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Bugs (The True Bugs)
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Bed bugs have piercing–sucking mouthparts typical of the insect order Hemiptera. Accordingly, bites from the bugs often produce welts and local inflammation, probably because of allergic reactions to salivary proteins injected via the mouthparts during feeding (see Chapter 4). On the other hand, for many people (estimated to be 30–50%) the bite is nearly undetectable, leaving no discernible lesion. 25,56,57 Treatment of common and complex cutaneous reactions is usually symptomatic and not necessarily evidence-based. If lesions are pruritic, topical application of over-the-counter or prescription antipruritic agents (paroxime, doxepin) or intermediate potency corticosteroids (triamcinolone) may be helpful. Secondary infections may benefit from topical mupirocin or systemic antibiotics as appropriate. Systemic reactions to bed bug bites are treated as insect-induced anaphylaxis. 40,53,58 That treatment includes intramuscular epinephrine first and antihistamines and corticosteroids where appropriate. Patients with previous generalized reactions should be instructed in the use of an epinephrine autoinjector device, which is to be kept available whenever traveling, and these patients should be referred to an allergist.
Recognition, Treatment, and Prevention of Anaphylaxis
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2014
Stephen F. Kemp, Richard D. deShazo
Systematic reviews have noted the lack of optimal, randomized controlled trials of epinephrine, H1 antihistamines, and corticosteroids in anaphylaxis [84–86]. Several ethical, clinical, and logistic considerations apply (reviewed in Reference [87]). Pending a strengthening of the evidence basis for the treatment of anaphylaxis, practice parameters [88] and consensus emergency management guidelines [89,90] concerning anaphylaxis and its management are available. However, physicians and other health-care professionals may not follow them. In a standardized clinical anaphylaxis scenario, as defined by the UK Resuscitation Council guidelines, 5% of senior house officers would use the proper dose and/or route of administration for epinephrine as outlined in the published guidelines [91]. Other reports examining treatment patterns for anaphylaxis in the emergency departments of civilian [92] and military hospitals [93] indicate that epinephrine is administered during anaphylaxis to 16% and 50% of patients, respectively, according to consensus guidelines. A systematic review of the medical literature identified over 200 gaps in management by physicians, patients, and community (parents, caregivers, teachers), with pervasive deficiencies noted in the knowledge of anaphylaxis clinical features and treatment and proper use of epinephrine autoinjector devices [94].
Peanut allergy: risk factors, immune mechanisms, and best practices for oral immunotherapy success
Published in Expert Review of Clinical Immunology, 2023
Jyothi Tirumalasetty, Suzanne Barshow, Laurie Kost, Lu Morales, Reyna Sharma, Carlos Lazarte, Kari C. Nadeau
There are several important steps that families must take to reduce the chances of an allergic reaction while on pOIT. Patients should be advised to take their pOIT dose at approximately the same time daily. Infants and young children should be supervised while taking pOIT to ensure that the full dose is consumed and to monitor for possible adverse reactions. Patients should be informed that while adverse reactions may be frequent, most are not life-threatening and will likely require management with antihistamines and/or adjustments in pOIT dose [58]. Infants and small children may need to be fed pOIT in a manner that prevents it from coming into prolonged contact with lips or skin around their mouth as this may cause contact urticaria or localized swelling. Exercise and excessive heat should be avoided for at least 1 hour before and 2 hours after taking pOIT. Patients should be advised to plan ahead in order to avoid missed doses secondary to sports or other extracurricular activities. Since consuming pOIT on an empty stomach may also increase the risk of an adverse reaction, pOIT should be taken with a snack or meal [59]. The patient and/or caregiver should understand how to manage reactions based on a physician prescribed emergency plan [43]. The plan should be updated at least yearly, confirming that it includes an appropriately dosed (weight-based) epinephrine autoinjector as well as antihistamines.
Performance characterization of spring actuated autoinjector devices for Emgality and Aimovig
Published in Current Medical Research and Opinion, 2020
Zhongwang Dou, Javad Eshraghi, Tianqi Guo, Jean-Christophe Veilleux, Kevin H. Duffy, Galen H. Shi, David S. Collins, Arezoo M. Ardekani, Pavlos P. Vlachos
Both devices have consistent performance in terms of activation force at both test conditions, and the users are not likely to experience variations for the force exerted on the activation button between monthly doses. However, for Aimovig users, there exists a sudden overshoot (Figure 5(b)) of the button reacting force upon activation, and the consequence of this force overshoot is unclear. Note that this activation force is far less compared to emergency used autoinjectors, e.g. EpiPen, Auvi-Q. The epinephrine autoinjector is an emergency-use autoinjector to treat Anaphylaxis. Therefore, the user may not be the patient, and it is necessary to have strong spring release mechanism so that the operator/helper could have clear feedback. Furthermore, such autoinjector is required to inject into the muscle layer even through clothing, a firm hold with a strong activation force could increase the insertion depth of the device21. However, Emgality/Aimovig are subcutaneous injections and used on a monthly basis, typically at home, and patients usually operate themselves. There is no need for Emgality/Aimovig to have a large activation force for activation.
Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management
Published in Prehospital Emergency Care, 2018
Emily Andrew, Ziad Nehme, Stephen Bernard, Karen Smith
While it is difficult to verify whether all cases receiving epinephrine before EMS arrival warranted this treatment, our data suggests that autoinjector use was associated with fewer abnormalities of vital signs on arrival of EMS. It is possible that a proportion of these cases represent localized allergic reactions, and this could explain the absence of signs of systemic involvement on EMS arrival. However, it could also indicate that patients who are treated with epinephrine before EMS arrival have earlier restoration of normal physiological values, and are therefore less likely to present with clinical signs of deterioration. This observation supports the view that epinephrine autoinjector use in these populations is safe and effective.