Food-induced fatal anaphylaxis: from epidemiological data to general prevention strategies

BACKGROUND: Anaphylaxis hospitalisations are increasing in many countries, in particular for medication and food triggers in young children. Food-related anaphylaxis remains an uncommon cause of death, but a significant proportion of these are preventable. AIM: To review published epidemiological data relating to food-induced anaphylaxis and potential risk factors of fatal and/or near-fatal anaphylaxis cases, in order to provide strategies to reduce the risk of severe adverse outcomes in food anaphylaxis. METHODS: We identified 32 published studies available in MEDLINE (1966-2017), EMBASE (1980-2017), CINAHL (1982-2017), using known terms and synonyms suggested by librarians and allergy specialists. RESULTS: Young adults with a history of asthma, previously known food allergy particularly to peanut/tree nuts are at higher risk of fatal anaphylaxis reactions. In some countries, cow's milk and seafood/fish are also becoming common triggers of fatal reactions. Delayed adrenaline injection is associated with fatal outcomes, but timely adrenaline alone may be insufficient. There is still a lack of evidence regarding the real impact of these risk factors and co-factors (medications and/or alcohol consumption, physical activities, and mast cell disorders). CONCLUSIONS: General strategies should include optimization of the classification and coding for anaphylaxis (new ICD 11 anaphylaxis codes), dissemination of international recommendations on the treatment of anaphylaxis, improvement of the prevention in food and catering areas and, dissemination of specific policies for allergic children in schools. Implementation of these strategies will involve national and international support for ongoing local efforts in relationship with networks of centres of excellence to provide personalized management (which might include immunotherapy) for the most at-risk patients. This article is protected by copyright. All rights reserved

Effects of Dibutyryl Cyclic-AMP on Survival and Neuronal Differentiation of Neural Stem/Progenitor Cells Transplanted into Spinal Cord Injured Rats

Neural stem/progenitor cells (NSPCs) have great potential as a cell replacement therapy for spinal cord injury. However, poor control over transplant cell differentiation and survival remain major obstacles. In this study, we asked whether dibutyryl cyclic-AMP (dbcAMP), which was shown to induce up to 85% in vitro differentiation of NSPCs into neurons would enhance survival of transplanted NSPCs through prolonged exposure either in vitro or in vivo through the controlled release of dbcAMP encapsulated within poly(lactic-co-glycolic acid) (PLGA) microspheres and embedded within chitosan guidance channels. NSPCs, seeded in fibrin scaffolds within the channels, differentiated in vitro to betaIII-tubulin positive neurons by immunostaining and mRNA expression, in response to dbcAMP released from PLGA microspheres. After transplantation in spinal cord injured rats, the survival and differentiation of NSPCs was evaluated. Untreated NSPCs, NSPCs transplanted with dbcAMP-releasing microspheres, and NSPCs pre-differentiated with dbcAMP for 4 days in vitro were transplanted after rat spinal cord transection and assessed 2 and 6 weeks later. Interestingly, NSPC survival was highest in the dbcAMP pre-treated group, having approximately 80% survival at both time points, which is remarkable given that stem cell transplantation often results in less than 1% survival at similar times. Importantly, dbcAMP pre-treatment also resulted in the greatest number of in vivo NSPCs differentiated into neurons (37±4%), followed by dbcAMP-microsphere treated NSPCs (27±14%) and untreated NSPCs (15±7%). The reverse trend was observed for NSPC-derived oligodendrocytes and astrocytes, with these populations being highest in untreated NSPCs. This combination strategy of stem cell-loaded chitosan channels implanted in a fully transected spinal cord resulted in extensive axonal regeneration into the injury site, with improved functional recovery after 6 weeks in animals implanted with pre-differentiated stem cells in chitosan channels

Gynecologic oncology group trials of chemotherapy for metastatic and recurrent cervical cancer

Because only 16% of patients with metastatic cervical cancer are alive 5 years after diagnosis, the Gynecologic Oncology Group (GOG) has carefully designed and conducted many phase II studies to identify promising drugs. Cisplatin has emerged as the most active single agent with overall response rates of 19%. Recent phase III trials have documented response rates of 27% and 39% when cisplatin has been combined with either paclitaxel or topotecan, respectively. The comparison of cisplatin to cisplatin plus topotecan in GOG-179 has yielded the first study to show a statistically significant impact on the overall response rate, median progression-free survival, and median survival, with all outcome measures favoring the two-drug regimen. Despite these encouraging results, however, most of the responses are partial and of short duration. The need for novel combinations and the implementation of active biologic agents is implicit. The accumulated data in this disease setting, as evidenced by the experience of the GOG, are presented in this review

Définition de l'anaphylaxie

International audienceHarmonized terminology and definition of any condition are key to capture more accurate epidemiological data, and it is not different for anaphylaxis. A standard registry of morbidity and mortality data provides health information for statistics and epidemiology, health care management, allocation of resources, monitoring and evaluation of research, and for disease prevention and treatment.Anaphylaxis is a multi-faceted condition that can manifest at any age and any health professional may be faced by it. Recently, the WAO anaphylaxis committee has proposed revisiting the definition and clinical criteria of anaphylaxis in a view of including more mild and atypical reactions: “Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterized by potentially life-threatening compromise in breathing and/or the circulation, and may occur without typical skin features or circulatory shock being present.” This proposal is aligned to the International Classification of Diseases eleventh edition, maintained by the World Health Organization (WHO).The WHO Collaborating Center for the Scientific Classification of Allergic and Hypersensitivity Diseases established at the University Hospital of Montpellier is the only WHO Center representing the allergy specialty, and is currently implementing actions related to anaphylaxis.The new definition of anaphylaxis is timely and will support better clinical recognition, epidemiological data, quality care of patients and public health actions, preventing avoidable deaths. It is expected that it will undergo international validation process, refinements and updates, understanding specific needs, such as adapting the definition to age groups.Harmoniser la terminologie des maladies est essentiel pour générer des données épidémiologiques précises, et il n'en va pas différemment pour l'anaphylaxie. Un registre standard de données de morbidité et de mortalité fournit des informations sanitaires pour les statistiques et l'épidémiologie, la gestion des soins de santé, l'allocation des ressources, le suivi et l'évaluation de la recherche, ainsi que pour la prévention et le traitement des maladies.L'anaphylaxie est une maladie à multiples facettes qui peut se manifester à tout âge et tout professionnel de la santé peut y être confronté. Récemment, le comité d'anaphylaxie de la World Allergy Organization (WAO) a proposé de revoir la définition et les critères cliniques de l'anaphylaxie en vue d'inclure des réactions plus légères et atypiques : « L'anaphylaxie est une réaction d'hypersensibilité systémique grave qui apparaît généralement rapidement et peut entraîner la mort. L'anaphylaxie sévère est caractérisée par une altération potentiellement mortelle de la respiration et/ou de la circulation, et peut survenir sans la présence de caractéristiques cutanées typiques ou de choc circulatoire. » Cette proposition est alignée avec la onzième édition de la Classification internationale des maladies (CIM) de l'Organisation mondiale de la santé (OMS).Le Centre collaborateur de l'OMS (CC OMS) pour la classification scientifique des maladies allergiques et d'hypersensibilité établi au centre hospitalier universitaire (CHU) de Montpellier est le seul centre de l'OMS représentant la spécialité allergologie ; il met actuellement en œuvre des actions liées à l'anaphylaxie. La nouvelle définition de l'anaphylaxie est opportune car elle pourra soutenir une meilleure reconnaissance clinique, de meilleures données épidémiologiques, des soins de qualité aux patients et des actions de santé publique, de façon à prévenir les décès évitables. On s'attend à ce qu'elle fasse l'objet d'un processus de validation internationale, d'affinements et de mises à jour avec notamment adaptation à des besoins spécifiques, tels que ceux liés aux diverses tranches d'âge