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Objective To observe the systemic reactions （SRs） associated with subcutaneous immunotherapy （SCIT） using dust mite allergen and to analyze potential risk factors. Methods The occurrence of SRs among 230 patients with allergic rhinitis （AR） who received house dust mite SCIT from December 2019 to December 2022 was retrospectively analyzed， and related risk factors were identified. Results A total of 5 422 injections were given to 230 patients， with an SRs incidence rate of 2.4% per injection and 20.0% per patient. Most SRs were grade I （51.9%）， and no fatal SRs occurred. Symptoms primarily affected the respiratory system for 111 times （84.7%）. Elevated peripheral blood eosinophil count （OR （95% CI）=6.02 （1.76， 20.60）， P = 0.004） and high levels of house dust mite-specific IgE （OR （95% CI）=1.01 （1.00， 1.01）， P = 0.016） were identified as risk factors for SRs， respectively. Conclusions Children with AR allergic to dust mites may experience SRs during SCIT with standardized dust mite allergen preparations， whereas the overall safety of SCIT is good. High eosinophil count and high levels of house dust mite-specific IgE are risk factors for SRs during SCIT.

Objective To observe the systemic reactions (SRs) associated with subcutaneous immunotherapy (SCIT) using dust mite allergen and to analyze potential risk factors. Methods The occurrence of SRs among 230 patients with allergic rhinitis (AR) who received house dust mite SCIT from December 2019 to December 2022 was retrospectively analyzed, and related risk factors were identified. Results A total of 5 422 injections were given to 230 patients, with an SRs incidence rate of 2.4% per injection and 20.0% per patient. Most SRs were grade I (51.9%), and no fatal SRs occurred. Symptoms primarily affected the respiratory system for 111 times (84.7%). Elevated peripheral blood eosinophil count (OR (95% CI)=6.02 (1.76, 20.60), P = 0.004) and high levels of house dust mite-specific IgE (OR (95% CI)=1.01 (1.00, 1.01), P = 0.016) were identified as risk factors for SRs, respectively. Conclusions Children with AR allergic to dust mites may experience SRs during SCIT with standardized dust mite allergen preparations, whereas the overall safety of SCIT is good. High eosinophil count and high levels of house dust mite-specific IgE are risk factors for SRs during SCIT. [ABSTRACT FROM AUTHOR]

Empty mast cell syndrome, also named post anaphylaxis mast cell anergy (PAMA), is a temporary state of loss of mast cell responsiveness after a severe immediate hypersensitivity reaction. In this study, we describe a case of PAMA after accidental re-exposure to amoxicillin in a patient who developed severe anaphylaxis to this drug three days earlier in the operating room. To our knowledge, this report is the second to document this phenomenon.

Introduction: Blood is one of the unique and precious gift that one person can give to another person. Most donors tolerate blood donation well, but sometimes donors can develop adverse reactions. Aim: To analyse the pattern of donor adverse reactions in blood donation in a tertiary care hospital in Bangalore, India. Materials and Methods: It was an ambispective cross-sectional study. Donors who developed adverse reactions over a period of three years from January 2018 to December 2020 (January 2018 to December 2019- retrospective and January 2020 to December 2020- prospective) in a tertiary care hospital in Bangalore were studied. The parameters analysed were the type of adverse reaction (systemic and local), the reaction in first-time donors or repeated donors, and the gender of the donor. Stata 2016 version was used in the analysis of data. Adverse Donor Reaction (ADR) is reported as a percentage and 95% confidence interval. The percentage of ADR in males and females was compared using the Chi-square test. Results: The population studied consisted of 37,007 whole blood donors, with 35347 (95.51%) males and 1660 (4.48%) females. Among 37,007 donors, 316 donors 316/37007 (0.85%) had adverse reactions out of which, 287 were males and 29 females. There were 238 first-time donors and 78 repeat donors. The Vasovagal Reaction (VVR) was the most common 307 donors (97.15%) systemic ADR seen. Local reactions were seen in 9 donors (2.84%). Conclusion: The number of donors who developed ADRs was low still it is desirable to reduce risks. The ADRs can be reduced by diligently following the screening protocols and carrying out the venipuncture precisely.

Abstract Background Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic rhinoconjunctivitis. However, adverse events, including life-threatening systemic reactions, may occur. The purpose of this project is to identify risk factors for systemic reactions to SCIT and to provide practice-based solutions using a quality improvement (QI) framework. Methods A QI initiative was performed in a hospital-based, Canadian Allergy clinic administering SCIT in a 12-month period. Results A total of 4242 injections of SCIT were performed over a period of 12 months. Of these, 10 injections resulted in a systemic reaction requiring epinephrine administration (i.e., an incidence of 1 in 424 injections, or 0.24%). Eight patients had at least one documented risk factor for a systemic reaction, and six had multiple risk factors. Major risk factors included seasonal exacerbation of allergic rhinitis, uncontrolled asthma, and an error in route of administration. All reactions occurred with the highest allergen extract concentration. Conclusion This QI initiative highlights the need for improved patient and health care practitioner education and pre-administration screening. We suggest several considerations for SCIT administration: provide patients with written information on safety; screen patients before injections, including a review of treatment plan adherence and asthma control; adjust dosing to slow down buildup of the most concentrated immunotherapy extract, particularly in high risk patients; and apply additional safety measures in patients with multiple risk factors.

Introduction: Insect bites and stings are common in the paediatric age group. Hymenoptera stings (hornets, wasps, bees and ants) are the leading cause of insect anaphylaxis. The post-envenomation severity varies and is unpredictable, ranging from local to severe systemic reactions. This study aimed to explore the prevalence and predictors of severe systemic reactions post Hymenoptera stings. Methods: A retrospective review of the medical records of paediatric patients with Hymenoptera stings, admitted to two major tertiary centres from January 2014 to December 2018, was conducted. Baseline characteristics, including age, positive history of atopy, type of insects, clinical manifestations (localised or systemic) and complications, were documented. The prevalence of systemic reaction was determined using descriptive statistics. Simple logistic regression and multiple logistic regression were used to determine the factors causing systemic reaction among children with alleged Hymenoptera stings. Results: There were 459 children in the study, predominantly male (n = 300 (65.4%)). The prevalence of systemic reaction in our cohort was 24.8% (n = 114). The majority of cases were hornet stings (n = 333), followed by bees (n = 78), wasps (n = 26) and ants (n = 22), respectively. Older children (OR = 1.13, 95% CI: 1.07-1.19), history of allergy (OR = 4.16, 95% CI: 1.86-9.29), history of atopy (OR = 2.77, 95% CI: 1.49-5.15), and number of sting (OR = 1.08, 95% CI: 1.01-1.15) were associated with higher likelihood of systemic reaction. Conclusion: Older children with a history of allergy or atopy and more stings were identified as increased risk factors for developing systemic reactions. [ABSTRACT FROM AUTHOR]

Abstract Background Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual. Methods A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University. Results 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance. Conclusions This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.

Summary: Background. Vespula spp. and Polistes spp. are relevant species in South Europe, with Vespa velutina nigrithorax (VVN) being considered a public health problem. We aimed to characterize a cohort of Portuguese patients referred for large local reaction (LLR) and/or systemic reaction (SR) to vespids. In patients treated with venom immunotherapy (VIT), induction protocol and frequency of adverse reactions were evaluated. Methods. Retrospective study including patients with LLR and SR to vespids referred to our Immunoallergology Department (2008-2022). Results. A total of 129 patients were evaluated, the majority were male adults (n = 77, 59.7%), from rural areas. From these, 51 patients had SR (Mueller classification: 7.8% grade I, 19.6% grade II, 37.3% grade III, 35.3% grade IV). We found no differences regarding the levels of total serum IgE, basal serum tryptase value, sIgE levels to the eliciting venom or their molecular components, regarding the severity of the SR that motivated the referral to our clinic. In the SR group, previous LLR Hymenoptera sting were reported in 15.7%. Thirty-eight patients (74.5%) initiated VIT: 22 with wasp venom, 14 with paper wasp venom and 2 with Vespa velutina venom. There was one mild systemic reaction, not requiring adrenaline and 4 LLR. Re-stings after VIT occurred in 16 patients, without any systemic or local reactions. Currently, eleven patients remain under VIT. Conclusions. Most vespid-venom allergic patients are male adults from rural areas. Sensitization to wasp venom was present in 52.9%, paper wasp in 33.3% and Vespa velutina in 13.7%. The frequency of adverse reactions during both induction and maintenance phases appears to be low. Despite a reduced sample size, our experience with VVN VIT, suggests its safety.

Background: Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic rhinoconjunctivitis. However, adverse events, including life-threatening systemic reactions, may occur. The purpose of this project is to identify risk factors for systemic reactions to SCIT and to provide practice-based solutions using a quality improvement (QI) framework. Methods: A QI initiative was performed in a hospital-based, Canadian Allergy clinic administering SCIT in a 12-month period. Results: A total of 4242 injections of SCIT were performed over a period of 12 months. Of these, 10 injections resulted in a systemic reaction requiring epinephrine administration (i.e., an incidence of 1 in 424 injections, or 0.24%). Eight patients had at least one documented risk factor for a systemic reaction, and six had multiple risk factors. Major risk factors included seasonal exacerbation of allergic rhinitis, uncontrolled asthma, and an error in route of administration. All reactions occurred with the highest allergen extract concentration. Conclusion: This QI initiative highlights the need for improved patient and health care practitioner education and pre-administration screening. We suggest several considerations for SCIT administration: provide patients with written information on safety; screen patients before injections, including a review of treatment plan adherence and asthma control; adjust dosing to slow down buildup of the most concentrated immunotherapy extract, particularly in high risk patients; and apply additional safety measures in patients with multiple risk factors. [ABSTRACT FROM AUTHOR]

Bee stings (BS) are a life-threatening issue and a growing concern for public health and animals in the Americas. We describe the clinical, pathological, and ultrastructural findings of a massive lethal bee attack in two non-human primates (NHPs). Both animals showed BS scattered throughout the skin, surrounded by a local reaction, diffuse pulmonary congestion, edema, hemorrhage, and remarkable degeneration and necrosis of renal epithelial cells from the proximal and distal tubules, characterizing a systemic bee envenomation reaction. [Display omitted] • First report of fatal bee attack in non-human primates (NHPs). • Clinical, pathological, and ultrastructural findings of BS in NHPs. • Severe local and systemic reactions to bee stings (BS) and venom. • Pulmonary damage and severe kidney injury due to BS. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence of systemic reactions (SR) to subcutaneous immunotherapy (SCIT) for bronchial asthma and/or allergic rhinitis in children and their risk factors. Methods A retrospective analysis was performed on 198 children with bronchial and/or allergic rhinitis. According to the presence or absence of SR and local reactions (LR) during SCIT, the patients were divided into two groups: SR (with SR and LR, n=31) and control (without SR or LR, n=142). A multivariate logistic regression analysis was used to determine the risk factors associated with SR. Results Among the 198 patients who received 8 157 injections of SCIT, 25 (12.6%) experienced SR (31 times, 0.38%), including grade I SR (18 times, 58%), grade II SR (10 times, 32%), grade III SR (3 times, 10%), and no grade IV SR. The multivariate logistic regression analysis showed that multiple sensitization with both food and inhaled allergens, specific IgE to dust mites (grade 6), total IgE (grade 6), and a history of LR were independent risk factors for SR (P<0.05). Conclusions SCIT is a safe treatment for bronchial asthma and/or allergic rhinitis in children, with a low incidence of SR. Children with multiple sensitization with both food and inhaled allergens, a hypersensitive state (specific IgE to dust mites, grade 6; total IgE, grade 6), and a history of LR have an increased risk of SR to SCIT. [ABSTRACT FROM AUTHOR]

Background: Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual. Methods: A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University. Results: 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance. Conclusions: This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT. [ABSTRACT FROM AUTHOR]

The findings of massive Africanized honeybee stings in two hair sheep and a mare are reported. One sheep died 15 h after attack, and the survivors developed skin necrosis on the sting sites. Pathological evaluation revealed necrosis in the dermis, degeneration of the tubular epithelial cells, and multifocal hemorrhages in heart and spleen. The massive attack by Africanized honeybees induced lesions in the skin, heart, muscles, kidneys, and lungs. • Only sporadic reports of honeybee stings in cattle and horses have been published. There is no report in sheep. • Epidemiology, clinical, and laboratory features of Africanized honeybee attacks in two hair sheep and a mare are reported. • Pathological findings of a fatal case in a sheep and development of the skin-biopsy lesions in another sheep are presented. • Lesions in the skin, heart, muscles, kidneys, and lungs induced by massive Africanized honeybee stings are presented. [ABSTRACT FROM AUTHOR]

L'immunothérapie orale (ITO) est le traitement de référence pour induire une tolérance allergénique chez les patients allergiques alimentaires, mais les effets indésirables associés occasionnent des refus ou des abandons de protocole. Les immunothérapies épicutanée (EPIT) et sublinguale (SLIT) sont des techniques d'immunothérapie développées en parallèle de l'ITO, ciblant principalement l'allergie à l'arachide. Elles reposent sur des bases immunologiques communes, capitalisant sur les cellules de Langerhans présentes dans les tissus cutané et buccal, et capables d'induire des lymphocytes T régulateurs et la production d'immunoglobulines G4 (IgG4) spécifiques de l'allergène, mais impliquant une exposition à des quantités nettement plus faibles de l'allergène que l'ITO. L'EPIT et la SLIT sont généralement bien tolérées, avec notamment un risque moindre d'anaphylaxie qu'en ITO. Sous réserve de l'absence d'étude offrant une comparaison directe, le potentiel d'augmentation du seuil de tolérance sous traitement apparaît moindre qu'avec l'ITO. En contrepartie, elles semblent avoir un potentiel comparable à l'ITO en termes de modulation de la réponse sérologique IgE et d'IgG4 spécifique à l'allergène et de l'évolution de la maladie notamment dans la tranche d'âge 1–4 ans. L'EPIT et la SLIT apparaissent ainsi comme des traitements complémentaires de l'ITO visant à promouvoir une tolérance à moyen–long terme chez les patients allergiques, notamment à l'arachide. Elles pourraient trouver une indication chez les patients non éligibles, en échec ou en refus de l'ITO, ou même en première intention, pour procéder au sauvetage d'un échec de prévention primaire en petite enfance. Oral immunotherapy (OIT) is the only treatment usable in practice for inducing tolerance in food-allergic patients. However, adverse events often lead to OIT refusal or discontinuation. Epicutaneous (EPIT) and sublingual (SLIT) immunotherapies are protocols developed concurrently with OIT, mainly for peanut allergy. They share immunological principles, capitalizing on Langerhans cells found in oral and cutaneous tissues to induce regulatory T lymphocytes and produce allergen-specific immunoglobulin G4 (IgG4). However, both EPIT and SLIT expose patients to smaller amounts of allergen compared to OIT. EPIT and SLIT are usually well tolerated, and have a lower risk of anaphylaxis when compared to OIT. Despite the lack of studies offering direct comparison, the ability of EPIT and SLIT to increase the tolerance threshold while on treatment seems lower compared to OIT. However, it appears that they have similar potential to OIT in terms of adjusting allergen-specific IgE and IgG4 serological responses as well as disease progression, especially in the age group of 1–4. EPIT and SLIT appear as complementary treatments to OIT, promoting medium- to long-term tolerance in peanut-allergic patients. These treatments could have an indication in patients who are ineligible, have failed, or refused OIT, or even as a first-line treatment to rescue a primary prevention failure in early childhood. [ABSTRACT FROM AUTHOR]

Summary: BLs allergy is considered a major health issue, as BLs are the most frequently involved in drug allergic reactions. Amoxicillin (AX) is the most frequently involved drug in sensitization among all BLs. AX is commercialized alone or combined to clavulanic acid (CLA) in order to increase the antibiotic spectrum. The growing prescriptions of AX-CLA formulations contributed to increase the role of CLA as an allergy inducer. At present, little is known about the clinical characteristics of hypersensitivity reactions to clavulanate. The aim of this study was to assess the difference in the prevalence of cutaneous vs systemic reactions in patients who had a documented history of allergic reactions to amoxicillin-clavulanate and tested positive for clavulanate or penicillin/amoxicillin. Our study suggests that patients who presented only muco-cutaneous reactions were more often sensitized to CLA rather than AX.

Background: Venom allergy is significantly underestimated in China. Venom-specific IgE may not provide accurate clinical reactions. Our conducted retrospective analysis observes alternative diagnostic considerations in assessing confirmation and severity of honeybee venom allergy. Methods: Retrospective review of honeybee venom allergy versus nonallergy patients presented with positive honeybee venom (i1) sIgE results. According to clinically observed reactions caused by a honeybee sting, patients were divided into three groups. Patient residence and exposure types were analyzed. The sIgE/T-IgE among allergy and control groups was compared. Results: Gender ratio male:female was 32:22; median age was 39 years (31, 50). 48% (26/54) of patients live in urban areas, 52% (28/54) in rural areas. Based on bee sting reactions, patients were divided into common localized reactions (32/54), large localized reactions (7/54), and systemic reactions (15/54). In the systemic reaction group, patients presented as Type II (6/15), Type III (6/15). There is significant difference (P < 0.001) between the three groups in regards to exposure types. In the systemic reaction group, 8.7% (13/15) of patients are beekeepers. A significant difference (P < 0.001) was observed between allergic and control groups based on sIgE/T-IgE results. As well as significant difference observed between the systemic reaction group to the other two reaction groups in regards to sIgE/T-IgE results. Six systemic reaction patients presented with large localized reactions before onset of system symptoms 1 month to 1 year of being stung. Conclusions: Occupational exposure is the most common cause in honeybee venom allergy induced systemic reactions. The use of sIgE/T-IgE results is a useful diagnostic parameter in determining honeybee venom allergy.

Post Marketing Surveillance should be conducted periodically to monitor whether the quality of marketed products is still favorable. The objectives of this study were to evaluate the protectiveness, local reaction, and systemic reaction after receiving booster dose of measles vaccine from different batch numbers. This study was a cohort study on elementary students in West Sumatra. Subjects from Agam District received measles vaccine with a batch number of 250210 while subjects from Limapuluh Kota District received measles vaccine with a batch number of 253080. Blood samples were collected before and 28 days after immunization. Antibody titers were measured using neutralization assay with a protective level of >200 mIU/mL. Local and systemic reactions were recorded within 28 days after immunization. The observation was held from November 2010 to March 2011 and involved 336 students: 170 students from Agam District and 166 students from Limapuluh Kota District. There were 1.2% students who experienced fever in the first three days after immunization, and 1(0.6%) student experienced mild fever 14 days after immunization. The most common local reaction was redness in the injection site, contributing approximately 14.48%. There were no serious adverse events after immunization. About 96.99% and 96.77% students were protected against measles 28 days after immunization in Agam and Limapuluh Kota Districts with an increase in GMT from 329.66 IU/mL to 983.43 IU/mL and from 198.00 IU/mL to 535.10 IU/mL (p=0.000). In conclusion, both measles vaccine batches show good safety and immune response.

Unilateral sciatic nerve compression (SNC) or complete sciatic nerve transection (CSNT), both varying degrees of nerve injury, induced activation of STAT3 bilaterally in the dorsal root ganglia (DRG) neurons of lumbar (L4-L5) as well as cervical (C6-C8) spinal cord segments. STAT3 activation was by phosphorylation at the tyrosine-705 (Y705) and serine-727 (S727) positions and was followed by their nuclear translocation. This is the first evidence of STAT3(S727) activation together with the well-known activation of STAT3(Y705) in primary sensory neurons upon peripheral nerve injury. Bilateral activation of STAT3 in DRG neurons of spinal segments anatomically both associated as well as non-associated with the injured nerve indicates diffusion of STAT3 activation inducers along the spinal cord. Increased levels of IL-6 protein in the CSF following nerve injury as well as activation and nuclear translocation of STAT3 in DRG after intrathecal injection of IL-6 shows that this cytokine, released into the subarachnoid space can penetrate the DRG to activate STAT3. Previous results on increased bilateral IL-6 synthesis and the present manifestation of STAT3 activation in remote DRG following unilateral sciatic nerve injury may reflect a systemic reaction of the DRG neurons to nerve injury. [ABSTRACT FROM AUTHOR]

Erythroderma is defined as generalized erythema and scaling involving more than 90% of the body surface area and associated with multiple systemic and cutaneous diseases in the pediatric population. Allergic contact dermatitis (ACD) associated with erythroderma is extremely rare. We report an unusual presentation of acute ACD with an essence named 'black cat fragrance' in a 13-month old girl. [ABSTRACT FROM AUTHOR]

Background Asian slow lorises (Nycticebus spp.) are one of few known venomous mammals, yet until now only one published case report has documented the impact of their venomous bite on humans. We describe the reaction of a patient to the bite of a subadult Nycticebus kayan, which occurred in the Mulu District of Sarawak in 2012. Findings Within minutes of the bite, the patient experienced paraesthesia in the right side of the jaw, ear and right foot. By 40 minutes, swelling of the face was pronounced. The patient was admitted to Mulu National Park Health Clinic/Klinik Kesihatan Taman Mulu Tarikh, at which time he was experiencing: swollen mouth, chest pain, mild abdominal pain, nausea, numbness of the lips and mouth, shortness of breath, weakness, agitation and the sensation of pressure in the ears due to swelling. The blood pressure was 110/76, the heart ratio was 116 and oxygen saturation was 96%. The patient was treated intramuscularly with adrenaline (0.5 mL), followed by intravenous injection of hydrocortisone (400 mg) and then intravenous fluid therapy of normal saline (500 mg). By 8 h10 the next day, the patient’s condition had significantly improved with no nausea, and with blood pressure and pulse rate stable. Conclusions A handful of anecdotes further support the real danger that slow loris bites pose to humans. As the illegal pet trade is a major factor in the decline of these threatened species, we hope that by reporting on the danger of handling these animals it may help to reduce their desirability as a pet.

Many factors (larger population, more dependency on technology, more human-caused interference in the natural systems and equilibria, climate changes,⋯) contribute to the seemingly growing number and severity of disasters. Additional exaggeration is generated by public media. As a consequence Disaster Prevention and Disaster Management must be given increased attention. The ultimate goal of Disaster Management is resilience of the affected system and thus the adequate and acceptable survival of the affected population. We discuss system behavior in the case of an assault or disturbance: from being fragile (loss of their functionality due to the assault) to being resilient (having the capacity... of bouncing back to dynamic stability after a disturbance), or even antifragile (being able to "learn" so as to improve disaster resilience). Resilience 2.0 identifies a new paradigm: modern Information and Communication Technologies (ICT) are employed as a basis for enabling and improving resilience of a system. ICT provide the basis for sufficient preparation before an assault, for quick recognition of, and for effective, efficient reactions to disasters. Only the coordinated intra- and interphase deployment of ICT promises sufficient success and can bring resilience to currently as yet fragile systems. We discuss stressors (time and performance pressure, physical and psychological stress on personnel) and problems due to damaged ICT-platforms and communication infrastructure. The basic message is that computer-aided Disaster Management is able to offers a new level of reactivity: Resilience 2.0. [ABSTRACT FROM AUTHOR]

Background Outside clinical trials, data on systemic reactions ( SRs) due to allergen immunotherapy ( AIT) are scarce. Methods A prospective, longitudinal, web-based survey of 'real-life' respiratory allergen immunotherapy ( AIT) clinical practice was conducted in France, Germany and Spain. SRs were recorded and coded according to the Medical Dictionary for Regulatory Activities (Med DRA) and risk factors associated with SRs were identified. Results A total of 4316 patients (corresponding to 4363 ongoing courses of AIT) were included. A total of 109 SRs were recorded, and 90 patients (2.1%) presented at least one SR. Most of the SRs occurred in subcutaneous allergen immunotherapy ( SCIT) (89%, n = 97). The most frequently reported symptoms were urticaria, rhinitis, dyspnoea and cough. Respiratory symptoms appeared before skin symptoms. Most SRs occurred during the up-dosing phase (75.8%) and were mild in severity (71.6%). Intramuscular adrenaline was administered in 17 SRs, but only 65% of these were subsequently classified as anaphylaxis. Independent risk factors for SRs during SCIT were as follows: the use of natural extracts (odds ratio, OR) [95% confidence interval ( CI)] = 2.74 [1.61-4.87], P = 0.001), the absence of symptomatic allergy medications (1.707 [1.008-2.892], P = 0.047), asthma diagnosis (1.74 [1.05-2.88], P = 0.03), sensitization to animal dander (1.93 [1.21-3.09], P = 0.006) or pollen (1.16 [1.03-1.30], P = 0.012) and cluster regimens ( vs rush) (4.18 [1.21-14.37], P = 0.023). A previous episode of anaphylaxis increased the risk for anaphylaxis in SCIT ( OR [95% CI] = 17.35 [1.91-157.28], P = 0.01). Conclusion AIT for respiratory allergy is safe, with a low number of SRs observed in real-life clinical practice. A personalized analysis of risk factors could be used to minimize SRs. [ABSTRACT FROM AUTHOR]

Background Safety data on 'real-life' allergen immunotherapy ( AIT) in children and adolescents is usually extrapolated from studies in adults. Methods Patients aged 18 or under initiating aeroallergen AIT were evaluated in a prospective European survey. Patient profiles and systemic reactions ( SRs) were recorded. Descriptive, univariate and multivariate analyses were used to identify risk factors for SRs. Results A total of 1563 patients (mean ± SD age: 11.7 ± 3.9 years; rhinitis: 93.7%; asthma: 61.5%; polysensitization: 62.5%) and 1578 courses of AIT were assessed. Single-allergen AIT was administered in 89.5% of cases (n = 1412; mites: 49%; grass pollen: 25.8%; tree pollen: 8.7%; Alternaria: 4.6%; dander: 0.8%; weed pollen: 0.6%). Subcutaneous AIT ( SCIT) was used in 71.4% (n = 1127) of the treatments, including 574 (50.9%) with natural extracts. Sublingual AIT ( SLIT) was used for the remaining 451 treatments (drops: 73.8%; tablets: 26.2%). The mean ± SD follow-up period was 12.9 ± 3.3 months. The estimated total number of doses was 19,669 for SCIT and 131,550 for SLIT. Twenty-four patients (1.53%) experienced 29 SRs. Respiratory (55.7%) and skin symptoms (37.9%) were most frequent. Anaphylaxis was diagnosed in 3 SRs (10.3%), and adrenaline was administered in 2 of these cases. In a univariate analysis, the risk of SRs was lower in mite-sensitized patients and higher in cases of pollen polysensitization (>3), grass pollen extracts and the use of natural extracts (vs. allergoids). Conclusions In a real-life paediatric setting, AIT is safe. SRs are infrequent and generally not severe. Pollen polysensitization, grass pollen extracts and natural extracts (vs. allergoids) were risk factors for AIT-associated SRs. [ABSTRACT FROM AUTHOR]