Hospitalisations due to exacerbation of asthma and COPD

Nr. 14 – 7. august 2012

Tidsskr Nor Legeforen 2012; 132:1607 – 9

doi: 10.4045/tidsskr.11.1310ORIGINAL ARTICLE

H Melbye　P C Moe　F Arstad　

SUMMARY

Background. Patients with exacerbation of asthma and COPD often need instant treatment, and acute hospitalisation may be necessary. The aim of the study was to determine what sort of contact with doctors patients had had and what sort of treatment they received prior to hospitalisation due to exacerbation.

Material and method. A questionnaire was distributed to patients aged over 18 who were hospitalised because of asthma or COPD exacerbation in Helgeland Hospital and the University Hospital of North Norway, Tromsø, between January 2010 and January 2011. The patients answered questions on the duration of the exacerbation, their contacts with doctors and their medical treatment prior to hospitalisation.

Results. Data received from 100 of the 122 patients were analysed. The median duration of illness prior to the initial contact with a doctor was four days. 52 of the patients had contacted their primary doctor first, 40 contacted A&E first, while eight contacted the hospital directly. The initial contact with a doctor resulted in the hospitalisation of 56 patients: 21 (40 %) of those who contacted their primary doctor and 26 (70 %) of those who contacted A&E. 41 patients were hospitalised without being clinically examined by the admitting doctor the same day, and 32 after a telephone consultation with their primary doctor or an A&E doctor. Patients aged over 70 were admitted more frequently without a clinical examination, as were patients who had been hospitalised previously.

Interpretation. Patients with asthma or COPD exacerbation are often hospitalised directly after a telephone consultation with their primary doctor or an A&E doctor.

Nr. 14 – 7. august 2012

Tidsskr Nor Legeforen 2012; 132:1607 – 9

doi: 10.4045/tidsskr.11.1310

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• Norwegian version

A 4-month-old baby boy presenting with systemic anaphylaxis to a banana: a case report

Case report

Andrew W O'Keefe and Moshe Ben-Shoshan

Author Affiliations

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Journal of Medical Case Reports 2014, 8:62  doi:10.1186/1752-1947-8-62

Published: 19 February 2014

Abstract (provisional)

Introduction

Food allergy is the most common cause of anaphylaxis in children and recent studies suggest increased prevalence of both food allergy and anaphylaxis. Among foods, fruits are rarely implicated as the cause of anaphylaxis. Furthermore, anaphylaxis cases in the first months of life to fruits are rarely described. Although banana allergy has been well described in adults, there are only two case reports of systemic anaphylaxis to banana in children.

Case presentation

A 4-month-old Hispanic baby boy with a history of eczema presented to our emergency room with vomiting, urticaria and cyanosis following first exposure to a banana. He improved with administration of intramuscular epinephrine. Skin prick tests showed positive results for both fresh banana (4mm wheal/15mm erythema) and banana extract (8mm wheal/20mm erythema).

Conclusions

Banana is not considered a highly allergenic food. However, as food allergy becomes more common and solid foods are being introduced earlier in babies, banana may become an important allergen to consider in cases of babies presenting with anaphylaxis.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

BMJ Open 2014;4:e003827 doi:10.1136/bmjopen-2013-003827

• Paediatrics

Associations between environmental exposures and asthma control and exacerbations in young children: a systematic review

1. Smita Dick1, 
2. Emma Doust2, 
3. Hilary Cowie2, 
4. Jon G Ayres3, 
5. Steve Turner1

+Author Affiliations

1. ¹Child Health, University of Aberdeen, Aberdeen, UK
2. ²Institute of Occupational Medicine, Edinburgh, UK
3. ³Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK

1. Correspondence toDr Steve Turner; s.w.turner@abdn.ac.uk

• Received 16 August 2013
• Revised 10 January 2014
• Accepted 16 January 2014
• Published 12 February 2014

Abstract

Objective To complete a systematic review of the literature describing associations between all environmental exposures and asthma symptoms and exacerbations in children up to mean age of 9 years.

Design Systematic review.

Setting Reference lists of identified studies and reviews were searched for all articles published until November 2013 in electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Controls Trials Register).

Participants Studies were selected which examined a link between exposure to environmental factors and asthma symptoms and exacerbations where the study participants were children with a mean age of ⩽9 years.

Primary and secondary outcome measures Indices of asthma symptoms, control and exacerbations.

Results A total of 27 studies were identified including eight where inhaled allergens and four where environmental tobacco smoke (ETS) were the exposures of interest. There was evidence that exposure to allergen, ETS, poor air quality and unflued heaters had a modest magnitude of effect (ORs between 2 and 3). There was also evidence of interactions observed between exposures such as allergen and ETS.

Conclusions Exposure to inhaled allergens, ETS, unflued heaters and poor air quality has an important effect on exacerbations in young children with asthma and should be minimised or, ideally, avoided. Better understanding of the effect of exposure to damp housing, air conditioning and dietary factors plus interactions between environmental exposures associated with exacerbations is required.

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• PLoS One
• v.9(2); 2014
• PMC3921143

PLoS One. 2014; 9(2): e88303.

Published online 2014 February 11. doi:  10.1371/journal.pone.0088303

PMCID: PMC3921143

Endotoxin, Ergosterol, Fungal DNA and Allergens in Dust from Schools in Johor Bahru, Malaysia- Associations with Asthma and Respiratory Infections in Pupils

Dan Norbäck,1,* Pawel Markowicz,2 Gui-Hong Cai,1 Zailina Hashim,3 Faridah Ali,4 Yi-Wu Zheng,5 Xu-Xin Lai,5 Michael Dho Spangfort,5 Lennart Larsson,2 and Jamal Hisham Hashim6,7

Joy Sturtevant, Editor

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Abstract

There are few studies on associations between respiratory health and allergens, fungal and bacterial compounds in schools in tropical countries. The aim was to study associations between respiratory symptoms in pupils and ethnicity, chemical microbial markers, allergens and fungal DNA in settled dust in schools in Malaysia. Totally 462 pupils (96%) from 8 randomly selected secondary schools in Johor Bahru, Malaysia, participated. Dust was vacuumed from 32 classrooms and analysed for levels of different types of endotoxin as 3-hydroxy fatty acids (3-OH), muramic acid, ergosterol, allergens and five fungal DNA sequences. Multiple logistic regression was applied. Totally 13.1% pupils reported doctor’s diagnosed asthma, 10.3% wheeze and 21.1% pollen or pet allergy. Indian and Chinese children had less atopy and asthma than Malay. Carbon dioxide levels were low (380–690 ppm). No cat (Fel d1), dog (Can f 1) or horse allergens (Ecu cx) were detected. The levels of Bloomia tropicalis (Blo t), house dust mite allergens (Der p 1, Der f 1, Der m 1) and cockroach allergens (Per a 1 and Bla g 1) were low. There were positive associations between levels of Aspergillus versicolor DNA and daytime breathlessness, between C14 3-OH and respiratory infections and between ergosterol and doctors diagnosed asthma. There were negative (protective) associations between levels of C10 3-OH and wheeze, between C16 3-OH and day time and night time breathlessness, between cockroach allergens and doctors diagnosed asthma. Moreover there were negative associations between amount of fine dust, total endotoxin (LPS) and respiratory infections. In conclusion, endotoxin at school seems to be mainly protective for respiratory illness but different types of endotoxin could have different effects. Fungal contamination measured as ergosterol and Aspergillus versicolor DNA can be risk factors for respiratory illness. The ethnical differences for atopy and asthma deserve further attention.

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Abstract

There are few studies on associations between respiratory health and allergens, fungal and bacterial compounds in schools in tropical countries. The aim was to study associations between respiratory symptoms in pupils and ethnicity, chemical microbial markers, allergens and fungal DNA in settled dust in schools in Malaysia. Totally 462 pupils (96%) from 8 randomly selected secondary schools in Johor Bahru, Malaysia, participated. Dust was vacuumed from 32 classrooms and analysed for levels of different types of endotoxin as 3-hydroxy fatty acids (3-OH), muramic acid, ergosterol, allergens and five fungal DNA sequences. Multiple logistic regression was applied. Totally 13.1% pupils reported doctor’s diagnosed asthma, 10.3% wheeze and 21.1% pollen or pet allergy. Indian and Chinese children had less atopy and asthma than Malay. Carbon dioxide levels were low (380–690 ppm). No cat (Fel d1), dog (Can f 1) or horse allergens (Ecu cx) were detected. The levels of Bloomia tropicalis (Blo t), house dust mite allergens (Der p 1, Der f 1, Der m 1) and cockroach allergens (Per a 1 and Bla g 1) were low. There were positive associations between levels of Aspergillus versicolor DNA and daytime breathlessness, between C14 3-OH and respiratory infections and between ergosterol and doctors diagnosed asthma. There were negative (protective) associations between levels of C10 3-OH and wheeze, between C16 3-OH and day time and night time breathlessness, between cockroach allergens and doctors diagnosed asthma. Moreover there were negative associations between amount of fine dust, total endotoxin (LPS) and respiratory infections. In conclusion, endotoxin at school seems to be mainly protective for respiratory illness but different types of endotoxin could have different effects. Fungal contamination measured as ergosterol and Aspergillus versicolor 

• Asia Pac Allergy
• v.4(1); Jan 2014
• PMC3921866

Asia Pac Allergy. 2014 January; 4(1): 54–67.

Published online 2014 January 31. doi:  10.5415/apallergy.2014.4.1.54

PMCID: PMC3921866

Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management

Evy Yunihastuti,1,2 Alvina Widhani,1 and Teguh Harjono Karjadi1,2

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Abstract

Human immunodeficiency virus (HIV)-infected patients present complex immunological alterations. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral pose these patients a higher risk of developing drug hypersensitivity. All antiretroviral agents and drugs to treat opportunistic infections have been reported to cause drug hypersensitivity reactions. Allergic reactions with antiretroviral are not restricted to older agents, although newer drugs usually more tolerated. Cutaneous adverse drug reactions are the most common manifestation of drug hypersensitivity in HIV, typically manifesting as maculopapular rash with or without systemic symptoms in the presence or absence of internal organ involvement. The onset of an allergic reaction is usually delayed. Severe drug hypersensitity reactions as erythema multiforme, Stevens Johnson syndrome and toxic epidermal necrolysis develop more often in HIV-infected patients compared to other populations. Mild to moderate rash without systemic symptom or organ involvement usually do not need drug discontinuation. Appropriate diagnosis and management of drug hypersensitivity reactions are essential, especially in patients with very low CD4+ T-cell count and multiple opportunistic infections. Clinicians should aware of different half-life of each drug when decided to stop the drug. Knowledge of the metabolism, recognition of the risk factors, and the ability to suggest the probability of particular drug as causative are also important points. A step wise rechallenge test or desensitization with the offending drug might be a preferable action and more commonly used in managing drug hypersensitivity in HIV-infected patients. Desensitization protocols have been successfully done for several antiretroviral and opportunistic infection drugs.

Keywords: Drug hypersensitivity, HIV, Desensitization

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Abstract

Human immunodeficiency virus (HIV)-infected patients present complex immunological alterations. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral pose these patients a higher risk of developing drug hypersensitivity. All antiretroviral agents and drugs to treat opportunistic infections have been reported to cause drug hypersensitivity reactions. Allergic reactions with antiretroviral are not restricted to older agents, although newer drugs usually more tolerated. Cutaneous adverse drug reactions are the most common manifestation of drug hypersensitivity in HIV, typically manifesting as maculopapular rash with or without systemic symptoms in the presence or absence of internal organ involvement. The onset of an allergic reaction is usually delayed. Severe drug hypersensitity reactions as erythema multiforme, Stevens Johnson syndrome and toxic epidermal necrolysis develop more often in HIV-infected patients compared to other populations. Mild to moderate rash without systemic symptom or organ involvement usually do not need drug discontinuation. Appropriate diagnosis and management of drug hypersensitivity reactions are essential, especially in patients with very low CD4+ T-cell count and multiple opportunistic infections. Clinicians should aware of different half-life of each drug when decided to stop the drug. Knowledge of the metabolism, recognition of the risk factors, and the ability to suggest the probability of particular drug as causative are also important points. A step wise rechallenge test or desensitization with the offending drug might be a preferable action and more commonly used in managing drug hypersensitivity in HIV-infected patients. Desensitization protocols have been successfully done for several antiretroviral and opportunistic infection drugs.

Keywords: Drug hypersensitivity, HIV, Desensitization

• Asia Pac Allergy
• v.4(1); Jan 2014
• PMC3921868

Asia Pac Allergy. 2014 January; 4(1): 68–72.

Published online 2014 January 31. doi:  10.5415/apallergy.2014.4.1.68

PMCID: PMC3921868

Rapid onset of Stevens-Johnson syndrome and toxic epidermal necrolysis after ingestion of acetaminophen

Eun-Jin Kim,† Hyun Lim,† So Young Park, Sujeong Kim, Sun-Young Yoon, Yun-Jeong Bae, Hyouk-Soo Kwon, You Sook Cho, Hee-Bom Moon, and Tae-Bum Kim

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Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but life-threatening, severe cutaneous adverse reactions most frequently caused by exposure to drugs. Several reports have associated the use of acetaminophen with the risk of SJS or TEN. A typical interval from the beginning of drug therapy to the onset of an adverse reaction is 1-3 weeks. A 43-year-old woman and a 60-year-old man developed skin lesions within 3 days after administration of acetaminophen for a 3-day period. Rapid identification of the symptoms of SJS and TEN caused by ingestion of acetaminophen enabled prompt withdrawal of the culprit drug. After administration of intravenous immunoglobulin G, both patients recovered fully and were discharged. These two cases of rapidly developed SJS/TEN after ingestion of acetaminophen highlight the possibility that these complications can develop within only a few days following ingestion of over-the-counter medications such as acetaminophen.

Keywords: Stevens-Johnson syndrome, Toxic epidermal necrolysis, Drug, Hypersensitivity, Acetaminophen

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Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but life-threatening, severe cutaneous adverse reactions most frequently caused by exposure to drugs. Several reports have associated the use of acetaminophen with the risk of SJS or TEN. A typical interval from the beginning of drug therapy to the onset of an adverse reaction is 1-3 weeks. A 43-year-old woman and a 60-year-old man developed skin lesions within 3 days after administration of acetaminophen for a 3-day period. Rapid identification of the symptoms of SJS and TEN caused by ingestion of acetaminophen enabled prompt withdrawal of the culprit drug. After administration of intravenous immunoglobulin G, both patients recovered fully and were discharged. These two cases of rapidly developed SJS/TEN after ingestion of acetaminophen highlight the possibility that these complications can develop within only a few days following ingestion of over-the-counter medications such as acetaminophen.

Keywords: