DOCSLIB.ORG

Abstracts from the Food Allergy and Anaphylaxis Meeting 2016 Rome, Italy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Abstracts from the Food Allergy and Anaphylaxis Meeting 2016 Rome, Italy Clin Transl Allergy 2017, 7(Suppl 1):10 DOI 10.1186/s13601-017-0142-2 Clinical and Translational Allergy MEETING ABSTRACTS Open Access Abstracts from the Food Allergy and Anaphylaxis Meeting 2016 Rome, Italy. 13–15 October 2016 Published: 30 March 2017 ORAL ABSTRACT SESSION 1: Food allergens • Anaphylaxis most frequent causes. Older age and male sex are risk factors of fatal anaphylaxis of any cause except for food-induced anaphylaxis. OP01 Fatal anaphylaxis is decreasing in France: analysis of national OP02 data, 1979–2011 Diagnostic workup after severe anaphylaxis Guillaume Pouessel1,2,3, Claire Claverie4, Julien Labreuche5, Jean‑Marie Linus Grabenhenrich1, Margitta Worm1, Sabine Dölle1, Kathrin Scherer2, Renaudin3,6, Aimée Dorkenoo4, Mireille Eb7, Anne Moneret‑Vautrin6, Isidor Hutteger3 Antoine Deschildre2,3, Stephane Leteurtre4 1Charité ‑ Universitätsmedizin Berlin, Berlin, Germany; 2University Hospital 1Department of Pediatrics, Children’s Hospital, Roubaix, France; 2Division Basel, Basel, Switzerland; 3Universitätsklinikum Salzburg, Salzburg, Austria of Pulmonology and Allergology, Department of Pediatrics, Faculty Correspondence: Linus Grabenhenrich - [email protected] of Medicine and Children’s Hospital, Lille, France; 3Allergy Vigilance Clinical and Translational Allergy 2017, 7(Suppl 1):OP02 Network, Vandoeuvre les Nancy, France; 4Université Lille 2, CHU Lille, EA 2694 ‑ Santé Publique: épidémiologie et qualité des soins, Lille, France; Introduction: After a severe anaphylactic reaction, a diagnostic 5Biostatistic Unit, Maison Régionale de la Recherche Clinique, CHRU Lille, workup is recommended to confirm or rule out the elicitor(s) in ques- Lille, France; 6Department of Allergology, Emile Durkheim Hospital, Epi‑ tion. The type of diagnostic chosen is usually based on the elicitor and nal, France; 7Centre d’Epidémiologie sur les Causes Médicales de Décès severity of the reaction and might follow local experiences. We aimed INSERM, CHU de Bicêtre, Le Kremlin‑Bicêtre, France to describe elicitor-specific diagnostic habits in the workup of severe Correspondence: Guillaume Pouessel - [email protected] anaphylaxis, comparing European countries. Clinical and Translational Allergy 2017, 7(Suppl 1):OP01 Methods: The Network for Online Registration of Anaphylaxis (NORA) collected details about elicitors, symptoms and severity, treatment Introduction: Incidence of anaphylaxis is increasing. Data regarding and the diagnostic workup of patients who experienced at least one anaphylaxis mortality are limited, but conflicting. Our objective was to episode of severe anaphylaxis, as documented within medical records document anaphylaxis mortality rate (deaths per million population), of participating tertiary referral centres. time trends and specificities according to triggers (iatrogenic, venom, Results: Between June 2011 and April 2016, the registry collected food, unknown), age groups, sex and geographical regions (North and data for 6465 cases of severe anaphylaxis, 74% of which reported South) in France, between 1979 and 2011. to know the elicitor, with a remaining 20% having only a suspicion Methods: Data were obtained (1) from database of the National and 6% cases of idiopathic anaphylaxis. The allergen was known Mortality Center (CEPIDC) to collect cases in which anaphylaxis was and confirmed by a diagnostic test in 4410 (92% of known elici- included as a cause of death, sex, age, and geographic region of death, tors). Of these, 68% had a reaction to this allergen for the first time, (2) from the database of the National Institute for Economical and Sta- and 32% reported at least one earlier reaction to the same allergen. tistical studies (INSEE) to define the referent populations. We used a In first-time reactors (n 3001) 7% reported that the allergen was multivariable log-linear Poisson regression model to assess the impact confirming by a diagnostic= test already before this reaction, for food of time period, age, sex and geographic region on anaphylaxis deaths. 14%, insects 3%, drugs 2%, and 80% for SIT-induced anaphylaxis. Of Results: During the period study, 1603 deaths were collected: 1564 in cases with recurrent anaphylaxis (n 1409), 30% had a test confirm- adults and 39 in children (age <18 year). The overall prevalence of ana- ing the allergen before the reported= reaction, for food 44%, insects phylaxis fatalities was 0.84 per million population (95% IC 0.80–0.88), 16%, drugs 18%, and 91% for SIT-induced anaphylaxis. Of all diagnos- ranging from 0.08 per million (95% IC 0.05–0.10) in pediatric popu- tically confirmed cases of food-induced anaphylaxis (n 1555), 78% lation to 1.12 per million (95% CI 1.06 to 1.17) in adult population. were assessed by a skin test (SPT, positive in 93%), 90%= by specific Annual percentage change for case fatality rate was 2.0% (95% CI IgE (sIgE, 94% positive), 27% tryptase (7% positive), and 13% under- 4 − 2.5 to 1.5; p < 10− ) indicating a decrease in case fatality rate dur- went an oral food challenge (positive in 88%). Patients with anaphy- ing− the study− period. Anaphylaxis fatality rate was higher in men (1.08 laxis caused by drugs had the following tests (positives of these): SPT per million [95% IC 1.00 1.16] than women (0.86 per million [95% IC 88% (49%), sIgE 31% (46%), tryptase 48% (11%), and provocation 19% 4 0.80–0.92]) (p < 10− ). Triggers of anaphylaxis fatalities were iatrogenic (68%). For reactions against insect venom: SPT 79% (84%), sIgE 98% (63%), mostly drugs, venom (14%) and food (0.6%). Unspecified ana- (97%), and tryptase 93 (8%). Irrespective of the elicitor, SPTs were per- phylaxis was frequent (23%). The highest rate was in persons aged formed more often in Austria, Ireland and Greece (92, 96, and 99%, >70 years (3.50 per million population per year [95% IC 3.25–3.76]) and respectively), and less often in Italy (64%). Tryptase was almost never 4 the lowest in the pediatric population (p < 10− ). Only venom-induced measured in Ireland, Greece and France, whereas determination of mortality rate was higher in South of France (0.16 per million [95% IC specific IgE was carried out similarly between European countries. 0.13–0.19]) compared with the North (0.11 per million [95% IC 0.09– Conclusion: The choice of diagnostic measure depended on the elicitor 0.13]) (p 0.004). Only 8 food-induced fatalities were recorded (age and varied by country. Especially the assessment of tryptase is handled <35 years= in 7 cases). very differently between allergens in question and countries. These dif- Conclusion: Overall anaphylaxis mortality rate is decreasing over the ferences may indicate aspects of the diagnostic workup with a certain three last decades in France. We confirm that iatrogenic causes are the degree of ambiguity, which might benefit from further harmonization. © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Clin Transl Allergy 2017, 7(Suppl 1):10 Page 2 of 79 OP03 corticosteroid, or antihistamine were compared with recommended Primary sensitisation versus co‑sensitisation to hydrolysed wheat adrenalin treatment according to the algorithm in Sampson 1–5. protein Results: Out of 346 challenges scored as grade 4 anaphylaxis, 296 were Morten Christensen, Carsten Bindslev‑Jensen, Charlotte Mortz terminated due to respiratory symptoms requiring adrenalin according Department of Dermatology and Allergy Centre, Odense Research Center to Sampson 1–5, i.e. “barky cough, hoarseness, difficulty swallowing” for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark (laryngeal, n 79), “wheezing, dyspnea, cyanosis” (lower resp. n 181) Correspondence: Morten J. Christensen ‑ [email protected] or both (n 36).= Nine of the 115 patients with laryngeal symptoms= were Clinical and Translational Allergy 2017, 7(Suppl 1):OP03 treated with= adrenalin, all due to inspiratory stridor. No patients with lower respiratory symptoms received adrenalin, but the majority were Introduction: Wheat protein is responsible for various phenotypes of aller- treated with β2 agonists (188/217), whereas in 30 challenges, symptoms gic diseases. More recently an increased number of immediate type 1 aller- disappeared without treatment or only antihistamine for concomitant gic reactions to hydrolyzed wheat proteins (HWP) have been reported. urticaria were used. Patients solely with laryngeal symptoms received The aim of this study was to characterize the clinical profile and evalu- β2-agonists in 16 challenges, but the majority of them (54/79) received ate patients with a case-history of anaphylaxis related to ingestion of a no treatment or only antihistamine. The 36 patients with both laryn- product containing HWP. Furthermore, to describe patients with other geal and lower respiratory symptoms were treated in same manner as types of wheat allergy co-sensitized for HWP. patients with only lower respiratory symptoms, i.e. β2 agonist for their Methods: From May 2010 to August 2015 we investigated 56 patients bronchial
Load more

Recommended publications
  • Food Allergy • Higher Prevalence in Children: Many Food Allergic Children Develop Immune Tolerance Background Ctd
    Overview of Food-Related Adverse Reactions ALLSA 2017 Dr Claudia Gray Dr Claudia Gray • MBChB, FRCPCH (London), MSc (Surrey), Dip Allergy (Southampton), DipPaedNutrition(UK), PhD (UCT) • Paediatrician and Allergologist, UCT Lung Institute • Red Cross Children’s Hospital Allergy and Asthma Department • [email protected] Background 1. Food allergies are common: • Infants: 6-10%; children 2-8%, adults 1-2% true food allergy • Higher prevalence in children: many food allergic children develop immune tolerance Background ctd 2. Food allergies are increasing: • Peanut allergy in UK doubled in 1-2 decades: 1.8%. ? Stabilising in some regions Background 3. Spectrum changing: • Multiple food allergies increasing • “Rare” food allergies are increasing e.g. Eosinophilic oesophagitis; FPIES Allergenic Foods • Prevalence of food allergies influenced by geography and diet; egg and milk allergy universally common • Relatively small number of food types cause the majority of reactions: Allergenic Foods Young Children Adults • Cow’s milk • Fin-fish • Hen’s Egg • Shellfish • Wheat • Treenut • Soya • Peanut • Peanut • Fruit and vegetables • Treenut • Sesame • Kiwi • (* persistence likely) Allergenic Foods • A single food allergen can induce a range of allergic reactions e.g. wheat Classification of Adverse reactions to Food Classification of adverse reactions to food Adverse Reaction to food May occur in all Occurs only in some individuals if they eat susceptible sufficient quantity individuals Pharma- Micro- Toxic Food Food (e.g. cological biological scromboid) e.g. e.g food aversion hypersensitivity tyramine poisoning Classification of adverse reactions to food Food Hypersensitivity Non-allergic food Food Allergy hypersensitivity Mixed IgE- Unknown Metabolic IgE- and non Non IgE- e.g.
    [Show full text]
  • Histamine Poisoning Fact Sheet
    Histamine Poisoning Fact Sheet What is Histamine? How much histamine is a harmful dose? Scombroid food poisoning is caused by A threshold dose is considered to be 90 mg/100 ingestion of histamine, a product of the g. Although, levels as low as 5-20 mg/ 100 g could degradation of the amino acid histidine. possibly be toxic; particularly in susceptible Histidine can be found freely in the muscles individuals. of some fish species and can be degraded to What are the symptoms? histamine by enzymatic action of some naturally occurring bacteria. Initial symptoms resemble some allergic reactions which include sweating, nausea, headache and tingling or peppery sensation in the mouth and Which types of fish can be implicated? throat. The scombrid fish such as tuna and mackerel are Other symptoms include urticarial rash (hives), traditionally considered to present the highest localised skin inflammation, vomiting, diarrhoea, risk. However, other species have also been abdominal cramps, flushing of the face and low associated with histamine poisoning; e.g. blood pressure. anchovies, sardines, Yellowtail kingfish, Amberjack and Australian salmon, Mahi Mahi and Severe symptoms include blurred vision, severe Escolar. respiratory distress and swelling of the tongue. Which bacteria are involved? What can be done to manage histamine in seafood? A variety of bacterial genera have implicated in the formation of histamine; e.g. Clostridium, • Histamine levels can increase over a wide Morganella, Pseudomonas, Photobacterium, range of storage temperatures. However, Brochothrix and Carnobacterium. histamine production is highest over 21.8 °C. Once the enzyme is present in the fish, it can What outbreaks have occurred? continue to produce histamine at refrigeration temperatures.
    [Show full text]
  • Urticaria and Angioedema
    Challenging Cases in Allergy and Immunology Massoud Mahmoudi Editor Challenging Cases in Allergy and Immunology Editor Massoud Mahmoudi D.O, Ph.D. RM (NRM), FACOI, FAOCAI, FASCMS, FACP, FCCP, FAAAAI Assistant Clinical Professor of Medicine University of California San Francisco San Francisco, California Chairman, Department of Medicine Community Hospital of Los Gatos Los Gatos, California USA ISBN 978-1-60327-442-5 e-ISBN 978-1-60327-443-2 DOI 10.1007/978-1-60327-443-2 Springer Dordrecht Heidelberg London New York Library of Congress Control Number: 2009928233 © Humana Press, a part of Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.
    [Show full text]
  • Date: 1/9/2017 Question: Botulism Is an Uncommon Disorder Caused By
    6728 Old McLean Village Drive, McLean, VA 22101 Tel: 571.488.6000 Fax: 703.556.8729 www.clintox.org Date: 1/9/2017 Question: Botulism is an uncommon disorder caused by toxins produced by Clostridium botulinum. Seven subtypes of botulinum toxin exist (subtypes A, B, C, D, E, F and G). Which subtypes have been noted to cause human disease and which ones have been reported to cause infant botulism specifically in the United States? Answer: According to the cited reference “Only subtypes A, B, E and F cause disease in humans, and almost all cases of infant botulism in the United States are caused by subtypes A and B. Botulinum-like toxins E and F are produced by Clostridium baratii and Clostridium butyricum and are only rarely implicated in infant botulism” (Rosow RK and Strober JB. Infant botulism: Review and clinical update. 2015 Pediatr Neurol 52: 487-492) Date: 1/10/2017 Question: A variety of clinical forms of botulism have been recognized. These include wound botulism, food borne botulism, and infant botulism. What is the most common form of botulism reported in the United States? Answer: According to the cited reference, “In the United States, infant botulism is by far the most common form [of botulism], constituting approximately 65% of reported botulism cases per year. Outside the United States, infant botulism is less common.” (Rosow RK and Strober JB. Infant botulism: Review and clinical update. 2015 Pediatr Neurol 52: 487-492) Date: 1/11/2017 Question: Which foodborne pathogen accounts for approximately 20 percent of bacterial meningitis in individuals older than 60 years of age and has been associated with unpasteurized milk and soft cheese ingestion? Answer: According to the cited reference, “Listeria monocytogenes, a gram-positive rod, is a foodborne pathogen with a tropism for the central nervous system.
    [Show full text]
  • Processing Parameters Needed to Control Pathogens in Cold-Smoked Fish
    Processing Parameters Needed to Control Pathogens in Cold-Smoked Fish A Report of the Institute of Food Technologists for the Food and Drug Administration of the U.S. Department of Health and Human Services submitted March 29, 2001 IFT/FDA Contract No. 223-98-2333 Task Order 2 Processing Parameters Needed to Control Pathogens in Cold-smoked Fish Table of Contents Preface ........................................................................ S-1058 7. Conclusions ....................................................................... S-1079 8. Research needs ................................................................. S-1079 Science Advisory Board .......................................... S-1058 References ............................................................................. S-1080 Scientific and Technical Panel ............................... S-1058 Chapter III. Potential Hazards in Cold-Smoked Fish: Clostridium botulinum type E Reviewers .................................................................. S-1058 Scope ...................................................................................... S-1082 1. Introduction ....................................................................... S-1082 Additional Acknowledgments ............................... S-1058 2. Prevalence in water, raw fish, and smoked fish .............. S-1083 3. Growth in refrigerated smoked fish ................................. S-1083 Background ...............................................................S-1059 4. Effect of processing
    [Show full text]
  • Histamine (Scombroid
    Histamine (Scombroid Poisioning) Fact Sheet What is Histamine? What are the symptoms? Initial symptoms resemble some allergic reactions, Scombroid food poisoning is caused by including sweating, nausea, headache and tingling ingestion of fish containing high or a peppery taste in the mouth and throat. concentrations of histamine, which is a Other symptoms include urticarial rash (hives), product of the degradation of the amino acid localised skin inflammation, vomiting, diarrhoea, histidine. Histidine can be found freely in the abdominal cramps, flushing of the face and low muscles of some fish species and can be blood pressure. degraded to histamine by enzymatic action of Severe symptoms include blurred vision, severe some naturally occurring bacteria. respiratory distress and swelling of the tongue. What can be done to manage histamine in Which types of fish can be implicated? seafood? The scombrid fish such as tuna and mackerel are Histamine levels can increase over a wide range traditionally considered to present the highest risk. of storage temperatures. However, histamine However, other species have also been associated production is highest over 21.8 °C. Once the with histamine poisoning; e.g. anchovies, sardines, enzyme is present in the fish, it can continue to Yellowtail kingfish, Amberjack, Australian salmon produce histamine at refrigeration and Mahi Mahi. temperatures. Which bacteria are involved? Preventing the degradation of histidine to A variety of bacterial genera have been implicated histamine by rapid chilling of fish immediately in the formation of histamine; e.g. Clostridium, after death, followed by good temperature Morganella, Pseudomonas, Photobacterium, control in the supply chain is the most Brochothrix and Carnobacterium.
    [Show full text]
  • Seafood Poisoning Symptom, Treatment and Prevention
    Borneo Journal of Marine Science and Aquaculture Volume: 02 | December 2018, 64 - 69 Seafood poisoning symptom, treatment and prevention Murtaza Mustafa1, Teruaki Yoshida2, Zarinah Waheed3, Mohd Yusof Ibrahim1, Mohammad Illzam Elahee4, Shahjee Hussain1, Sharifa Mariam Uma Abdullah5 and Mehvish Muhammad Hanif6 1Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, Malaysia 2Harmful Algal Blooms Research Unit, Borneo Marine Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3Endangered Marine Species Research Unit, Borneo Marine Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 4Polyclinic Sihat, Likas, Kota Kinabalu, Sabah, Malaysia 5Quality Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia. 6Department of Zoology, Wildlife and Fisheries, Agriculture University, Faisalabad, Pakistan. *Corresponding author: [email protected] Abstract Food related disease or food poisoning is prevalent worldwide and is associated with high mortality. It can be caused by bacteria, viruses, parasites, enterotoxins, mycotoxins, chemicals, histamine poisoning (scombroid) ciguatera and harmful algal bloom (HAB). Illness can also result by red tide while breathing in the aerosolized brevitoxins (i.e. PbTx or Ptychodiscus toxins). Bacterial toxin food poisoning can affect within 1-6 hours and 8-16 hours, and illness can be with or without bloody diarrhea. The common symptoms of food poisoning include abdominal cramps, vomiting and diarrhea. Diagnosis includes examination of leftover food, food preparation environment, food handlers, feces, vomitus, serum and blood. Treatment involves oral rehydration, antiemetic, and anti-peristaltic drugs. Antimicrobial agents may be needed in the treatment of shigellosis, cholera, lifesaving invasive salmonellosis and typhoid fever. Proper care in handling and cooking is important to prevent any food borne diseases.
    [Show full text]
  • Diseases Tiunsmitted by Foods
    DISEASES TIUNSMITTED BY FOODS ( A CLASSIFICATION AND SUMMARY) SECOND EDITION U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL CENTER FOR PROFESSIONAL DEVELOPMENT AND TRAINING ATLANTA. GEORGIA 30333 DISEASES TIUNSMITTED BY FOODS ( A CIJiSSIFICATION AND SUMMARY) SECOND EDITION Frank L. Bryan, Ph.D., M.P.H. — U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL CENTER FOR PROFESSIONAL DEVE~PMENR AN_QTRAtNING ATLANTA, GEORGIA 30333 1982 DISEASES TRANSMITTED BY FOODS CONTENTS Page 1 INTRODUCTION 2 BACTERIAL DISEASES 2 Diseases of Contemporary Importance 7 Usually Transmitted by Other Means but Sometimes Foodborne Diseases in Which Proof of Transmission by Foods Is Inconclusive Unknown Role in Foodborne Transmission (Pathogenic and 16 Isolated from Foods) 17 VIRAL AND RICKETTSIW DISEASES 17 Epidemiological Evidence of Foodborne Transmission Viral Diseases which Could Possible be Transmitted by Foods but Proof Is Lacking 18 -I.-I PAMSITIC DISEASES LL 22 Always or Usually Transmitted by Foods 29 Usually Transmitted by Other Means but Sometimes Foodborne 33 FUNGAL DISEASES ‘- 33 Mycotoxicoses 37 Mushrooms 42 Mycotic Infections 43 PLANT TOXICANTS AND TOXINS 43 Alkaloids 47 Glycosides 4.9 Toxalbumins Resins 50 50 Other Toxicants, Toxins, and Allergens 54 TOXIC ANIM4LS 54 Fish Shellfish 53 60 Other Marine Animals 62 Non-Marine Animals 64 POISONOUS CHEMICALS 64 Metallic’Containers 65 Intentional Additives 68 Incidental and Accidental Food Additives 75 Allergens
    [Show full text]
  • Pepid Pediatric Emergency Medicine Clinical Topics
    PEPID PEDIATRIC EMERGENCY MEDICINE CLINICAL TOPICS NEONATOLOGY • CEPHAL HEMATOMA • CYSTIC FIBROSIS • ABDOMINAL AND CHEST WALL • CEREBRAL PALSY • CYTOMEGALOVIRUS (CMV) DEFECTS (NEONATE AND INFANT) • CHRONIC NEONATAL LUNG • DELAYED TRANSITION • ABNORMAL HEAD SHAPE DISEASE • DRUG EXPOSED INFANT • ABO-INCOMPATIBILITY • COMNGENITAL PARVOVIRUS B 19 • ERYTHROBLASTOSIS FETALIS • ACNE - INFANTILE • CONGENITAL CANDIDIASIS • EXAMINATION OF THE NEWBORN • ALIGILLE SYNDROME • CONGENITAL CATARACTS • EXCHANGE TRANSFUSION • AMBIGUOUS GENITALIA • CONGENITAL CMV • EYE MISALIGNMENT • AMNIOTIC FLUID ASPIRATION • CONGENITAL COXSACKIEVIRUS • FETAL HYDRONEPHROSIS • ANAL ATRESIA • CONGENITAL DYSERYTHROPOIETIC • FETOMATERNAL TRANSFUSION • ANEMIA - SEVERE AT BIRTH ANEMIA • FFEDS/FLUIDS - PRETERM • ANEMIA OF PREMATURITY • CONGENITAL EMPHYSEMA • FPIES(FOOD PROTEIN INDUCED • ANHYDRAMNIOS SEQUENCE • CONGENITAL GLAUCOMA ENTEROCOLITIES SYNDROME) • APGAR SCORE • CONGENITAL GOITER • GASTRO INTESTINAL REFLUX • APNEA OF PREMATURITY • CONGENITAL HEART BLOCK • GROUP B STREPTOCOCCUS • APT TEST • CONGENITAL HEPATIC FIBROSIS • HEMORRHAGIC DISEASE OF THE • ASPHYXIATING THORACIC DYSTRO- • CONGENITAL HEPATITIS B NEWBORN PHY (JEUNE SYNDROME) INFECTION • HEPATIC RUPTURE • ATELECTASIS • CONGENITAL HEPTITIS C • HIV • ATRIAL SEPTAL DEFECTS INFECTION • HYALINE MEMBRANE DISEASE • BARLOW MANEUVER • CONGENITAL HYDROCELE • HYDROCEPHALUS • BECKWITH-WIEDEMANN SYN- • CONGENITAL HYPOMYELINATING • HYDROPS FETALIS DROME • CONGENITAL HYPOTHYROIDISM • HYPOGLYCEMIA OF INFANCY • BENIGN FAMILIAL NEONATAL
    [Show full text]
  • Ecairdiac Poisons
    CHAPTER 36 ECAIRDIAC POISONS NICOTIANA TABACUM : All parts are FATAL DOSE: 50 to 100 rug, of nicotine. It rivals poisonous except the ripe seeds. The dried leaves cyanide as a poison capable of producing rapid death; (tobacco, lanthaku) contain one to eight percent of 15 to 30 g. of crude tobacco. nicotine and are used in the form of smoke or snuff FATAL PERIOD: Five to 15 minutes. or chewed. The leaves contain active principles, which TREATMENT: (I) Wash the stomach with warm are the toxic alkaloids nicotine and anabasine (which water containing charcoal, tannin or potassium are equall y toxic); nornicotine (less toxic). Nicotine permanganate. (2) A purge and colonic wash-out. (3) is a colourless, volatile, hitter, hygroscopic liquid Mecamylamine (Inversine) is a specific antidote given alkaloid. It is used extensively in agricultural and orally (4) Protect airway. (5) Oxygen. (6) horticultural work, for fumigating and spraying, as Symptomatic. insecticides, worm powders, etc. POST-MORTEM APPEARANCES: They are those ABSORPTION ANT) EXCRETION : Each of asphyxia. Brownish froth at mouth and nostrils, cigarette contains about IS to 20 mg. of nicotine of haemorrhagic congestion of Cl tract, and pulmonary which I to 2 rug, is absorbed by smoking; each cigar oedema are seen. Stomach may contain fragments of contains 15 to 40 mg. Nicotine is rapidly absorbed from leaves or may smell of tobacco. all mucous membranes, lungs and the skin. 80 to. 90 THE CIRCUMSTANCES OF POISONING: (1) percent is metabolised by the liver, but some may be Accidental poisoning results due to ingestion, excessive metabolised in the kidneys and the lungs.
    [Show full text]
  • 1 Food Mirrobiolog and There Have Been a Few Recorded Outbreaks As a Result of Fungal Contamination In
    microorganisms or foreign matter. In simple terms, the presence in food of harmful, Food Contaminant unpalatable, or otherwise objectionable foreign substances, this may be chemicals, - microorganisms or diluents, before, during, or after processing or storage, is food contamination. Codex Alimentarius (or food code elaborated by the Codex Alimentarius Commission of the Food and Agriculture Organization and World Health Organization) defines , 'food contamination' as any substance not intentionally added to food, which is present in such food as a result of the production (including operations carried out in crop husbandv, animal husbandv and veterinary medicine), manufacture, processing, preparation, treatment, packing, packaging, transport or holding of such food as a result of environmental contamination. In day to day practice, our food can get contaminated by the water used for cooking or washing, by the soil in which the food is grown, by the container used for storage, preparation and service, by the personnel handling the food at various stages etc. During recent years, the problem of dioxin contaminated chickens, hormone injected cattle, genetically modified varieties of maize such as star link, animal carcasses used to make animal feed and subsequent mad cow disease among animals consuming such feed, pesticide residue containing mineral water and soft drinks of popular brand etc. had received considerable media attention. The list of contaminated food is getting longer and longer. Contaminants in foodstuffs can chiefly be classified as physical, biological and chemical contaminants. Physical contaminants include extraneous matter such as sand, soil, hair etc. Biological contaminants consist of microorganisms such as fungi and their metabolic products. Chemical contaminants, on the other hand, are the products of fast growing modem technology.
    [Show full text]
  • Allergy: the Unmet Need a Blueprint for Better Patient Care
    Allergy: the unmet need A blueprint for better patient care A report of the Royal College of Physicians Working Party on the provision of allergy services in the UK Royal College of Physicians June 2003 Royal College of Physicians of London 11 St Andrews Place, London NW1 4LE Registered charity No. 210508 Copyright © 2003 Royal College of Physicians of London ISBN 1 86016 183 9 Cover design: Merriton Sharp Typeset by Dan-Set Graphics, Telford, Shropshire Printed in Great Britain by The Lavenham Press Ltd, Sudbury, Suffolk Contents Members of the Working Party vii Foreword ix Preface xi Executive summary and recommendations xiii PART ONE Allergy services: current deficits and recommendations for improvement 1. What is allergy? 3 2. The burden of allergic disease in the UK 7 A study on prevalence, healthcare utilisation and trends 7 3. Allergy in children: special issues 9 Prevalence of paediatric allergic diseases in the UK 9 Special requirements of children with allergy 9 Delivery of care 9 Nutrition, growth and development 10 Psychological, social and educational issues 10 Patient education 10 Deficits in current paediatric care 11 Primary care 11 Lack of trained paediatric allergists 11 Fragmented specialty care 11 Medication and side effects 11 Research and preventive measures: the importance of early life events 12 4. Allergy in primary care 13 A UK survey of allergy care in general practice 13 Methods 13 Results 13 Discussion 14 Further research on primary care 15 Management of allergy in primary care 15 The need for more training 16 GP with a special interest (GPSI) in allergy: a new concept 16 Recommendations 17 iii Allergy: the unmet need 5.
    [Show full text]