Therapeutics and Clinical Risk Management

Safe medication use based on knowledge of information about contraindications concerning cross allergy and comprehensive clinical intervention

Short Report

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Authors: Li W, Zhu LL, Zhou Q

Published Date February 2013 Volume 2013:9 Pages 65 - 72

DOI: http://dx.doi.org/10.2147/TCRM.S42013

Received:	31 December 2012
Accepted:	22 January 2013
Published:	26 February 2013

Wei Li,¹ Ling-Ling Zhu,² Quan Zhou^3
1Division of Medical Affairs, ²Cadre Department, Division of Nursing, ³Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, People's Republic of China

Background: An investigation of safety issues regarding information on contraindications related to cross allergy was conducted to promote clinical awareness and prevent medical errors in a 2200-bed tertiary care teaching hospital.
Methods: Prescribing information on contraindications concerning cross allergy was collected from an information system and package inserts. Data mining and descriptive analysis were performed. A risk register was used for project management and risk assessment. A Plan, Do, Check, Act cycle was used as part of continuous quality improvement. Records of drug counseling and medical errors were collected from an online reporting system. A pharmacist-led multidisciplinary team initiated an intervention program on cross allergy in August 2008.
Results: Four years of risk management at our hospital achieved successful outcomes, ie, the number of medical errors related to cross allergies decreased by 97% (10 cases monthly before August 2008 versus three cases yearly in 2012) and risk rating decreased significantly [initial risk rating:25 (high-risk) before August 2008 versus final risk rating:6 (medium-risk) in December 2012].
Conclusion: We conclude that comprehensive clinical interventions are very effective through team cooperation. Medication use has potential for safety risks if sufficient attention is not paid to contraindications concerning cross allergy. The potential for cross allergy involving drugs which belong to completely different pharmacological classes is easily overlooked and can be dangerous. Pharmacists can play an important role in reducing the risk of cross allergy as well as recommending therapeutic alternatives

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Immunotherapy

March 2013, Vol. 5, No. 3, Pages 203-206 , DOI 10.2217/imt.13.6

(doi:10.2217/imt.13.6)

Predictive biomarkers of clinical efficacy of allergen-specific immunotherapy: how to proceed

Mohamed H Shamji, Christian Ljørring & Peter A Würtzen^*

* Author for correspondence

Various mode-of-action studies have been conducted to describe and substantiate the immunologic mechanisms behind the long-lasting effect of allergen-specific immunotherapy (SIT) and how it changes the course of IgE-mediated allergic disease. These randomized, double-blind, placebo-controlled studies have reported both cellular and humoral changes systemically and in the target organ following SIT. However, demonstrating that these immunological changes can be used to monitor the effect of treatment has proven challenging. Although we are able to distinguish between actively and placebo-treated patients, candidate biomarkers of effect or biomarker combinations remain to be determined. The validation of such biomarkers may need to involve unconventional ways to evaluate clinical effect, such as challenge chambers or controlled provocation tests of individual organs, to clearly distinguish between strong and weak or early and late responders, as discussed below.

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Clinical Predictors of Primary Immunodeficiency Diseases in Children

Original Article  Open Access

|  | Full Text    |    Allergy Asthma Immunol Res. 2013 Mar;5(2):88-95. English. Published online 2012 November 02.  http://dx.doi.org/10.4168/aair.2013.5.2.88  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Clinical Predictors of Primary Immunodeficiency Diseases in Children Shereen M. Reda,1 Dalia H. El-Ghoneimy,1 and Hanaa M. Afifi2 1Department of Pediatric Allergy and Immunology, Children's Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.  Correspondence to: Shereen M. Reda, MD, PhD, Department of Pediatric Allergy and Immunology, Children's Hospital, Faculty of Medicine, Ain Shams University, 110 El-Merghany Street, Heliopolis, Cairo 11341, Egypt. Tel: +202-24187440; Fax: +202-22591561; Email: shereen.m.reda@gmail.com  Received May 10, 2012; Revised July 09, 2012; Accepted July 23, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose To promote awareness of primary immunodeficiency (PID), the "10 warning signs" of PID and an immunodeficiency-related (IDR) score were developed. However, their efficiency in identifying PID cases was not sufficiently evaluated in clinical practice. The objective of this study was to test the validity of the 10 warning signs and IDR score in identifying PID among children with recurrent infections at a tertiary pediatric hospital in Egypt. Methods A retrospective analysis of the medical records of 204 patients was performed. Of these patients, 92 had defined PID diseases and 112 were considered non-PID cases because investigations were inconclusive. Results Demonstrating two warning signs and an IDR score of 6 led to sensitivities of 94 and 66%, respectively, and specificities of 64 and 75%, respectively, in identifying PID cases. The strongest predictor of PID was family history that, if combined with the need for intravenous antibiotics, recurrent deep-seated infections, and failure to thrive, could identify 81% of PID patients. A family history of PID, sibling death, and/or parental consanguinity would predict 92% of combined immunodeficiencies, 92% of phagocyte defects, 87% of well-identified immunodeficiency syndromes, and 84% of antibody deficiency if the need for intravenous antibiotics is considered in the latter. Conclusions The 10 warning signs and IDR score do not aid in an early diagnosis of severe PID. Educational campaigns should target pediatricians aiming to increase PID awareness and to address family history of PID, parental consanguinity, and previous sibling death as key predictors of PID in communities with a high prevalence of consanguineous marriages.

The Influence of the Time and Temperature of Heat Treatment on the Allergenicity of Egg White Proteins

Original Article  Open Access

|  | Full Text    |    Allergy Asthma Immunol Res. 2013 Mar;5(2):96-101. English. Published online 2012 November 02.  http://dx.doi.org/10.4168/aair.2013.5.2.96  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease The Influence of the Time and Temperature of Heat Treatment on the Allergenicity of Egg White Proteins Meeyong Shin,1 Youngshin Han,2 and Kangmo Ahn3 1Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. 2Environmental Health Center for Atopic Dermatitis, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.  Correspondence to: Kangmo Ahn, MD, PhD, Department of Pediatrics, Sungkyunkwan University Samsung Medical Center, 80 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3530; Fax: +82-2-3410-3669; Email:kmaped@skku.edu  Received July 27, 2012; Revised August 24, 2012; Accepted September 17, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose The present study was performed to determine the factor, either duration or the temperature of heat treatment, exerting maximal and significant influence on the composition and allergenicity of egg white (EW) proteins. Methods Raw EW and 4 kinds of heated EW (fried EW, boiled EW for 10 minutes, boiled EW for 30 minutes, and baked EW for 20 minutes at 170℃) were prepared, and subsequently protein extraction was carried out. The proteins were separated by SDS-PAGE, and then immunoglobulin E (IgE) immunoblots were performed with the sera of 7 egg-allergic patients. Furthermore, the antigenic activities of ovalbumin (OVA), ovomucoid (OM), and ovotransferrin (OT) in different EW samples were measured by inhibition enzyme-linked Immuno-sorbent assay (ELISA). Results In SDS-PAGE analysis, the intensity of the protein band at 45 kD (corresponding to OVA) decreased significantly in boiled EW (30 minutes) and baked EW, but no change was observed in the case of boiled EW for 10 minutes. In IgE immunoblots, the IgE response to 34-50 kD (OM and OVA) in boiled EW for 30 minutes decreased significantly, when compared with raw EW and other heated EWs. In inhibition ELISA, a significant decrease in the OVA antigenic activity was observed in boiled EW for 30 minutes amongst other heated EW samples. However, OM antigenic activity in all kinds of heated EW including boiled EW for 30 minutes did not reduce after heat treatment. The OT antigenic activity nearly disappeared in heated EWs except in the case of boiled EW for 10 minutes. Conclusions Amongst 4 kinds of heated EWs, the boiled EW for 30 minutes showed the most significant changes both in composition and reduction in allergenicity. Our results revealed that the duration of heat treatment had more influence on the composition and allergenicity of EW proteins than the temperature.

Intraoperative anaphylaxis: a case report of allergy to ranitidine

European Annals of Allergy and Clinical Immunology Vol 44, No 6 (2012) > Antonicelli

Intraoperative anaphylaxis: a case report of allergy to ranitidine

L. Antonicelli, G. Stagnozzi, C. Massaccesi, et al.

Abstract

We report the case of a 18-year old male who developed intraoperative anaphylaxis. The presence of specific IgE to ranitidine was documented. This case confirms the possibility of anaphylaxis at first exposure.

Keywords

Ranitidine, hypersensitivity, intraoperative anaphylaxis

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Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood

European Annals of Allergy and Clinical Immunology Vol 44, No 6 (2012) > Calamelli

Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood

E. Calamelli, G. Ricci, A. Pession

Abstract

Some of the most recent advances in the diagnosis and treatment of childhood asthma and allergies are here reviewed. New perspectives have been opened by in vitro diagnostic tests for allergies based on a molecular approach and novel approaches to in vivo tests (SPT or FEno). A better characterization of the patients is opening new classifications of allergic asthma and rhinitis phenotypes, which allow personalizing management disease programs and targeting pharmacotherapy. Educational programs and better communication are improving awareness and compliance with medical prescriptions and adherence to guidelines. Increasing information is being acquired on the mechanisms, efficacy and safety profiles of anti-asthma and anti-allergic drugs, including antihistamines, inhaled corticosteroids, long acting beta agonists, antibiotics, anti-IgE antibodies. Progress in biotechnologies is fostering new approaches to allergen-specific immunotherapy (subcutaneous, sublingual) concerning the quality, mechanisms, efficacy and safety of allergen products.

Keywords

Allergen-specific immunotherapy, allergic rhinitis, asthma, children, inhaled corticosteroids, IgE, longacting beta-2 agonists, nitric oxide, omalizumab, skin prick test.

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Pattern of airway inflammation and remodelling in mild persistent atopic asthma and in mild persistent asthma related to Gastroesophageal Reflux

European Annals of Allergy and Clinical Immunology Vol 44, No 6 (2012) 

Pattern of airway inflammation and remodelling in mild persistent atopic asthma and in mild persistent asthma related to Gastroesophageal Reflux

R.W. Dal Negro, M. Guerriero, C. Micheletto

Abstract

Background: The increase of basement membrane thickness (BMT) represents a structural feature described as commonly characterizing airway remodelling in asthma, even if the non-atopic condition had been investigated only episodically from this point of view. Gastroesophageal-reflux is a pathological condition which can frequently cause and/or sustain asthma in non-atopic individuals. Objectives: The aim of the study was to measure BMT; some inflammatory mediators in BAL; cys-leucotrienes (LTE4) in urine; e-NO, and BHR to Methacholine (MCh) in mild atopic and in mild non-atopic, GER-related asthma. Methods: After their informed consent, 25 mild atopic (40.9 years ± 13.1 sd, FEV1=95.9% pred. ± 12.9 sd) and 39 non-atopic, GER-related asthmatics (57.3 years ± 14.2 ds, FEV1=101.3% pred. ± 12.2 sd), nonsmoker and of a comparable asthma duration, underwent measurements of basal lung function and bronchial response to MCh (PD20 FEV1); endobronchial biopsies and BAL (in the right middle lobe), and a 24-h gastroesophageal pHmetry. Results: Atopic and GER-related asthma showed two distinct patterns of airway inflammation. The eosinophilic contribution to airway inflammation was systematically prevailing in the former group, such as: EOS=10.7% ± 13.4 sd vs 2.0% ± 2.8 sd, p=0.001; ECP=344.9 mcg/l ± 635.9 sd vs 59.2 mcg/l ± 75.1 sd, p=0.001. Conclusions: Data from the present study are suggesting that persistent mild atopic and mild GER-related asthma seem to represent two distinct phenotypes of asthma in terms of airway remodelling, and in particular of BMT involvement.

Keywords

Airway remodelling; atopic asthma; GER-related asthma; mild asthma

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Bioactive proteins in breast milk. Full text.

Review Article

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Bioactive proteins in breast milk

1. Bo Lönnerdal^*

Article first published online: 1 MAR 2013

DOI: 10.1111/jpc.12104

© 2013 The Author. Paediatrics and Child Health Division (Royal Australasian College of Physicians)

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Journal of Paediatrics and Child Health

Special Issue: Bioactive proteins in breast milk

Volume 49, Issue Supplement S1, pages 1–7, March 2013

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Keywords:

• infant formula;
• milk;
• human;
• prebiotics;
• protein;
• bioactive;
• recombinant protein

Abstract

Human milk contains many proteins that have been shown to be bioactive, but it is still not known whether these activities are exerted in breast-fed infants. These bioactivities include enzyme activities, enhancement of nutrient absorption, growth stimulation, modulation of the immune system and defence against pathogens. The antimicrobial activities are very diverse, ranging from stimulation of beneficial microorganisms (i.e. prebiotic effects), killing or inhibition of growth of pathogens, to mechanisms preventing attachment or invasion of harmful microorganisms. Among the bioactive proteins are lactoferrin, lysozyme, secretory immunoglobulin A, haptocorrin, lactoperoxidase, α-lactalbumin, bile salt stimulated lipase, β- and κ-casein, and tumour growth factor β. Human milk proteins may be largely resistant against digestion in the gastrointestinal tract, be partially digested into bioactive peptides, or be more or less completely digested and utilised as a source of amino acids. These events can be studied using an in vitro digestion model, which is useful for predicting results in human infants. Some bovine milk proteins, for example, lactoferrin and tumour growth factor β, may also resist proteolysis and be capable of exerting bioactivities similar to those of human milk proteins.

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