Potentiated anaphylaxis in patients with drug-induced beta-adrenergic blockade

Jacobs, Robert L.; Rake, Geoffrey; Fournier, Donald C.; Chilton, Robert; Culver, William G.; Beckmann, Charles H.

doi:10.1016/0091-6749(81)90170-6

Cited by 143 publications

(30 citation statements)

References 7 publications

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“…Concern has been raised regarding not only the incidence of SR but also their severity and whether they respond well to IM epinephrine, especially in patients on concurrent BB or ACE-i treatment [10,12,16,17,18,19,20]. Our data do not support this apprehension.…”

Section: Discussioncontrasting

confidence: 56%

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Rosman

Confino‐Cohen²,

Goldberg³

2017

Int Arch Allergy Immunol

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Background: Venom immunotherapy (VIT) is considered to be the gold standard treatment for patients with hymenoptera venom allergy. This treatment induces systemic reactions (SR) in a significant number of patients. Objective: To evaluate the outcome of VIT in patients with known risk factors for VIT-induced SR and to compare rush VIT (RVIT) and conventional VIT (CVIT). Methods: All of the patients who received VIT and had at least one of the following risk factors were included: current cardiovascular disease, uncontrolled asthma, high basal serum tryptase, current treatment with β-blockers or angiotensin-converting enzyme inhibitors, and age >70 or <5 years. Results: Sixty-four patients were included, and most of them (52; 81.5%) were allergic exclusively to bee venom. Thirty-five (54.7%) patients underwent RVIT and 29 CVIT. The incidence of patients who developed SR during the build-up phase was similar for RVIT and CVIT (25.7 and 27.5%, respectively; p = 1). However, the incidence of SR per injection was significantly higher in CVIT than in RVIT (5.6 and 2.75%, respectively; p = 0.01). Most reactions (79.1%) were mild, limited to the skin. Most of the patients (92.1%) reached the full maintenance dose of 100 μg. This dose was reached by a significantly larger number of patients receiving RVIT compared to CVIT (100 and 82.7%, respectively; p = 0.01). None of the patients experienced exacerbation of their concurrent chronic disease during VIT. Conclusion: VIT can be performed safely and efficiently in patients with risk factors for immunotherapy. In these patients RVIT appears to be safer and more efficient than CVIT.

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Section: Discussioncontrasting

confidence: 56%

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Rosman

Confino‐Cohen²,

Goldberg³

2017

Int Arch Allergy Immunol

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“…There have been reports of increased anaphylaxis severity and impaired response to epinephrine among beta-blocker users [45][46][47]. However, a study evaluating patients presenting peanut allergy and cardiac disease (congestive heart failure or postmyocardial infarction) observed that beta-blocker use should not be discouraged in these patients, since heart disease mortality was markedly reduced and outweighs beta blocker usage risks [48].…”

Section: Tryptasementioning

confidence: 93%

Perioperative Anaphylaxis

Galvão

Giavina‐Bianchi

Castells

2014

Curr Allergy Asthma Rep

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Perioperative anaphylaxis is a life-threatening condition with an estimated prevalence of 1:3,500 to 1:20,000 procedures and a mortality rate of up to 9 %. Clinical presentation involves signs such as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Prompt recognition and treatment is of utmost importance to the patient's prognosis, since clinical deterioration can develop rapidly. Epinephrine is the main treatment drug, and its use should not be postponed, since delayed administration is associated with increased mortality. Elevated levels of serum tryptase help to confirm the diagnosis. The main agents involved in IgE-mediated perioperative anaphylaxis are neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Specific investigation should be conducted 4 to 6 weeks after the reaction and relies on skin tests, serum-specific IgE, and challenge procedures. This review aims to discuss the main aspects of perioperative anaphylaxis: risk factors, diagnosis, treatment, culprit agents, specific investigation, and preventive measures.

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“…Jacobs et al [16] described two severe nonfatal anaphylactic reactions that featured an inappropriately slow pulse during profound hypotension and a sluggish response to pharmacotherapy. Newman and Schultz [17] reported a similar case.…”

Section: Clinical Observationsmentioning

confidence: 98%

Do β-blockers really enhance the risk of anaphylaxis during immunotherapy?

Lang

2008

Curr Allergy Asthma Rep

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Both beta-blockers and allergen immunotherapy are frequently prescribed, and allergy/immunology physicians commonly encounter patients who are candidates for immunotherapy and are receiving beta-blockers. The evidence in the medical literature indicates that although anaphylaxis does not appear to be more frequent, beta-blocker exposure is associated with greater risk for severe anaphylaxis, and for anaphylaxis refractory to treatment. Use of beta-blocker suspension merits consideration to reduce risk for untoward outcomes, while supplanting the beta-blocker medication with an equally efficacious non-beta-blocker alternative. For patients who require a beta-blocker for an indication for which there is no equally effective substitute, a management decision by the physician prescribing allergen immunotherapy should be approached carefully from an individualized risk-benefit standpoint.

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Potentiated anaphylaxis in patients with drug-induced beta-adrenergic blockade

Cited by 143 publications

References 7 publications

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Perioperative Anaphylaxis

Do β-blockers really enhance the risk of anaphylaxis during immunotherapy?

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