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Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life.
Burrell, S, Patel, N, Vazquez-Ortiz, M, Campbell, DE, DunnGalvin, A, Turner, PJ
Archives of disease in childhood. 2021;(6):558-563
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Abstract
OBJECTIVE To assess the impact of anaphylaxis on health-related quality of life (HRQL) and self-efficacy in food-allergic patients undergoing in-hospital food challenge. DESIGN Secondary analysis of a randomised controlled trial. SETTING Specialist allergy centre. PATIENTS Peanut-allergic young people aged 8-16 years. INTERVENTIONS Double-blind, placebo-controlled food challenge to peanut, with HRQL and self-efficacy assessed using validated questionnaire, approximately 2 weeks prior to and 2 weeks after challenge. Where possible, anaphylaxis was treated with self-injected adrenaline (epinephrine). MAIN OUTCOME MEASURES Change in HRQL and self-efficacy. RESULTS 56 participants had reactions at food challenge, of whom 16 (29%) had anaphylaxis. Overall, there was an improvement in HRQL (mean 2.6 points (95% CI 0.3 to 4.8); p=0.030) and self-efficacy (mean 4.1 points (95% CI 2.4 to 5.9); p<0.0001), independent of whether anaphylaxis occurred. Parents also reported improved HRQL (mean 10.3 points (95% CI 5.9 to 14.7); p<0.0001). We found evidence of discordance between the improvement in HRQL and self-efficacy as reported by young people and that perceived by parents in their child. CONCLUSIONS Anaphylaxis at food challenge, followed by self-administration of injected adrenaline, was associated with an increase in HRQL and self-efficacy in young people with peanut allergy. We found no evidence that the occurrence of anaphylaxis had a detrimental effect. Young people should be encouraged to self-administer adrenaline using their autoinjector device to treat anaphylaxis at in-hospital challenge. TRIAL REGISTRATION NUMBER NCT02149719.
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Effect of caffeine ingestion on lymphocyte counts and subset activation in vivo following strenuous cycling.
Bishop, NC, Fitzgerald, C, Porter, PJ, Scanlon, GA, Smith, AC
European journal of applied physiology. 2005;(5-6):606-13
Abstract
Caffeine ingestion is associated with increases in the concentration of plasma epinephrine and epinephrine is associated with alterations in immune cell trafficking and function following intensive exercise. Therefore, the purpose of this study was to investigate the effect of caffeine ingestion on plasma epinephrine concentration, lymphocyte counts and subset activation in vivo, as measured by the expression the CD69 surface antigen, before and after intensive cycling. On two occasions, following an overnight fast and 60 h abstention from caffeine containing foods and drinks, eight endurance trained males cycled for 90 min at 70% O(2 max) 60 min after ingesting caffeine (6 mg kg(-1 )body mass; CAF) or placebo (PLA). Venous blood samples were collected at pre-treatment, pre-exercise, post-exercise and 1 h post-exercise. Plasma epinephrine concentrations were significantly higher in CAF compared with PLA at pre-exercise [0.28 (0.05) nmol l(-1) versus 0.08 (0.03) nmol l(-1), P<0.01; mean (SE)] and immediately post-exercise [1.02 (0.16) nmol l(-1) versuss 0.60 (0.13) nmol l(-1), P<0.01]. Compared with pre-treatment, numbers of CD4(+) and CD8(+) cells decreased by 54% and 55%, respectively, in CAF at 1 h post-exercise (both P<0.01) but did not significantly differ in PLA. Compared with PLA, in CAF the percentage of CD4(+)CD69(+) cells was 5-fold higher at post-exercise (P<0.05) and 5.5-fold higher at 1 h post-exercise (P=0.01). Compared with PLA, in CAF the percentage of CD8(+)CD69(+) cells was 2-fold higher at pre-exercise (P<0.05) and 1.7-fold higher at post-exercise (P<0.05). These findings suggest that caffeine ingestion is associated with alterations in lymphocyte subset trafficking and expression of CD69 in vivo following prolonged, intensive exercise.
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Glucose ingestion blunts hormone-sensitive lipase activity in contracting human skeletal muscle.
Watt, MJ, Krustrup, P, Secher, NH, Saltin, B, Pedersen, BK, Febbraio, MA
American journal of physiology. Endocrinology and metabolism. 2004;(1):E144-50
Abstract
To examine the effect of attenuated epinephrine and elevated insulin on intramuscular hormone sensitivity lipase activity (HSLa) during exercise, seven men performed 120 min of semirecumbent cycling (60% peak pulmonary oxygen uptake) on two occasions while ingesting either 250 ml of a 6.4% carbohydrate (GLU) or sweet placebo (CON) beverage at the onset of, and at 15 min intervals throughout, exercise. Muscle biopsies obtained before and immediately after exercise were analyzed for HSLa. Blood samples were simultaneously obtained from a brachial artery and a femoral vein before and during exercise, and leg blood flow was measured by thermodilution in the femoral vein. Net leg glycerol and lactate release and net leg glucose and free fatty acid (FFA) uptake were calculated from these measures. Insulin and epinephrine were also measured in arterial blood before and throughout exercise. During GLU, insulin was elevated (120 min: CON, 11.4 +/- 2.4, GLU, 35.3 +/- 6.9 pM, P < 0.05) and epinephrine suppressed (120 min: CON, 6.1 +/- 2.5, GLU, 2.1 +/- 0.9 nM; P < 0.05) compared with CON. Carbohydrate feeding also resulted in suppressed (P < 0.05) HSLa relative to CON (120 min: CON, 1.71 +/- 0.18, GLU, 1.27 +/- 0.16 mmol.min-1.kg dry mass-1). There were no differences in leg lactate or glycerol release when trials were compared, but leg FFA uptake was lower (120 min: CON, 0.29 +/- 0.06, GLU, 0.82 +/- 0.09 mmol/min) and leg glucose uptake higher (120 min: CON, 3.16 +/- 0.59, GLU, 1.37 +/- 0.37 mmol/min) in GLU compared with CON. These results demonstrate that circulating insulin and epinephrine play a role in HSLa in contracting skeletal muscle.
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Urinary catecholamine levels in daily life are elevated in women at familial risk of breast cancer.
James, GD, Berge-Landry Hv, Hv, Valdimarsdottir, HB, Montgomery, GH, Bovbjerg, DH
Psychoneuroendocrinology. 2004;(7):831-8
Abstract
Recent experimental research has shown that women facing the chronic stress of being at familial risk of breast cancer have greater neuroendocrine reactivity responses to stressful laboratory tasks. Whether this enhanced stress response also occurs outside the laboratory under daily life conditions is unknown. In the present study, urinary epinephrine and norepinephrine excretion rates at work (e.g. 11:00 AM-3:00 PM), home (e.g. 6:00 PM-10:00 PM) and during sleep (e.g. 10:00 PM-6:00 AM) were compared between 73 employed women with family histories of breast cancer in first degree relatives (FH+; age=36.8+/-8.7) and 81 without such family histories (FH-; age=38.1+/-9.4). Differences in sympathetic adrenal medullary responses to an ordinary life stressor (work) were assessed in naturalistic settings. Repeated measures MANCOVA with family history group as a fixed factor, body mass index as a covariate and daily microenvironment (work, home and sleep) as a repeating factor were conducted to evaluate whether catecholamine excretion rates differed between FH+ and FH- groups. The results revealed that women with family histories of breast cancer had a higher rate of epinephrine excretion while at work (p<0.005). In addition, women in the FH+ group were also more reactive to the stress of work, showing a greater percentage of increase in both epinephrine and norepinephrine from sleep to work (p<0.05). The results also indicated that the chronic stress effects associated with a family history of breast cancer were moderated by BMI, such that their impact was more pronounced and apparent when women were not obese. These findings support the idea that the heightened neuroendocrine reactivity to experimental stressors in women at familial risk of breast cancer also occurs when women encounter stressors in ordinary life (work stress). Additional research to explore the health consequences of increased reactivity in women at familial risk of breast cancer, and perhaps in individuals at familial risk of other life-threatening disease, would appear warranted.
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Randomized controlled trial of nebulized adrenaline in acute bronchiolitis.
Hariprakash, S, Alexander, J, Carroll, W, Ramesh, P, Randell, T, Turnbull, F, Lenney, W
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. 2003;(2):134-9
Abstract
Use of both l-epinephrine and racemic epinephrine (adrenaline) has improved clinical symptoms and composite respiratory scores in acute bronchiolitis. The objective of this randomized double-blind placebo-controlled study was to assess whether there was sufficient improvement in clinical state to reduce hospital admissions. Seventy-five infants aged 1 month to 1 year with a clinical diagnosis of acute bronchiolitis were treated with either 2 ml of 1:1000 nebulized adrenaline or 2 ml of nebulized normal saline administered after baseline assessment and 30 min later. Clinical respiratory parameters were recorded at 15-min intervals for a period of 2 h following the baseline assessment. Admission to hospital was the primary end-point and changes in respiratory parameters were secondary end-points. Fifty percent (19/38) of infants treated with adrenaline were discharged home compared with 38 percent (14/37) of those treated with saline. This 12 percent reduction in rate of admission is not statistically significant (95% CI of difference: -10% to 35%). There was no difference between treated and placebo groups in respiratory rate, oxygen saturation, heart rate or a composite respiratory distress score at 30, 60 or 120 min post-treatment. In this study, nebulized epinephrine did not confer a significant advantage over nebulized saline in the emergency room treatment of acute bronchiolitis.
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Effect of alkalosis on plasma epinephrine responses to high intensity cycle exercise in humans.
Marx, JO, Gordon, SE, Vos, NH, Nindl, BC, Gómez, AL, Volek, JS, Pedro, J, Ratamess, N, Newton, RU, French, DN, et al
European journal of applied physiology. 2002;(1):72-7
Abstract
The purpose of this study was to determine the effects of alkalosis on epinephrine concentrations in response to a 90 s maximal exercise test. A group of ten healthy men ingested either a bicarbonate (BS) supplement (0.3 g x kg(-1) of body mass of sodium bicarbonate) or placebo mixture (P) prior to performing a 90 s maximal cycle ergometer test. An indwelling Teflon cannula was placed in the antecubital vein and blood samples were drawn at three times at rest separated by 10 min, immediately following the protocol, and at 2.5, 5, and 10 min post exercise to determine plasma epinephrine concentrations. Sodium bicarbonate ingestion significantly ( P<0.05) induced alkalosis both at rest [mean (SD) pH=7.42 (0.02) BS, 7.38 (0.02) P] and after the exercise protocol [pH=7.16 (0.02) BS, 7.12 (0.02) P]. Plasma epinephrine concentrations were not significantly different immediately post exercise between the two conditions [4.2 (0.6) compared to 4.2 (0.7) pmol x ml(-1) in BS and P, respectively]. Work performed and power output attained were not significantly different between the two treatment conditions [mean power=258.7 (35.1) W BS, 260.3 (35.4) W P; peak power=534.7 (61.6) W BS, 535.7 (54.4) W P]. The primary finding of this investigation was that orally-induced alkalosis does not significantly affect plasma epinephrine concentrations or performance following 90 s of maximal cycle exercise in untrained men.
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Caffeine affects cardiovascular and neuroendocrine activation at work and home.
Lane, JD, Pieper, CF, Phillips-Bute, BG, Bryant, JE, Kuhn, CM
Psychosomatic medicine. 2002;(4):595-603
Abstract
OBJECTIVE This study investigated the effects of moderate doses of caffeine on ambulatory blood pressure and heart rate, urinary excretion of epinephrine, norepinephrine, and cortisol, and subjective measures of stress during normal activities at work and at home in the evening. METHODS Healthy, nonsmoking, habitual coffee drinkers (N = 47) participated in 3 days of ambulatory study. After a day of ad lib caffeine consumption, caffeine (500 mg) and placebo were administered double-blind in counter-balanced order on separate workdays. Ambulatory blood pressure and heart rate were monitored from the start of the workday until bedtime. Urinary excretion of catecholamines and cortisol was assessed during the workday and evening. RESULTS Caffeine administration significantly raised average ambulatory blood pressure during the workday and evening by 4/3 mm Hg and reduced average heart rate by 2 bpm. Caffeine also increased by 32% the levels of free epinephrine excreted during the workday and the evening. In addition, caffeine amplified the increases in blood pressure and heart rate associated with higher levels of self-reported stress during the activities of the day. Effects were undiminished through the evening until bedtime. CONCLUSIONS Caffeine has significant hemodynamic and humoral effects in habitual coffee drinkers that persist for many hours during the activities of everyday life. Furthermore, caffeine may exaggerate sympathetic adrenal-medullary responses to the stressful events of normal daily life. Repeated daily blood pressure elevations and increases in stress reactivity caused by caffeine consumption could contribute to an increased risk of coronary heart disease in the adult population.
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Magnesium sulphate infusion suppresses the cardiac release of noradrenaline during a handgrip stress test.
Ohtsuka, S, Oyake, Y, Seo, Y, Eda, K, Yamaguchi, I
The Canadian journal of cardiology. 2002;(2):133-40
Abstract
BACKGROUND Magnesium has several important cardiovascular effects, but its effect on cardiac sympathetic efferent neuron activity has not been clarified. OBJECTIVES To examine the effect of magnesium sulphate infusion on cardiac sympathetic efferent postganglionic neuronal liberation of noradrenaline. PATIENTS AND METHODS Twenty-two patients who underwent cardiac catheterization were randomly allocated to the control group or the magnesium group. Plasma noradrenaline and adrenaline concentrations in the aorta and the coronary sinus were measured. Noradrenaline or adrenaline release from the heart was calculated by dividing the difference in noradrenaline or adrenaline concentration between the aorta and the coronary sinus by that of the aorta. After baseline blood sampling, the control patients and the patients in the magnesium group received intravenous infusion of saline or magnesium sulphate (10 mmol). All patients were then subjected to 3 min of handgrip exercise stress test to augment sympathetic efferent neuronal activity, and the blood sampling was repeated. RESULTS Although blood pressure was increased by the handgrip stress test, there were no differences in heart rate and blood pressure between the two groups, both at baseline and during the handgrip stress test. The plasma noradrenaline and adrenaline concentrations and noradrenaline or adrenaline release from the heart did not differ between the two groups in the baseline condition. However, the handgrip stress increased plasma noradrenaline concentrations and the cardiac noradrenaline release was increased in the control group, whereas the cardiac noradrenaline release was not increased by the handgrip stress in the magnesium group (P<0.02). CONCLUSIONS These data indicate that magnesium sulphate infusion suppresses the release of catecholamines by the heart, which is an indirect index of sympathetic efferent neuronal activity.
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Comparison of epidural pain treatment with sufentanil-ropivacaine infusion with and without epinephrine in children.
Kokki, H, Ruuskanen, A, Karvinen, M
Acta anaesthesiologica Scandinavica. 2002;(6):647-53
Abstract
BACKGROUND Epidural analgesia provides outstanding pain relief after surgery, but it is also associated with numerous adverse effects. In order to improve postoperative pain management in children we determined whether the use of epinephrine added to epidural sufentanil-ropivacaine infusion reduced drug requirements, the intensity and duration of postoperative pain and the incidence and severity of adverse effects. METHODS A prospective, randomized, double blind, parallel group study design was used in 61 children. The children were given continuous epidural sufentanil-ropivacaine infusion either with (n=32) or without (n=29) epinephrine for postoperative analgesia. Intravenous ketoprofen, a non-steroid anti-inflammatory drug, was used for all children, and epidural ropivacaine was used for rescue analgesia. The drug consumption, intensity of pain at rest and during activity, and all adverse effects were recorded. RESULTS : The need for sufentanil (P=0.001) and ropivacaine (P=0.006) was significantly lower in the with-epinephrine group than in the without-epinephrine group. The mean duration of epidural infusion (62 h) was similar in both groups. Four children in the without-epinephrine group were noticed to have a low oxygen saturation (SpO2<90%), and in one child a low respiratory rate (8 breaths min-1). The incidence of pruritus was higher in the without-epinephrine group (P=0.026). CONCLUSION Both infusions provided effective pain relief, and epinephrine as an adjuvant to continuous epidural sufentanil-ropivacaine infusion seems to be useful in children.
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A combined stress hormone infusion decreases in vivo protein synthesis in human T lymphocytes in healthy volunteers.
Januszkiewicz, A, Essén, P, McNurlan, MA, Ringdén, O, Garlick, PJ, Wernerman, J
Metabolism: clinical and experimental. 2001;(11):1308-14
Abstract
In vivo protein synthesis decreases in mononuclear cells following a combined stress hormone infusion given to healthy volunteers as a human trauma model. Here, the purpose was to further investigate this finding and to measure in vivo protein synthesis in isolated T lymphocytes. Furthermore, the effects of stress hormones on the lymphocyte subpopulations and mononuclear cells, characterized by flow cytometry and phytohemagglutinin (PHA)-induced and unstimulated proliferative responses in vitro, were elucidated. Healthy volunteers (n = 16) were randomized into 2 groups to receive either a stress hormone or a saline infusion for 6 hours. In vivo protein synthesis was studied before and after the treatment by measuring the incorporation of stable isotopically-labeled phenylalanine into lymphocyte and mononuclear cell proteins. Protein synthesis decreased after stress hormone infusion in both cell populations: in T lymphocytes from 13.0% +/- 0.7%/d (mean +/- SD) to 8.6% +/- 2.1%/d (P <.01) and in mononuclear cells from 13.3% +/- 1.2%/d to 6.3 +/- 2.0%/d (P <.001). No change in proliferative responsiveness in vitro was observed. The stress hormone infusion produced a decrease in the percentage of T helper CD3/CD4 from 41% to 18% (P <.001), T cytotoxic CD3/CD8 from 27% to 15% (P <.001), as well as total T CD3 cells from 69% to 35% (P <.001). There was an increase in the percentage of natural killer (NK) cells CD16/CD56 from 17% to 55% (P <.001). Determination of phenotypes expressed on activated T lymphocytes showed that CD3/HLA-DR was unchanged and CD3/CD25 decreased from 14% to 7% (P <.01) in the stress hormone group. The study showed that the decrease of in vivo protein synthesis was 34% in T lymphocytes as compared with 53% in mononuclear cells, when determined immediately after a 6-hour stress hormone infusion. This change was associated with a pronounced decrease in all lymphocyte subpopulations, except for the NK cells, which increased substantially.