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- A Case of Zaltoprofen Induced Kounis Syndrome
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Seong You Lee, Won Young Sung, Jang Young Lee, Sang Won Seo, Won Suk Lee
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J Korean Soc Clin Toxicol. 2019;17(1):32-37. Published online June 30, 2019
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DOI: https://doi.org/10.22537/jksct.2019.17.1.32
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Abstract
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- Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal anti-inflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.
- Fomepizole for Ethylene Glycol or Methanol Poisoning in Children
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Ha Na Min, Yoon Jung Hwang, Dong Ryul Ko, Young Seon Joo, Tae Young Kong, Min Hong Choa, In Cheol Park, Sung Phil Chung
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J Korean Soc Clin Toxicol. 2017;15(2):79-85. Published online December 31, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.2.79
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- Purpose: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. Methods: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. Results: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. Conclusion: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.
- Accuracy of Disease Codes Registered for Anaphylaxis at Emergency Department
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Jin Kyun Choi, Sun Hyu Kim, Hyeji Lee, Byungho Choi, Wook-jin Choi, Ryeok Ahn
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J Korean Soc Clin Toxicol. 2017;15(1):24-30. Published online June 30, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.1.24
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- Purpose: This study was conducted to investigate the frequency and clinical characteristics of anaphylaxis patients who are registered inaccurately with other disease codes. Methods: Study subjects presenting at the emergency department (ED) were retrospectively collected using disease codes to search for anaphylaxis patients in a previous studies. The study group was divided into an accurate and inaccurate group according to whether disease codes were accurately registered as anaphylaxis codes. Results: Among 266 anaphylaxis patients, 144 patients (54%) received inaccurate codes. Cancer was the most common comorbidity, and the radio-contrast media was the most common cause of anaphylaxis in the accurate group. Cutaneous and respiratory symptoms manifested more frequently in the inaccurate group, while cardiovascular and neurological symptoms were more frequent in the accurate group. Blood pressure was lower, and shock and non-alert consciousness were more common in the accurate group. Administration of intravenous fluid and epinephrine use were more frequent in the accurate group. Anaphylaxis patients with a history of cancer, shock, and epinephrine use were more likely to be registered as anaphylaxis codes accurately, but patients with respiratory symptoms were more likely to be registered with other disease codes. Conclusion: In cases of anaphylaxis, the frequency of inaccurately registered disease codes was higher than that of accurately registered codes. Anaphylaxis patients who were not treated with epinephrine at the ED who did not have a history of cancer, but had respiratory symptoms were at increased risk of being registered with disease codes other than anaphylaxis codes.
- Predictors of Anaphylactic Shock in Patients with Anaphylaxis after Exposure to Bee Venom
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Hyung-Joo Kim, Sun-Hyu Kim, Hyoung-Do Park, Woo-Youn Kim, Eun-Seog Hong
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J Korean Soc Clin Toxicol. 2010;8(1):30-36. Published online June 30, 2010
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- Purpose: The purpose of this study is to analyze the clinical characteristics of anaphylaxis and anaphylactic shock caused by bee venom. Methods: We retrospectively collected the data of the patients who experienced anaphylaxis caused by natural bee sting or acupuncture using bee venom from January 1999 to December 2008. Seventy subjects were divided into the shock and non-shock groups. The clinical characteristics, sources of bee venom, treatments and outcomes were compared between the two groups. Results: The mean age of the subjects was $45.5{pm}16.3$ years old and the number of males was 44 (62.9%). There were 25 patients in the shock group and 45 in the non-shock group. The age was older (p=0.001) and females (p=0.003) were more frequent in the shock group. Transportation to the hospital via ambulance was more frequent in the shock group (p<0.001). No difference was found in species of bee between the two groups. The cephalic area, including the face, was the most common area of bee venom in both groups. Anaphylaxis caused by bee sting commonly occurred between July and October. Cutaneous and respiratory symptoms were the most frequent symptoms related to anaphylaxis. Cardiovascular and neurologic symptoms were more frequent in the shock group. The amount of intravenously administered fluid and subcutaneous injection of epinephrine were much more in the shock group than that in the non-shock group. Conclusion: Older age was the factors related to anaphylactic shock caused by bee venom. Further validation is needed to evaluate the gender factor associated with shock.
- The Optimal Length of Time to Observe Patients with Contrast Media Anaphylaxis in the Emergency Department
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Sun-Min Hwang, Sung-Hwa Lee, Seok-Ran Yeom, Ji-Ho Ryu, Jin-Woo Jeong, Yong-In Kim, Sang-Kyoon Han
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J Korean Soc Clin Toxicol. 2010;8(1):37-42. Published online June 30, 2010
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- Purpose: The purpose of this study was to determine the optimal length of time to observe patients with contrast media anaphylaxis in the Emergency Department. Methods: This study included the patients of all age groups who presented with anaphylaxis due to contrast media to the ED of Pusan National University Hospital from January 2006 to August 2009. The medical records were retrospectively reviewed. We analyzed the 100 patients who met the inclusion criteria. Their median age was 55 (46-62), and 38 out of the 100 patients (38%) were male. Results: The most common symptom of patients was urticaria. Corticosteroid and H1 antihistamine were given to most of the patients in the ED. All were discharged after observation in the ED and none were admitted to the ward. The average time from injection of the contrast media to the onset of symptom was 31 minutes (24-39) and the average time to symptom recovery was 127 minutes (89-188). The mean observation time in the ED was 93 minutes (59-153). Biphasic reactions were reported in only one case (1/100, 1%). Conclusion: These results suggest that patients who present with an anaphylactic reaction after radiologic studies that use intravenous contrast media can be safely discharged early from the ED because the symptom recovery time is not long and a biphasic reaction is rare.
- Drug-Induced Anaphylactic Shock at the Emergency Department
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Sang-Guen Han, Ryeok Ahn, Sun-Hyu Kim, Seung-Won Choe, Seung-Won Hong
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J Korean Soc Clin Toxicol. 2009;7(2):137-142. Published online December 31, 2009
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- Purpose: This study was conducted to investigate the characteristics of drug induced anaphylactis and anaphylactic shock in patients who were admitted to the emergency department Methods: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. Results: The mean age of the study subjects was $47.9P{pm}14.2$ years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group ($51.5{pm}15.1$ vs $42.5{pm}10.6$, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. Conclusion: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.
- Two Cases of Contact Urticaria Syndrome from Cefotiam in Nurses
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Pyeong-Moon Jang, Jung-Won Lee, Yong-Seung Kim, Young-Shin Cho, Ki-Won Yu, Hoon Lim, Ho-Jung Kim
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J Korean Soc Clin Toxicol. 2006;4(1):65-68. Published online June 30, 2006
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- Contact urticaria describes a wheal and falre response elicitied within 30-60 minutes after cutaneous exposure to certain agents. Contact urticaria encompasses a number of different clinical manifestations and the symptoms which can vary from the mildest forms of burning, stinging and itching sensation to life-threatening anaphylaxis referred to as contact urticaria syndrome. Cefotiam is one of the most popular second generation cephem antibiotic used in korea. Since 1975, contact urticaria due to cephalosporins has been reported, and also, in japan, this reported from about last 15 years. Recently we experienced three nurses working at the general wards with showing contact urticaria and anaphylaxis after occupational exposure to cefotiam antibiotics.
- A Case of Electrocardiographic Change Associated with Anaphylaxis
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Dong Hoon Lee, Hye Young Jang, Eun Kyung Eo, Koo Young Jung
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J Korean Soc Clin Toxicol. 2004;2(1):12-14. Published online June 30, 2004
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- Anaphylaxis is a systemic allergic reaction which can bring fatal results. The common symptoms are erythema, angioedema, urticaria, hypertension and dyspnea. However, in very few cases, ST segment changes in the electrocardiogram can be seen. This is a case of a 51 year old female with normal heart function who showed reversible ST segment depression during anaphylaxis caused by a $H_2$-blocker agent. The cause of ST segment changes during anaphylaxis is thought to be the result of coronary vasospasm mediated by various factors.
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