Anafilaxia al látex / Latex anaphylaxis

Prevalencia de los signos de sensibilidad al látex en pacientes con múltiples cirugías por mielomengocele Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures. Yeh WS, Kiohara PR, Soares IS, Carmona MJ, Rocha FT, Galvão CE. Rev Bras Anestesiol. 2012 Jan-Feb;62(1):56-62. doi: 10.1016/S0034-7094(12)70103-4. Abstract BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p=0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it. PDF Perfil molecular de sensibilización en personas con exposición ocupacional breve al látex Molecular profile of sensitization in subjects with short occupational exposure to latex. Lamberti M, Buonanno R, Ritonnaro C, Giovane G, Crispino V, Feola A, Medici N, Sannolo N, Di Carlo A, Di Domenico M. Int J Occup Med Environ Health. 2015;28(5):841-8. doi: 10.13075/ijomeh.1896.00413. Abstract OBJECTIVES: We examined the prevalence of latex allergy in subjects with occupational exposure to latex allergens for less than 5 years, determining the disease spectrum in symptomatic workers. We identified the most frequent molecular allergens by Immuno- CAP (ICAP), correlating the findings with skin prick test (SPT) results. MATERIAL AND METHODS: Seven hundred twenty-three healthcare students using latex gloves on a regular basis were invited to participate in a baseline questionnaire screening. An ICAP serum test was performed only when a possible latex allergy was indicated by the questionnaire. RESULTS: The total number of participants responding to the baseline survey was 619. Glove-related symptoms were indicated by 4% (N = 25) of the students. The most common symptom was contact dermatitis (N = 18, 72%). In 12 subjects, ICAP revealed a real sensitization to latex, with a recombinant latex allergen profile showing a high frequency for rHev b 6.01 specific immunoglobulin E (sIgE) (N = 9, 67%). In these individuals, skin symptoms were more prevalent than other types (88%). CONCLUSIONS: The combined positivity for rHev b 6.01, rHev 8 and rHev b 5 determined by ICAP identified 92% of latex-allergic subjects with short-term exposure to latex. PDF La alergia al látex en anestesiólogos : son los trabajadores de salud pacientes de alto riesgo? Latex allergy on anaesthesiologist and anaesthesia managements: are the health workers high risk patients? Bigat Z, Kayacan N, Ertugrul F, Karsli B. J Pak Med Assoc. 2014 Apr;64(4):453-6. Abstract Anaphylaxis is defined as a severe, life threating, generalized or systemic hypersensitivity reaction. The most common agent involved in intraoperative anaphylactic reactions is muscle relaxant (61-70%); natural rubber latex (NRL) is the second most implicated agent and the incidence of latex-related anaphylactic reactions is increasing despite increasing awareness and preventive measures taken. Latex is a ubiquitous part of life today. Medical products which contain latex are present in our environment, especially in the hospital setting. This study focuses on our experience with two different anaesthetic techniques performed on the same patient who had latex hypersensitivity reaction and underwent surgery for myomectomy twice in 5 years. This case report aims to point out to latex hypersensitivity on health workers. The patient described had latex allergy and strategy of management during perioperative period is detailed. PDF Alergia al latex Dres. Claudio A. Parisi, Beatrice Biló, Floriano Bonifazzi, Sergio Bonini, José F. Máspero Arch Argent Pediatr 2006; 104(6):520-529 PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Alergia a drogas y anestesia / Drugs allergy and anesthesia

Enero 4, 2016. No. 2196

Tendencias en las reacciones de hipersensibilidad: más drogas, más patrones de respuestas, más heterogeneidad Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity. Doña I, Barrionuevo E, Blanca-Lopez N, Torres MJ, Fernandez TD, Mayorga C, Canto G,Blanca M. J Investig Allergol Clin Immunol. 2014;24(3):143-53; quiz 1 p following 153. Abstract Hypersensitivity drug reactions (HDRs) vary over time in frequency, drugs involved, and clinical entities. Specific reactions are mediated by IgE, other antibody isotypes (IgG or IgM), and T cells. Nonspecific HDRs include those caused by nonsteroidal anti-inflammatory drugs (NSAIDs). beta-Lactams--the most important of which are amoxicillin and clavulanic acid--are involved in specific immunological mechanisms. Fluoroquinolones (mainly moxifloxacin, followed by ciprofloxacin and levofloxacin) can also induce HDRs mediated by IgE and T cells. In the case of radio contrast media, immediate reactions have decreased, while nonimmediate reactions, mediated by T cells, have increased. There has been a substantial rise in hypersensitivity reactions to antibiotics and latex in perioperative allergic reactions to anesthetics. NSAIDs are the most frequent drugs involved in HDRs. Five well-defined clinical entities, the most common of which is NSAID-induced urticaria/angioedema, have been proposed in a new consensus classification. Biological agents are proteins including antibodies that have been humanized in order to avoid adverse reactions. Reactions can be mediated by IgE or T cells or they may be due to an immunological imbalance. Chimeric antibodies are still in use and may have epitopes that are recognized by the immune system, resulting in allergic reactions. PDF Alergia clorhexidina perioperatoria: ¿Es en serio? Perioperative chlorhexidine allergy: Is it serious? Abdallah C. J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):152-4. doi: 10.4103/0970-9185.155140. Abstract Chlorhexidine is an antiseptic agent, commonly used, in many different preparations, and for multiple purposes. Despite its superior antimicrobial properties, chlorhexidine is a potentially allergenic substance. The following is a review of the current evidence-based knowledge of allergic reactions to chlorhexidine associated with surgical and interventional procedures. KEYWORDS: Allergy; anesthesia; chlorhexidine; complications; perioperative PDF Reacciones anafilácticas durante anestesia y en el periodo perioperatorio Anaphylactic reactions during anaesthesia and the perioperative period. Michalska-Krzanowska G. Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):104-11. Abstract Allergy and hypersensitivity occurring during anaesthesia remains a major cause of concern for anaesthesiologists.Drugs administered during surgery and various anaesthetic procedures can elicit two major groups of adverse reactions. The first group includes reactions that are usually dose-dependent and related to the pharmacological properties of a drug and/or its metabolites. The remaining reactions are mostly related to hypersensitivity and allergic responses. They do not depend on specific pharmacology and are usually not dose-dependent.Anaphylaxis is among the most severe of immune-mediated reactions; it generally occurs following re-exposure to specific antigens and release of proinflamatory mediators. The commonest drugs responsible for intraoperative anaphylaxis are muscle relaxants, but latex also accounts for a significant number of incidents, and the frequency of intraoperative latex anaphylactic reactions is increasing. Multiple organ failure, beginning with bronchospasm and cardiovascular collapse, is typical of latex reactions. An increased serum tryptase concentration confirms the diagnosis of an anaphylactic reaction, and triggers can be identified by skin prick, intradermal injection, or serologic testing.The elimination of triggers during subsequent medical episodes is essential to avoid major mortality and morbidity. PDF

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Fibromialgia/Fibromyalgia

Abordaje clínico de la fibromialgia: síntesis de recomendaciones basadas en la evidencia, una revisión sistemática "Clinical approach to fibromyalgia: Synthesis of Evidence-based recommendations, a systematic review". Ángel García D, Martínez Nicolás I, Saturno Hernández PJ. Reumatol Clin. 2015 Oct 16. pii: S1699-258X(15)00110-2. doi: 10.1016/j.reuma.2015.06.001. [Epub ahead of print] Resumen Objetivos: Se han hecho esfuerzos en estandarizar una práctica basada en la evidencia, pero las guías de práctica clínica no siempre siguen métodos rigurosos de desarrollo. El objetivo de esta revisión es identificar las guías actuales, analizar la variabilidad de sus recomendaciones y hacer una síntesis para su uso clínico. Material y método: Se realizó una búsqueda sistemática de guías de práctica clínica en las bases de datos electrónicas y bases de guías; con los términos: «fibromyalgia» AND [«guideline» OR «Clinical Practice guideline»], desde enero de 2003 a julio de 2013. Se seleccionaron las guías según los siguientes criterios: a) dirigidas al tratamiento de la fibromialgia en población adulta, b) basadas en evidencia científica, buscada de forma sistemática, c) incluyen niveles de evidencia y fuerza de recomendación, d) escritas en inglés o espanol. ˜ Resultados: De los 249 resultados, 6 guías cumplieron con los criterios de inclusión. Las guías analizadas en esta revisión muestran gran variabilidad tanto en presencia como en nivel de evidencia y fuerza de recomendación de muchos tratamientos. El ejercicio físico y la terapia cognitivo-conductual son las terapias de primera elección, con alto nivel de evidencia. La amitriptilina, usada por periodos cortos para controlar el dolor, es el tratamiento farmacológico con evidencia más sólida. El abordaje multimodal reporta mejores resultados que la aplicación aislada de cualquier tratamiento. Conclusiones: Las recomendaciones finales identifican los tratamientos óptimos, facilitando la translación de la evidencia a la práctica y permitiendo mayor eficiencia y efectividad en una actividad asistencial de calidad.   Abstract OBJECTIVES: Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. MATERIAL AND METHODS:A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using "fibromyalgia" AND ["guideline" OR "Clinical Practice guideline"] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. RESULTS: From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behaviouraltherapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologictreatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. CONCLUSIONS: Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care. PDF Aplicación del modelo de incertidumbre a la fibromialgia Triviño Martínez Á, Solano Ruiz MC, Siles González J Aten Primaria. 2015 Aug 12. pii: S0212-6567(15)00187-0. doi: 10.1016/j.aprim.2015.04.007. [Epub ahead of print] Resumen Objetivo: Conocer las experiencias vividas por las mujeres diagnosticadas de fibromialgia aplicando la Teoría de la Incertidumbre propuesta por M. Mishel. Diseno: ˜ Estudio cualitativo con enfoque fenomenológico. Emplazamiento una Asociación de enfermas de fibromialgia de la provincia de Alicante durante los meses de junio 2012 a noviembre de 2013. Participantes: Catorce mujeres diagnosticadas de fibromialgia con edades comprendidas entre 45 y 65 anos ˜ participaron de forma voluntaria. Método: Generación de información a través de entrevistas semiestructuradas con grabación y transcripción previo compromiso de confidencialidad y consentimiento informado. Análisis de contenido extrayendo diferentes categorías de acuerdo con la teoría propuesta. Resultados: Las pacientes del estudio perciben un elevado nivel de incertidumbre vinculado a la dificultad para hacer frente a los síntomas, incertidumbre ante el diagnóstico y la complejidad deltratamiento. Por otra parte, la capacidad de afrontamiento de la enfermedad se verá influida por el apoyo social, la relación con los profesionales de la salud y la búsqueda de ayuda e información acudiendo a las asociaciones de pacientes. Conclusiones: El profesional de la salud debe ofrecer una información clara sobre la patología a las enfermas de fibromialgia; cuanto mayor es el nivel de conocimientos de las pacientes sobre su enfermedad y mejor es la calidad de la información que se presta, se informa de menor ansiedad e incertidumbre en la vivencia de la enfermedad. Así mismo, las asociaciones de pacientes deberían disponer de profesionales de la salud para evitar sesgos en la información y el asesoramiento con evidencia científica.   Application of an uncertainty model for fibromyalgia. Abstract OBJECTIVES: Finding out women's experiences diagnosed with fibromyalgia applying the Theory of Uncertainty proposed by M. Mishel. DESIGN: A qualitative study was conducted, using a phenomenological approach. LOCATION: An Association of patients in the province of Alicante during the months of June 2012 to November 2013. PARTICIPANTS: A total of 14 women diagnosed with fibromyalgia participated in the study as volunteers, aged between 45 and 65years. METHOD: Information generated through structured interviews with recording and transcription, prior confidentiality pledge and informed consent. Analysis content by extracting different categories according to the theory proposed. RESULTS: The study patients perceive a high level of uncertainty related to the difficulty to deal with symptoms, uncertainty about diagnosis andtreatment complexity. Moreover, the ability of coping with the disease it is influenced by social support, relationships with health professionals and help and information attending to patient associations. CONCLUSIONS: The health professional must provide clear information on the pathology to the fibromyalgia suffers, the larger lever of knowledge of the patients about their disease and the better the quality of the information provided, it is reported to be the less anxiety and uncertainty in the experience of the disease. Likewise patient associations should have health professionals in order to avoid bias in the information and advice with scientific evidence.  PDF Revisión de la farmacoterapia en el síndrome de fibromialgia Review of pharmacological therapies in fibromyalgia syndrome. Häuser W, Walitt B, Fitzcharles MA, Sommer C. Arthritis Res Ther. 2014 Jan 17;16(1):201. doi: 10.1186/ar4441. Abstract This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration. PDF Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015