Looking for Mast Cell Doc recommendation for Phoenix area?
https://www.annemergmed.com/article/S0196-0644(00)43749-2/pdf
Improved Outcomes in Patients With Acute Allergic Syndromes Who Are Treated With Combined H1 and H2 Antagonists
R Y Lin et al. Ann Emerg Med. 2000 Nov.
These data show that adding H2 blockers to H1 antagonists results in additional improvement of certain cutaneous outcomes for patients presenting with acute allergic syndromes. These findings favor the recommendation for using combined H1 and H2 antihistamines in acute allergic syndromes.
Good reference on autoimmune diseases from NIH
Mast cells, which are part of the immune system and are involved in the inflammatory allergic response, are activated in some chronic pain conditions, including headache.
Researchers are examining the possibility of a relationship between the mast cellsâ anti-analgesic properties and their proximity to and enhanced activation of nerve fiber endings that receive and transmit pain signals (nociceptors).
Mast cells may release substances that activate nociceptive nerve cells that transmit signals from the linings of the skull and its blood vessels. Findings that link mast cell activation to headache pain may identify drug targets that could lead to new analgesics for headache and other pain syndromes.
Great New Paper from JAMA on Meds
Pathogenesis, Newly Recognized Etiologies, and Management of Idiopathic Anaphylaxis
James L. Kuhlen and Yamini V. Virkud
Additional article information
Abstract
Idiopathic anaphylaxis (IA) is a life-threatening allergic disease and the most common diagnosis given to patients following an anaphylactic event.
The inability of the healthcare provider and the patient to identify the trigger for anaphylaxis makes standard allergen avoidance measures ineffectual. IA is diagnosed after other causes of anaphylaxis have been excluded.
Mast cell activation syndromes (MCAS), mastocytosis, IgE to galactose-alpha-1,3-galactose (α-gal), and certain medications have recently been recognized as causes of anaphylaxis that were previously labeled idiopathic.
This review will describe the epidemiology and proposed theories of pathogenesis for IA, its diagnostic approach, its clinical management, and examine newly recognized disorders that were previously labeled as idiopathic anaphylaxis.
When every thing seems overwhelming remember⊠You Are Whirling around Earth at 1000 miles per hour; around the Sun at 67,000 mph; spinning at 514,000 mph around the Galaxy; and zooming along at 1.3 million miles per hour across the Universe. So grab a coffee, sit down, buckle up, shut up, hang on, and enjoy the ride. Wheeeeeeeeeeeee!!!
Iâve reached this point.
And the early cures were called what? Cocktails yâallâŠGood for what ails yaâ⊠I think I hear a Sazerac calling my name.
Meselson Matthew. (2020) Droplets and Aerosols in the Transmission of SARS-CoV-2. N Engl J Med DOI: 10.1056/NEJMc2009324.
âThe act of speaking generates oral fluid droplets that vary widely in size,1 and these droplets can harbor infectious virus particles. Whereas large droplets fall quickly to the ground, small droplets can dehydrate and linger as âdroplet nucleiâ in the air, where they behave like an aerosol and thereby expand the spatial extent of emitted infectious particles.2 We report the results of a laser light-scattering experiment in which speech-generated droplets and their trajectories were visualized.â
Yay! Doubling time is over 10 Days (10.3 days), up from 2.2 days in March.
The chart above shows the percent increase in total coronavirus cases in the U.S. each day since March 18. It does not show a decrease in cases. Nor does it show that there were fewer new cases each day.
Instead, it demonstrates that the rate of increase in new cases is slowing fairly consistently. By that measure, the pandemic has arguably now peaked in the U.S., even though the total number of cases is expected to continue rising for now. A second wave of infections remains a major risk.
Glucose metabolism aggravation of cytokine response.
Latest info on spread. Just talking spreads it and watch those shoes, blue suede or not.
"On the whole, Wang finds it too early to say what the role of antibodies is for SARS-CoV-2.
âWe have no idea if production of antibodies during a primary infection, for example, has any role in clearing virus during that infection, or for that matter, we donât have any good data on whether antibodies produced during an infection are protective against a second infection,â she says.
And even if they were protective, they may not be protective for everyone. âAntibody responses can vary tremendously from person to person.â"
From OZY
92% The Big Number 92%
A whopping 92 percent of Americans say they are practicing social distancing, shocking public health experts who predicted maybe half would actually comply. Then again, theyâve been wrong about everything from the efficacy of masks to the ability for the virus to be transmitted by air, so whatâs new.
It turns out a nation born in revolution is remarkably cooperative when Uncle Sam says lives are at stake â so far, anyway. Americans when faced with a common enemy rise to the challenge.
âThe share of U.S. residents who report taking precautions or making preparations in reaction to the coronavirus outbreak has increased dramatically in recent weeks. Nearly all Americans â including large majorities across partisans and age groups â report they have either been taking social distancing measures such as deciding not to travel, cancelling plans, or staying home instead of going to work, school, or other activities (92%), or say they have been sheltering-in-place and not leaving home except for essential services such as food, medicine, or health care (82%).â
Guideline Watch | GENERAL MEDICINE
April 16, 2020
Updated Anaphylaxis Guidelines
David J. Amrol, MD reviewing Shaker MS et al. J Allergy Clin Immunol 2020 Apr
Use of epinephrine is stressed, and recommendations are given for managing biphasic reactions.
Sponsoring Organizations: The Joint Task Force on Practice Parameters (from the American Academy of Allergy, Asthma & Immunology [AAAAI] and the American College of Allergy, Asthma, and Immunology [ACAAI])
Background
As many as 5% of people experience anaphylaxis in their lifetime, with medications and stinging insects being the leading causes of anaphylaxis in adults, and foods and stings being the leading causes in children.
Although overall risk for death from anaphylaxis is quite low (0.3% of emergency visits or hospitalizations for anaphylaxis end with fatalities), comorbid conditions, such as uncontrolled asthma, cardiovascular disease, or advanced age, are associated with excess risk.
Key Points
The only effective treatment for anaphylaxis is epinephrine (0.01 mg/kg; maximum, 0.3 mg in children and 0.5 mg in adults) given intramuscularly in the anterolateral thigh.
As many as 20% of patients experience biphasic reactions that can occur as long as 72 hours later, with potentially life-threatening symptoms. Patients with severe anaphylaxis, those who require multiple doses of epinephrine, or those with delayed administration of epinephrine are at greatest risk. Negative predictive values for a biphasic reaction after discharge are 95% and 97% for patients who are watched for 1 and 6 hours, respectively. Using a cost-benefit analysis, the panel recommends observing patients with mild episodes for 1 hour after resolution of symptoms and observing patients with severe symptoms for at least 6 hours.
No evidence supports use of glucocorticoids or antihistamines to treat severe anaphylaxis symptoms or prevent biphasic reactions; however, antihistamines might help reduce acute itching and urticaria.
To prevent reactions in some chemotherapy protocols, pretreatment with corticosteroids and antihistamines might help, but the panel suggests against using them to avoid radiocontrast reactions in patients with prior hypersensitivity reactions who are about to receive low- or iso-osmolar nonionic radiocontrast agents.
Comment
Although most of these recommendations are based on very lowâcertainty evidence, the take-home point is that anaphylaxis should be treated promptly and, if needed, repeatedly, with epinephrine. Patients should then be watched for biphasic reactions.
Antihistamines might help suppress cutaneous, but not life-threatening, symptoms; glucocorticoids probably have no role in anaphylaxis.
And finally, after years of using antihistamines and corticosteroids to pretreat patients who had previous reactions to radiocontrast agents, pretreatment is no longer recommended before exposure to low- and iso-osmolar nonionic radiocontrast agents.
Shaker MS et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020 Apr; 145:1082. (Redirecting)
Shaker MS et al.
Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis.
J Allergy Clin Immunol 2020 Apr; 145:1082.
CONCLUSIONS
Anaphylaxis is a multisystem allergic emergency. Early recognition and prompt administration of intramuscular epinephrine remain the cornerstone of management.
Risk factors for biphasic reactions include severe anaphylaxis and/for the need for >1dose of epinephrine. Additional biphasic anaphylaxis risk factors include wide pulse pressures, unknown anaphylaxis trigger, cutaneous signs and symptoms, and drug trigger in children.
Although treatment of anaphylaxis in the United States also traditionally has included use of antihistamines and glucocorticoids, data demonstrating the benefit of these additional approaches are very low certainty and when evaluated on the whole do not offer clear support for this practice to prevent biphasic anaphylaxis.
Supplemental therapies such as glucocorticoids and antihistamines should never delay the rapid administration of epinephrine assoon asanaphylaxis is recognized.
Consistent with the lack of clear benefit of antihistamines and/or glucocorticoids in prevention of biphasic anaphylaxis, current evidence is poor that routine use of these therapies prevents anaphylaxis in patients with a history of RCM HSRs (vs using a low-or iso-osmolar contrast without premedication, preferably an alternative agent) or in patients receiving infliximab without prior anaphylaxis; however, some circumstances do exist where premedication with antihistamines and/or glucocorticoids is warranted (eg, RITand some forms of chemotherapy).
As such, while prompt recognition and administration of epinephrine remains paramount in anaphylaxis management, clinical judgment is an irreplaceable key factor to optimize high-quality care.