Biomedical subjects

Phil Lieberman

Publications and source records attributed to Phil Lieberman.

7 recordsLinked to original sources

PubMed2006

Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group.

OBJECTIVE: To improve understanding of the epidemiology of anaphylaxis. DATA SOURCES: We performed a qualitative review by hand of the major epidemiology studies of anaphylaxis. This review was restricted to articles in the English language. STUDY SELECTION: Articles chosen were selected by the committee and dated back to 1968. There was no specific criterion used for selection except the determination of the members of the committee. RESULTS: Data on anaphylaxis incidence and prevalence are sparse and often imprecise. Findings are based on diverse study designs and are not entirely comparable. These factors have contributed to widely varying estimates of the frequency of this important condition. The roundtable discussion led to an improved estimation of the frequency of anaphylaxis: approximately 50 to 2,000 episodes per 100,000 persons or a lifetime prevalence of 0.05% to 2.0%. The largest number of incident cases is among children and adolescents. In addition to underdiagnosis, we noted undertreatment, especially for those at highest risk (ie, those without immediate access to treatment with epinephrine). CONCLUSIONS: Anaphylaxis is a relatively common problem, affecting up to 2% of the population. Further data on epinephrine dispensing could improve current estimates. Another way to improve current understanding would be through better population-based study designs in different geographic regions. A recurring theme was the importance of broader access to self-injectable epinephrine for high-risk populations. An improved epidemiologic understanding of this disorder would aid ongoing efforts to reduce morbidity and mortality from anaphylaxis and could provide important clues for primary prevention.

Anaphylaxis↗

PubMed2006

Anaphylaxis: a review of 601 cases.

BACKGROUND: The allergist usually sees patients with anaphylaxis after the event for the purposes of identifying the cause, establishing a prognosis, and preventing further episodes. Knowledge of the characteristics of such patients is essential to achieve these goals. OBJECTIVE: To examine the natural history, clinical manifestations, and factors that affect the patients' adherence to suggested treatment and preventive strategies of anaphylaxis. METHODS: A retrospective medical record review spanning 25 years (1978-2003) and follow-up questionnaires were used to obtain data on 601 patients who presented with anaphylaxis of unknown origin to a private university-affiliated allergy-immunology practice. RESULTS: Patients ranged in age from 1 to 79 years, with a mean age of 37 years. Females comprised 62% of cases. Causes of anaphylaxis were elucidated in 41% of cases. Known causes included foods in 131 patients (22%), medications in 69 cases (11%), and exercise in 31 cases (5%). Two hundred twenty-three patients (37%) were found to be atopic by history confirmed with skin prick testing. The most common manifestation was urticaria and/or angioedema, reported in 87% of patients. Systemic mastocytosis was found in 3 patients. Episodes tended to decline in frequency with time. Adherence to instructions to carry epinephrine can be improved with more effective teaching. CONCLUSIONS: In most cases, the cause of anaphylaxis is undetermined. Women are affected more commonly than men. Systemic mastocytosis should be considered in cases of idiopathic anaphylaxis, and patients with a history of atopy are at an increased risk of developing anaphylaxis. Patients are more reliably carrying epinephrine as a result of changes in physician instructions. Finally, anaphylactic episodes tend to decrease in frequency and severity with time.

Adolescent↗

PubMed2006

Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.

The Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology was charged with formulating a position paper regarding the potential release of intranasal corticosteroids for over-the-counter use. We took the position that safety issues regarding this proposal would be our sole concern. We reviewed the literature to evaluate the frequency and severity of potential adverse events related to the administration of intranasal corticosteroids. We limited this review to 5 areas: (1) effects on growth, (2) ocular effects, (3) effects on bone, (4) effects on the hypothalamic-pituitary-adrenal axis, and (5) local adverse effects. After review of the available data, we concluded that intranasal corticosteroids should remain prescription-only drugs. Patients receiving an intranasal corticosteroid should be instructed in its use and that use should be monitored by a physician or an appropriately trained medical provider (eg, nurse practitioner or physician assistant) under the direct supervision of a physician. This conclusion was reached based on the evidence that corticosteroids administered by any route, including the intranasal route, have the potential to cause adverse effects in all the areas noted herein. Our conclusion was strengthened by the fact that these adverse effects can be insidious and therefore not evident for many years; there is the potential for overuse; patients could also have access to other forms of topically administered corticosteroids, thus increasing their total dose; and individuals vary in their susceptibility to corticosteroid-induced adverse effects. We were also influenced to take this position knowing that generally reassuring data regarding the use of respiratory tract-administered corticosteroids are based on mean data and that all such studies have shown outliers in whom adverse effects were evident. Thus, as stated, we recommend that intranasal corticosteroids remain prescription-only drugs.

Administration, Inhalation↗

PubMed2005

Biphasic anaphylactic reactions.

OBJECTIVE: To examine the impact of the second phase of a biphasic response on the required observation time after resolution of symptoms that occurred during the initial phase. DATA SOURCES: We performed a MEDLINE search of the literature for studies published between January 1970 and January 2005 on biphasic response using the keywords anaphylaxis, biphasic anaphylaxis, late phase reaction, and early phase reaction. STUDY SELECTION: Prospective studies, retrospective studies, and case reports were selected for inclusion in this review. RESULTS: The incidence of biphasic anaphylactic reactions as described in the literature is highly variable, ranging from a low of 1% to a high of 20% of episodes. There is no clear consensus regarding distinguishing features of the primary response that predicts the occurrence of a secondary response. However, the severity of the reaction, the time of onset after administration of antigen before the occurrence of symptoms of the primary response, the presence of hypotension or laryngeal edema during the primary response, and the history of a previous biphasic reaction have all been mentioned as risk factors in various studies. The severity of the late-phase reaction is highly variable, and events have ranged from mild to severe with rare fatalities. Most late-phase reactions, however, are mild to moderate in severity. A delay in the administration of epinephrine and too small a dose of epinephrine given for the primary response have also been mentioned as risk factors. It is unclear whether corticosteroids given for the primary event can prevent or ameliorate the second reaction. CONCLUSIONS: Biphasic responses occur with significant frequency and therefore should be taken into consideration when one considers the observation period after the initial event. An observation period of 8 hours is sufficient for most reactions, but since reactions can occur as long as 72 hours after resolution of the primary event, some authors have recommended a 24-hour waiting period.

Adolescent↗

PubMed2005

Open-label evaluation of azelastine nasal spray in patients with seasonal allergic rhinitis and nonallergic vasomotor rhinitis.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of azelastine (Astelin) nasal spray, a topical second-generation antihistamine, in the treatment of symptoms of seasonal allergic rhinitis, seasonal allergic rhinitis with nonallergic triggers (mixed rhinitis), and nonallergic vasomotor rhinitis. RESEARCH DESIGN AND METHODS: A total of 2343 primary care physicians, allergists, ENT specialists, and other health professionals participated in this 2-week, open-label evaluation of azelastine nasal spray. Data were collected through a physician questionnaire that included patient demographics, rhinitis diagnosis, medication history, and inclusion/exclusion criteria; and two patient questionnaires that included symptom history, response to previous rhinitis medications, symptom control, and level of satisfaction with azelastine nasal spray. A completed physician questionnaire and two completed patient questionnaires were required for each patient to be included in the analysis. Patients who qualified for enrollment were given open-label azelastine nasal spray and instructed to administer 2 sprays per nostril twice daily for 2 weeks. RESULTS: A total of 1225 health professionals enrolled 7864 patients into the study. Completed physician and patient questionnaires were returned by 1081 health professionals and 5073 patients, 4364 of whom used azelastine nasal spray as their only rhinitis medication during the 2-week study period. The patients were predominantly caucasian (82.6%) and female (61.1%), with a mean age of 50 years. The majority had a diagnosis of mixed rhinitis (51.5%), followed by seasonal allergic rhinitis (32.3%), and nonallergic (vasomotor) rhinitis (16.2%). After 2 weeks of treatment, the percentage of patients reporting some control or complete control of individual symptoms ranged from 78% for postnasal drip in patients with nonallergic vasomotor rhinitis to 90% for sneezing in patients with seasonal allergic rhinitis. More than 85% of patients who reported difficulty sleeping or impairment of daytime activities due to rhinitis symptoms had improvement in these parameters. Azelastine nasal spray was well tolerated, the discontinuation rate due to adverse events was 2.3%. CONCLUSIONS: Azelastine nasal spray was reported to control all rhinitis symptoms, including nasal congestion, regardless of rhinitis diagnosis during the 2-week study period. Patients with seasonal allergic rhinitis and patients with seasonal allergic rhinitis plus nonallergic triggers were identified as patient types most likely to respond to azelastine nasal spray.

Administration, Intranasal↗

PubMed2003

Use of epinephrine in the treatment of anaphylaxis.

PURPOSE OF REVIEW: This paper is intended to review recent literature that impacts the use of epinephrine in the therapy of anaphylaxis. RECENT FINDINGS: The most important recent finding regarding the administration of epinephrine is that the intramuscular route of administration is the route of choice for the treatment of anaphylaxis, and the lateral aspect of the thigh is the site of choice. In addition, recent research emphasizes the fact that epinephrine is grossly underused in the management of anaphylaxis, which accentuates the need for further education of both physician and patient in this regard. SUMMARY: Several major themes have emerged from this review of the recent literature. The finding that the intramuscular route of administration for epinephrine is superior has now been recognized by the guidelines, and because the site of choice has been found to be the lateral aspect of the thigh, the needle used for injection must be long enough to penetrate the vastus lateralis muscle. The reasons for the underutilization of epinephrine in the treatment of anaphylaxis are also discussed. Other important findings include the fact that outdated EpiPens can usually be administered safely, and alternative routes of administration, which may be more acceptable to patients, may be on the horizon as a result of preliminary studies assessing the administration of sublingual epinephrine by wafer. Finally, it is now understood that epinephrine prescription data may be one of our best tools to study the epidemiology and incidence of anaphylactic episodes.

Adrenergic Agonists↗

PubMed2002

Anaphylactic reactions during surgical and medical procedures.

The most common agents that are responsible for intraoperative anaphylaxis are muscle relaxants. However, latex accounts for a significant number of these reactions, and the incidence of intraoperative anaphylaxis caused by latex is increasing. It is now probably the second most important cause of intraoperative anaphylaxis. Following muscle relaxants and latex are probably antibiotics and anesthesia induction agents. Other agents that are responsible include colloids, opioids, and radiocontrast material. However, they account for less than 10% of all reactions. The clinical manifestations of intraoperative reactions differ from those of anaphylactic reactions outside of anesthesia. Cutaneous manifestations are far less common; cardiovascular collapse may be more common. The diagnosis can be made more difficult because patients cannot express symptoms. There is a paucity of cutaneous findings; the patient is draped, and concomitantly administered drugs may alter the manifestations. These additional drugs can also complicate therapy. There are populations who are at-risk for anaphylaxis to latex during surgical procedures: individuals with a genetic predisposition (atopic individuals), individuals with increased previous exposure to latex (eg, anyone who requires chronic bladder care with repeated insertion of latex catheters or chronic indwelling catheters), health care workers who are exposed to latex mainly by inhalation, and possibly patients who have undergone multiple surgical procedures and therefore have been exposed to latex intravascularly and by catheterization on a number of occasions. It has been shown that pretreatment with antihistamines and corticosteroids that are used successfully for the prevention of reactions to radiocontrast material are not as effective in the prevention of anaphylactic reactions to latex. Therefore, the major emphasis has been on prevention. The key elements of prevention include an adequate history, testing for latex allergy in high-risk patients, preadmission measures, and the establishment of a "latex-free environment" while the individual is hospitalized. This is particularly important in the operating and recovery rooms.

Anaphylaxis↗