Phil Lieberman - Academia.edu (original) (raw)
Papers by Phil Lieberman
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, Jan 25, 2015
Cardiovascular disease (CVD) increases the risk of severe or fatal anaphylaxis. Some medications ... more Cardiovascular disease (CVD) increases the risk of severe or fatal anaphylaxis. Some medications used to treat CVD can exacerbate anaphylaxis. To review anaphylaxis and the heart, the potential impact of medications for CVD on anaphylaxis and anaphylaxis treatment, and the cardiovascular effects of epinephrine; to examine the therapeutic dilemmas arising from these issues and propose a way forward. PubMed searches were performed for the years 1990-2014 inclusive, using terms such as angiotensin-converting enzyme (ACE) inhibitors, adrenaline, allergic myocardial infarction, anaphylaxis, angiotensin-receptor blockers (ARBs), beta-adrenergic blockers, epinephrine, and Kounis syndrome. Cardiac mast cells are key constituents of atherosclerotic plaques. Mast cell mediators play an important role in acute coronary syndrome (ACS). Patients with CVD have an increased risk of developing severe or fatal anaphylaxis. Medications used in CVD treatment, including beta-adrenergic blockers and ACE...
Journal of Allergy and Clinical Immunology, 2012
RATIONALE: To delineate triggers of anaphylaxis and compare awareness, knowledge and behaviors am... more RATIONALE: To delineate triggers of anaphylaxis and compare awareness, knowledge and behaviors among patients at-risk for anaphylaxis. METHODS: A nationwide, cross-sectional random-digit-dial telephone survey was conducted using a standardized questionnaire. Household members were screened for allergic reactions to foods, insect stings, latex, medications, and other allergens, and for idiopathic reactions. When multiple household members had allergies, the person with the most severe allergic reaction was chosen for the interview. Participants were asked over 100 questions about anaphylaxis awareness, triggers, symptoms, treatments, knowledge, perceptions, behaviors, and quality of life. RESULTS: Over 20,000 phone calls were made to identify and interview a nationally representative sample of 1,000 persons who had experienced allergic reactions within the past ten years. The survey found that 18% of persons with these types of allergies had experienced at least one likely anaphylactic reaction. Among those reporting anaphylactic reactions, 42% occurred within 15 minutes of exposure and the most common triggers were medications (33%), followed by foods (28%), insect stings (21%), other (15%), unknown (7%), and latex (3%). Also among those reporting anaphylaxis, 38% sought emergency room care, 28% self-treated with antihistamines, 13% went to a doctor's office, and 13% self-administered epinephrine. Although 57% reported two or more lifetime episodes, only 18% of the individuals reporting anaphylaxis currently carry epinephrine. CONCLUSIONS: Severe allergic reactions consistent with anaphylaxis are common among persons reporting allergic reactions in the general population. This comprehensive national survey on anaphylaxis, including its triggers and treatment, supports the need for public health initiatives to improve anaphylaxis practices and education.
Annals of Allergy Asthma & Immunology, 2020
Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of id... more Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of idiopathic anaphylaxis (IA) are identical to those of anaphylaxis because of a known cause and can include cutaneous, circulatory, respiratory, gastrointestinal, and neurologic symptoms. Idiopathic anaphylaxis can be a frustrating disease for patients and health care providers. Episodes are unpredictable, and differential diagnosis is challenging. Current anaphylaxis guidelines have little specific guidance regarding differential diagnosis and long-term management of IA. Therefore, the objective of the Idiopathic Anaphylaxis Yardstick is to use published data and the authors' combined clinical experience to provide practical recommendations for the diagnosis and management of patients with IA.
Clinical Reviews in Allergy, 1986
Contrast Agent Chemistry The first successful organic, iodinated contrast agent was developed and... more Contrast Agent Chemistry The first successful organic, iodinated contrast agent was developed and tested by Moses Swick, an intern from Mt. Sinai Hospital in New York City, while on fellowship in Germany in 1929.1 The material, Uroselectan, had a monoiodinated pyridone structure ...
Investigative Radiology, 1980
There are multiple problems of iodinated contrast physiology and iodinated contrast reactions tha... more There are multiple problems of iodinated contrast physiology and iodinated contrast reactions that remain unresolved. The authors' recent work has included studies in four of these areas. (I) In evaluating complement activation following contrast reactions, significant drops in total hemolytic complement were found, as well as that the reactors had lower baseline complement levels than nonreactors. (II) The leukocytes of atopics and of nonatopics were incubated with contrast and a greater release of histamine was found among the atopics than among the normal subjects. (III) Since histamine can be shown to be released from leukocytes by contrast, I-125-sodium diatrizoate was incubated with blood to detect any cellular association for the contrast. Significant retention of radioactivity was demonstrated by the leukocytes and not the erythrocytes. (IV) The gluteraldehyde technique was used to conjugate diatrizoate to bovine serum albumen. After injection of this conjugate into a rabbit, antibody activity in the rabbit serum to the diatrizoate was demonstrated via the enzyme-linked immunospecific assay system.
Investigative Radiology, 1976
Studies were performed on nine patients who had just suffered urticarial or bronchospastic reacti... more Studies were performed on nine patients who had just suffered urticarial or bronchospastic reactions following injection of iodinated contrast material (ICM). The parameters studied were white cell histamine, serum complement components C'3 and C'4 and circulating immune complexes. The white cells of the nine patients demonstrated an average increase of 125% in intracellular histamine over the 3-4 week period following the ICM reaction. Control volunteers averaged only a 10% change. The data implies that there was a loss of white cell histamine during the ICM reaction with replenishment during the following 3-4 week period. Complement components C'3 and C'4 were normal. Circulating antigen-antibody complexes were sought via precipitin bands in agar gel using Clq. None could be isolated following seven ICM reactions. Thus these ICM reactions appeared to release histamine without detection of circulating immune complexes and with normal levels of two major complement components.
Arerugi = [Allergy], 2011
ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guide... more ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines
The Journal of Allergy and Clinical Immunology: In Practice, 2020
Hospital Practice, 1996
Episodes are clinically identical to classic anaphylaxis, yet no external allergen or psychologic... more Episodes are clinically identical to classic anaphylaxis, yet no external allergen or psychological disorder can be identified as the cause of the patient's symptoms and signs. Combinations of a corticosteroid, an H1-histamine receptor blocker, and a sympathomimetic amine are highly effective at inducing control and can often achieve a remission.
Medical economics, Jan 10, 2015
Pediatric Annals, 2000
1. Pediatr Ann. 2000 Jul;29(7):405-10. A pathophysiologic link between allergic rhinitis and asth... more 1. Pediatr Ann. 2000 Jul;29(7):405-10. A pathophysiologic link between allergic rhinitis and asthma. Lieberman P. Department of Medicine, University of Tennessee, Memphis 38018, USA. PMID: 10911629 [PubMed - indexed for MEDLINE]. Publication Types: Review. ...
Anaphylaxis and Hypersensitivity Reactions, 2010
It seems anti-intuitive that a phenomenon such as anaphylaxis, with explosive manifestations and... more It seems anti-intuitive that a phenomenon such as anaphylaxis, with explosive manifestations and distinct symptoms, should be difficult to define. However, since its discovery as a medical event in humans, there have been numerous different definitions. These definitions have evolved over approximately one century since the first demonstration of an anaphylactic event in an animal model.
The Journal of Allergy and Clinical Immunology: In Practice, 2014
Current Clinical Practice
Histamine is widely distributed throughout the body, with the highest concentrations in the lung,... more Histamine is widely distributed throughout the body, with the highest concentrations in the lung, skin, and gastrointestinal tract. H1 receptors are the most important in producing allergic symptoms. Most first-generation antihistamines have a structural resemblance to histamine. The most important side effect of first-generation antihistamines is sedation. As a consequence, increasing numbers of second-generation antihistamines have become available. The activities
Clinical Immunology, 2008
The Journal of Clinical Endocrinology & Metabolism, 1975
A 25-year-old obese woman with adult onset diabetes, with known insulin allergy, was evaluated fo... more A 25-year-old obese woman with adult onset diabetes, with known insulin allergy, was evaluated for her insulin response to glucagon. Intravenous injection of glucagon produced severe generlaized allergic reaction. Skin tests with various insulin and glucagon preparations showed allergic reaction to be most pronounced with beef regular single peak and single component insulin, pork regular single peak, beef lente single peak, and neutral regular (beef-pork) single peak insulin. Allergic reactions to numerous glucagon preparations were found to be directly proportional to the amount of insulin contamination in those preparations. Purification of one glucagon lot by column chromatography verified the presence of proinsulin and insulin contaminants in the preparation.
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, Jan 25, 2015
Cardiovascular disease (CVD) increases the risk of severe or fatal anaphylaxis. Some medications ... more Cardiovascular disease (CVD) increases the risk of severe or fatal anaphylaxis. Some medications used to treat CVD can exacerbate anaphylaxis. To review anaphylaxis and the heart, the potential impact of medications for CVD on anaphylaxis and anaphylaxis treatment, and the cardiovascular effects of epinephrine; to examine the therapeutic dilemmas arising from these issues and propose a way forward. PubMed searches were performed for the years 1990-2014 inclusive, using terms such as angiotensin-converting enzyme (ACE) inhibitors, adrenaline, allergic myocardial infarction, anaphylaxis, angiotensin-receptor blockers (ARBs), beta-adrenergic blockers, epinephrine, and Kounis syndrome. Cardiac mast cells are key constituents of atherosclerotic plaques. Mast cell mediators play an important role in acute coronary syndrome (ACS). Patients with CVD have an increased risk of developing severe or fatal anaphylaxis. Medications used in CVD treatment, including beta-adrenergic blockers and ACE...
Journal of Allergy and Clinical Immunology, 2012
RATIONALE: To delineate triggers of anaphylaxis and compare awareness, knowledge and behaviors am... more RATIONALE: To delineate triggers of anaphylaxis and compare awareness, knowledge and behaviors among patients at-risk for anaphylaxis. METHODS: A nationwide, cross-sectional random-digit-dial telephone survey was conducted using a standardized questionnaire. Household members were screened for allergic reactions to foods, insect stings, latex, medications, and other allergens, and for idiopathic reactions. When multiple household members had allergies, the person with the most severe allergic reaction was chosen for the interview. Participants were asked over 100 questions about anaphylaxis awareness, triggers, symptoms, treatments, knowledge, perceptions, behaviors, and quality of life. RESULTS: Over 20,000 phone calls were made to identify and interview a nationally representative sample of 1,000 persons who had experienced allergic reactions within the past ten years. The survey found that 18% of persons with these types of allergies had experienced at least one likely anaphylactic reaction. Among those reporting anaphylactic reactions, 42% occurred within 15 minutes of exposure and the most common triggers were medications (33%), followed by foods (28%), insect stings (21%), other (15%), unknown (7%), and latex (3%). Also among those reporting anaphylaxis, 38% sought emergency room care, 28% self-treated with antihistamines, 13% went to a doctor's office, and 13% self-administered epinephrine. Although 57% reported two or more lifetime episodes, only 18% of the individuals reporting anaphylaxis currently carry epinephrine. CONCLUSIONS: Severe allergic reactions consistent with anaphylaxis are common among persons reporting allergic reactions in the general population. This comprehensive national survey on anaphylaxis, including its triggers and treatment, supports the need for public health initiatives to improve anaphylaxis practices and education.
Annals of Allergy Asthma & Immunology, 2020
Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of id... more Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of idiopathic anaphylaxis (IA) are identical to those of anaphylaxis because of a known cause and can include cutaneous, circulatory, respiratory, gastrointestinal, and neurologic symptoms. Idiopathic anaphylaxis can be a frustrating disease for patients and health care providers. Episodes are unpredictable, and differential diagnosis is challenging. Current anaphylaxis guidelines have little specific guidance regarding differential diagnosis and long-term management of IA. Therefore, the objective of the Idiopathic Anaphylaxis Yardstick is to use published data and the authors' combined clinical experience to provide practical recommendations for the diagnosis and management of patients with IA.
Clinical Reviews in Allergy, 1986
Contrast Agent Chemistry The first successful organic, iodinated contrast agent was developed and... more Contrast Agent Chemistry The first successful organic, iodinated contrast agent was developed and tested by Moses Swick, an intern from Mt. Sinai Hospital in New York City, while on fellowship in Germany in 1929.1 The material, Uroselectan, had a monoiodinated pyridone structure ...
Investigative Radiology, 1980
There are multiple problems of iodinated contrast physiology and iodinated contrast reactions tha... more There are multiple problems of iodinated contrast physiology and iodinated contrast reactions that remain unresolved. The authors' recent work has included studies in four of these areas. (I) In evaluating complement activation following contrast reactions, significant drops in total hemolytic complement were found, as well as that the reactors had lower baseline complement levels than nonreactors. (II) The leukocytes of atopics and of nonatopics were incubated with contrast and a greater release of histamine was found among the atopics than among the normal subjects. (III) Since histamine can be shown to be released from leukocytes by contrast, I-125-sodium diatrizoate was incubated with blood to detect any cellular association for the contrast. Significant retention of radioactivity was demonstrated by the leukocytes and not the erythrocytes. (IV) The gluteraldehyde technique was used to conjugate diatrizoate to bovine serum albumen. After injection of this conjugate into a rabbit, antibody activity in the rabbit serum to the diatrizoate was demonstrated via the enzyme-linked immunospecific assay system.
Investigative Radiology, 1976
Studies were performed on nine patients who had just suffered urticarial or bronchospastic reacti... more Studies were performed on nine patients who had just suffered urticarial or bronchospastic reactions following injection of iodinated contrast material (ICM). The parameters studied were white cell histamine, serum complement components C'3 and C'4 and circulating immune complexes. The white cells of the nine patients demonstrated an average increase of 125% in intracellular histamine over the 3-4 week period following the ICM reaction. Control volunteers averaged only a 10% change. The data implies that there was a loss of white cell histamine during the ICM reaction with replenishment during the following 3-4 week period. Complement components C'3 and C'4 were normal. Circulating antigen-antibody complexes were sought via precipitin bands in agar gel using Clq. None could be isolated following seven ICM reactions. Thus these ICM reactions appeared to release histamine without detection of circulating immune complexes and with normal levels of two major complement components.
Arerugi = [Allergy], 2011
ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guide... more ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines
The Journal of Allergy and Clinical Immunology: In Practice, 2020
Hospital Practice, 1996
Episodes are clinically identical to classic anaphylaxis, yet no external allergen or psychologic... more Episodes are clinically identical to classic anaphylaxis, yet no external allergen or psychological disorder can be identified as the cause of the patient's symptoms and signs. Combinations of a corticosteroid, an H1-histamine receptor blocker, and a sympathomimetic amine are highly effective at inducing control and can often achieve a remission.
Medical economics, Jan 10, 2015
Pediatric Annals, 2000
1. Pediatr Ann. 2000 Jul;29(7):405-10. A pathophysiologic link between allergic rhinitis and asth... more 1. Pediatr Ann. 2000 Jul;29(7):405-10. A pathophysiologic link between allergic rhinitis and asthma. Lieberman P. Department of Medicine, University of Tennessee, Memphis 38018, USA. PMID: 10911629 [PubMed - indexed for MEDLINE]. Publication Types: Review. ...
Anaphylaxis and Hypersensitivity Reactions, 2010
It seems anti-intuitive that a phenomenon such as anaphylaxis, with explosive manifestations and... more It seems anti-intuitive that a phenomenon such as anaphylaxis, with explosive manifestations and distinct symptoms, should be difficult to define. However, since its discovery as a medical event in humans, there have been numerous different definitions. These definitions have evolved over approximately one century since the first demonstration of an anaphylactic event in an animal model.
The Journal of Allergy and Clinical Immunology: In Practice, 2014
Current Clinical Practice
Histamine is widely distributed throughout the body, with the highest concentrations in the lung,... more Histamine is widely distributed throughout the body, with the highest concentrations in the lung, skin, and gastrointestinal tract. H1 receptors are the most important in producing allergic symptoms. Most first-generation antihistamines have a structural resemblance to histamine. The most important side effect of first-generation antihistamines is sedation. As a consequence, increasing numbers of second-generation antihistamines have become available. The activities
Clinical Immunology, 2008
The Journal of Clinical Endocrinology & Metabolism, 1975
A 25-year-old obese woman with adult onset diabetes, with known insulin allergy, was evaluated fo... more A 25-year-old obese woman with adult onset diabetes, with known insulin allergy, was evaluated for her insulin response to glucagon. Intravenous injection of glucagon produced severe generlaized allergic reaction. Skin tests with various insulin and glucagon preparations showed allergic reaction to be most pronounced with beef regular single peak and single component insulin, pork regular single peak, beef lente single peak, and neutral regular (beef-pork) single peak insulin. Allergic reactions to numerous glucagon preparations were found to be directly proportional to the amount of insulin contamination in those preparations. Purification of one glucagon lot by column chromatography verified the presence of proinsulin and insulin contaminants in the preparation.