Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil
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Transcript of Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil
J ALLERGY CLIN IMMUNOL
VOLUME 131, NUMBER 2
Abstracts AB177
MONDAY
627 Incidence of Intraoperative Anaphylaxis in A UniversityGeneral Hospital in Brazil
Laila Sabino Garro, MD1, Maria Jos�e Carvalho Carmona2, Iracy Silvia
Correa Soares2, Marcelo Vivolo Aun, MD1, Marisa Rosimeire
Ribeiro, MD1, Adriana Teixeira Rodrigues1, Jorge Kalil, MD, PhD1, Pe-
dro Giavina-Bianchi, MD, PhD1, Antonio Ab�ılio Motta, MD, PhD1; 1Di-
vision of Clinical Immunology and Allergy, University of S~ao Paulo,
Brazil, 2Anesthesia Division, University of S~ao Paulo, Brazil.
RATIONALE: The epidemiology of intraoperative anaphylaxis is un-
known in Brazil. We aimed to evaluate the incidence and clinical features
of anaphylaxis during anesthesia in a University General Hospital in Sao
Paulo, Brazil.
METHODS: A cross-sectional, observational study analyzing data from
voluntary notification sent by anesthesiologists, about occurrence of
intraoperative anaphylaxis during the period between January and
December 2010. The diagnostic criteria for anaphylaxis were based on
the World Allergy Organization Guidelines. We analyzed the incidence of
intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types
of surgical procedures, classification of anesthetic risk (American Society
of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and
type of treatment provided.
RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000
surgeries. The mean age of patients with anaphylaxis was 36.7 years-old
and 57% were women. The most common procedures associated with
anaphylaxis were the abdominal non-vascular (17.1%) and urologic
(17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and
all patients who presented cardiovascular shock were classified as ASA II
(42.9%) or ASA III (57.1%). Epinephrine was used preferentially in
anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades
1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly
etiologic drugs cited by the anesthesiologists were the neuromuscular
blocking agents (22.9%).
CONCLUSIONS: Our incidence of intraoperative anaphylaxis was
higher than in other studies reported in the literature. These data are a
warning signal to encourage measures to reduce the incidence of these
severe reactions.
628 Knowledge of Food Protein-Induced Enterocolitis (FPIES)Among General Pediatricians
Nikhil Menon, Medical student1, Elizabeth Feuille, MD1, Faith
Huang, MD2, Anna H. Nowak-Wegrzyn, MD, FAAAAI3; 1Mount Sinai
School of Medicine, 2Mount Sinai Hospital, New York, NY, 3Mt. Sinai
School of Medicine, New York, NY.
RATIONALE: FPIES is a non-IgE, presumably T cell-mediated gastro-
intestinal childhood food allergy that manifests within 2-4 hours following
food ingestion with repetitive emesis, ashen-gray appearance and lethargy;
15%progress to hypotension.We sought to determine knowledge of FPIES
among pediatricians.
METHODS: A 22-question anonymous survey was sent via email to
randomly selected physicians who registered with American Medical
Association (AMA) as pediatricians.
RESULTS: Eighty-six surveys were completed; 55% responders were in
practice more that 15 years, 67% in suburban location and 85% in private
office. Twenty percent declared full understanding, 56% limited under-
standing of FPIES; 24% never heard of FPIES. When presented with
clinical vignettes, 73% recognized chronic FPIES, 53% recognized acute
FPIES; 58% misdiagnosed allergic proctocolitis and 15% colic as FPIES.
Recognition of specific FPIES symptoms was as follows: severe diarrhea
57%, severe emesis 48%, failure to thrive 41%, hypotension 11%, cyanosis
9%, and elevatedWBC9%. Seventy-three percent reported having patients
with FPIES in their practice, with most common triggers being cow’s milk,
followed by concomitant milk and soy. Diagnosis was made by a
gastroenterologist in 57% and allergist in 32%. Regarding management
of acute FPIES, 30% recommended oral rehydration at home followed by
emergency room evaluation, 29% prescribed epinephrine autoinjector, and
14% prescribed oral steroids. 39% reported managing FPIES by them-
selves, 68% referred out to a gastroenterologist and 34% to an allergist.
CONCLUSIONS: Pediatricians have limited knowledge of manifesta-
tions and management of FPIES. There is a need for education and
establishing a role of allergists in diagnosis and management of FPIES.
629 M. Pneumoniae Is a Potential Trigger for EosinophilicEsophagitis
Maya D. Srivastava, MD, PhD, FAAAAI; SUNY at Buffalo, East Am-
herst, NY.
RATIONALE:Mycoplasma pneumoniae (MP) is suggested as a trigger of
asthma. MP undergoes cyclic epidemics, has increasing macrolide resis-
tance, increases IL-5 and VEGF and contains gene CARDS promoting
TH2 inflammation. It has never before to our knowledge been implicated in
eosinophilic esophagitis (EOE). We recently treated a 10 year old male for
two months of acute onset morning vomiting and cough. He had multiple
similarly ill contacts at school. He had failed reflux therapy. EGD showed
over 50 eosinophils/HFP in all 3 levels, Ph-impedance probe was normal,
MRI of CNS revealed severe pansinusitis. Blood work showed positive
2177 u/ml IgM for MP. Treatment with clarithromycin and topical flovent
rapidly improved symptoms. This suggested to us that MP may have been
the trigger for him and possibly others with EOE.
METHODS: Patients treated for EOE in our (NY) practice over this
spring-summer (2012) were offered standard serology for MP, with the
intention to treat acute cases.
RESULTS: 1/13 was positive for IgM (with eosinophilic gastritis), 10/12
were positive for IgG including the oldest and youngest patient. MP
infection is rare in very young children.
CONCLUSIONS: Patients with EOE had almost universal serologic
evidence of prior MP, but serology can not distinguish past versus active
infection. We plan PCR for MP on esophageal biopsies from EOE and
controls, and will assess MP-TSLP genetic polymorphism interactions, a
proposed mechanism linking infection and atopy.
630 Eosinophilic Esophagitis : Clinical Spectrum of PuertorricanChildren
Vylma Velazquez, MD; Hospital Episcopal San Lucas, Ponce, PR.
RATIONALE: Eosinophilic Esophagitis (EoE) is a chronic inflammatory
condition of the esophagus induced by pro-inflammatory mediators
released by eosinophils. This disease links a gastroenterology condition
with an allergic component. The aim of our study is to describe charac-
teristics, demographic features, endoscopic findings and allergy associa-
tions of EoE children in a Puertorrican population
METHODS: Chart review of children with EoE diagnosed by endoscopic
study (15 ormore eosinophils per high power field) between 2005 and 2012
at Hospital Episcopal San Lucas Pediatric Gastroenterology clinic. Will
evaluate, gender, age, presenting symptoms, family and patient history of
atopy. and endoscopic findings
RESULTS: 68 patients with EoE were identified, 60% were male.
Predominant symptoms were abdominal pain and vomiting in (70%).
Age distribution; 0-4 years 26%, 5 to 9 years 31% and over 10 years of age
43%. 51% of patients have a family history of atopy, 30% were allergic to
food or environmental allergens. Endoscopic findings include chronic
esophagitis, but there were no linear furrows, no narrow esophagus, or
strictures. Pathologic findings include from 16 to 60 eosinophils counted
by high power field.
CONCLUSIONS: EoE is prevalent in the pediatric population of Puerto
Rico and should be suspected in children with chronic abdominal pain and
vomiting even though there are no typical endoscopic findings; diagnosis is
confirmed by the presence of over 15 eosinophils on histologic evaluation
by high power field. Endoscopic findings were not as prevalent in our
patients as adults. The prevalence of atopy is high in patients and family.