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Anaphylaxis care in pregnancy: New guidance published

Anaphylaxis care in pregnancy: New guidance published

 Anaphylaxis in pregnancy – a condition that poses risks for both the mother and the fetus – now has published guidelines, thanks to work done at the University of California in San Diego and the Kaiser Permanente Medical Center. Guidelines previously did not exist.  The authors point out that just as the general incidence of anaphylaxis is increasing, it is also increasing in pregnant women.

During the three trimesters of pregnancy the causes of anaphylaxis are the same as in the general population. In order of decreasing frequency these are: foods, stinging insects, medications, biologic agents (X-ray dyes) and latex. At the time of labor and delivery the causes shift. Again in the order of decreasing frequency they are: antibiotics, latex, neuromuscular blockers (used as part of anesthesia), oxytosin (used to stimulate contractions of the uterus), local anesthetics and transfusion of blood or blood products.

The symptoms of anaphylaxis in pregnancy are the same as in non-pregnant women, with a few caveats, and include itching, rash, swelling, throat constriction, wheezing, nausea, vomiting, diarrhea, tachycardia and low blood pressure. Symptoms somewhat unique to pregnancy include severe vulvar and vaginal itching, low back pain and premature labor contractions.

Treatment of anaphylaxis in pregnancy is the same as for non-pregnant women with some special considerations. Adrenalin (epinephrine) is still the mainstay of therapy. It is critical to give enough adrenalin to maintain the mother’s systolic blood pressure above 90 (and thereby the fetal blood flow).

IV fluids are used as in all people with anaphylaxis, as is oxygen – except in pregnant patients high levels, even 100 percent oxygen, are recommended. Recumbency is part of treatment of all anaphylaxis, but it is best for the pregnant woman lie on her left side so as to better ensure uterine blood flow.

Finally, if the anaphylaxis is protracted or severe, emergency C-section delivery of the infant is indicated.

Vaccine Research addresses serious worldwide uptick in food allergy

Vaccine Research addresses serious worldwide uptick in food allergy

Another part of the Journal of Allergy and Clinical Immunology’s food allergy symposium addressed European research on food vaccines. Impetus for this research is the worldwide increase in food allergy and also the increasing frequency of anaphylactic shock from food allergy.

Since vaccine therapy has proven successful in treating respiratory allergies and has also worked to prevent recurrent anaphylaxis from insects, it stands to reason that it could help eliminate food allergy and prevent food-related anaphylaxis.

Four types of vaccines for food allergy have been studied in Europe (and other countries): oral, sublingual, epicutaneous and subcutaneous.

All of these methods have proven to be of some benefit. Unfortunately, the ones that lead to the best improvement seem to have more side effects. Between the two ingestion vaccines (immunotherapy), oral immunotherapy leads to better reduction in allergy than sublingual.

The oral route commonly leads to GI side effects such as heartburn, nausea, vomiting, cramps and diarrhea. The sublingual route was much less likely to cause these symptoms, but did lead to itching and swelling in the mouth. Epinephrine shots had to be given twice as often for reactions in the oral group as compared to the sublingual group.

But patients who were successfully treated from both groups were able to ingest the implicated food – such as peanut – without going into allergic shock.

Subcutaneous immunotherapy, which is how traditional allergy shots are given, was more effective than epicutaneous immunotherapy. But once again, the more effective format led to more frequent vaccine reactions and to greater need for epinephrine to treat some of the reactions. When either of these techniques was successful, it again allowed the patient to safely ingest the offending food.

The European study group is conducting new and longer studies of these various forms of immunotherapy. The studies will include children, adolescents and adults. They also are adding studies to compare the use of pharmaceutical-grade food extracts versus the use of the entire native food as a vaccine substrate to see which works better and is safer.