Delayed anaphylaxis to red meat masquerading as idiopathic anaphylaxis.

Anaphylaxis is traditionally recognized as a rapidly developing combination of symptoms that often includes hives and hypotension or respiratory symptoms. Furthermore, when a specific cause is identified, exposure to this cause is usually noted to have occurred within minutes to 2 hours before the onset of symptoms. This case is of a 79-year-old woman who developed a severe episode of anaphylaxis 3 hours after eating pork.

Changes in cat specific IgE and IgG antibodies with decreased cat exposure.

Background: Current understanding of the effects of reducing exposure to cat allergens is limited. It has also become clear that there are different forms of immune response to cat allergens.

Objective: To investigate changes in skin tests and cat specific IgG and IgE antibodies when students from a home with a cat move to a college dormitory.

Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose.

Background: In 2009, we reported a novel form of delayed anaphylaxis to red meat related to serum IgE antibodies to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal). Although patients were remarkably consistent in their description of a 3- to 6-hour delay between eating mammalian meat and the appearance of symptoms, this delay has not been demonstrated under observed studies.

Objectives: We sought to formally document the time course of clinical symptoms after the ingestion of mammalian meat in subjects with IgE to alpha-gal and to monitor ex vivo for the appearance of markers of an allergic reaction.

A modern-day purgatory: older adults in the emergency department with nonoperative injuries.

Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These individuals typically do not meet criteria for hospital admission, but because of limited reimbursement for observation, admitting physicians are often reluctant to accept these individuals for observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in-home care is also often difficult or impossible.

Peanut, milk, and wheat intake during pregnancy is associated with reduced allergy and asthma in children.

Background: Maternal diet during pregnancy may affect childhood allergy and asthma.

Objective: We sought to examine the associations between maternal intake of common childhood food allergens during early pregnancy and childhood allergy and asthma.

Methods: We studied 1277 mother-child pairs from a US prebirth cohort unselected for any disease.

Comparison of viral load in individuals with and without asthma during infections with rhinovirus.

Rationale: Most virus-induced attacks of asthma are caused by rhinoviruses (RVs).

Objectives: To determine whether people with asthma are susceptible to an increased viral load during RV infection.

Methods: Seventy-four children (4-18 yr old) were enrolled; 28 with wheezing, 32 with acute rhinitis, and 14 without respiratory tract symptoms.

Drug allergens and food--the cetuximab and galactose-α-1,3-galactose story.

Objective: A novel form of food allergy has been described that initially became apparent from IgE reactivity with the drug cetuximab. Ongoing work regarding the etiology, distribution, clinical management, and cellular mechanisms of the IgE response to the oligosaccharide galactose-α-1,3-galactose (α-gal) is reviewed.

Data Sources: Brief review of the relevant literature in peer-reviewed journals.

Non-publication of large randomized clinical trials: cross sectional analysis.

Objective: To estimate the frequency with which results of large randomized clinical trials registered with ClinicalTrials.gov are not available to the public.

Design: Cross sectional analysis

Setting: Trials with at least 500 participants that were prospectively registered with ClinicalTrials.

Wheeze in infancy: protection associated with yeasts in house dust contrasts with increased risk associated with yeasts in indoor air and other fungal taxa.

Background: While fungal exposures are assumed to provoke wheeze through irritant or allergenic mechanisms, little is known about the differential effects of indoor and outdoor fungi on early-life wheeze.

Methods: In a Boston prospective birth cohort of 499 at-risk infants, culturable fungi in bedroom air and dust and outdoor air were measured at the age of 2-3 months. Wheeze was determined using bimonthly telephone questionnaires.

Predictive value of initial triage vital signs for critically ill older adults.

Introduction: Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED.

Methods: We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults.

Emerging antigens involved in allergic responses.

New allergic diseases can 'emerge' because of exposure to a novel antigen, because the immune responsiveness of the subject changes, or because of a change in the behavior of the population. Novel antigens have entered the environment as new pests in the home (e.g.

Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis.

Background: Atopic dermatitis (AD) is common in children; however, persistence of AD with or without asthma is less common. Longitudinal studies remain limited in their ability to characterize how IgE antibody responses evolve in AD, and their relationship with asthma.

Objective: To use a cross-sectional study design of children with active AD to analyse age-related differences in IgE antibodies and relation to wheeze.

Side effects from oral opioids in older adults during the first week of treatment for acute musculoskeletal pain.

Objectives: The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain.

Methods: This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects.

Computer-facilitated review of electronic medical records reliably identifies emergency department interventions in older adults.

Objectives: An estimated 14% to 25% of all scientific studies in peer-reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time-consuming and error-prone. Computer-based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records.

Tick bites and red meat allergy.

Purpose Of Review: A novel form of anaphylaxis has been described that is due to IgE antibody (Ab) directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). Ongoing work regarding the cause and distribution of this IgE response is reviewed.

Recent Findings: Our recent work has identified a novel IgE Ab response that has been associated with two distinct forms of anaphylaxis: immediate-onset anaphylaxis during first exposure to intravenous cetuximab and delayed-onset anaphylaxis 3-6 h after ingestion of mammalian food products (e.

Pain treatment for older adults during prehospital emergency care: variations by patient gender and pain severity.

Unlabelled: Older adults are less likely than younger adults to receive analgesic treatment during emergency department visits. Whether older adults are less likely to receive analgesics during protocolized prehospital care is unknown. We analyzed all ambulance transports in 2011 in the state of North Carolina and compared the administration of any analgesic or an opioid among older adults (aged 65 and older) versus adults aged 18 to 64.

Physical deconditioning as a cause of breathlessness among obese adolescents with a diagnosis of asthma.

Background: Obese children frequently complain of breathlessness. Asthma and obesity can both contribute to the symptoms during exercise, and this symptom can contribute to a diagnosis of asthma in these children. Despite the high prevalence of obesity few studies have investigated the cardiopulmonary physiology of breathlessness in obese children with a diagnosis of asthma.

Shared decision-making in the selection of outpatient analgesics for older individuals in the emergency department.

Objectives: To assess the relationship between older adults' perceptions of shared decision-making in the selection of an analgesic to take at home for acute musculoskeletal pain and (1) patient satisfaction with the analgesic and (2) changes in pain scores at 1 week.

Design: Cross-sectional study.

Setting: Single academic emergency department.