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Insect sting anaphylaxis; prospective evaluation of treatment with intravenous adrenaline and volume resuscitation
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  • Published on:
    Authors response to Kounis & Kounis
    • Simon G. A. Brown, Emergency Physician and Clinical Senior Lecturer
    • Other Contributors:
      • Robert J. Heddle, Konrad E. Blackman

    Dear Editor

    We thank Kounis & Kounis for their interest in our article. Their insights into the link between allergic mechanisms and coronary disease are interesting. However, the level of evidence supporting their extrapolations of this and other animal data to human anaphylaxis is limited.

    Different species exhibit different patterns of organ involvement during anaphylaxis [1]. Animal data can only...

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    Conflict of Interest:
    None declared.
  • Published on:
    Kounis Syndrome, Insect Sting Anaphylaxis and Adrenaline treatment
    • Nicholas G. Kounis, Professor of Cardiology
    • Other Contributors:
      • George N.Kounis, medical student

    Dear Editor

    In the elegant paper of Brown et al [1] concerning insect sting anaphylaxis and its treatment, two patients developed electrocardiographic changes suggesting acute inferior myocardial ischaemia with normal troponin and cardiac enzymes. These cases are characteristic examples of type II variant of Kounis syndrome [2].

    Kounis syndrome [3][4][5] is the concurrence of allergic or hypersensitivit...

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    Conflict of Interest:
    None declared.
  • Published on:
    Authors response to Gori et al
    • Simon G A Brown, Emergency Physician and Clinical Senior Lecturer
    • Other Contributors:
      • Robert J Heddle, Konrad E Blackman

    Dear Editor

    Dr Gori, Cinotti and Papagallo's concerns [1] reflect the inexperience of many medical staff in the use of adrenaline to treat anaphylaxis, a misunderstanding of the ethical issues relating to our trial, and perhaps over-reliance on invasive measures of severity that are a sign of sustained and untreated cardiorespiratory collapse. To deal with each comment in turn:

    - Even Mueller Grade I re...

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    Conflict of Interest:
    None declared.
  • Published on:
    Risks of Overzelous Adrenalin Administration
    • Luigi Gori, Emergency Medicine Resident
    • Other Contributors:
      • Stefano Cinotti, Stefano Pappagallo

    Dear Editor

    In the paper of SGA Brown [1] adrenaline was administered to 19 patients of 21, 3 of which in stage II and 5 in stage I of Muller's grading of systemic allergic reactions, we think that adrenaline administrationat at this stage is excessive and potentially hazardous in respect to signs and symptoms, although the patients were continuously monitored. We think adrenaline administration should be avoided o...

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    Conflict of Interest:
    None declared.
  • Published on:
    Authors' response to Heywood and Fatovich
    • Simon G. A. Brown, Emergency Physician and Clinical Senior Lecturer
    • Other Contributors:
      • Robert J. Heddle, Konrad E. Blackman

    Dear Editor

    Dr Fatovich asks about initial reaction severity in three participants who were prescribed steroids and antihistamines for large local reactions or persistent urticaria.[1]

    Two initially had severe (hypotensive) reactions whereas the other had no systemic reaction. Although frequently used, it is difficult to determine the benefit of steroids and antihistamines to manage large local reactions an...

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    Conflict of Interest:
    None declared.
  • Published on:
    Questions raised by this study

    Dear Editor

    Brown et al's [1] study provoked lively debate amongst the staff at Ipswich Hospital.

    I would like to pose two questions:

    1) What was the interval between sting challenge and onset of symptoms? Was this related to severity of reaction?

    2) What were the details of ethical approval, and what was the consent process and documentation?

    I wonder if such a stu...

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    Conflict of Interest:
    None declared.
  • Published on:
    Limited use of corticosteroids for insect sting anaphylaxis

    Dear Editor

    I congratulate Dr Brown and his colleagues on conducting the first prospective trial of a management protocol for anaphylaxis.[1]

    Perhaps one of the most telling results was that corticosteroids and antihistamines were prescribed for only three of the 21 patients. In my experience, corticosteroids and antihistamines are frequently overprescribed and overemphasised for the management of allergic...

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    Conflict of Interest:
    None declared.