concerns the integration of components which have already been tested separately. We show that, with certain restrictions, the ioco-test theory for conformance testing is suitable for component based testing, in the sense that the integration of fully conformant components is

  2. Component Composition Using Feature Models

    DEFF Research Database (Denmark)

    Eichberg, Michael; Klose, Karl; Mitschke, Ralf


    In general, components provide and require services and two components are bound if the first component provides a service required by the second component. However, certain variability in services - w.r.t. how and which functionality is provided or required - cannot be described using standard i...

  3. Component failure data handbook

    International Nuclear Information System (INIS)

    Gentillon, C.D.


    This report presents generic component failure rates that are used in reliability and risk studies of commercial nuclear power plants. The rates are computed using plant-specific data from published probabilistic risk assessments supplemented by selected other sources. Each data source is described. For rates with four or more separate estimates among the sources, plots show the data that are combined. The method for combining data from different sources is presented. The resulting aggregated rates are listed with upper bounds that reflect the variability observed in each rate across the nuclear power plant industry. Thus, the rates are generic. Both per hour and per demand rates are included. They may be used for screening in risk assessments or for forming distributions to be updated with plant-specific data

  4. Impedance and component heating

    CERN Document Server

    Métral, E; Mounet, N; Pieloni, T; Salvant, B


    The impedance is a complex function of frequency, which represents, for the plane under consideration (longitudinal, horizontal or vertical), the force integrated over the length of an element, from a “source” to a “test” wave, normalized by their charges. In general, the impedance in a given plane is a nonlinear function of the test and source transverse coordinates, but it is most of the time sufficient to consider only the first few linear terms. Impedances can influence the motion of trailing particles, in the longitudinal and in one or both transverse directions, leading to energy loss, beam instabilities, or producing undesirable secondary effects such as excessive heating of sensitive components at or near the chamber wall, called beam-induced RF heating. The LHC performance limitations linked to impedances encountered during the 2010-2012 run are reviewed and the currently expected situation during the HL-LHC era is discussed.

  5. Food Components and Supplements

    DEFF Research Database (Denmark)

    Parlesak, Alexandr


    The major part of food consists of chemical compounds that can be used for energy production, biological synthesis, or maintenance of metabolic processes by the host. These components are defined as nutrients, and can be categorized into macronutrients (proteins, carbohydrates, triglycerides......, and alcohol), minerals, and micronutrients. The latter category comprises 13 vitamins and a hand full of trace elements. Many micronutrients are used as food supplements and are ingested at doses exceeding the amounts that can be consumed along with food by a factor of 10–100. Both macro- and micronutrients...... can interact with enzyme systems related to xenobiotic metabolism either by regulation of their expression or direct interference with their enzymatic activity. During food consumption, we consume a wide range of xenobiotics along with the consumable food, either as an original part of the food (e...

  6. High thermal load component

    International Nuclear Information System (INIS)

    Fuse, Toshiaki; Tachikawa, Nobuo.


    A cooling tube made of a pure copper is connected to the inner portion of an armour (heat resistant member) made of an anisotropic carbon/carbon composite (CFC) material. The CFC material has a high heat conductivity in longitudinal direction of fibers and has low conductivity in perpendicular thereto. Fibers extending in the armour from a heat receiving surface just above the cooling tube are directly connected to the cooling tube. A portion of the fibers extending from a heat receiving surface other than portions not just above the cooling tube is directly bonded to the cooling tube. Remaining fibers are disposed so as to surround the cooling tube. The armour and the cooling tube are soldered using an active metal flux. With such procedures, high thermal load components for use in a thermonuclear reactor are formed, which are excellent in a heat removing characteristic and hardly causes defects such as crackings and peeling. (I.N.)

  7. Autonomous component carrier selection

    DEFF Research Database (Denmark)

    Garcia, Luis Guilherme Uzeda; Pedersen, Klaus; Mogensen, Preben


    management and efficient system operation. Due to the expected large number of user-deployed cells, centralized network planning becomes unpractical and new scalable alternatives must be sought. In this article, we propose a fully distributed and scalable solution to the interference management problem......Low-power base stations such as e.g. Femto-cells are one of the candidates for high data rate provisioning in local areas, such as residences, apartment complexes, business offices and outdoor hotspot scenarios. Unfortunately, the benefits are not without new challenges in terms of interference...... in local areas, basing our study case on LTE-Advanced. We present extensive network simulation results to demonstrate that a simple and robust interference management scheme, called autonomous component carrier selection allows each cell to select the most attractive frequency configuration; improving...

  8. Solar bowl component efficiencies

    International Nuclear Information System (INIS)

    O'Hair, E.A.; Green, B.L.


    Battelle Pacific Northwest Laboratory has published two volumes on the economic evaluation of various proposed configurations and plant sizes for the four solar thermal technologies. These are the latest in a series of publications sponsored by the Department of Energy (DOE) on plant and operational costs and are more complete in that they include calculations of electrical output. These latest Battelle volumes use the 1976 solar data from Barstow, Calif., and by calculating or estimating the energy conversion efficiency of each element in the process from sun to electricity predict the output and cost of electricity from different plant sizes for each of the four technologies. In this paper a comparison is presented of the component efficiencies developed by Battelle and those of the solar bowl at Crosbyton, Tex

  9. Optical communication components (United States)

    Eldada, Louay


    We review and contrast key technologies developed to address the optical components market for communication applications. We first review the component requirements from a network perspective. We then look at different material systems, compare their properties, and describe the functions achieved to date in each of them. The material systems reviewed include silica fiber, silica on silicon, silicon on insulator, silicon oxynitride, sol-gels, polymers, thin-film dielectrics, lithium niobate, indium phosphide, gallium arsenide, magneto-optic materials, and birefringent crystals. We then describe the most commonly used classes of optical device technology and present their pros and cons as well as the functions achieved to date in each of them. The technologies reviewed include passive, actuation, and active technologies. The passive technologies described include fused fibers, dispersion-compensating fiber, beam steering, Bragg gratings, diffraction gratings, holographic elements, thin-film filters, photonic crystals, microrings, and birefringent elements. The actuation technologies include thermo-optics, electro-optics, acousto-optics, magneto-optics, electroabsorption, liquid crystals, total internal reflection technologies, and mechanical actuation. The active technologies include heterostructures, quantum wells, rare-earth doping, dye doping, Raman amplification, and semiconductor amplification. We also investigate the use of different material systems and device technologies to achieve building-block functions, including lasers, amplifiers, detectors, modulators, polarization controllers, couplers, filters, switches, attenuators, isolators, circulators, wavelength converters, chromatic dispersion compensators, and polarization mode dispersion compensators. Some of the technologies presented are well established in the industry and in some cases have reached the commodity stage, others have recently become ready for commercial introduction, while some others

  10. Oral beta-stimulants can inhibit passive cutaneous anaphylaxis in rats through an indirect inhibitory mechanism: possible involvement of afferent and efferent nervous system via gastric beta2-adrenoceptor stimulation. (United States)

    Shibata, H; Minami, E; Hirata, R; Nabe, T; Kohno, S


    We previously demonstrated that oral l-ephedrine exerts an extremely rapid (within 20 s) inhibition of 48-h passive cutaneous anaphylaxis reaction (PCA) in rats by a possibly unidentified mode of action. In the present experiments, we elucidated the mechanism of the PCA inhibition by l-ephedrine using adrenoceptor agonists and antagonists. Rat antiserum was prepared with dinitrophenylated Ascaris suum extract + Bordetella pertussis. Passively skin-sensitised Wistar rats were mainly used. l-Ephedrine, and adrenoceptor agonists and antagonists were orally administered immediately before PCA provocation. Catecholamine depleting (6-hydroxydopamine, 6-OHDA), amine depleting (reserpine) or ganglion blocking (hexamethonium) agent was intraperitoneally or intravenously administered before the provocation. The effects of the drugs on PCA were assessed by inhibition of the dye leakage. beta-(propranolol) and beta2-(butoxamine) blocking agents reduced the inhibition of PCA by l-ephedrine, while the inhibition was not altered by either an a-blocking agent (phentolamine) or a beta1-(atenolol) selective antagonist. On the other hand, beta-(isoproterenol) and beta2-selective (salbutamol) agonists showed extremely rapid inhibition of PCA. However, the beta-selective agonist (dobutamine) had no effect on the reaction. The pretreatment with hexamethonium, reserpine or 6-OH-DA substantially attenuated the inhibitory effect of l-ephedrine on PCA. The results strongly suggest that beta2-adrenoceptors locate in the stomach and that their receptor excitement finally may lead to the inhibition of PCA via the stimulation of the central and peripheral nervous systems.

  11. Radiation damage in components

    International Nuclear Information System (INIS)

    Takano, Tomehachi


    The performance change of typical capacitors and resistors in electronic components by Co-60 γ-irradiation from the 1320 Ci source was examined in the range of 10 5 to 10 8 R. Specifically, the characteristic change during irradiation and the recovery after irradiation were continuously observed. The capacity change is +2.4% at maximum in ceramic and metallized paper capacitors, and -2.4% at maximum in mylar and paper capacitors. It is also +-0.4% at maximum in mica and polystyrene capacitors. Some of these capacitors showed the recovery of the capacity change, but the others did not. Dielectric loss varied by 15% at larger dose in some capacitors, and the recovery was not observed. While, the insulation resistance of the resistors of 10 15 Ω or more lowered to 10 13 Ω or less after 10 to 30 sec. irradiation, but recovered soon nearly to the initial values after irradiation was interrupted. The resistance change of carbon film resistors is about 0.2 to 2%, and recovered to the initial values in 100 hours after irradiation. The resistance change of composition resistors is large over the range of -13 to +35%, besides, no sign of recovery was seen. In carbon film resistors, the surface insulated type indicated far better results which are assumed to be caused by the selection of element materials and the forming of coating materials. (Wakatsuki, Y.)

  12. Control component structure

    International Nuclear Information System (INIS)

    Walton, L.A.


    This invention provides a control component structure comprising: a spider having a plurality of arms, at least one spider bore formed in said plurality of arms, said spider bore including an enlarged recess and a small recess with an upright truncated conical section forming a transition from the enlarged recess to the small recess, and a burnable poison rod including a tube terminating in transverse end, a plug with a chamfered end that leads into a cylindrical portion, said cylindrical portion of the plug snugly fitting within the tube and terminating in a radially protruding shoulder which engages the transverse end of the tube to which it is welded, and a stem protruding in the longitudinal direction from the central portion of the shoulder having a longitudinal stem bore extending through about half of the length of the stem, at least part of the stem which defines the stem bore being fixed within the truncated conical section, the enlarged recess and the small recess of the spider by outward deformation of that part of the stem in order to releasably attach the rod to the spider, said stem being adapted to substantially reshape itself by movement of the rod in a longitudinal direction with respect to the spider bore, while maintaining the structural integrity of the poison rod and maintaining the structural integrity of the spider

  13. Magnesium for Crashworthy Components (United States)

    Abbott, T.; Easton, M.; Schmidt, R.

    Most applications of magnesium in automobiles are for nonstructural components. However, the light weight properties of magnesium make it attractive in structural applications where energy absorption in a crash is critical. Because most deformation in a crash occurs as bending rather than simple tension or compression, the advantages of magnesium are greater than anticipated simply from tensile strength to weight ratios. The increased thickness possible with magnesium strongly influences bending behavior and theoretical calculations suggest almost an order of magnitude greater energy absorption with magnesium compared to the same weight of steel. The strain rate sensitivity of steel is of concern for energy absorption. Mild steels exhibit a distinct yield point which increases with strain rate. At strain rates typical of vehicle impact, this can result in strain localization and poor energy absorption. Magnesium alloys with relatively low aluminum contents exhibit strain rate sensitivity, however, this is manifest as an increase in work hardening and tensile / yield ratio. This behavior suggests that the performance of magnesium alloys in terms of energy absorption actually improves at high strain rates.

  14. Towards Prognostics for Electronics Components (United States)

    National Aeronautics and Space Administration — Electronics components have an increasingly critical role in avionics systems and in the development of future aircraft systems. Prognostics of such components is...

  15. Software Components for Web Services


    Ramachandran, Muthu; Nair, T. R. Gopalakrsihnan; Selvarani, R.


    Service-oriented computing has emerged as the new area to address software as a service. This paper proposes a model for component based development for service-oriented systems and have created best practice guidelines on software component design.

  16. Statistics of Shared Components in Complex Component Systems (United States)

    Mazzolini, Andrea; Gherardi, Marco; Caselle, Michele; Cosentino Lagomarsino, Marco; Osella, Matteo


    Many complex systems are modular. Such systems can be represented as "component systems," i.e., sets of elementary components, such as LEGO bricks in LEGO sets. The bricks found in a LEGO set reflect a target architecture, which can be built following a set-specific list of instructions. In other component systems, instead, the underlying functional design and constraints are not obvious a priori, and their detection is often a challenge of both scientific and practical importance, requiring a clear understanding of component statistics. Importantly, some quantitative invariants appear to be common to many component systems, most notably a common broad distribution of component abundances, which often resembles the well-known Zipf's law. Such "laws" affect in a general and nontrivial way the component statistics, potentially hindering the identification of system-specific functional constraints or generative processes. Here, we specifically focus on the statistics of shared components, i.e., the distribution of the number of components shared by different system realizations, such as the common bricks found in different LEGO sets. To account for the effects of component heterogeneity, we consider a simple null model, which builds system realizations by random draws from a universe of possible components. Under general assumptions on abundance heterogeneity, we provide analytical estimates of component occurrence, which quantify exhaustively the statistics of shared components. Surprisingly, this simple null model can positively explain important features of empirical component-occurrence distributions obtained from large-scale data on bacterial genomes, LEGO sets, and book chapters. Specific architectural features and functional constraints can be detected from occurrence patterns as deviations from these null predictions, as we show for the illustrative case of the "core" genome in bacteria.

  17. Components of Burden: Interventive Implications. (United States)

    Kosberg, Jordan I.; And Others


    Studied 127 informal caregivers of Alzheimer's disease patients to determine correlates of 5 components of burden as measured by Cost of Care Index. Significant relationships between predictor variables and burden components suggest that global scores and measures of burden do not identify specific problem areas relative to various components of…

  18. Unblockable Compositions of Software Components

    DEFF Research Database (Denmark)

    Dong, Ruzhen; Faber, Johannes; Liu, Zhiming


    . To this end, we develop an algorithm to compute the unblockable interaction behavior, called the interface model of a component, from its execution model. Based on this model, we introduce composition operators for the components and prove important compositionality results, showing the conditions under which......We present a new automata-based interface model describing the interaction behavior of software components. Contrary to earlier component- or interface-based approaches, the interface model we propose specifies all the non-blockable interaction behaviors of a component with any environment...

  19. 4-Chlorotetrazolo[1,5-a]quinoxaline inhibits activation of Syk kinase to suppress mast cells in vitro and mast cell-mediated passive cutaneous anaphylaxis in mice

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kui Lea [Center for Drug Development Assistance, National Institute of Food Drug Safety Evaluation (NIFDS), KFDA, Cheongwon-gun (Korea, Republic of); Ko, Na Young; Lee, Jun Ho; Kim, Do Kyun; Kim, Hyuk Soon; Kim, A-Ram; Her, Erk; Kim, Bokyung [Department of Immunology and physiology, College of Medicine, Konkuk University, Chungju (Korea, Republic of); Kim, Hyung Sik [College of Pharmacy, Pusan National University, Busan (Korea, Republic of); Moon, Eun-Yi [Department of Bioscience and Biotechnology, College of Biological Science, Sejong University, Seoul (Korea, Republic of); Kim, Young Mi [College of Pharmacy, Duksung Women' s University, Seoul (Korea, Republic of); Kim, Hang-Rae, E-mail: [Department of Anatomy, Seoul National University College of Medicine, Seoul (Korea, Republic of); Choi, Wahn Soo, E-mail: [Department of Immunology and physiology, College of Medicine, Konkuk University, Chungju (Korea, Republic of)


    4-Chlorotetrazolo[1,5-a]quinoxaline is a quinoxaline derivative. We aimed to study the effects of 4-chlorotetrazolo[1,5-a]quinoxaline on activation of mast cells in vitro and in mice. 4-Chlorotetrazolo[1,5-a]quinoxaline reversibly inhibited degranulation of mast cells in a dose-dependent manner, and also suppressed the expression and secretion of TNF-{alpha} and IL-4 in mast cells. Mechanistically, 4-chlorotetrazolo[1,5-a]quinoxaline inhibited activating phosphorylation of Syk and LAT, which are crucial for early Fc{epsilon}RI-mediated signaling events, as well as Akt and MAP kinases, which play essential roles in the production of various pro-inflammatory cytokines in mast cells. Notably, although 4-chlorotetrazolo[1,5-a]quinoxaline inhibited the activation of Fyn and Syk, minimal inhibition was observed in mast cells in the case of Lyn. Furthermore, consistent with its in vitro activity, 4-chlorotetrazolo[1,5-a]quinoxaline significantly suppressed mast cell-mediated passive cutaneous anaphylaxis in mice. In summary, the results from this study demonstrate that 4-chlorotetrazolo[1,5-a]quinoxaline shows an inhibitory effect on mast cells in vitro and in vivo, and that this is mediated by inhibiting the activation of Syk in mast cells. Therefore, 4-chlorotetrazolo[1,5-a]quinoxaline could be useful in the treatment of mast cell-mediated allergic diseases. -- Highlights: Black-Right-Pointing-Pointer 4-chlorotetrazolo[1,5-a]quinoxaline is a quinoxaline derivative. Black-Right-Pointing-Pointer The effect of 4-chlorotetrazolo[1,5-a]quinoxaline on mast cells was investigated. Black-Right-Pointing-Pointer 4-chlorotetrazolo[1,5-a]quinoxaline reversibly inhibited Syk activation. Black-Right-Pointing-Pointer 4-chlorotetrazolo[1,5-a]quinoxaline could be useful for IgE-mediated allergy.

  20. Immunoglobulin E-reactivity of wheat-allergic subjects (baker's asthma, food allergy, wheat-dependent, exercise-induced anaphylaxis) to wheat protein fractions with different solubility and digestibility. (United States)

    Mittag, Diana; Niggemann, Bodo; Sander, Ingrid; Reese, Imke; Fiedler, Eva-Maria; Worm, Margitta; Vieths, Stefan; Reese, Gerald


    Baker's asthma, food allergy to wheat, and wheat-dependent, exercise-induced anaphylaxis (WDEIA) are different clinical forms of wheat allergy. We investigated the correlation of solubility and digestion stability of wheat allergens with the IgE-reactivity patterns of different patient groups. Three wheat protein fractions were extracted according to their solubility: salt-soluble albumins and globulins, ethanol-soluble gliadins, and glutenins soluble only after treatment with detergents and reducing reagents. Sera from subjects with history of each variant of wheat allergy were characterized by CAP FEIA and immunoblotting. There was a high degree of heterogeneity of recognized allergens between the different subject groups as well as within these groups. However, subjects with WDEIA showed similar immunoglobulin E (IgE)-reactivity patterns to gliadins and especially to a 65 kDa protein. Subjects with baker's asthma as well as the food-allergic subjects had the most intense IgE-reactivity to the albumin/globulin fraction. The latter group additionally showed IgE-reactivity to the other fractions. Divergent results of immunoblotting and CAP-FEIA demonstrated that the detection of wheat-specific IgE highly depends on the applied method, thus the diagnostic tool must be carefully chosen. Most wheat allergens were rapidly digested as analyzed by determination of IgE-reactivity on immunoblots to wheat extracts after simulation of gastric and duodenal digestion. However, ethanol-soluble gliadins were stable to gastric enzymes and exhibit low solubility in gastric and duodenal fluids. Therefore, they are likely to be important in food allergy to wheat.

  1. 4-Chlorotetrazolo[1,5-a]quinoxaline inhibits activation of Syk kinase to suppress mast cells in vitro and mast cell-mediated passive cutaneous anaphylaxis in mice

    International Nuclear Information System (INIS)

    Park, Kui Lea; Ko, Na Young; Lee, Jun Ho; Kim, Do Kyun; Kim, Hyuk Soon; Kim, A-Ram; Her, Erk; Kim, Bokyung; Kim, Hyung Sik; Moon, Eun-Yi; Kim, Young Mi; Kim, Hang-Rae; Choi, Wahn Soo


    4-Chlorotetrazolo[1,5-a]quinoxaline is a quinoxaline derivative. We aimed to study the effects of 4-chlorotetrazolo[1,5-a]quinoxaline on activation of mast cells in vitro and in mice. 4-Chlorotetrazolo[1,5-a]quinoxaline reversibly inhibited degranulation of mast cells in a dose-dependent manner, and also suppressed the expression and secretion of TNF-α and IL-4 in mast cells. Mechanistically, 4-chlorotetrazolo[1,5-a]quinoxaline inhibited activating phosphorylation of Syk and LAT, which are crucial for early FcεRI-mediated signaling events, as well as Akt and MAP kinases, which play essential roles in the production of various pro-inflammatory cytokines in mast cells. Notably, although 4-chlorotetrazolo[1,5-a]quinoxaline inhibited the activation of Fyn and Syk, minimal inhibition was observed in mast cells in the case of Lyn. Furthermore, consistent with its in vitro activity, 4-chlorotetrazolo[1,5-a]quinoxaline significantly suppressed mast cell-mediated passive cutaneous anaphylaxis in mice. In summary, the results from this study demonstrate that 4-chlorotetrazolo[1,5-a]quinoxaline shows an inhibitory effect on mast cells in vitro and in vivo, and that this is mediated by inhibiting the activation of Syk in mast cells. Therefore, 4-chlorotetrazolo[1,5-a]quinoxaline could be useful in the treatment of mast cell-mediated allergic diseases. -- Highlights: ► 4-chlorotetrazolo[1,5-a]quinoxaline is a quinoxaline derivative. ► The effect of 4-chlorotetrazolo[1,5-a]quinoxaline on mast cells was investigated. ► 4-chlorotetrazolo[1,5-a]quinoxaline reversibly inhibited Syk activation. ► 4-chlorotetrazolo[1,5-a]quinoxaline could be useful for IgE-mediated allergy.

  2. Open Component Portability Infrastructure (OPENCPI) (United States)


    Integrated Circuit ( ASIC ) processor components. As used here, the HDL was applied to the Verilog, the Very High Speed Integrated Circuit (VHSIC...and a number of existing tests were migrated and ported into it. The motivation for selecting a unit test framework was to improve and enforce the...Interface ASIC Application-Specific Integrated Circuit BSV Bluespec System Verilog CBD Component-Based Development CDK Component Developer’s Kit

  3. Active Component Responsibility in Reserve Component Pre- and Postmobilization Training (United States)


    President Lyndon Johnson refused to mobi- lize the RCs (MacCarley, 2012, pp. 38–39). 8 Active Component Responsibility in Reserve Component...ARFORGENwhitePaper1aug2011v3g2g.pdf Pernin, Christopher G., Dwayne M. Butler, Louay Constant, Lily Geyer, Duncan Long, Dan Madden, John E. Peters, James D. Powers

  4. SBA Network Components & Software Inventory (United States)

    Small Business Administration — SBA’s Network Components & Software Inventory contains a complete inventory of all devices connected to SBA’s network including workstations, servers, routers,...

  5. Components selection for ageing management

    International Nuclear Information System (INIS)

    Mingiuc, C.; Vidican, D.


    Full text: The paper presents a synthesis of methods and activities realized for the selection of critical components to assure plant safety and availability (as electricity supplier). There are presented main criteria for selection, screening process. For the resulted categories of components shall be applied different category of maintenance (condition oriented, scheduled or corrective), function of the importance and financial effort necessary to fulfil the task. 1. Systems and components screening for plant safety assurance For the systems selection, from Safety point of view, was necessary first, to define systems which are dangerous in case of failure (mainly by rupture/ release of radioactivity) and the safety systems which have to mitigate the effects. This is realized based on accident analysis (from Safety Report). Also where taken in to account the 4 basic Safety Principles: 'Reactor shut down; Residual heat removal; Radioactivity products confinement; NPP status monitoring in normal and accident conditions'. Following step is to establish safety support systems, which have to action to assure main safety systems operation. This could be realized based on engineering judgement, or on PSA Level I analysis. Finally shall be realized chains of the support systems, which have to work, till primary systems. For the critical components selection, was realized a Failure Mode and Effect Analysis (FMEA), considering the components effects of failures, on system safety function. 2. Systems and components screening for plant availability assurance The work was realized in two steps: Systems screening; Components screening The systems screening, included: General, analyze of the plant systems list and the definition of those which clearly have to run continue to assure the nominal power; Realization of a complex diagram to define interdependence between the systems (e.g. PHT and auxiliaries, moderator and auxiliaries, plant electrical diagram); Fill of special

  6. APS beamline standard components handbook

    Energy Technology Data Exchange (ETDEWEB)

    Kuzay, T.M.


    It is clear that most Advanced Photon Source (APS) Collaborative Access Team (CAT) members would like to concentrate on designing specialized equipment related to their scientific programs rather than on routine or standard beamline components. Thus, an effort is in progress at the APS to identify standard and modular components of APS beamlines. Identifying standard components is a nontrivial task because these components should support diverse beamline objectives. To assist with this effort, the APS has obtained advice and help from a Beamline Standardization and Modularization Committee consisting of experts in beamline design, construction, and operation. The staff of the Experimental Facilities Division identified various components thought to be standard items for beamlines, regardless of the specific scientific objective of a particular beamline. A generic beamline layout formed the basis for this identification. This layout is based on a double-crystal monochromator as the first optical element, with the possibility of other elements to follow. Pre-engineering designs were then made of the identified standard components. The Beamline Standardization and Modularization Committee has reviewed these designs and provided very useful input regarding the specifications of these components. We realize that there will be other configurations that may require special or modified components. This Handbook in its current version (1.1) contains descriptions, specifications, and pre-engineering design drawings of these standard components. In the future, the APS plans to add engineering drawings of identified standard beamline components. Use of standard components should result in major cost reductions for CATs in the areas of beamline design and construction.

  7. APS beamline standard components handbook

    International Nuclear Information System (INIS)

    Kuzay, T.M.


    It is clear that most Advanced Photon Source (APS) Collaborative Access Team (CAT) members would like to concentrate on designing specialized equipment related to their scientific programs rather than on routine or standard beamline components. Thus, an effort is in progress at the APS to identify standard and modular components of APS beamlines. Identifying standard components is a nontrivial task because these components should support diverse beamline objectives. To assist with this effort, the APS has obtained advice and help from a Beamline Standardization and Modularization Committee consisting of experts in beamline design, construction, and operation. The staff of the Experimental Facilities Division identified various components thought to be standard items for beamlines, regardless of the specific scientific objective of a particular beamline. A generic beamline layout formed the basis for this identification. This layout is based on a double-crystal monochromator as the first optical element, with the possibility of other elements to follow. Pre-engineering designs were then made of the identified standard components. The Beamline Standardization and Modularization Committee has reviewed these designs and provided very useful input regarding the specifications of these components. We realize that there will be other configurations that may require special or modified components. This Handbook in its current version (1.1) contains descriptions, specifications, and pre-engineering design drawings of these standard components. In the future, the APS plans to add engineering drawings of identified standard beamline components. Use of standard components should result in major cost reductions for CATs in the areas of beamline design and construction

  8. Secure coupling of hardware components

    NARCIS (Netherlands)

    Hoepman, J.H.; Joosten, H.J.M.; Knobbe, J.W.


    A method and a system for securing communication between at least a first and a second hardware components of a mobile device is described. The method includes establishing a first shared secret between the first and the second hardware components during an initialization of the mobile device and,

  9. Active components in food supplements

    NARCIS (Netherlands)

    Siemelink M; Jansen EHJM; Piersma AH; Opperhuizen A; LEO


    The growing food supplement market, where supplements are both more diverse and more easily available (e.g. through Internet) formed the backdrop to the inventory of the active components in food supplements. The safety of an increased intake of food components via supplements was also at issue

  10. Statistical inference on variance components

    NARCIS (Netherlands)

    Verdooren, L.R.


    In several sciences but especially in animal and plant breeding, the general mixed model with fixed and random effects plays a great role. Statistical inference on variance components means tests of hypotheses about variance components, constructing confidence intervals for them, estimating them,

  11. Component reliability for electronic systems

    CERN Document Server

    Bajenescu, Titu-Marius I


    The main reason for the premature breakdown of today's electronic products (computers, cars, tools, appliances, etc.) is the failure of the components used to build these products. Today professionals are looking for effective ways to minimize the degradation of electronic components to help ensure longer-lasting, more technically sound products and systems. This practical book offers engineers specific guidance on how to design more reliable components and build more reliable electronic systems. Professionals learn how to optimize a virtual component prototype, accurately monitor product reliability during the entire production process, and add the burn-in and selection procedures that are the most appropriate for the intended applications. Moreover, the book helps system designers ensure that all components are correctly applied, margins are adequate, wear-out failure modes are prevented during the expected duration of life, and system interfaces cannot lead to failure.

  12. Component Fragility Research Program: Phase 1 component prioritization

    International Nuclear Information System (INIS)

    Holman, G.S.; Chou, C.K.


    Current probabilistic risk assessment (PRA) methods for nuclear power plants utilize seismic ''fragilities'' - probabilities of failure conditioned on the severity of seismic input motion - that are based largely on limited test data and on engineering judgment. Under the NRC Component Fragility Research Program (CFRP), the Lawrence Livermore National Laboratory (LLNL) has developed and demonstrated procedures for using test data to derive probabilistic fragility descriptions for mechanical and electrical components. As part of its CFRP activities, LLNL systematically identified and categorized components influencing plant safety in order to identify ''candidate'' components for future NRC testing. Plant systems relevant to safety were first identified; within each system components were then ranked according to their importance to overall system function and their anticipated seismic capacity. Highest priority for future testing was assigned to those ''very important'' components having ''low'' seismic capacity. This report describes the LLNL prioritization effort, which also included application of ''high-level'' qualification data as an alternate means of developing probabilistic fragility descriptions for PRA applications

  13. The major royal jelly proteins 8 and 9 (Api m 11) are glycosylated components of Apis mellifera venom with allergenic potential beyond carbohydrate-based reactivity. (United States)

    Blank, S; Bantleon, F I; McIntyre, M; Ollert, M; Spillner, E


    As hymenoptera venoms are one of the allergen sources causing the highest incidence of anaphylaxis and sometimes fatal consequences, the detailed characterization of all venom allergens is imperative for design of component-resolved diagnostic approaches and improved intervention strategies. Our aim was the immunochemical characterization of major royal jelly proteins (MRJP) 8 and 9, both components identified in honeybee venom (HBV) and putative allergens. Both MRJPs were recombinantly produced as soluble differentially glycosylated proteins providing a defined degree of reactivity to cross-reactive carbohydrate determinants (CCD) in insect cells. Allergen-specific IgE(sIgE) reactivity of HBV-allergic patients was analysed by ELISA and immunoblotting. MRJP8 and MRJP9 were identified as venom components by MS-based proteomic analyses. In a population of 47 HBV-allergic patients, reactivities with CCD-carrying MRJPs were in the range of 56% (61%), underlining the contribution of CCDs to allergen-binding. Beyond CCD-reactivity, 15% of patients showed sIgE reactivity with MRJP8 and 34% with MRJP9 respectively. These reactivities roughly in the range of Api m 2 render the MRJPs minor, but important allergens. The glycosylated MRJP8 and MRJP9 of HBV have IgE-sensitizing potential in HBV-allergic patients beyond CCD reactivity and have to be considered as allergens, which might be potentially important for a fraction of venom allergic patients. They are valuable tools to elucidate individual component-resolved reactivity profiles of venom allergic patients and to provide insights into the role of particular venom components. Due to their allergenic properties, MRJP8 and MRJP9 were designated as isoallergens Api m 11.0101 and Api m 11.0201 respectively. © 2012 Blackwell Publishing Ltd.

  14. Ageing of zirconium alloy components (United States)

    Chatterjee, S.; Shah, Priti Kotak; Dubey, J. S.


    India has two types (pressurized heavy water reactors (PHWRs) and boiling water reactors (BWRs)) of commercial nuclear reactors in operation, in addition to research reactors. Many of the life limiting critical components in these reactors are fabricated from zirconium alloys. The progressive degradation of these components caused by the cumulative exposure of high energy neutron irradiation with increasing period of reactor operation was monitored to assess the degree of ageing. The components/specimens examined included fuel element claddings removed from BWRs, pressure tubes and garter springs removed from PHWRs and calandria tube specimens used in PHWRs. The tests included tension test (for cladding, garter spring), fracture toughness test (for pressure tube), crush test (for garter spring), and measurement of irradiation induced growth (for calandria tube). Results of various tests conducted are presented and applications of the test results are elaborated for residual life estimation/life extension of the components.

  15. Metallurgical Laboratory and Components Testing (United States)

    Federal Laboratory Consortium — In the field of metallurgy, TTC is equipped to run laboratory tests on track and rolling stock components and materials. The testing lab contains scanning-electron,...

  16. Semantic Issues for Component Technologies

    National Research Council Canada - National Science Library

    Sanders, Beverly


    The availability of components that can be assembled together to build customized system promises to decrease software development costs and, one hopes, also increase the reliability of the resulting system...

  17. Component Processes in Analogical Reasoning (United States)

    Sternberg, Robert J.


    Describes alternative theoretical positions regarding (a) the component information processes used in analogical reasoning and (b) strategies for combining these processes. Also presents results from three experiments on analogical reasoning. (Author/RK)

  18. Passive Microwave Components and Antennas

    DEFF Research Database (Denmark)

    State-of-the-art microwave systems always require higher performance and lower cost microwave components. Constantly growing demands and performance requirements of industrial and scientific applications often make employing traditionally designed components impractical. For that reason, the design...... and development process remains a great challenge today. This problem motivated intensive research efforts in microwave design and technology, which is responsible for a great number of recently appeared alternative approaches to analysis and design of microwave components and antennas. This book highlights...... techniques. Modelling and computations in electromagnetics is a quite fast-growing research area. The recent interest in this field is caused by the increased demand for designing complex microwave components, modeling electromagnetic materials, and rapid increase in computational power for calculation...

  19. Multiview Bayesian Correlated Component Analysis

    DEFF Research Database (Denmark)

    Kamronn, Simon Due; Poulsen, Andreas Trier; Hansen, Lars Kai


    are identical. Here we propose a hierarchical probabilistic model that can infer the level of universality in such multiview data, from completely unrelated representations, corresponding to canonical correlation analysis, to identical representations as in correlated component analysis. This new model, which...... we denote Bayesian correlated component analysis, evaluates favorably against three relevant algorithms in simulated data. A well-established benchmark EEG data set is used to further validate the new model and infer the variability of spatial representations across multiple subjects....

  20. Automated cleaning of electronic components

    International Nuclear Information System (INIS)

    Drotning, W.; Meirans, L.; Wapman, W.; Hwang, Y.; Koenig, L.; Petterson, B.


    Environmental and operator safety concerns are leading to the elimination of trichloroethylene and chlorofluorocarbon solvents in cleaning processes that remove rosin flux, organic and inorganic contamination, and particulates from electronic components. Present processes depend heavily on these solvents for manual spray cleaning of small components and subassemblies. Use of alternative solvent systems can lead to longer processing times and reduced quality. Automated spray cleaning can improve the quality of the cleaning process, thus enabling the productive use of environmentally conscious materials, while minimizing personnel exposure to hazardous materials. We describe the development of a prototype robotic system for cleaning electronic components in a spray cleaning workcell. An important feature of the prototype system is the capability to generate the robot paths and motions automatically from the CAD models of the part to be cleaned, and to embed cleaning process knowledge into the automatically programmed operations

  1. Mechanical design of machine components

    CERN Document Server

    Ugural, Ansel C


    Mechanical Design of Machine Components, Second Edition strikes a balance between theory and application, and prepares students for more advanced study or professional practice. It outlines the basic concepts in the design and analysis of machine elements using traditional methods, based on the principles of mechanics of materials. The text combines the theory needed to gain insight into mechanics with numerical methods in design. It presents real-world engineering applications, and reveals the link between basic mechanics and the specific design of machine components and machines. Divided into three parts, this revised text presents basic background topics, deals with failure prevention in a variety of machine elements and covers applications in design of machine components as well as entire machines. Optional sections treating special and advanced topics are also included.Key Features of the Second Edition:Incorporates material that has been completely updated with new chapters, problems, practical examples...

  2. Two component systems: physiological effect of a third component.

    Directory of Open Access Journals (Sweden)

    Baldiri Salvado

    Full Text Available Signal transduction systems mediate the response and adaptation of organisms to environmental changes. In prokaryotes, this signal transduction is often done through Two Component Systems (TCS. These TCS are phosphotransfer protein cascades, and in their prototypical form they are composed by a kinase that senses the environmental signals (SK and by a response regulator (RR that regulates the cellular response. This basic motif can be modified by the addition of a third protein that interacts either with the SK or the RR in a way that could change the dynamic response of the TCS module. In this work we aim at understanding the effect of such an additional protein (which we call "third component" on the functional properties of a prototypical TCS. To do so we build mathematical models of TCS with alternative designs for their interaction with that third component. These mathematical models are analyzed in order to identify the differences in dynamic behavior inherent to each design, with respect to functionally relevant properties such as sensitivity to changes in either the parameter values or the molecular concentrations, temporal responsiveness, possibility of multiple steady states, or stochastic fluctuations in the system. The differences are then correlated to the physiological requirements that impinge on the functioning of the TCS. This analysis sheds light on both, the dynamic behavior of synthetically designed TCS, and the conditions under which natural selection might favor each of the designs. We find that a third component that modulates SK activity increases the parameter space where a bistable response of the TCS module to signals is possible, if SK is monofunctional, but decreases it when the SK is bifunctional. The presence of a third component that modulates RR activity decreases the parameter space where a bistable response of the TCS module to signals is possible.

  3. Radiation effects on eye components (United States)

    Durchschlag, H.; Fochler, C.; Abraham, K.; Kulawik, B.


    The most important water-soluble components of the vertebrate eye (lens proteins, aqueous humor, vitreous, hyaluronic acid, ascorbic acid) have been investigated in aqueous solution, after preceding X- or UV-irradiation. Spectroscopic, chromatographic, electrophoretic, hydrodynamic and analytic techniques have been applied, to monitor several radiation damages such as destruction of aromatic and sulfur-containing amino acids, aggregation, crosslinking, dissociation, fragmentation, and partial unfolding. Various substances were found which were able to protect eye components effectively against radiation, some of them being also of medical relevance.

  4. Robotics-Components and Subsystems

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 4; Issue 12. Robotics - Components and Subsystems. J R Vengateswaran. General Article Volume 4 Issue 12 December 1999 pp 76-82. Fulltext. Click here to view fulltext PDF. Permanent link: ...

  5. Potting procedure for electronic components (United States)

    Rubino, A. G.; Zimmerman, J.


    Potting process is modified to effect a match more closely between embedded electronic components, potting mediums, and thermal environment. Application of room-temperature vulcanizing silicone rubber band cured in modified thermal cycle minimizes coil-to-resin adhesion and thus lowers stresses between transformer and potting compound.

  6. Fabrication of plastic microfluidic components (United States)

    Martin, Peter M.; Matson, Dean W.; Bennett, Wendy D.; Hammerstrom, D. J.


    Plastic components have many advantages, including ease of fabrication, low cost, chemical inertness, lightweight, and disposability. We report on the fabrication of three plastics-based microfluidic components: a motherboard, a dialysis unit, and a metal sensor. Microchannels, headers, and interconnects were produced in thin sheets (>=50 microns) of polyimide, PMMA, polyethylene, and polycarbonate using a direct-write excimer laser micromachining system. Machined sheets were laminated by thermal and adhesive bonding to form leak-tight microfluidic components. The microfluidic motherboard borrowed the `functionality on a chip' concept from the electronics industry and was the heart of a complex microfluidic analytical device. The motherboard platform was designed to be tightly integrated and self-contained (i.e., liquid flows are all confined within machined microchannels), reducing the need for tubing with fluid distribution and connectivity. This concept greatly facilitated system integration and miniaturization. As fabricated, the motherboard consisted of three fluid reservoirs connected to micropumps by microchannels. The fluids could either be pumped independently or mixed in microchannels prior to being directed to exterior analytical components via outlet ports. The microdialysis device was intended to separate electrolytic solutes from low volume samples prior to mass spectrometric analysis. The device consisted of a dialysis membrane laminated between opposed serpentine microchannels containing the sample fluid and a buffer solution. The laminated metal sensor consisted of fluid reservoirs, micro-flow channels, micropumps, mixing channels, reaction channels, and detector circuitry.

  7. Inspection of disposal canisters components

    International Nuclear Information System (INIS)

    Pitkaenen, J.


    This report presents the inspection techniques of disposal canister components. Manufacturing methods and a description of the defects related to different manufacturing methods are described briefly. The defect types form a basis for the design of non-destructive testing because the defect types, which occur in the inspected components, affect to choice of inspection methods. The canister components are to nodular cast iron insert, steel lid, lid screw, metal gasket, copper tube with integrated or separate bottom, and copper lid. The inspection of copper material is challenging due to the anisotropic properties of the material and local changes in the grain size of the copper material. The cast iron insert has some acoustical material property variation (attenuation, velocity changes, scattering properties), which make the ultrasonic inspection demanding from calibration point of view. Mainly three different methods are used for inspection. Ultrasonic testing technique is used for inspection of volume, eddy current technique, for copper components only, and visual testing technique are used for inspection of the surface and near surface area

  8. A forgotten component of biodiversity

    Indian Academy of Sciences (India)


    Jul 8, 2011 ... Home; Journals; Journal of Biosciences; Volume 36; Issue 4. Clipboard: Helminth richness in Arunachal Pradesh fishes: A forgotten component of biodiversity. Amit Tripathi. Volume 36 Issue 4 September 2011 pp 559-561. Fulltext. Click here to view fulltext PDF. Permanent link:

  9. Factor Analysis via Components Analysis (United States)

    Bentler, Peter M.; de Leeuw, Jan


    When the factor analysis model holds, component loadings are linear combinations of factor loadings, and vice versa. This interrelation permits us to define new optimization criteria and estimation methods for exploratory factor analysis. Although this article is primarily conceptual in nature, an illustrative example and a small simulation show…


    Directory of Open Access Journals (Sweden)

    G. I. Tamoshina


    Full Text Available Marketing communications are the specific communication program of the company. It consists of: advertising, which is intended for informing about commodity and accommodations (services; encouragement of marketing- sales augmentation for acceleration of marketing; straight marketing, that provide with personal contacts, flexibility and ability to make a bargain; public relations - all that components are promoting and uphold the image of the firm.

  11. Anaphylaxis after intravenous infusion of dexketoprofen trometamol. (United States)

    Guler, Sertac; Ertok, Ilyas; Sahin, Nurdan Yilmaz; Ramadan, Hayri; Katirci, Yavuz


    Dexketoprofen trometamol (DT), a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS) secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT.

  12. Anaphylaxis after intravenous infusion of dexketoprofen trometamol

    Directory of Open Access Journals (Sweden)

    Sertac Guler


    Full Text Available Dexketoprofen trometamol (DT, a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT. Keywords: Anaphylactic shock, Dexketoprofen trometamol, Intravenous infusion (MeSH database

  13. Beer-induced anaphylaxis: identification of allergens. (United States)

    Figueredo, E; Quirce, S; del Amo, A; Cuesta, J; Arrieta, I; Lahoz, C; Sastre, J


    We report on a 21-year-old atopic woman who developed urticaria, angioedema of the face, and wheezy dyspnea shortly after drinking beer and after eating a corn-made snack. Skin prick tests and specific IgE determinations to beer ingredients and cereal extracts were performed. Immunoblotting inhibition assays were carried out to investigate possible common allergens shared by barley and malt with corn. Skin prick tests and specific IgE measurements with beer, barley, malt, wheat, corn, rye, rice, and oat flour were positive. Ten pollen-allergic patients showed negative skin tests to beer. Double-blind, placebo-controlled, oral challenge tests with sodium metabisulfite and wheat flour were negative. Immunoblotting demonstrated several IgE-binding bands at 31-56 kDa in malt and barley extracts, and a major band at 38 kDa in the beer extract. Immunoblot inhibition assays showed that malt extract was able to inhibit most of the IgE-binding bands in wheat and corn extracts, whereas corn did not produce significant inhibition to barley and malt extracts. This patient developed type I hypersensitivity to barley/malt and corn. Although she also showed IgE reactivity to wheat and other cereals, no symptoms were elicited upon ingestion of these cereals, probably indicating latent sensitization to them.

  14. [Anaphylaxis by atracurium. One case report]. (United States)

    Domínguez-Sansores, Luis; González-Díaz, Sandra; Arias-Cruz, Alfredo; Palacios-Rìos, Dionisio; López-Cabrera, Norma Guadalupe


    The incidence of severe intraoperative anesthetic reactions varies among countries from 1:10,000 to 1:13 000 patients submitted to surgery. A 13 year old male, with family history of atopy, who underwent 5 surgeries for hydrocephalus, using general anesthesia. He was on lamotrigine for seizures. He also suffers from chronic rhinitis, and oral allergy syndrome related to bananas since the age of 6 months. He had a posterior fossa tumor resection. During anesthesia induction with atracurium he developed a local rash in one arm, being the intubation without difficulty. Twenty minutes later he presented bipalpebral edema, accompanied by generalized rash, severe bronchoconstriction and hypotension, not reversing with the use of bronchodilators and corticosteroids. With the use of antihistamines, epinephrine and controlled ventilation the reaction subsides. One month later a skin prick test with atracurium besylate (50 mg/mL) diluted 1:10,000, negative and positive controls was performed. The result with atracurium was negative. After the application of intradermal tests with 0.02 mL of atracurium at dilutions of 1:10,000 and 1:1000, we found a positive skin response to atracurium (wheal diameter >8 mm and >9 mm with dilutions 1:10,000 and 1:1000, respectively and erythema). The response to atracurium intradermal test could be related to the ability of histamine release by a nonimmunological mechanism. But the magnitude of the skin response in this case, do not rule out the possibility of an IgE-mediated reaction. Atracurium is a known potent histamine releaser from mast cells, but rarely can it cause IgE-mediated reactions.

  15. Intraoperative anaphylaxis: an association with latex sensitivity. (United States)

    Gold, M; Swartz, J S; Braude, B M; Dolovich, J; Shandling, B; Gilmour, R F


    Latex products have recently been identified as the cause of severe intraoperative anaphylactic reactions. We have identified a group of pediatric patients who appear to be at increased risk for such reactions. Fifteen patients with either spina bifida or congenital urologic abnormalities experienced 19 intraoperative anaphylactic reactions. All patients had frequent previous exposures to rubber materials since infancy as part of their management and/or investigative procedures. Seven of 15 patients had a previous history of local skin reactions to rubber. Only four patients were atopic. All patients had undergone multiple (two of 26) operative procedures before their reactions, the onset of which ranged from 40 to 290 minutes after induction of anesthesia. The reactions varied in intensity from urticaria to severe cardiorespiratory collapse. All these patients subsequently had positive allergy skin tests and positive RAST to latex antigen. We conclude that this group is at risk when they are exposed to latex intraoperatively as a result of frequent past exposure to these materials. Allergic evaluation for latex allergy may assist in the preoperative evaluation of similar patients. In sensitized patients, appropriate prophylactic measures, particularly the avoidance of latex, is required.

  16. Nuclear power plant component protection

    International Nuclear Information System (INIS)

    Michel, E.; Ruf, R.; Dorner, H.


    Described is a nuclear power plant installation which includes a concrete biological shield forming a pit in which a reactor pressure vessel is positioned. A steam generator on the outside of the shield is connected with the pressure vessel via coolant pipe lines which extend through the shield, the coolant circulation being provided by a coolant pump which is also on the outside of the shield. To protect these components on the outside of the shield and which are of mainly or substantially cylindrical shape, semicylindrical concrete segments are interfitted around them to form complete outer cylinders which are retained against outward separation radially from the components, by rings of high tensile steel which may be interspaced so closely that they provide, in effect, an outer steel cylinder. The invention is particularly applicable to pressurized-water coolant reactor installations

  17. Cylinder components properties, applications, materials

    CERN Document Server


    Owing to the ever-increasing requirements to be met by gasoline and diesel engines in terms of CO2 reduction, emission behavior, weight, and service life, a comprehensive understanding of combustion engine components is essential today. It is no longer possible for professionals in automotive engineering to manage without the corresponding expertise, whether they work in the field of design, development, testing, or maintenance. This technical book provides in-depth answers to questions about design, production, and machining of cylinder components. In this second edition, every section has been revised and expanded to include the latest developments in the combustion engine. Content Piston rings Piston pins and piston pin circlips Bearings Connecting rods Crankcase and cylinder liners Target audience Engineers in the field of engine development and maintenanceLecturers and students in the areas of mechanical engineering, engine technology, and vehicle constructionAnyone interested in technology Publisher MAH...

  18. Mechanical component screening for scanner (United States)

    Olson, J. L.; Quinn, W. J.


    The critical mechanical components of the scan mirror mechanism are described and their evaluation and screening procedures are discussed. A bumper/damper unit is used in the design to reverse motion of the mirror and effect scan and retrace cycles. A wear evaluation was conducted on the bumper impact surfaces that established nylon 6-10 as an acceptable material. The elastomeric dampers were subjected to thermal vacuum tests for condensables and outgassing as well as parametric life tests. The flexure pivots that support the mirror were tested to establish a curve of stress plotted as a function of cycles to failure for rotational operation. The pivots met the life requirement of 150,000,000 cycles at a + or - 2.9 deg amplitude during fatigue testing. Screening procedures were established for dampers and flexure pivots to obtain flight quality components.

  19. Processing of Activated Core Components

    Energy Technology Data Exchange (ETDEWEB)

    Friske, A.; Gestermann, G.; Finkbeiner, R.


    Used activated components from the core of a NPP like control elements, water channels from a BWR, and others like in-core measurement devices need to be processed into waste forms suitable for interim storage, and for the final waste repository. Processing of the activated materials can be undertaken by underwater cutting and packaging or by cutting and high-pressure compaction in a hot cell. A hot cell is available in Germany as a joint investment between GNS and the Karlsruhe Research Center at the latter's site. Special transport equipment is available to transport the components ''as-is'' to the hot cell. Newly designed underwater processing equipment has been designed, constructed, and operated for the special application of NPP decommissioning. This equipment integrates an underwater cutting device with an 80 ton force underwater in-drum compactor.

  20. Metal binding by food components

    DEFF Research Database (Denmark)

    Tang, Ning

    For calcium binding: Electrochemical method (calcium ion selective electrode) combined with quantum mechanical calculations (density functional theory) were used to investigate the calcium binding affinity of the amino acids and small glycine peptides. The effects of the ionic strength and p......, synergistic effect in calcium binding was found for the small glycine peptide rather than amino acids mixtures with the enhanced driving force up to -6 kJ/mol. Such study provides useful information for the future development of calcium supplements. For zinc binding: Isothermal titration calorimetry...... titration calorimetry and quantum mechanical calculations. This is due to the zinc binding affinity of the relatively softer ligands (investigated food components) will become much stronger than citrate or phytate when they present together in aqueous solution. This mechanism indicates these food components...

  1. HG ion thruster component testing (United States)

    Mantenieks, M. A.


    Cathodes, isolators, and vaporizers are critical components in determining the performance and lifetime of mercury ion thrusters. The results of life tests of several of these components are reported. A 30-cm thruster CIV test in a bell jar has successfully accumulated over 26,000 hours. The cathode has undergone 65 restarts during the life test without requiring any appreciable increases in starting power. Recently, all restarts have been achieved with only the 44 volt keeper supply with no change required in the starting power. Another ongoing 30-cm Hg thruster cathode test has successfully passed the 10,000 hour mark. A solid-insert, 8-cm thruster cathode has accumulated over 4,000 hours of thruster operation. All starts have been achieved without the use of a high voltage ignitor. The results of this test indicate that the solid impregnated insert is a viable neutralizer cathode for the 8-cm thruster.

  2. Component processes underlying future thinking. (United States)

    D'Argembeau, Arnaud; Ortoleva, Claudia; Jumentier, Sabrina; Van der Linden, Martial


    This study sought to investigate the component processes underlying the ability to imagine future events, using an individual-differences approach. Participants completed several tasks assessing different aspects of future thinking (i.e., fluency, specificity, amount of episodic details, phenomenology) and were also assessed with tasks and questionnaires measuring various component processes that have been hypothesized to support future thinking (i.e., executive processes, visual-spatial processing, relational memory processing, self-consciousness, and time perspective). The main results showed that executive processes were correlated with various measures of future thinking, whereas visual-spatial processing abilities and time perspective were specifically related to the number of sensory descriptions reported when specific future events were imagined. Furthermore, individual differences in self-consciousness predicted the subjective feeling of experiencing the imagined future events. These results suggest that future thinking involves a collection of processes that are related to different facets of future-event representation.

  3. Plasmonic components fabrication via nanoimprint

    DEFF Research Database (Denmark)

    Boltasseva, Alexandra


    A review report on nanoimprinted plasmonic components is given. The fabrication of different metal–dielectric geometries and nanostructured surfaces that support either propagating or localized surface plasmon modes is discussed. The main characteristics and advantages of the nanoimprint technology...... for the fabrication of various plasmonic structures are outlined. The discussion of plasmonic waveguiding structures focuses on planar waveguides based on metal strips embedded into a dielectric and on profiled metal surfaces. Nanoimprint-based fabrication of two-dimensional nanostructured plasmonic surfaces...... for enhanced transmission studies and sensor applications is also discussed. Throughout the report, the main fabrication schemes are described, as well as the challenges facing future manufacturing of plasmonic components for device applications....

  4. Tritium in fusion reactor components

    International Nuclear Information System (INIS)

    Watson, J.S.; Fisher, P.W.; Talbot, J.B.


    When tritium is used in a fusion energy experiment or reactor, several implications affect and usually restrict the design and operation of the system and involve questions of containment, inventory, and radiation damage. Containment is expected to be particularly important both for high-temperature components and for those components that are prone to require frequent maintenance. Inventory is currently of major significance in cases where safety and environmental considerations limit the experiments to very low levels of tritium. Fewer inventory restrictions are expected as fusion experiments are placed in more-remote locations and as the fusion community gains experience with the use of tritium. However, the advent of power-producing experiments with high-duty cycle will again lead to serious difficulties based principally on tritium availability; cyclic operations with significant regeneration times are the principal problems

  5. Reformulating Component Identification as Document Analysis Problem

    NARCIS (Netherlands)

    Gross, H.G.; Lormans, M.; Zhou, J.


    One of the first steps of component procurement is the identification of required component features in large repositories of existing components. On the highest level of abstraction, component requirements as well as component descriptions are usually written in natural language. Therefore, we can

  6. Stochastic Modeling Of Wind Turbine Drivetrain Components

    DEFF Research Database (Denmark)

    Rafsanjani, Hesam Mirzaei; Sørensen, John Dalsgaard


    reliable components are needed for wind turbine. In this paper focus is on reliability of critical components in drivetrain such as bearings and shafts. High failure rates of these components imply a need for more reliable components. To estimate the reliability of these components, stochastic models...

  7. Behavior Protocols for Software Components

    Czech Academy of Sciences Publication Activity Database

    Plášil, František; Višňovský, Stanislav


    Roč. 28, č. 11 (2002), s. 1056-1076 ISSN 0098-5589 R&D Projects: GA AV ČR IAA2030902; GA ČR GA201/99/0244 Grant - others:Eureka(XE) Pepita project no.2033 Institutional research plan: AV0Z1030915 Keywords : behavior protocols * component-based programming * software architecture Subject RIV: JC - Computer Hardware ; Software Impact factor: 1.170, year: 2002

  8. Component Control System for a Vehicle (United States)

    Fraser-Chanpong, Nathan (Inventor); Spain, Ivan (Inventor); Dawson, Andrew D. (Inventor); Bluethmann, William J. (Inventor); Lee, Chunhao J. (Inventor); Vitale, Robert L. (Inventor); Guo, Raymond (Inventor); Waligora, Thomas M. (Inventor); Akinyode, Akinjide Akinniyi (Inventor); Reed, Ryan M. (Inventor)


    A vehicle includes a chassis, a modular component, and a central operating system. The modular component is supported by the chassis. The central operating system includes a component control system, a primary master controller, and a secondary master controller. The component control system is configured for controlling the modular component. The primary and secondary master controllers are in operative communication with the component control system. The primary and secondary master controllers are configured to simultaneously transmit commands to the component control system. The component control system is configured to accept commands from the secondary master controller only when a fault occurs in the primary master controller.

  9. Experimental qualification of nuclear components

    International Nuclear Information System (INIS)

    Alliot, P.; Fronte, T.; Genty, F.


    In the process of showing the adequacy of the seismic design of French PWR reactor, Fermat has repeatedly used dynamic testing on actual nuclear reactor components both on site and in manufacturing shops. The objective and results of a few representative examples of this on-site experimental verification are presented in this paper: the experimental dynamic analysis of a manipulator crane; the investigation of the seismic behaviour of fuel storage racks equipped with aseismic bearing devices. Difficulties to select satisfactory testing methods are also discussed for the particular case of the electrical cabinets. (author)

  10. Management of Talar Component Subsidence. (United States)

    Li, Shu-Yuan; Myerson, Mark S


    Component subsidence has been found to be the top complication that leads to failure of the total ankle arthroplasty (TAA). The cause of subsidence formation is unclear, and is multifactorial. Talar subsidence is more frequently met than tibial subsidence, and the subsequent big bone loss is demanding to handle. As a revision treatment option, neither a revision TAA nor a salvage ankle and/or hindfoot arthrodesis procedure is easy to perform or can obtain a definite outcome. The Salto XT can be used to treat most of the TAA systems available for use in the United States with acceptable short-term outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Magnetooptical current transformer. 2: Components. (United States)

    Aulich, H; Beck, W; Douklias, N; Harms, H; Papp, A; Schneider, H


    In this second part, the most important components of a magnetooptical current transformer are described and their suitability is discussed. Today He-Ne gas lasers and laser diodes seem to meet best the requirements of the light source. Single-mode optical fibers are capable of transmitting polarized light without depolarization. A fiber coil wound on a special coil former is used as a measuring sensor. Two P-I-N photodiodes, together with an analog electronic circuit, transform the optical into an electrical measuring signal.

  12. Lifetime of superheated steam components

    International Nuclear Information System (INIS)

    Stoklossa, K.H.; Oude-Hengel, H.H.; Kraechter, H.J.


    The current evaluation schemes in use for judging the lifetime expectations of superheated steam components are compared with each other. The influence of pressure and temperature fluctuations, the differences in the strength of the wall, and the spread band of constant-strainrates are critically investigated. The distribution of these contributory effects are demonstrated in the hight of numerous measuring results. As an important supplement to these evaluation schemes a newly developed technique is introduced which is designed to calculate failure probabilities. (orig./RW) [de


    Directory of Open Access Journals (Sweden)

    Anatolii M. Malivskyi


    Full Text Available The purpose of the article is to outline and comprehend the Descartes’ theory about anthropological component of ontology as the most important part of his philosophy. The accomplishment of this purpose covers the successive solution of the following tasks: 1 review of the research literature concerning the problem of human’s presence and the individual nature of truth; 2 emphasize the ambivalence of the basic intention of his legacy; 3 justify the thesis about constitutivity of human’s presence and comprehend passions as the form of disclosure of ontology’s anthropological component. Methodology. The use of the euristic potential of phenomenology, postpositivism and postmodernism makes it possible to emphasize the multiple-layer and multiple-meaning classical philosophy works, to comprehend the limitation and scarcity of the naïve-enlightening vision of human nature and to look for a new reception of European classics that provides the overcoming of established nihilism and pessimism concerning the interpretation of human nature. Scientific novelty. It is the first time that anthropological component of Descartes’ ontology became an object of particular attention. It previously lacked attention because of following main reasons: 1 traditional underestimating of the fact of Descartes’ legacy incompleteness as an unrealized anthropological project and 2 lack of proper attention to the individual nature of truth. The premise for its constructive overcoming is the attention to ambivalence of the basic intention and the significance of ethics in the philosopher’s legacy. His texts and research literature allow confirming the constitutive nature of human’s presence and passions as the key form of disclosure of the ontology anthropological component. Conclusions. The established tradition of interpretation the Descartes’ philosophizing nature as the filiation process of impersonal knowledge loses its cogency these days. The

  14. Anthropological Component of Descartes’ Ontology

    Directory of Open Access Journals (Sweden)

    Anatolii M. Malivskyi


    Full Text Available The purpose of the article is to outline and comprehend the Descartes’ theory about anthropological component of ontology as the most important part of his philosophy. The accomplishment of this purpose covers the successive solution of the following tasks: 1 review of the research literature concerning the problem of human’s presence and the individual nature of truth; 2 emphasize the ambivalence of the basic intention of his legacy; 3 justify the thesis about constitutivity of human’s presence and comprehend passions as the form of disclosure of ontology’s anthropological component. Methodology. The use of the euristic potential of phenomenology, postpositivism and postmodernism makes it possible to emphasize the multiple-layer and multiple-meaning classical philosophy works, to comprehend the limitation and scarcity of the naïve-enlightening vision of human nature and to look for a new reception of European classics that provides the overcoming of established nihilism and pessimism concerning the interpretation of human nature. Scientific novelty. It is the first time that anthropological component of Descartes’ ontology became an object of particular attention. It previously lacked attention because of following main reasons: 1 traditional underestimating of the fact of Descartes’ legacy incompleteness as an unrealized anthropological project and 2 lack of proper attention to the individual nature of truth. The premise for its constructive overcoming is the attention to ambivalence of the basic intention and the significance of ethics in the philosopher’s legacy. His texts and research literature allow confirming the constitutive nature of human’s presence and passions as the key form of disclosure of the ontology anthropological component. Conclusions. The established tradition of interpretation the Descartes’ philosophizing nature as the filiation process of impersonal knowledge loses its cogency these days. The

  15. Parametric functional principal component analysis. (United States)

    Sang, Peijun; Wang, Liangliang; Cao, Jiguo


    Functional principal component analysis (FPCA) is a popular approach in functional data analysis to explore major sources of variation in a sample of random curves. These major sources of variation are represented by functional principal components (FPCs). Most existing FPCA approaches use a set of flexible basis functions such as B-spline basis to represent the FPCs, and control the smoothness of the FPCs by adding roughness penalties. However, the flexible representations pose difficulties for users to understand and interpret the FPCs. In this article, we consider a variety of applications of FPCA and find that, in many situations, the shapes of top FPCs are simple enough to be approximated using simple parametric functions. We propose a parametric approach to estimate the top FPCs to enhance their interpretability for users. Our parametric approach can also circumvent the smoothing parameter selecting process in conventional nonparametric FPCA methods. In addition, our simulation study shows that the proposed parametric FPCA is more robust when outlier curves exist. The parametric FPCA method is demonstrated by analyzing several datasets from a variety of applications. © 2017, The International Biometric Society.

  16. Safety engineering with COTS components

    International Nuclear Information System (INIS)

    O'Halloran, Mark; Hall, Jon G.; Rapanotti, Lucia


    Safety-critical systems are becoming more widespread, complex and reliant on software. Increasingly they are engineered through (COTS) (Commercial Off The Shelf) components to alleviate the spiralling costs and development time, often in the context of complex supply chains. A parallel increased concern for safety has resulted in a variety of safety standards, with a growing consensus that a safety life cycle is needed which is fully integrated with the design and development life cycle, to ensure that safety has appropriate influence on the design decisions as system development progresses. In this article we explore the application of an integrated approach to safety engineering in which assurance drives the engineering process. The paper reports on the outcome of a case study on a live industrial project with a view to evaluate: its suitability for application in a real-world safety engineering setting; its benefits and limitations in counteracting some of the difficulties of safety engineering with (COTS) components across supply chains; and, its effectiveness in generating evidence which can contribute directly to the construction of safety cases. - Highlights: • Assurance as effective driver for COTS-based safety-critical system development. • Engages stakeholders, captures requirements and provides rich traceability. • Shares appropriate safety requirements across the supply chain.

  17. Components of Adenovirus Genome Packaging (United States)

    Ahi, Yadvinder S.; Mittal, Suresh K.


    Adenoviruses (AdVs) are icosahedral viruses with double-stranded DNA (dsDNA) genomes. Genome packaging in AdV is thought to be similar to that seen in dsDNA containing icosahedral bacteriophages and herpesviruses. Specific recognition of the AdV genome is mediated by a packaging domain located close to the left end of the viral genome and is mediated by the viral packaging machinery. Our understanding of the role of various components of the viral packaging machinery in AdV genome packaging has greatly advanced in recent years. Characterization of empty capsids assembled in the absence of one or more components involved in packaging, identification of the unique vertex, and demonstration of the role of IVa2, the putative packaging ATPase, in genome packaging have provided compelling evidence that AdVs follow a sequential assembly pathway. This review provides a detailed discussion on the functions of the various viral and cellular factors involved in AdV genome packaging. We conclude by briefly discussing the roles of the empty capsids, assembly intermediates, scaffolding proteins, portal vertex and DNA encapsidating enzymes in AdV assembly and packaging. PMID:27721809

  18. Bioactive Components in Fish Venoms (United States)

    Ziegman, Rebekah; Alewood, Paul


    Animal venoms are widely recognized excellent resources for the discovery of novel drug leads and physiological tools. Most are comprised of a large number of components, of which the enzymes, small peptides, and proteins are studied for their important bioactivities. However, in spite of there being over 2000 venomous fish species, piscine venoms have been relatively underrepresented in the literature thus far. Most studies have explored whole or partially fractioned venom, revealing broad pharmacology, which includes cardiovascular, neuromuscular, cytotoxic, inflammatory, and nociceptive activities. Several large proteinaceous toxins, such as stonustoxin, verrucotoxin, and Sp-CTx, have been isolated from scorpaenoid fish. These form pores in cell membranes, resulting in cell death and creating a cascade of reactions that result in many, but not all, of the physiological symptoms observed from envenomation. Additionally, Natterins, a novel family of toxins possessing kininogenase activity have been found in toadfish venom. A variety of smaller protein toxins, as well as a small number of peptides, enzymes, and non-proteinaceous molecules have also been isolated from a range of fish venoms, but most remain poorly characterized. Many other bioactive fish venom components remain to be discovered and investigated. These represent an untapped treasure of potentially useful molecules. PMID:25941767

  19. GMES Space Component: Programme overview (United States)

    Aschbacher, J.; Milagro-Perez, M. P.


    The European Union (EU) and the European Space Agency (ESA) have developed the Global Monitoring for Environment and Security (GMES) programme as Europe's answer to the vital need for joined-up data about our climate, environment and security. Through a unique combination of satellite, atmospheric and Earth-based monitoring systems, the initiative will provide new insight into the state of the land, sea and air, providing policymakers, scientists, businesses and the public with accurate and timely information. GMES capabilities include monitoring and forecasting of climatic change, flood risks, soil and coastal erosion, crop and fish resources, air pollution, greenhouse gases, iceberg distribution and snow cover, among others. To accomplish this, GMES has been divided into three main components: Space, In-situ and Services. The Space Component, led by ESA, comprises five types of new satellites called Sentinels that are being developed by ESA specifically to meet the needs of GMES, the first of which to be launched in 2013. These missions carry a range of technologies, such as radar and multi-spectral imaging instruments for land, ocean and atmospheric monitoring. In addition, access to data from the so-called Contributing Missions guarantees that European space infrastructure is fully used for GMES. An integrated Ground Segment ensures access to Sentinels and Contributing Missions data. The in-situ component, under the coordination of the European Environment Agency (EEA), is composed of atmospheric and Earth based monitoring systems, and based on established networks and programmes at European and international levels. The European Commission is in charge of implementing the services component of GMES and of leading GMES overall. GMES services, fed with data from the Space and In-situ components, will provide essential information in five main domains, atmosphere, ocean and land monitoring as well as emergency response and security. Climate change has been added

  20. Understanding symmetrical components for power system modeling

    CERN Document Server

    Das, J C


    This book utilizes symmetrical components for analyzing unbalanced three-phase electrical systems, by applying single-phase analysis tools. The author covers two approaches for studying symmetrical components; the physical approach, avoiding many mathematical matrix algebra equations, and a mathematical approach, using matrix theory. Divided into seven sections, topics include: symmetrical components using matrix methods, fundamental concepts of symmetrical components, symmetrical components –transmission lines and cables, sequence components of rotating equipment and static load, three-phase models of transformers and conductors, unsymmetrical fault calculations, and some limitations of symmetrical components.

  1. On Bayesian Principal Component Analysis

    Czech Academy of Sciences Publication Activity Database

    Šmídl, Václav; Quinn, A.


    Roč. 51, č. 9 (2007), s. 4101-4123 ISSN 0167-9473 R&D Projects: GA MŠk(CZ) 1M0572 Institutional research plan: CEZ:AV0Z10750506 Keywords : Principal component analysis ( PCA ) * Variational bayes (VB) * von-Mises–Fisher distribution Subject RIV: BC - Control Systems Theory Impact factor: 1.029, year: 2007

  2. Components of attention in synesthesia

    DEFF Research Database (Denmark)

    Sørensen, Thomas Alrik; Nordfang, Maria; Pedersen, Michael Nygaard


    One of the most common forms of synesthesia is between colors and graphemes (Colizoli, Murre, & Rouw, 2012). Numerous studies have investigated different aspects of attention and synesthesia, e.g. effects of Stroop-like interference by colors that are incongruent with the synesthetic experience...... synesthesia (Mattingley, 2009). Results from the present experiment show that synesthesia affects both speed of processing (C) and the number of objects that can be retained in visual short-term memory (K). Participants were faster at encoding characters that were colored congruently with their synesthesia....... Here we attempt to isolate how speci¿ c components of attention are affected by grapheme-color synesthesia. Eight carefully screened healthy participants with synesthesia reported the letters in brie¿ y presented, post-masked arrays of letters and digits. On half the trials, the letters and digits were...

  3. Component codification and identification systems

    International Nuclear Information System (INIS)

    Pannenbaecker, K.


    The lecture covers the codification in power stations during the erection phase and commercial operation phase. A diagram gives a survey. There are three basic-codifications for application; 1) Kraftwerk-Kennzeichen-System (KKS) for marking each component in orientated systems, for marking electrical orientated positions in cubicals, switch gears etc. and for marking rooms in buildings; 2) Ordnungssystem (OS) for cost calculation and ordering; 3) Unterlagenarten-Schluessel (UAS) for letters, reports etc. and for documentation. The OS is developed on the principle of cost account number and is therefore close to the organization of each supplier and his special form of design and constrution. KKS has only to mark hardware. Therefore all German owners, consultants, authorities and suppliers develop KKS together and conform to it in DIN 407119. (ORU) [de

  4. LCA profiles for building components:

    DEFF Research Database (Denmark)

    Marsh, Rob


    , a new approach explores how environmental information on building components can be simplified for strategic use early in the design process in a Danish context. In this paper, life cycle assessments (LCAs) are undertaken for several hundred typical external wall solutions, based on relevant standards....... A full bivariate linear regression analysis is performed, showing statistically significant correlations with strong direct relationships between environmental impact categories. A simplified LCA profile consisting of total primary energy, global warming potential and acidification potential is developed....... This simplified LCA profile presents environmental data in a more understandable way, creating a strategic overview that can be easily used by non-technical clients and construction professionals in the early design stages. This has a scientific and statistical validity generated by environmental assessment...

  5. Rosin components identified in diapers. (United States)

    Karlberg, A T; Magnusson, K


    As part of the investigation of sources of exposure to rosin allergens, disposable diapers (napkins) common on the Swedish market were analyzed, using gas chromatography, to detect the main rosin compounds. Rosin components were detected in all diapers, the highest amounts in those from the 2 major producers. In these diapers, more rosin was found in the top layer, which is in close contact with the skin than in the fluff. Despite the possibly minimal risk of induction of sensitization to rosin allergens in diapers, there is a real risk of elicitation of dermatitis in sensitive individuals, especially since penetration is enhanced by occlusion and irritation. Such material is not only used for infant diapers, but also for adult incontinence products and feminine hygiene products.

  6. The magnet components database system

    International Nuclear Information System (INIS)

    Baggett, M.J.; Leedy, R.; Saltmarsh, C.; Tompkins, J.C.


    The philosophy, structure, and usage of MagCom, the SSC magnet components database, are described. The database has been implemented in Sybase (a powerful relational database management system) on a UNIX-based workstation at the Superconducting Super Collider Laboratory (SSCL); magnet project collaborators can access the database via network connections. The database was designed to contain the specifications and measured values of important properties for major materials, plus configuration information (specifying which individual items were used in each cable, coil, and magnet) and the test results on completed magnets. The data will facilitate the tracking and control of the production process as well as the correlation of magnet performance with the properties of its constituents. 3 refs., 9 figs

  7. Library thermohydraulic components for training simulators

    International Nuclear Information System (INIS)

    Castelao Caruana, M. J.; Di Benedetto, A.; Pierini, J.P.


    The thermohydraulic components Library was modeled in MatLab/Simulink®. This library owns Pipe type components (pump, control valve and / or heaters), storage tanks (Open, Closed and Equilibrium Water Vapor-Air) and Heat Exchangers (Co-Current, Counter-Current and U-tubes). Each component can be attached to other components through the component library Header, in order to create a more complex thermal-hydraulic system which in turn can interact with other thermal-hydraulic systems. (author)

  8. Bioactive Egg Components and Inflammation

    Directory of Open Access Journals (Sweden)

    Catherine J. Andersen


    Full Text Available Inflammation is a normal acute response of the immune system to pathogens and tissue injury. However, chronic inflammation is known to play a significant role in the pathophysiology of numerous chronic diseases, such as cardiovascular disease, type 2 diabetes mellitus, and cancer. Thus, the impact of dietary factors on inflammation may provide key insight into mitigating chronic disease risk. Eggs are recognized as a functional food that contain a variety of bioactive compounds that can influence pro- and anti-inflammatory pathways. Interestingly, the effects of egg consumption on inflammation varies across different populations, including those that are classified as healthy, overweight, metabolic syndrome, and type 2 diabetic. The following review will discuss the pro- and anti-inflammatory properties of egg components, with a focus on egg phospholipids, cholesterol, the carotenoids lutein and zeaxanthin, and bioactive proteins. The effects of egg consumption of inflammation across human populations will additionally be presented. Together, these findings have implications for population-specific dietary recommendations and chronic disease risk.

  9. IT Infrastructure Components for Biobanking (United States)

    Prokosch, H.U.; Beck, A.; Ganslandt, T.; Hummel, M.; Kiehntopf, M.; Sax, U.; Ückert, F.; Semler, S.


    Objective Within translational research projects in the recent years large biobanks have been established, mostly supported by homegrown, proprietary software solutions. No general requirements for biobanking IT infrastructures have been published yet. This paper presents an exemplary biobanking IT architecture, a requirements specification for a biorepository management tool and exemplary illustrations of three major types of requirements. Methods We have pursued a comprehensive literature review for biobanking IT solutions and established an interdisciplinary expert panel for creating the requirements specification. The exemplary illustrations were derived from a requirements analysis within two university hospitals. Results The requirements specification comprises a catalog with more than 130 detailed requirements grouped into 3 major categories and 20 subcategories. Special attention is given to multitenancy capabilities in order to support the project-specific definition of varying research and bio-banking contexts, the definition of workflows to track sample processing, sample transportation and sample storage and the automated integration of preanalytic handling and storage robots. Conclusion IT support for biobanking projects can be based on a federated architectural framework comprising primary data sources for clinical annotations, a pseudonymization service, a clinical data warehouse with a flexible and user-friendly query interface and a biorepository management system. Flexibility and scalability of all such components are vital since large medical facilities such as university hospitals will have to support biobanking for varying monocentric and multicentric research scenarios and multiple medical clients. PMID:23616851

  10. Components development in the EU

    International Nuclear Information System (INIS)


    In the Euratom Sixth Framework Programme (FP6) an integrated project IP-EUROTRANS (transmutation) is ongoing. One of this project’s objectives is to develop and assess structural materials and heavy liquid metal (HLM) lead–lead-bismuth technologies for transmutation systems, where the HLM is both the spallation material and the core coolant. This involves specification and fabrication of reference materials, their characterisation in HLM and in representative conditions (with and without irradiation environment) in order to provide the data base needed for design purposes (e.g. fuel cladding, in-vessel components, primary vessel, instrumentation, target container, beam window), thermalhydraulics, measurement techniques, large scale integral tests and PTA studies for the MEGAPIE spallation target of FP5. In particular the ongoing R&D for the subcritical reactors XT-ADS, cooled by LBE, and EFIT, cooled by pure lead are: – To provide necessary information for designers, as concerns both T91 and 316L steels in contact with LBE and lead. This R&D is aimed to: • Determine the creep, low cycle fatigue, relaxation (fatigue and creep) fatigue behaviour of T91 and 316L in contact with lead and LBE, both qualitatively and quantitatively; • Characterize their fracture resistance, once again both qualitatively and quantitatively; • Constitute reliable data base over a wide temperature range, attaining 550°C; • Determine the fracture mechanisms of both ferritic–martensitic and austenitic materials in contact with HLMs

  11. Teaching Principal Components Using Correlations. (United States)

    Westfall, Peter H; Arias, Andrea L; Fulton, Lawrence V


    Introducing principal components (PCs) to students is difficult. First, the matrix algebra and mathematical maximization lemmas are daunting, especially for students in the social and behavioral sciences. Second, the standard motivation involving variance maximization subject to unit length constraint does not directly connect to the "variance explained" interpretation. Third, the unit length and uncorrelatedness constraints of the standard motivation do not allow re-scaling or oblique rotations, which are common in practice. Instead, we propose to motivate the subject in terms of optimizing (weighted) average proportions of variance explained in the original variables; this approach may be more intuitive, and hence easier to understand because it links directly to the familiar "R-squared" statistic. It also removes the need for unit length and uncorrelatedness constraints, provides a direct interpretation of "variance explained," and provides a direct answer to the question of whether to use covariance-based or correlation-based PCs. Furthermore, the presentation can be made without matrix algebra or optimization proofs. Modern tools from data science, including heat maps and text mining, provide further help in the interpretation and application of PCs; examples are given. Together, these techniques may be used to revise currently used methods for teaching and learning PCs in the behavioral sciences.

  12. Fluidics: Basic components and applications (United States)

    Joyce, J. W.


    Since its discovery at Harry Diamond Lab. in 1959, fluidics has gradually been developed into a viable technology. This report describes fluidic components and systems now in use or ready for use in many applications. The fluidic technology provides sensing, computing, and controlling functions with fluid power through interaction of fluid streams. Since fluidics can perform these functions without mechanical moving parts that will wear out, it has the advantages of simplicity and reliability. Other advantages are the low cost, environmental insensitivity, and safety of fluidic systems. Commercial applications of fluidics in the aerospace industry, include medicine, and personal-use items. The first aerospace application in production in the United States was for the thrust-reverser control for a DC-10 airplane. In industry, fluidics has been applied to air-conditioning controls, machine controls, process controls, and production-line controls. One of the first commercial applications of fluidics was for life-support medical equipment. For military use, fluidics has been successfully applied to a fluidic generator to convert pneumatic energy into electrical energy, a fluidic stability augmentation system for helicopters, and a pressure-regulating system for aircraft. Under development are rate sensing circuits for roll rate control of cannon-launched guided projectiles and missiles, and a fluidic capillary pyrometer for continuous temperature measurements in high-temperature process control.

  13. Estimating pure component vapor pressures

    Energy Technology Data Exchange (ETDEWEB)

    Myrdal, P.B.; Yalkowsky, S.H. [Univ. of Arizona, Tucson, AZ (United States). Dept. of Pharmaceutical Sciences


    The hazard of exposure to volatile organic compounds is an increasing concern all chemical industries. Recent EPA and FDA guidelines require the environmental assessment of new chemical entities, which includes the determination or estimation of vapor pressure. This work presents a means for the reliable estimation of pure component vapor pressures. The method presented is an extension of the work proposed by Mishra and Yalkowsky. New equations are presented for the heat capacity change upon boiling and the entropy of boiling. The final vapor pressure equation requires only the knowledge of transition temperatures and molecular structure. The equation developed has been successfully applied to 296 organic compounds, giving an overall average absolute error of 0.12 log units (in atm. at 25 C). In addition, the equation is shown to be very accurate in predicting vapor pressure as a function of temperature. However, for many compounds of environmental interest, the boiling point is not known or cannot be determined due to decomposition. In light of this, a new technique has been developed which can be used to estimate ``hypothetical`` boiling points. This enables the estimation of vapor pressure from as little as one transition temperature and molecular structure.

  14. High temperature two component explosive (United States)

    Mars, James E.; Poole, Donald R.; Schmidt, Eckart W.; Wang, Charles


    A two component, high temperature, thermally stable explosive composition comprises a liquid or low melting oxidizer and a liquid or low melting organic fuel. The oxidizer and fuel in admixture are incapable of substantial spontaneous exothermic reaction at temperatures on the order of K. At temperatures on the order of K., the oxidizer and fuel in admixture have an activation energy of at least about 40 kcal/mol. As a result of the high activation energy, the preferred explosive compositions are nondetonable as solids at ambient temperature, and become detonable only when heated beyond the melting point. Preferable oxidizers are selected from alkali or alkaline earth metal nitrates, nitrites, perchlorates, and/or mixtures thereof. Preferred fuels are organic compounds having polar hydrophilic groups. The most preferred fuels are guanidinium nitrate, acetamide and mixtures of the two. Most preferred oxidizers are eutectic mixtures of lithium nitrate, potassium nitrate and sodium nitrate, of sodium nitrite, sodium nitrate and potassium nitrate, and of potassium nitrate, calcium nitrate and sodium nitrate.

  15. Precision fiducialization of transport components

    International Nuclear Information System (INIS)

    Fischer, G.E.; Bressler, V.E.; Cobb, J.K.; Jensen, D.R.; Ruland, R.E.; Walz, H.V.; Williams, S.H.


    The Final Focus Test Beam (FFTB) is a transport line designed to test both concept and advanced technology for application to future linear colliders. It is currently under construction at SLAC in the central beam line. Most of the quadrupoles of the FFTB have ab initio alignment tolerances of less than 30 microns, if the planned for beam based alignment tuning procedure is to converge. For such placement tolerances to have any meaning requires that the coordinates of the effective centers, seen by the beam particles, be tansferred to tooling (that can be reached by mechanical or optical alignment methods) located on the outside of the components to comparable or better values. We have constructed an apparatus that simultaneously locates to micron tolerances, the effective magnetic center of fussing lenses, as well as the electrical center of beam position monitors (BPM) imbedded therein, and once located, for transferring these coordinates to specially mounted tooling frames that supported the external retroreflectors used in a laser tracker based alignment of the beam line. Details of construction as well as experimental results from the method are presented

  16. Bioactive Egg Components and Inflammation (United States)

    Andersen, Catherine J.


    Inflammation is a normal acute response of the immune system to pathogens and tissue injury. However, chronic inflammation is known to play a significant role in the pathophysiology of numerous chronic diseases, such as cardiovascular disease, type 2 diabetes mellitus, and cancer. Thus, the impact of dietary factors on inflammation may provide key insight into mitigating chronic disease risk. Eggs are recognized as a functional food that contain a variety of bioactive compounds that can influence pro- and anti-inflammatory pathways. Interestingly, the effects of egg consumption on inflammation varies across different populations, including those that are classified as healthy, overweight, metabolic syndrome, and type 2 diabetic. The following review will discuss the pro- and anti-inflammatory properties of egg components, with a focus on egg phospholipids, cholesterol, the carotenoids lutein and zeaxanthin, and bioactive proteins. The effects of egg consumption of inflammation across human populations will additionally be presented. Together, these findings have implications for population-specific dietary recommendations and chronic disease risk. PMID:26389951

  17. Molecular Components of Catalytic Selectivity

    Energy Technology Data Exchange (ETDEWEB)

    Somorjai, Gabor A.; Park, Jeong Y.


    Selectivity, that is, to produce one molecule out of many other thermodynamically feasible product molecules, is the key concept to develop 'clean manufacturing' processes that do not produce byproducts (green chemistry). Small differences in potential energy barriers for elementary reaction steps control which reaction channel is more likely to yield the desired product molecule (selectivity), instead of the overall activation energy for the reaction that controls turnover rates (activity). Recent studies have demonstrated the atomic- or molecular-level tailoring of parameters such as the surface structures of active sites that give rise to nanoparticle size and shape dependence of turnover rates and reaction selectivities. Here, we highlight seven molecular components that influence reaction selectivities. These include: surface structure, adsorbate-induced restructuring, adsorbate mobility, reaction intermediates, surface composition, charge transport, and oxidation states for model metal single crystal and colloid nanoparticle catalysts. We show examples of their functioning and describe in-situ instruments that permit us to investigate their roles in surface reactions.

  18. Nondestructive Characterization of Aged Components

    Energy Technology Data Exchange (ETDEWEB)

    Panetta, Paul D.; Toloczko, Mychailo B.; Garner, Francis A.; Balachov, Iouri I.


    It is known that high energy radiation can have numerous effects on materials. In metals and alloys, the effects include, but may not be limited to, mechanical property changes, physical property changes, compositional changes, phase changes, and dimensional changes. Metals and alloys which undergo high energy self-irradiation are also susceptible to these changes. One of the greatest concerns with irradiation of materials is the phenomenon of void swelling which has been observed in a wide variety of metals and alloys. Irradiation causes the formation of a high concentration point defects and microclusters of vacancies and interstitials. With the assistance of an inert atom such as helium, the vacancy-type defects can coalesce to form a stable bubble. This bubble will continue to grow through the net absorption of more vacancy-type defects and helium atoms, and upon reaching a certain critical size, the bubble will begin to grow at an accelerated rate without the assistance of inert atom absorption. The bubble is then said to be an unstably growing void. Depending on the alloy system and environment, swelling values can reach in excess of 50% !V/Vo where Vo is the initial volume of the material. Along with dimensional changes resulting from the formation of bubbles and voids comes changes in the macroscopically observed speed of sound, moduli, electrical resistivity, yield strength, and other properties. These effects can be detrimental to the designed operation of the aged components. In situations where irradiation has sufficient time to cause degradation to materials used in critical applications such as nuclear reactor core structural materials, it is advisable to regularly survey the material properties. It is common practice to use surveillance specimens, but this is not always possible. When surveillance materials are not available, other means for surveying the material properties must be utilized. Sometimes it is possible to core out a small sample which

  19. Design of microstrip components by computer (United States)

    Cisco, T. C.


    Development of computer programs for component analysis and design aids used in production of microstrip components is discussed. System includes designs for couplers, filters, circulators, transformers, power splitters, diode switches, and attenuators.

  20. CoC Awards by Program Component (United States)

    Department of Housing and Urban Development — CoC Awards by Program Component reports provide snapshots of award data broken down by eligible program component types for the year selected. The reports, which can...

  1. Additive Manufacturing of Aerospace Propulsion Components (United States)

    Misra, Ajay K.; Grady, Joseph E.; Carter, Robert


    The presentation will provide an overview of ongoing activities on additive manufacturing of aerospace propulsion components, which included rocket propulsion and gas turbine engines. Future opportunities on additive manufacturing of hybrid electric propulsion components will be discussed.

  2. Glomerular extracellular matrix components and integrins

    NARCIS (Netherlands)

    Sterk, L. M.; de Melker, A. A.; Kramer, D.; Kuikman, I.; Chand, A.; Claessen, N.; Weening, J. J.; Sonnenberg, A.


    It has become apparent that extracellular matrix components and their cellular receptors, the integrins, are important regulators of glomerular development and function. In this rapidly evolving field we studied the production of extracellular matrix components and integrins by rat glomerular

  3. Analytical Study of Component Based Software Engineering


    Iqbaldeep Kaur; Parvinder S. Sandhu; Hardeep Singh; Vandana Saini


    This paper is a survey of current component-based software technologies and the description of promotion and inhibition factors in CBSE. The features that software components inherit are also discussed. Quality Assurance issues in componentbased software are also catered to. The feat research on the quality model of component based system starts with the study of what the components are, CBSE, its development life cycle and the pro & cons of CBSE. Various attributes are s...

  4. Aspects for Run-time Component Integration

    DEFF Research Database (Denmark)

    Truyen, Eddy; Jørgensen, Bo Nørregaard; Joosen, Wouter


    Component framework technology has become the cornerstone of building a family of systems and applications. A component framework defines a generic architecture into which specialized components can be plugged. As such, the component framework leverages the glue that connects the different inserted...... to dynamically integrate into the architecture of middleware systems new services that support non-functional aspects such as security, transactions, real-time....

  5. Development of standard components for remote handling

    Energy Technology Data Exchange (ETDEWEB)

    Taguchi, Kou; Kakudate, Satoshi; Nakahira, Masataka; Ito, Akira [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment


    The core of Fusion Experimental Reactor consists of various components such as superconducting magnets and forced-cooled in-vessel components, which are remotely maintained due to intense of gamma radiation. Mechanical connectors such as cooling pipe connections, insulation joints and electrical connectors are commonly used for maintenance of these components and have to be standardized in terms of remote handling. This paper describes these mechanical connectors developed as the standard component compatible with remote handling and tolerable for radiation. (author)

  6. A case hardened component of titanium

    DEFF Research Database (Denmark)


    The present invention relates to a case hardened component of a titanium alloy, the component having a diffusion zone of a thickness of at least 50 μιτι, as calculated from the surface of the component, the diffusion zone comprising oxygen and carbon in solid solution and having a distinct phase...

  7. Tautness and Fatou components in []2

    NARCIS (Netherlands)

    Peters, H.; Zeager, C.


    Hyperbolicity played an important role in the classification of Fatou components for rational functions in the Riemann sphere. In higher dimensions Fatou components are not nearly as well understood. We investigate the Kobayashi completeness and tautness of invariant Fatou components for holomorphic

  8. Two component theory and electron magnetic moment

    NARCIS (Netherlands)

    Veltman, M.J.G.


    The two-component formulation of quantum electrodynamics is studied. The relation with the usual Dirac formulation is exhibited, and the Feynman rules for the two-component form of the theory are presented in terms of familiar objects. The transformation from the Dirac theory to the two-component

  9. Component failure data base of TRIGA reactors

    International Nuclear Information System (INIS)

    Djuricic, M.


    This compilation provides failure data such as first criticality, component type description (reactor component, population, cumulative calendar time, cumulative operating time, demands, failure mode, failures, failure rate, failure probability) and specific information on each type of component of TRIGA Mark-II reactors in Austria, Bangladesh, Germany, Finland, Indonesia, Italy, Indonesia, Slovenia and Romania. (nevyjel)

  10. Knee Arthroplasty: With or Without Patellar Component?

    Directory of Open Access Journals (Sweden)

    Árpád Sólyom


    Full Text Available Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components or a tricompartimental (femoral, tibial and patellar components prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component.

  11. Blind Detection of Independent Dynamic Components

    DEFF Research Database (Denmark)

    Hansen, Lars Kai; Larsen, Jan; Kolenda, Thomas


    In certain applications of independent component analysis (ICA) it is of interest to test hypotheses concerning the number of components or simply to test whether a given number of components is significant relative to a "white noise" null hypothesis. We estimate probabilities of such competing...


    DEFF Research Database (Denmark)


    . The microfluidic component (100) comprises at least one flexible tube piece (102) for transporting a fluid. The microfluidic component (100) also comprises means for applying and maintaining pressure (104) between the flexible tube piece (102) and a tube piece (208, 210) housed in another microfluidic component...

  13. Method of nickel-plating large components

    International Nuclear Information System (INIS)

    Wilbuer, K.


    The invention concerns a method of nickel-plating components, according to which even large components can be provided with an adequate layer of nickel which is pore- and stress-free and such that water is not lost. According to the invention, the component is heated and, after heating, is pickled, rinsed, scoured, plated in an electrolysis process, and rinsed again. (author)

  14. Principal component regression analysis with SPSS. (United States)

    Liu, R X; Kuang, J; Gong, Q; Hou, X L


    The paper introduces all indices of multicollinearity diagnoses, the basic principle of principal component regression and determination of 'best' equation method. The paper uses an example to describe how to do principal component regression analysis with SPSS 10.0: including all calculating processes of the principal component regression and all operations of linear regression, factor analysis, descriptives, compute variable and bivariate correlations procedures in SPSS 10.0. The principal component regression analysis can be used to overcome disturbance of the multicollinearity. The simplified, speeded up and accurate statistical effect is reached through the principal component regression analysis with SPSS.

  15. Model Of Reconfiguration In Component Environments


    Jakub Grzesiak; Łukasz Jędrychowski


    The significance of the component-based software and component platforms has increased in the last 20 years. To achieve full flexibility there is a need of reconfiguration process, which allows to change parameters of system without rebuilding or restarting it. In terms of components such a process should be executed with extraordinary care as contracts between components have to be preserved. In this article model of reconfiguration and roles of the components, which are used in the process,...

  16. Repair process and a repaired component

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, III, Herbert Chidsey; Simpson, Stanley F.


    Matrix composite component repair processes are disclosed. The matrix composite repair process includes applying a repair material to a matrix composite component, securing the repair material to the matrix composite component with an external securing mechanism and curing the repair material to bond the repair material to the matrix composite component during the securing by the external securing mechanism. The matrix composite component is selected from the group consisting of a ceramic matrix composite, a polymer matrix composite, and a metal matrix composite. In another embodiment, the repair process includes applying a partially-cured repair material to a matrix composite component, and curing the repair material to bond the repair material to the matrix composite component, an external securing mechanism securing the repair material throughout a curing period, In another embodiment, the external securing mechanism is consumed or decomposed during the repair process.


    Directory of Open Access Journals (Sweden)

    E. Lazarevich


    Full Text Available The article is present new idea of the creation, developments and improvements of the electronic equipment of complex systems by means of the virtual electronic components. The idea of the virtual electronic components is a presentation and perception of the creation and developments of the equipment on two forming: real – in the manner of standard marketed block of the intellectual property and image – in the manner of virtual component. The real component in most cases slows the development of the electronic equipment. The imaginary component is the «locomotive» of development of the electronic equipment. The Imaginary component contains the scientific has brushed against developer. The scientific has brushed against developer reveals of itself in the manner of virtual component on the modern level of the design rates of microelectronics.

  18. The artifacts of component-based development

    International Nuclear Information System (INIS)

    Rizwan, M.; Qureshi, J.; Hayat, S.A.


    Component based development idea was floated in a conference name Mass Produced Software Components in 1968 (1). Since then engineering and scientific libraries are developed to reuse the previously developed functions. This concept is now widely used in SW development as component based development (CBD). Component-based software engineering (CBSE) is used to develop/ assemble software from existing components (2). Software developed using components is called component where (3). This paper presents different architectures of CBD such as Active X, common object request broker architecture (CORBA), remote method invocation (RMI) and simple object access protocol (SOAP). The overall objective of this paper is to support the practice of CBD by comparing its advantages and disadvantages. This paper also evaluates object oriented process model to adapt it for CBD. (author)

  19. Vitellogenins Are New High Molecular Weight Components and Allergens (Api m 12 and Ves v 6) of Apis mellifera and Vespula vulgaris Venom (United States)

    Blank, Simon; Seismann, Henning; McIntyre, Mareike; Ollert, Markus; Wolf, Sara; Bantleon, Frank I.; Spillner, Edzard


    Background/Objectives Anaphylaxis due to hymenoptera stings is one of the most severe clinical outcomes of IgE-mediated hypersensitivity reactions. Although allergic reactions to hymenoptera stings are often considered as a general model for the underlying principles of allergic disease, venom immunotherapy is still hampered by severe systemic side effects and incomplete protection. The identification and detailed characterization of all allergens of hymenoptera venoms might result in an improvement in this field and promote the detailed understanding of the allergological mechanism. Our aim was the identification and detailed immunochemical and allergological characterization of the low abundant IgE-reactive 200 kDa proteins of Apis mellifera and Vespula vulgaris venom. Methods/Principal Findings Tandem mass spectrometry-based sequencing of a 200 kDa venom protein yielded peptides that could be assigned to honeybee vitellogenin. The coding regions of the honeybee protein as well as of the homologue from yellow jacket venom were cloned from venom gland cDNA. The newly identified 200 kDa proteins share a sequence identity on protein level of 40% and belong to the family of vitellogenins, present in all oviparous animals, and are the first vitellogenins identified as components of venom. Both vitellogenins could be recombinantly produced as soluble proteins in insect cells and assessed for their specific IgE reactivity. The particular vitellogenins were recognized by approximately 40% of sera of venom-allergic patients even in the absence of cross-reactive carbohydrate determinants. Conclusion With the vitellogenins of Apis mellifera and Vespula vulgaris venom a new homologous pair of venom allergens was identified and becomes available for future applications. Due to their allergenic properties the honeybee and the yellow jacket venom vitellogenin were designated as allergens Api m 12 and Ves v 6, respectively. PMID:23626765

  20. Analyser Framework to Verify Software Components

    Directory of Open Access Journals (Sweden)

    Rolf Andreas Rasenack


    Full Text Available Today, it is important for software companies to build software systems in a short time-interval, to reduce costs and to have a good market position. Therefore well organized and systematic development approaches are required. Reusing software components, which are well tested, can be a good solution to develop software applications in effective manner. The reuse of software components is less expensive and less time consuming than a development from scratch. But it is dangerous to think that software components can be match together without any problems. Software components itself are well tested, of course, but even if they composed together problems occur. Most problems are based on interaction respectively communication. Avoiding such errors a framework has to be developed for analysing software components. That framework determines the compatibility of corresponding software components. The promising approach discussed here, presents a novel technique for analysing software components by applying an Abstract Syntax Language Tree (ASLT. A supportive environment will be designed that checks the compatibility of black-box software components. This article is concerned to the question how can be coupled software components verified by using an analyzer framework and determines the usage of the ASLT. Black-box Software Components and Abstract Syntax Language Tree are the basis for developing the proposed framework and are discussed here to provide the background knowledge. The practical implementation of this framework is discussed and shows the result by using a test environment.

  1. Shaking table testing of mechanical components

    International Nuclear Information System (INIS)

    Jurukovski, D.; Taskov, Lj.; Mamucevski, D.; Petrovski, D.


    Presented is the experience of the Institute of Earthquake Engineering and Engineering Seismology, Skopje, Republic of Macedonia in seismic qualification of mechanical components by shaking table testing. Technical data and characteristics for the three shaking tables available at the Institute are given. Also, for characteristic mechanical components tested at the Institute laboratories, basic data such as producer, testing investor, description of the component, testing regulation, testing equipment and final user of the results. (author)

  2. Component framework support for developing device drivers


    Michiels, Sam; Kenens, Peter; Matthijs, Frank; Walravens, Dirk; Berbers, Yolande; Verbaeten, Pierre


    In this paper, we advocate the use of component framework technology for developing state-of-the-art system software. Relevant contributions of DiPS (Distrinet Protocol Stack), a component framework, include its anonymous interaction model, connectors for handling non-functional issues such as the concurrency model, and builder support. DiPS has effectively been used in industrial protocol stacks. This paper shows how we are using the DiPS component framework to build and support flexib...

  3. Passive components used in power converters


    Rufer, A; Veestra, M; Barrade, P


    In power converters, passive components play an important role, and have in general specific nature and properties. The goal of this tutorial is to give an overview, first on inductive components for power conversion, and second on dedicated power capacitors. In a third part, new components— supercapacitors—will be presented. Generally, inductors for power applications must be custom designed. In this tutorial, the most important effects encountered when realising inductive components will be...

  4. SOFA 2 Component Framework and Its Ecosystem

    Czech Academy of Sciences Publication Activity Database

    Malohlava, M.; Hnětynka, P.; Bureš, Tomáš


    Roč. 295, 9 May (2013), s. 101-106 ISSN 1571-0661. [FESCA 2012. International Workshop on Formal Engineering approaches to Software Components and Architectures /9./. Tallinn, 31.03.2012] R&D Projects: GA ČR GD201/09/H057 Grant - others:GA AV ČR(CZ) GAP202/11/0312; UK(CZ) SVV-2012-265312 Keywords : CBSE * component system * component model * component * sofa * ecosystem * development tool Subject RIV: JC - Computer Hardware ; Software

  5. Epistemic uncertainties when estimating component failure rate

    International Nuclear Information System (INIS)

    Jordan Cizelj, R.; Mavko, B.; Kljenak, I.


    A method for specific estimation of a component failure rate, based on specific quantitative and qualitative data other than component failures, was developed and is described in the proposed paper. The basis of the method is the Bayesian updating procedure. A prior distribution is selected from a generic database, whereas likelihood is built using fuzzy logic theory. With the proposed method, the component failure rate estimation is based on a much larger quantity of information compared to the presently used classical methods. Consequently, epistemic uncertainties, which are caused by lack of knowledge about a component or phenomenon are reduced. (author)

  6. Tengi Interfaces for Tracing between Heterogeneous Components

    DEFF Research Database (Denmark)

    Pfeiffer, Rolf-Helge; Wasowski, Andrzej


    , typically general programming languages, provide an interface description mechanism able to specify software com- ponent boundaries. Unfortunately, these interface mechanisms can not express relations for components containing heterogeneous artifacts. We introduce Tengi, a tool that allows...... for the definition of software components containing heterogeneous artifacts. Tengi interfaces link components containing different textual and visual software development artifacts ranging from high-level specification documents to low-level implementation documents. We formally define and implement Tengi...... interfaces, a component algebra and operations on them and present a case study demonstrating Tengi’s capabilities....

  7. Compatibility and testing of electronic components

    CERN Document Server

    Jowett, C E


    Compatibility and Testing of Electronic Components outlines the concepts of component part life according to thresholds of failure; the advantages that result from identifying such thresholds; their identification; and the various tests used in their detection. The book covers topics such as the interconnection of miniature passive components; the integrated circuit compatibility and its components; the semiconductor joining techniques; and the thin film hybrid approach in integrated circuits. Also covered are topics such as thick film resistors, conductors, and insulators; thin inlays for el

  8. Agile Objects: Component-Based Inherent Survivability

    National Research Council Canada - National Science Library

    Chien, Andrew


    We have developed a framework called Agile Objects which leverages component object models and enables the construction of survivable systems that support increased application survivability through elusive technologies...

  9. Cognitive components of rural tourism destination images

    DEFF Research Database (Denmark)

    Kokkali, Panagiota; Koutsouris, Alex; Chrysochou, Polymeros

    This paper aims at exploring issues related to rural tourism destination image focusing on TDI cognitive components. By means of empirical research addressing tourists visiting the Lake Plastiras area, Central Greece, the cognitive components of the area's TDI were identified along with their eff......This paper aims at exploring issues related to rural tourism destination image focusing on TDI cognitive components. By means of empirical research addressing tourists visiting the Lake Plastiras area, Central Greece, the cognitive components of the area's TDI were identified along...

  10. OCSEGen: Open Components and Systems Environment Generator (United States)

    Tkachuk, Oksana


    To analyze a large system, one often needs to break it into smaller components.To analyze a component or unit under analysis, one needs to model its context of execution, called environment, which represents the components with which the unit interacts. Environment generation is a challenging problem, because the environment needs to be general enough to uncover unit errors, yet precise enough to make the analysis tractable. In this paper, we present a tool for automated environment generation for open components and systems. The tool, called OCSEGen, is implemented on top of the Soot framework. We present the tool's current support and discuss its possible future extensions.

  11. Digital Components in Swedish NPP Power Systems

    International Nuclear Information System (INIS)

    Karlsson, Mattias; Eriksson, Tage


    Swedish nuclear power plants have over the last 20 years of operation modernised or exchanged several systems and components of the electrical power system. Within these works, new components based on digital technology have been employed in order to realize functionality that was previously achieved by using electro-mechanical or analogue technology. Components and systems such as relay protection, rectifiers, inverters, variable speed drives and diesel-generator sets are today equipped with digital components. Several of the systems and components fulfil functions with a safety-role in the NPP. Recently, however, a number of incidents have occurred which highlight deficiencies in the design or HMI of the equipment, which warrants questions whether there are generic problems with some applications of digital components that needs to be addressed. The use of digital components has presented cost effective solutions, or even the only available solution on the market enabling a modernisation. The vast majority of systems using digital components have been operating without problems and often contribute to improved safety but the challenge of non-detectable, or non-identifiable, failure modes remain. In this paper, the extent to which digital components are used in Swedish NPP power systems will be presented including a description of typical applications. Based on data from maintenance records and fault reports, as well as interviews with designers and maintenance personnel, the main areas where problems have been encountered and where possible risks have been identified will be described. The paper intends to investigate any 'tell-tales' that could give signals of unwanted behaviour. Furthermore, particular benefits experienced by using digital components will be highlighted. The paper will also discuss the safety relevance of these findings and suggest measures to improve safety in the application of digital components in power systems. (authors)

  12. Liquefaction of wood and its model components

    NARCIS (Netherlands)

    Barnés, M. Castellví; de Visser, M. M.; van Rossum, G.; Kersten, S. R.A.; Lange, J. P.


    Pinewood and various model components were liquefied to bio-oil at 300–310 °C in 1-methylnaphthalene to study the chemistry of the liquefaction process. Cellulose, amylopectin and organosolv lignin were used as model components for the cellulose, hemicellulose and lignin parts of the wood.

  13. 21 CFR 225.142 - Components. (United States)


    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Components. 225.142 Section 225.142 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS Product Quality Assurance § 225.142 Components...

  14. 21 CFR 225.42 - Components. (United States)


    ... CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS Product Quality Control § 225.42 Components. (a) A... inventory control for all such drugs to aid in assuring their identity, strength, quality, and purity when... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Components. 225.42 Section 225.42 Food and Drugs...

  15. Polymeric components for telecom and datacom

    NARCIS (Netherlands)

    Diemeer, Mart; Dekker, R.; Hilderink, L.T.H.; Leinse, Arne; Balakrishnan, M.; Faccini, M.; Driessen, A.; Lambeck, Paul; Gorecki, Christophe; Pustelny, Tadeusz


    Polymeric optical waveguide components offer attractive properties for applications in optical telecom and datacom systems. These are high speed for electro-optic modulators, low power dissipation for thermo-optic (digital) switches and low-cost for all active and passive components. We report on

  16. Runtime Concepts of Hierarchical Software Components

    Czech Academy of Sciences Publication Activity Database

    Bureš, Tomáš; Hnětynka, P.; Plášil, František


    Roč. 8, special (2007), s. 454-463 ISSN 1525-9293 R&D Projects: GA AV ČR 1ET400300504 Institutional research plan: CEZ:AV0Z10300504 Keywords : component -based development * hierarchical component s * connectors * controlers * runtime environment Subject RIV: JC - Computer Hardware ; Software

  17. Active components for integrated plasmonic circuits

    DEFF Research Database (Denmark)

    Krasavin, A.V.; Bolger, P.M.; Zayats, A.V.


    We present a comprehensive study of highly efficient and compact passive and active components for integrated plasmonic circuit based on dielectric-loaded surface plasmon polariton waveguides.......We present a comprehensive study of highly efficient and compact passive and active components for integrated plasmonic circuit based on dielectric-loaded surface plasmon polariton waveguides....

  18. Trends in chassis and automobile electronics components

    Energy Technology Data Exchange (ETDEWEB)

    Hackenberg, Ulrich [Volkswagen AG, Wolfsburg (Germany)


    The rapidly-growing importance of electronics in automobile construction is in part determined by the debate on sustainability and the clear trend towards electric power trains. Another factor, however, is the decisive impact of electronics on the further development of components, e.g. for chassis. Apart from environmental protection, key motivators for component development include comfort, safety, infotainment and driver assistance. (orig.)

  19. Systems with randomly failing repairable components

    DEFF Research Database (Denmark)

    Der Kiureghian, Armen; Ditlevsen, Ove Dalager; Song, Junho


    Closed-form expressions are derived for the steady-state availability, mean rate of failure, mean duration of downtime and reliability of a general system with randomly and independently failing repairable components. Component failures are assumed to be homogeneous Poisson events in time and rep...

  20. Radiation dose effects, hardening of electronic components

    International Nuclear Information System (INIS)

    Dupont-Nivet, E.


    This course reviews the mechanism of interaction between ionizing radiation and a silicon oxide type dielectric, in particular the effect of electron-hole pairs creation in the material. Then effects of cumulated dose on electronic components and especially in MOS technology are examined. Finally methods hardening of these components are exposed. 93 refs

  1. A framework for sequential multiblock component methods

    NARCIS (Netherlands)

    Smilde, A.K.; Westerhuis, J.A.; Jong,


    Multiblock or multiset methods are starting to be used in chemistry and biology to study complex data sets. In chemometrics, sequential multiblock methods are popular; that is, methods that calculate one component at a time and use deflation for finding the next component. In this paper a framework

  2. Least-squares variance component estimation

    NARCIS (Netherlands)

    Teunissen, P.J.G.; Amiri-Simkooei, A.R.


    Least-squares variance component estimation (LS-VCE) is a simple, flexible and attractive method for the estimation of unknown variance and covariance components. LS-VCE is simple because it is based on the well-known principle of LS; it is flexible because it works with a user-defined weight

  3. Hybrid solar lighting distribution systems and components (United States)

    Muhs, Jeffrey D [Lenoir City, TN; Earl, Dennis D [Knoxville, TN; Beshears, David L [Knoxville, TN; Maxey, Lonnie C [Powell, TN; Jordan, John K [Oak Ridge, TN; Lind, Randall F [Lenoir City, TN


    A hybrid solar lighting distribution system and components having at least one hybrid solar concentrator, at least one fiber receiver, at least one hybrid luminaire, and a light distribution system operably connected to each hybrid solar concentrator and each hybrid luminaire. A controller operates all components.

  4. Insulating jacket for heat sensitive components

    International Nuclear Information System (INIS)

    Class, G.


    The insulating jacket for long core components of sodium-cooled reactors consists of several layers of austenitic steel, between which a woven wire mesh of the same material is fitted. It is wound in the form of a spiral bandage on the core component. (DG) [de

  5. Pedagogical Support Components of Students' Social Adaptation (United States)

    Vlasova, Vera K.; Simonova, Galina I.; Soleymani, Nassim


    The urgency of the problem stated in the article is caused by the need of pedagogical support of students' social adaptation on the basis of systematicity, which is achieved if we correctly define the components of the process. The aim of the article is to determine the pedagogical support components of students' social adaptation. The leading…

  6. Fatou components with punctured limit sets

    NARCIS (Netherlands)

    Boc-Thaler, L.; Fornæss, J.E.; Peters, H.


    We study invariant Fatou components for holomorphic endomorphisms in P 2 . In the recurrent case these components were classified by Fornæss and Sibony [Classification of recurrent domains for some holomorphic maps. Math. Ann. 301(4) (1995), 813-820]. Ueda [Holomorphic maps on projective spaces and

  7. Sandia_HighTemperatureComponentEvaluation_2015

    Energy Technology Data Exchange (ETDEWEB)

    Cashion, Avery T. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    The objective of this project is to perform independent evaluation of high temperature components to determine their suitability for use in high temperature geothermal tools. Development of high temperature components has been increasing rapidly due to demand from the high temperature oil and gas exploration and aerospace industries. Many of these new components are at the late prototype or first production stage of development and could benefit from third party evaluation of functionality and lifetime at elevated temperatures. In addition to independent testing of new components, this project recognizes that there is a paucity of commercial-off-the-shelf COTS components rated for geothermal temperatures. As such, high-temperature circuit designers often must dedicate considerable time and resources to determine if a component exists that they may be able to knead performance out of to meet their requirements. This project aids tool developers by characterization of select COTS component performances beyond published temperature specifications. The process for selecting components includes public announcements of project intent (e.g., FedBizOps), direct discussions with candidate manufacturers,and coordination with other DOE funded programs.

  8. Metacognitive components in smart learning environment (United States)

    Sumadyo, M.; Santoso, H. B.; Sensuse, D. I.


    Metacognitive ability in digital-based learning process helps students in achieving learning goals. So that digital-based learning environment should make the metacognitive component as a facility that must be equipped. Smart Learning Environment is the concept of a learning environment that certainly has more advanced components than just a digital learning environment. This study examines the metacognitive component of the smart learning environment to support the learning process. A review of the metacognitive literature was conducted to examine the components involved in metacognitive learning strategies. Review is also conducted on the results of study smart learning environment, ranging from design to context in building smart learning. Metacognitive learning strategies certainly require the support of adaptable, responsive and personalize learning environments in accordance with the principles of smart learning. The current study proposed the role of metacognitive component in smart learning environment, which is useful as the basis of research in building environment in smart learning.

  9. Hot gas path component cooling system (United States)

    Lacy, Benjamin Paul; Bunker, Ronald Scott; Itzel, Gary Michael


    A cooling system for a hot gas path component is disclosed. The cooling system may include a component layer and a cover layer. The component layer may include a first inner surface and a second outer surface. The second outer surface may define a plurality of channels. The component layer may further define a plurality of passages extending generally between the first inner surface and the second outer surface. Each of the plurality of channels may be fluidly connected to at least one of the plurality of passages. The cover layer may be situated adjacent the second outer surface of the component layer. The plurality of passages may be configured to flow a cooling medium to the plurality of channels and provide impingement cooling to the cover layer. The plurality of channels may be configured to flow cooling medium therethrough, cooling the cover layer.

  10. Emotional stability components of human performance problems

    International Nuclear Information System (INIS)

    Wexler, R.H.


    Over half of all significant events that occur in nuclear plants involve human performance problems. There is increasing worldwide recognition that human performance problems have a significant impact on the safety, cost, and efficiency of nuclear plant operations. Emotional stability components have an important direct and indirect impact on human performance problems. This paper examines emotional stability components that are currently incorporated into human performance evaluation systems (HPES) in nuclear plants. It describes HPES programs being developed around the world, the emotional stability components that are currently referred to in these programs, and suggestions for improving HPES programs through a greater understanding of emotion stability components. A review of emotional stability components that may hinder or promote a plant environment that encourages the voluntary reporting and correction of human error is also presented

  11. LWR nuclear power plant component failures

    International Nuclear Information System (INIS)

    Schmidt, W.H.


    An analysis of the most significant light water reactor (LWR) nuclear power plant component failures, from information in the computerized Nuclear Safety Information Center (NSIC) data bank, shows that for both pressurized water reactor (PWR) and boiling water reactor (BWR) plants the component category most responsible for reactor shutdowns is valves. Next in importance for PWR shutdowns is steam generators followed by seals of all kinds. For BWR plants, seals, and pipes and pipe fittings are the second and third most important component failure categories which lead to reactor shutdown. The data are for records extending from early 1972 through September 1978. A list of the most significant component categories and a breakdown of the number of component citations for both PWR and BWR reactor types are presented

  12. COPD phenotype description using principal components analysis

    DEFF Research Database (Denmark)

    Roy, Kay; Smith, Jacky; Kolsum, Umme


    BACKGROUND: Airway inflammation in COPD can be measured using biomarkers such as induced sputum and Fe(NO). This study set out to explore the heterogeneity of COPD using biomarkers of airway and systemic inflammation and pulmonary function by principal components analysis (PCA). SUBJECTS...... AND METHODS: In 127 COPD patients (mean FEV1 61%), pulmonary function, Fe(NO), plasma CRP and TNF-alpha, sputum differential cell counts and sputum IL8 (pg/ml) were measured. Principal components analysis as well as multivariate analysis was performed. RESULTS: PCA identified four main components (% variance...... associations between the variables within components 1 and 2. CONCLUSION: COPD is a multi dimensional disease. Unrelated components of disease were identified, including neutrophilic airway inflammation which was associated with systemic inflammation, and sputum eosinophils which were related to increased Fe...


    Directory of Open Access Journals (Sweden)

    D. Jeyamala


    Full Text Available High quality software can be obtained by means of rigorous testing of all the components of the software. This research work has proposed an automated software testing framework that performs a mutant based components impact analysis to identify the higher critical components from the Software Under Test (SUT. In this work, the mutants are automatically generated by injecting faults in the original program and they are used to identify the impact over the other components in the SUT. The generated mutants are executed using a suite of test cases to identify their impact over the other components of the system. Based on their impact level, the critical components are identified and then rigorously verified using the test cases generated using Genetic Algorithm (GA based approach with branch coverage and mutation score based test adequacy criterion as the fitness functions. For unit testing, the branch coverage based test case adequacy criteria is used to test whether all the branches have been covered or not. In integration testing, the components are tested against the test cases generated using GA by means of identifying the execution trace of each method and each intermediate results is compared against the expected output stored in the repository. The testing tool named as “JImpact Arbiter” developed as part of this work has carried out all these tasks in an automated way and has generated various graphs for the purpose of visualization.

  14. The Component-Based Application for GAMESS

    Energy Technology Data Exchange (ETDEWEB)

    Peng, Fang [Iowa State Univ., Ames, IA (United States)


    GAMESS, a quantum chetnistry program for electronic structure calculations, has been freely shared by high-performance application scientists for over twenty years. It provides a rich set of functionalities and can be run on a variety of parallel platforms through a distributed data interface. While a chemistry computation is sophisticated and hard to develop, the resource sharing among different chemistry packages will accelerate the development of new computations and encourage the cooperation of scientists from universities and laboratories. Common Component Architecture (CCA) offers an enviromnent that allows scientific packages to dynamically interact with each other through components, which enable dynamic coupling of GAMESS with other chetnistry packages, such as MPQC and NWChem. Conceptually, a cotnputation can be constructed with "plug-and-play" components from scientific packages and require more than componentizing functions/subroutines of interest, especially for large-scale scientific packages with a long development history. In this research, we present our efforts to construct cotnponents for GAMESS that conform to the CCA specification. The goal is to enable the fine-grained interoperability between three quantum chemistry programs, GAMESS, MPQC and NWChem, via components. We focus on one of the three packages, GAMESS; delineate the structure of GAMESS computations, followed by our approaches to its component development. Then we use GAMESS as the driver to interoperate integral components from the other tw"o packages, arid show the solutions for interoperability problems along with preliminary results. To justify the versatility of the design, the Tuning and Analysis Utility (TAU) components have been coupled with GAMESS and its components, so that the performance of GAMESS and its components may be analyzed for a wide range of systetn parameters.

  15. Thermally activated, single component epoxy systems

    KAUST Repository

    Unruh, David A.


    A single component epoxy system in which the resin and hardener components found in many two-component epoxies are combined onto the same molecule is described. The single molecule precursor to the epoxy resin contains both multiple epoxide moieties and a diamine held latent by thermally degradable carbamate linkages. These bis-carbamate "single molecule epoxies" have an essentially infinite shelf life and access a significant range in curing temperatures related to the structure of the carbamate linkages used. © 2011 American Chemical Society.

  16. Research regarding reverse engineering for aircraft components

    Directory of Open Access Journals (Sweden)

    Udroiu Razvan


    Full Text Available Reverse engineering is a useful technique used in manufacturing and design process of new components. In aerospace industry new components can be developed, based on existing components without technical Computer Aided Design (CAD data, in order to reduce the development cycle of new products. This paper proposes a methodology wherein the CAD model of turbine blade can be build using computer aided reverse engineering technique utilising a 5 axis Coordinate Measuring Machine (CMM. The proposed methodology uses a scanning strategy by features, followed by a design methodology for 3D modelling of complex shapes.

  17. Concentrated Solar Power: Components and materials

    Directory of Open Access Journals (Sweden)

    Kribus A.


    Full Text Available CSP technologies are well developed and offer many advantages compared to other renewable energy options. They can also be very effective in many locations with high solar radiation around the world. However today they are less competitive than other technologies. Understanding the limitations, and identifying opportunities for improvements, requires a detailed analysis of the energy conversion processes, the needed components, and the required technologies for these plant components. Here we present the three main energy conversion steps in a CSP plant, the behavior and limitations of the technologies that are currently used in commercial CSP plants, and some directions for development of plant components that will offer better performance.

  18. Ionizing radiations simulation on bipolar components

    International Nuclear Information System (INIS)

    Montagner, X.


    This thesis presents the ionizing radiation effects on bipolar components and more specially their behavior facing the total dose. The first part is devoted to the radiation environments with a special attention to the spatial environments and new emergent environments. The specificities of bipolar components are then presented and their behavior facing the interactions. The physical mechanisms bound to the dose rate are also discussed. The second part presents a physical analysis of degradations induced by the cumulated dosimetry on bipolar components and simulation with the ATLAS code. The third part exposes an electric empirical simulation induced by the cumulated dose in static conditions. (A.L.B.)

  19. Spatio temporal media components for neurofeedback

    DEFF Research Database (Denmark)

    Jensen, Camilla Birgitte Falk; Petersen, Michael Kai; Larsen, Jakob Eg


    A class of Brain Computer Interfaces (BCI) involves interfaces for neurofeedback training, where a user can learn to self-regulate brain activity based on real-time feedback. These particular interfaces are constructed from audio-visual components and temporal settings, which appear to have...... a strong influence on the ability to control brain activity. Therefore, identifying the different interface components and exploring their individual effects might be key for constructing new interfaces that support more efficient neurofeedback training. We discuss experiments involving two different...... designs of neurofeedback interfaces and suggest further research to clarify the influence of different audiovisual components and temporal settings on neurofeedback effect....

  20. Modular core component support for nuclear reactor

    International Nuclear Information System (INIS)

    Finch, L.M.; Anthony, A.J.


    The core of a nuclear reactor is made up of a plurality of support modules for containing components such as fuel elements, reflectors and control rods. Each module includes a component support portion located above a grid plate in a low-pressure coolant zone and a coolant inlet portion disposed within a module receptacle which depends from the grid plate into a zone of high-pressure coolant. Coolant enters the module through aligned openings within the receptacle and module inlet portion and flows upward into contact with the core components. The modules are hydraulically balanced within the receptacles to prevent expulsion by the upward coolant forces. (U.S.)

  1. Description of the RDCDS Meteorological Component

    Energy Technology Data Exchange (ETDEWEB)

    Pekour, Mikhail S.; Berg, Larry K.


    This report provides a detailed description of the Rapidly Deployable Chemical Defense System (RDCDS) Meteorological Component. The Meteorological Component includes four surface meteorological stations, miniSODAR, laptop computers, and communications equipment. This report describes the equipment that is used, explains the operation of the network, and gives instructions for setting up the Component and replacing defective parts. A detailed description of operation and use of the individual sensors, including the data loggers is not covered in the current document, and the interested reader should refer to the manufacturer’s documentation.

  2. Concentrated Solar Power: Components and materials (United States)

    Kribus, A.


    CSP technologies are well developed and offer many advantages compared to other renewable energy options. They can also be very effective in many locations with high solar radiation around the world. However today they are less competitive than other technologies. Understanding the limitations, and identifying opportunities for improvements, requires a detailed analysis of the energy conversion processes, the needed components, and the required technologies for these plant components. Here we present the three main energy conversion steps in a CSP plant, the behavior and limitations of the technologies that are currently used in commercial CSP plants, and some directions for development of plant components that will offer better performance.

  3. Measurements for stresses in machine components

    CERN Document Server

    Yakovlev, V F


    Measurements for Stresses in Machine Components focuses on the state of stress and strain of components and members, which determines the service life and strength of machines and structures. This book is divided into four chapters. Chapter I describes the physical basis of several methods of measuring strains, which includes strain gauges, photoelasticity, X-ray diffraction, brittle coatings, and dividing grids. The basic concepts of the electric strain gauge method for measuring stresses inside machine components are covered in Chapter II. Chapter III elaborates on the results of experim

  4. Travelling cranes for heavy reactor component handling

    International Nuclear Information System (INIS)

    Champeil, M.


    Structure and operating machinery of two travelling cranes (600 t and 450 t) used in the Framatome factory for handling heavy reactor components are described. When coupled, these cranes can lift loads up to 1000 t [fr

  5. Analysis of failed nuclear plant components

    International Nuclear Information System (INIS)

    Diercks, D.R.


    Argonne National Laboratory has conducted analyses of failed components from nuclear power generating stations since 1974. The considerations involved in working with and analyzing radioactive components are reviewed here, and the decontamination of these components is discussed. Analyses of four failed components from nuclear plants are then described to illustrate the kinds of failures seen in service. The failures discussed are (a) intergranular stress corrosion cracking of core spray injection piping in a boiling water reactor, (b) failure of canopy seal welds in adapter tube assemblies in the control rod drive head of a pressure water reactor, (c) thermal fatigue of a recirculation pump shaft in a boiling water reactor, and (d) failure of pump seal wear rings by nickel leaching in a boiling water reactor

  6. Thermochemical nanolithography components, systems, and methods (United States)

    Riedo, Elisa; Marder, Seth R.; de Heer, Walt A.; Szoskiewicz, Robert J.; Kodali, Vamsi K.; Jones, Simon C.; Okada, Takashi; Wang, Debin; Curtis, Jennifer E.; Henderson, Clifford L.; Hua, Yueming


    Improved nanolithography components, systems, and methods are described herein. The systems and methods generally employ a resistively heated atomic force microscope tip to thermally induce a chemical change in a surface. In addition, certain polymeric compositions are also disclosed.

  7. Modified cleaning method for biomineralized components (United States)

    Tsutsui, Hideto; Jordan, Richard W.


    The extraction and concentration of biomineralized components from sediment or living materials is time consuming and laborious and often involves steps that remove either the calcareous or siliceous part, in addition to organic matter. However, a relatively quick and easy method using a commercial cleaning fluid for kitchen drains, sometimes combined with a kerosene soaking step, can produce remarkable results. In this study, the method is applied to sediments and living materials bearing calcareous (e.g., coccoliths, foraminiferal tests, holothurian ossicles, ichthyoliths, and fish otoliths) and siliceous (e.g., diatom valves, silicoflagellate skeletons, and sponge spicules) components. The method preserves both components in the same sample, without etching or partial dissolution, but is not applicable to unmineralized components such as dinoflagellate thecae, tintinnid loricae, pollen, or plant fragments.

  8. The multi-component WKI hierarchy

    International Nuclear Information System (INIS)

    Yao Yuqin; Zhang Yufeng


    Firstly a new loop algebra G∼ M with 3M dimensions is constructed, which is devoted to establishing a new isospectral problem. Then the multi-component WKI hierarchy of soliton equations is obtained

  9. Component resolved testing for allergic sensitization

    DEFF Research Database (Denmark)

    Skamstrup Hansen, Kirsten; Poulsen, Lars K


    Component resolved diagnostics introduces new possibilities regarding diagnosis of allergic diseases and individualized, allergen-specific treatment. Furthermore, refinement of IgE-based testing may help elucidate the correlation or lack of correlation between allergenic sensitization and allergi...

  10. IPRDS: component histories and nuclear plant aging

    International Nuclear Information System (INIS)

    Borkowski, R.J.; Kahl, W.K.


    A comprehensive assessment of nuclear power plant component operating histories, maintenance histories, and design and fabrication details is essential to understanding aging phenomena. As part of the In-Plant Reliability Data System (IPRDS), an attempt is being made to collect and analyze such information from a sampling of US nuclear power plants. Utilizing the IPRDS, one can reconstruct the failure history of the components and gain new insight into the causes and modes of failures resulting from normal or premature aging. This information assembled from the IPRDS can be combined with operating histories and postservice component inspection results for cradle-to-grave assessments of component aging under operating conditions. A comprehensive aging assessment can then be used to provide guidelines for improving the detection, monitoring, and mitigation of aging-related failures

  11. Solid State Lighting Reliability Components to Systems

    CERN Document Server

    Fan, XJ


    Solid State Lighting Reliability: Components to Systems begins with an explanation of the major benefits of solid state lighting (SSL) when compared to conventional lighting systems including but not limited to long useful lifetimes of 50,000 (or more) hours and high efficacy. When designing effective devices that take advantage of SSL capabilities the reliability of internal components (optics, drive electronics, controls, thermal design) take on critical importance. As such a detailed discussion of reliability from performance at the device level to sub components is included as well as the integrated systems of SSL modules, lamps and luminaires including various failure modes, reliability testing and reliability performance. This book also: Covers the essential reliability theories and practices for current and future development of Solid State Lighting components and systems Provides a systematic overview for not only the state-of-the-art, but also future roadmap and perspectives of Solid State Lighting r...

  12. Recommendations for the use of irradiated components

    International Nuclear Information System (INIS)


    The disease 'graft-versus-host' associated with the transfusion (EIVH TA) is an adverse reaction rare but fatal, linked to the proliferation of T cells that are found in cellular components and reacting against the receptor's tissues). Gamma irradiation of cellular components is used as a prevention method because it deactivates the lymphocytes T by reducing its survival and by restraining its proliferation without producing alterations in others cells function. Recommendations for the use of gamma irradiation along with clinical indications for pediatric patients, patients with acquired immunosuppression and immunocompetent patients are given in this study. A brief description of operative aspects of irradiation procedures such as components to be irradiated, irradiation method, irradiation dose and viability of irradiated components is given [es

  13. Joining porous components to solid metal structures (United States)

    Fortini, A.; Tulisiak, G.


    Process for joining porous metal material to solid metal structure without cracking or blockage of porous component is described. Procedures of electron beam welding and electroforming are discussed. Illustration of microstructure resulting from process is included.

  14. Software Component Certification: 10 Useful Distinctions

    National Research Council Canada - National Science Library

    Wallnau, Kurt C


    .... One persistent and largely unaddressed challenge is how the consumers of software components-that is, the developers of mission-critical systems-can obtain a meaningful level of trust in the runtime...

  15. Perspective : component tracking on the Nova system

    International Nuclear Information System (INIS)

    MacDonald, S.


    The issue of introducing Component Tracking as a service to natural gas producers, shippers and straddle plant operators was discussed. Approximately 39 companies in the industry were contacted by consultants at Nova Gas Transmission in an effort to assess if introducing this service would add value to individual producers. The numerous implications that may have to be dealt with if Component Tracking is introduced were also described. Component Tracking would provide an equitable approach to the allocation of molecules in the gas stream, and could provide producers with the ability to avoid capital outlay in field plants by alternatively contracting for recovery of the liquids at the straddle plants. Component Tracking is to be voluntary and each shipper would be able to decide whether to utilize the service at each of their receipt points onto the Nova system

  16. Manufacture of components for Canadian reactor programs

    International Nuclear Information System (INIS)

    Perry, L.P.

    Design features, especially those relating to calandrias, are pointed out for many CANDU-type reactors and the Taiwan research reactor. The special requirements shouldered by the Canadian suppliers of heavy reactor components are analyzed. (E.C.B.)

  17. NEPR Principle Component Analysis - NOAA TIFF Image (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This GeoTiff is a representation of seafloor topography in Northeast Puerto Rico derived from a bathymetry model with a principle component analysis (PCA). The area...

  18. Silicon Micromachining for Terahertz Component Development (United States)

    Chattopadhyay, Goutam; Reck, Theodore J.; Jung-Kubiak, Cecile; Siles, Jose V.; Lee, Choonsup; Lin, Robert; Mehdi, Imran


    Waveguide component technology at terahertz frequencies has come of age in recent years. Essential components such as ortho-mode transducers (OMT), quadrature hybrids, filters, and others for high performance system development were either impossible to build or too difficult to fabricate with traditional machining techniques. With micromachining of silicon wafers coated with sputtered gold it is now possible to fabricate and test these waveguide components. Using a highly optimized Deep Reactive Ion Etching (DRIE) process, we are now able to fabricate silicon micromachined waveguide structures working beyond 1 THz. In this paper, we describe in detail our approach of design, fabrication, and measurement of silicon micromachined waveguide components and report the results of a 1 THz canonical E-plane filter.

  19. Transforming the Reserve Component: Four Essays

    National Research Council Canada - National Science Library

    Binnendijk, Hans; Baranick, Michael J; Bell, Raymond E., Jr; Cordero, Gina; Duncan, Stephen M; Holshek, Christopher; Wentz, Larry


    This volume contains four essays on various aspects of the Reserve Component. We publish it at a time when Reserves are serving overseas at historically high rates and when new missions like homeland security demand their attention...

  20. Genetics Home Reference: complement component 2 deficiency (United States)

    ... Topic: Immune System and Disorders Health Topic: Lupus Genetic and Rare Diseases Information Center (1 link) Complement component 2 deficiency Additional NIH Resources (1 link) National Institute of Allergy and Infectious Diseases: Primary Immune Deficiency Diseases Educational Resources (6 ...