LAILA SABINO GARRO
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- Anaphylaxis to quinolones in mastocytosis: Hypothesis on the mechanism(2019) GIAVINA-BIANCHI, Pedro; GONCALVES, Danilo Gois; ZANANDREA, Andressa; CASTRO, Raisa Borges de; GARRO, Laila Sabino; KALIL, Jorge; CASTELLS, Mariana
- Drug-induced anaphylaxis in children: Nonsteroidal anti-inflammatory drugs and drug provocation test REPLY(2014) AUN, Marcelo Vivolo; BLANCA, Miguel; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; KALIL, Jorge; MOTTA, Antonio Abilio; CASTELLS, Mariana; GIAVINA-BIANCHI, Pedro
- Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions(2018) GARRO, Laila S.; V, Marcelo Aun; SOARES, Iracy Silvia C.; RIBEIRO, Marisa R.; MOTTA, Antonio A.; KALIL, Jorge; CASTELLS, Mariana C.; CARMONA, Maria Jose C.; GIAVINA-BIANCHI, PedroOBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
bookPart Reações a contrastes(2017) GARRO, Laila SabinobookPart Reações a contrastes(2015) GARRO, Laila SabinoconferenceObject Perioperative Anaphylaxis: Clinical Features of 51 Patients(2012) GARRO, L. S.; RODRIGUES, A. T.; RIBEIRO, M. R.; AUN, M. V.; KALIL, J.; MOTTA, A. A.; GIAVINA-BIANCHI, P.Rationale: Perioperative anaphylaxis is an important and life-threatening adverse reaction in clinical practice. We aimed to evaluate the prevalence and the etiology of perioperative anaphylaxis referred to an outpatient clinic specialized in adverse drug reactions (ADRs). Methods: We evaluated 806 patients with history of ADRs through the questionnaire “European Network for Drug Allergy” (ENDA) from October 2006 to June 2011. Patients with a history of perioperative anaphylaxis were selected. The diagnostic criteria for anaphylaxis were based on the World Allergy Organization Guidelines. Etiological investigation was made with skin tests for latex, neuromuscular blockers (NMBs), antibiotics, hypnotics, opioids and local anesthetics. Drug provocation tests (DPTs) for antibiotics, NSAIDs, local anesthetics and latex were also performed. Serum specific IgE was tested for antibiotics (Penicillin, Ampicillin and Amoxicillin) and latex. Results: We identified 51 (6%) patients with a history of perioperative anaphylaxis. Among them, 16 patients (31%) had hypersensitivity reactions with positive cutaneous test, 14 patients (27%) abandoned the investigation and 8 patients (16%) completed the investigation with all tests being negative. Currently 12 patients (23%) are still under investigation. The main cause of perioperative anaphylaxis was latex allergy (22%), followed by NMBs hypersensitivity (6%). Three patients had positive tests for two different agents. Conclusions: Latex allergy was the main cause of perioperative anaphylaxis in this study. The importance of testing all the possible agents involved was demonstrated by the occurrence of three cases with positive test for two agents.conferenceObject Midazolam is a major cause of intraoperative immediate hypersensitivity reactions(2018) D'ONOFRIO, Ana Carolina; BORALLI, Cristiane Fernandes; PORTILHO, Nathalia Coelho; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; MAGALHAES, Manoela Crespo De; CAMPOS, Lucila; MOTTA, Antonio Abilio; KALIL FILHO, Jorge Elias; GIAVINA-BIANCHI, Pedro; AUN, Marcelo V.- Outcomes and safety of drug provocation tests(2011) AUN, Marcelo Vivolo; BISACCIONI, Carla; GARRO, Laila Sabino; RODRIGUES, Adriana Teixeira; TANNO, Luciana Kase; ENSINA, Luis Felipe Chiaverirti; KALIL, Jorge; MOTTA, Antonio Abilio; GIAVINA-BIANCHI, PedroDrug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs. (Allergy Asthma Proc 32:301-306, 2011; doi: 10.2500/aap.2011.32.3450)
article 3 Citação(ões) na Scopus Anafilaxia perioperatória: A experiência brasileira(2016) AUN, Marcelo Vivolo; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; MOTTA, Antônio Abílio; KALIL, Jorge; GIAVINA-BIANCHI, PedroPerioperative anaphylaxis is a rare hypersensitivity reaction, but it has a rapid onset and is potentially fatal. The true incidence is not well known and varies in accordance with the country from 1:1 250 to 1:13 000 surgeries. It may occur through an allergic (IgE-mediated or not) or non-allergic mechanism, but it is believed that the IgE-mediated reactions are the most common and severe. Any product or drug used in the procedure has the potential to be the cause of a reaction, but neuromuscular blocking agents are the most frequently reported, followed by latex and antibiotics. In this mini-review we discuss some key points of the management of these patients and w present Brazilian data, which suggest that an active search for cases by working together with anesthesiologists could lead to an increase in diagnosis and, therefore, better prevention of future reactionsconferenceObject Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil(2013) GARRO, Laila Sabino; CARMONA, Maria Jose Carvalho; SOARES, Iracy Silvia Correa; AUN, Marcelo Vivolo; RIBEIRO, Marisa Rosimeire; RODRIGUES, Adriana Teixeira; KALIL, Jorge; GIAVINA-BIANCHI, Pedro; MOTTA, Antonio AbilioRATIONALE: The epidemiology of intraoperative anaphylaxis is un-known in Brazil. We aimed to evaluate the incidence and clinical features of anaphylaxis during anesthesia in a University General Hospital in Sao Paulo, Brazil. METHODS: A cross-sectional, observational study analyzing data fromvoluntary notification sent by anesthesiologists, about occurrence of intraoperative anaphylaxis during the period between January and December 2010. The diagnostic criteria for anaphylaxis were based onthe World Allergy Organization Guidelines. We analyzed the incidence of intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types of surgical procedures, classification of anesthetic risk (American Society of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and type of treatment provided. RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000 surgeries. The mean age of patients with anaphylaxis was 36.7 years-old and 57% were women. The most common procedures associated with anaphylaxis were the abdominal non-vascular (17.1%) and urologic (17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and all patients who presented cardiovascular shock were classified as ASA II (42.9%) or ASA III (57.1%). Epinephrine was used preferentially in anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades 1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly etiologic drugs cited by the anesthesiologists were the neuromuscular blocking agents (22.9%). CONCLUSIONS: Our incidence of intraoperative anaphylaxis was higher than in other studies reported in the literature. These data are a warning signal to encourage measures to reduce the incidence of these severe reactions.