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Titolo:
TRYPTASE LEVELS ARE NOT INCREASED DURING VANCOMYCIN INDUCED ANAPHYLACTOID REACTIONS
Autore:
RENZ CL; LAROCHE D; THURN JD; FINN HA; LYNCH JP; THISTED R; MOSS J;
Indirizzi:
UNIV CHICAGO,DEPT ANESTHESIA & CRIT CARE,5841 S MARYLAND AVE,MC 4028 CHICAGO IL 60637 UNIV CHICAGO,DEPT ANESTHESIA & CRIT CARE CHICAGO IL 60637 UNIV CHICAGO,COMM CLIN PHARMACOL CHICAGO IL 60637
Titolo Testata:
Anesthesiology
fascicolo: 3, volume: 89, anno: 1998,
pagine: 620 - 625
SICI:
0003-3022(1998)89:3<620:TLANID>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
MAST-CELL TRYPTASE; NEUROMUSCULAR BLOCKING-DRUGS; RED-MAN SYNDROME; HISTAMINE-RELEASE; SYSTEMIC-ANAPHYLAXIS; ANESTHESIA; ACTIVATION; DIAGNOSIS; MASTOCYTOSIS; HYPOTENSION;
Keywords:
ANAPHYLAXIS; ANTIHISTAMINES; HISTAMINE; RED MAN SYNDROME;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
28
Recensione:
Indirizzi per estratti:
Citazione:
C.L. Renz et al., "TRYPTASE LEVELS ARE NOT INCREASED DURING VANCOMYCIN INDUCED ANAPHYLACTOID REACTIONS", Anesthesiology, 89(3), 1998, pp. 620-625

Abstract

Background: Anaphylaxis, mediated by immunoglobulin E, may be clinically indistinguishable but is mechanistically different than chemicallymediated anaphylactoid reactions induced by drugs such as morphine, curare, and vancomycin. A test to distinguish anaphylactic from anaphylactoid reactions would clarify therapeutic and medicolegal issues. Tryptase levels identify anaphylactic reactions but have not been evaluated in vivo during anaphylactoid reactions. A prospective, randomized, double-blinded, placebo-controlled trial of antihistamine chemoprophylaxis for rapid vancomycin infusion was performed, and plasma tryptase was measured using a new immunoassay, Histamine release was established by measurement of plasma histamine and the ability of prophylactic H-1 and H-2 antagonists to prevent common histamine-associated side effects. Tryptase levels were compared with histamine levels and clinicalsymptoms. Methods: Before elective arthroplasty, 40 patients receivedvancomycin infusion (1 g over 10 min) and pretreatment with either antihistamines (1 mg/kg diphenhydramine and 4 mg/kg cimetidine) or placebo. Changes in tryptase (at peak histamine and 10 min after vancomycininfusion), histamine levels, and histamine-mediated symptoms mere assessed using Fisher's exact test, the Student's t test, or the paired ttest, as appropriate. Logistic regression models were used to quantify the association of clinical symptoms with antihistamine treatment and serum levels. Results: Plasma tryptase levels mere unchanged (99% CI, -0.5 to 1.6) independent of increased histamine levels, antihistamine pretreatment, clinical symptoms, or all of these. Histamine levels >1 ng/ml were significantly associated with hypotension, moderate-to-severe rash, and stopped infusion. Antihistamine pretreatment significantly decreased the incidence and severity of the reactions. Conclusion:Plasma tryptase levels were not significantly elevated in confirmed anaphylactoid reactions, so they can be used to distinguish chemical from Immunologic reactions.

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Documento generato il 27/01/21 alle ore 01:00:32