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Park H, Kim SM, Kim WY. Cardiac arrest caused by anaphylaxis refractory to prompt management: A case series and review of the literature. Am J Emerg Med 2022; 61:74-80. [PMID: 36057212 DOI: 10.1016/j.ajem.2022.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anaphylaxis is a potentially life-threatening condition that occurs in the emergency department (ED). Although anaphylaxis is rapidly recognized and treated in the hospital compared with that in the community, in some cases, it does not respond to proper management. OBJECTIVE The aim of this study is to describe our experience of cases of refractory anaphylaxis leading to cardiac arrest in hospital, to review their characteristics compared with those seen in the community, and to discuss the best management practices for anaphylaxis-induced cardiac arrest with a literature review. METHODS We reviewed the medical records of patients referred to the ED with possible in-hospital anaphylaxis between January 2017 and May 2021. According to the anaphylaxis protocol, epinephrine, corticosteroid, and antihistamine were administered immediately on-site at our institution before the study period. Refractory anaphylaxis was defined as the development of anaphylaxis-induced cardiac arrest even after following the anaphylaxis protocol. RESULTS A total of 246 cases were evaluated for possible anaphylaxis, with 236 cases meeting the criteria for a diagnosis of anaphylaxis. Among them, 178 patients showed the signs and symptoms of shock, and cardiac arrest occurred in 6 patients (2.5%). Of the six patients, three had a return of spontaneous circulation before admission to the ED, while two died due to refractory cardiac arrest despite resuscitation in the ED. Following post-cardiac arrest care, including temperature management, one patient who received extracorporeal cardiopulmonary resuscitation survived neurologically intact. CONCLUSION We present our case series to highlight the risk of developing refractory anaphylaxis with subsequent in-hospital cardiac arrest. Patients may progress to cardiac arrest within minutes despite prompt recognition and management. If patients present with potentially fatal symptoms, a more aggressive approach, including intravenous adrenaline infusion, should be taken.
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Affiliation(s)
- Hanna Park
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Min Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Horita N, Miyagi E, Mizushima T, Hagihara M, Hata C, Hattori Y, Hayashi N, Irie K, Ishikawa H, Kawabata Y, Kitani Y, Kobayashi N, Kobayashi N, Kurita Y, Miyake Y, Miyake K, Oguri S, Ota I, Shimizu A, Takeuchi M, Yamada A, Yamamoto K, Yukawa N, Masuda M, Oridate N, Ichikawa Y, Kaneko T. Severe anaphylaxis caused by intravenous anti-cancer drugs. Cancer Med 2021; 10:7174-7183. [PMID: 34505396 PMCID: PMC8525120 DOI: 10.1002/cam4.4252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background The incidence and risk factors of severe anaphylaxis by intravenous anti‐cancer drugs are unclear, whereas those of milder reactions have been reported. Study Design Electronic medical charts of cancer patients who have undergone intravenous chemotherapy between January 2013 and October 2020 in a university hospital were retrospectively reviewed. Non‐epithelial malignancies were also included in the analysis. "Severe anaphylaxis" was judged using Brown's criteria: typical presentation of anaphylaxis and one or more of hypoxia, shock, and neurologic compromise. (UMIN000042887). Results Among 5584 patients (2964 males [53.1%], 2620 females [46.9%], median age 66 years), 88,200 person‐day anti‐cancer drug administrations were performed intravenously, and 27 severe anaphylaxes were observed. The causative drugs included carboplatin (14 cases), paclitaxel (9 cases), and cisplatin, docetaxel, trastuzumab, and cetuximab (1 case each). The person‐based lifetime incidence of severe anaphylaxis for patients who received at least one intravenous chemotherapy was 0.48% (27/5584, 95% confidence interval (CI) 0.30%–0.67%) and the administration‐based incidence was 0.031% (27/88,200, 95% CI 0.019%–0.043%). Among 124 patients who received at least 10 carboplatin administrations, 10 patients experienced carboplatin‐induced severe anaphylaxis (10/124, 8.1%, 95% CI 3.0%–13.1%). Carboplatin caused severe anaphylaxis after at least 9‐min interval since the drip started. Thirteen out of 14 patients experienced carboplatin‐induced severe anaphylaxis within a 75‐day interval from the previous treatment. Paclitaxel infusion caused severe anaphylaxis after a median of 5 min after the first drip of the day at a life‐long incidence of 0.93% (9/968, 95% CI 0.27%–1.59%). Conclusion We elucidated the high‐risk settings of chemotherapy‐induced severe anaphylaxis.
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Affiliation(s)
- Nobuyuki Horita
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Taichi Mizushima
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Maki Hagihara
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Chiaki Hata
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Yuki Hattori
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Narihiko Hayashi
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Kuniyasu Irie
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Hideyuki Ishikawa
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Kawabata
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Yosuke Kitani
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | | | - Nobuaki Kobayashi
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Kurita
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Yohei Miyake
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Kentaro Miyake
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Senri Oguri
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Ichiro Ota
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Ayako Shimizu
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Masanobu Takeuchi
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Akimitsu Yamada
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Kojiro Yamamoto
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Norio Yukawa
- Chemotherapy Committee, Yokohama City University Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology Head and Neck Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Yasushi Ichikawa
- Department of Oncology, Yokohama City University Hospital, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Hospital, Yokohama, Japan
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Maoz A, Ciccone MA, Matsuzaki S, Coleman RL, Matsuo K. Emerging serine-threonine kinase inhibitors for treating ovarian cancer. Expert Opin Emerg Drugs 2020; 24:239-253. [PMID: 31755325 DOI: 10.1080/14728214.2019.1696773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Ovarian cancer is the leading cause of gynecologic cancer death, owing to high rates of incurable, recurrent disease after initial treatment. Serine threonine kinases (STKs) have been proposed as potential therapeutic targets in ovarian cancer because of their role in the initiation and progression of cancers. Experience in non-ovarian cancers suggests that STK inhibitors are active against tumors with specific molecular alterations.Areas covered: This review discusses STK inhibitors in active development in phase II/III clinical trials for ovarian cancer. PubMed and ClinicalTrials.gov were systematically searched to identify STK inhibitor trials for ovarian cancer; active development was confirmed via Pharmaprojects. Available data regarding the efficacy and safety of these compounds are explored.Expert opinion: STK inhibitors currently in development have modest activity as single agents and are unlikely to achieve approval as monotherapy for unselected ovarian cancer patients. Combination trials of STK inhibitors with chemotherapy and/or targeted therapies have suggested an acceptable efficacy/toxicity ratio for certain combinations but confirmatory studies are needed. Carefully designed trials, especially those including somatic molecular analysis, may help identify the subsets of patients most likely to benefit from these therapeutic strategies and determine the role of STK inhibitors in the evolving landscape of precision oncology.
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Affiliation(s)
- Asaf Maoz
- Department of Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Robert L Coleman
- Department of Gynecologic Oncology, University of Texas, MD-Anderson Cancer Center, Houston, TX, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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