Anaphylaxis in Elderly Patients-Data From the European Anaphylaxis Registry

Background: Elicitors and symptoms of anaphylaxis are age dependent. However, little is known about typical features of anaphylaxis in patients aged 65 years or more. Methods: The data from the Network for Online Registration of Anaphylaxis (NORA) considering patients aged ≥65 (elderly) in comparison to data from adults (18–64 years) regarding elicitors, symptoms, comorbidities, and treatment measures were analyzed. Results: We identified 1,123 elderly anaphylactic patients. Insect venoms were the most frequent elicitor in this group (p < 0.001), followed by drugs like analgesics and antibiotics. Food allergens elicited less frequently anaphylaxis (p < 0.001). Skin symptoms occurred less frequently in elderly patients (77%, p < 0.001). The clinical symptoms were more severe in the elderly (51% experiencing grade III/IV reactions), in particular when skin symptoms (p < 0.001) were absent. Most strikingly, a loss of consciousness (33%, p < 0.001) and preexisting cardiovascular comorbidity (59%, p < 0.001) were more prevalent in the elderly. Finally, adrenaline was used in 30% of the elderly (vs. 26% in the comparator group, p < 0.001) and hospitalization was more often required (60 vs. 50%, p < 0.001). Discussion and Conclusion: Anaphylaxis in the elderly is often caused by insect venoms and drugs. These patients suffer more often from cardiovascular symptoms, receive more frequently adrenaline and require more often hospitalization. The data indicate that anaphylaxis in the elderly tends to be more frequently life threatening and patients require intensified medical intervention. The data support the need to recognize anaphylaxis in this patient group, which is prone to be at a higher risk for a fatal outcome

Peanut‐induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

Background Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition

Secular trends in ocean tides: Observations and model results

During the last century the response of the oceans to tidal forces has changed significantly. This study focuses on an analysis of long‐term sea level records located in the Atlantic and Pacific, primarily in the Northern Hemisphere. It shows that changes of tidal amplitude and/or phase have taken place over large scales. The principal solar semidiurnal (S2) tide shows the largest trends. At some locations, the change in the mean tidal range due to tidal trends is significant compared with the trend in mean sea level. Thus, it might be advisable to consider these changes in studies of the impact of rising sea level. Numerical simulations of the principal lunar semidiurnal tide (M2) demonstrate a model sensitivity in the North Atlantic to changes in glacial isostatic adjustment and sea level rise, which captures 30–40% of the magnitude of the trends in observations. However, the spatial patterns do not agree well with those inferred from observations, suggesting that forward global models are currently useful for qualitative but not quantitative understanding of the observed trends. A global free oscillation synthesis indicates that sea level rise due to glacial isostatic adjustment leads to decreasing global resonant periods and increasing damping in the system and a coupled oscillator model shows that changes in sea level on the shelf are much more effective at perturbing shelf and ocean tides than sea level changes in the deep ocean.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84335/1/jgr_seculartrendsintides.pd

Validation of a low dose simulation technique for computed tomography images.

PURPOSE: Evaluation of a new software tool for generation of simulated low-dose computed tomography (CT) images from an original higher dose scan. MATERIALS AND METHODS: Original CT scan data (100 mAs, 80 mAs, 60 mAs, 40 mAs, 20 mAs, 10 mAs; 100 kV) of a swine were acquired (approved by the regional governmental commission for animal protection). Simulations of CT acquisition with a lower dose (simulated 10-80 mAs) were calculated using a low-dose simulation algorithm. The simulations were compared to the originals of the same dose level with regard to density values and image noise. Four radiologists assessed the realistic visual appearance of the simulated images. RESULTS: Image characteristics of simulated low dose scans were similar to the originals. Mean overall discrepancy of image noise and CT values was -1.2% (range -9% to 3.2%) and -0.2% (range -8.2% to 3.2%), respectively, p>0.05. Confidence intervals of discrepancies ranged between 0.9-10.2 HU (noise) and 1.9-13.4 HU (CT values), without significant differences (p>0.05). Subjective observer evaluation of image appearance showed no visually detectable difference. CONCLUSION: Simulated low dose images showed excellent agreement with the originals concerning image noise, CT density values, and subjective assessment of the visual appearance of the simulated images. An authentic low-dose simulation opens up opportunity with regard to staff education, protocol optimization and introduction of new techniques

Time flow of CT scans at different dose levels.

<p>First, all native scans were performed. Afterwards, contrast enhanced scans were acquired, in a random order of the different dose levels. There was a gap of 30 minutes between the scans. 100 mAs scan ( =  base of the simulations) was achieved twice in order to minimize discrepancies between originals and simulations caused by differences in contrast accumulation.</p

Differences of the mean and confidence interval for noise (a) and CT values (b) for bone, fat, fluid, lung, and muscle at different dose levels.

<p>Differences of the mean and confidence interval for noise (a) and CT values (b) for bone, fat, fluid, lung, and muscle at different dose levels.</p

Image noise for different anatomical regions in original and simulated images at different dose levels.

<p>There were no significant differences between originals and simulations (p>0.05).</p><p>Image noise for different anatomical regions in original and simulated images at different dose levels.</p